medical applications of nuclear sciences ilham al qarada… · –nuclear medicine for diagnostic...
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Medical
Applications of
Nuclear Sciences
Ilham Al-Qaradawi Professor of Physics, Qatar University
Doha, Qatar
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WNU-SI 2012 Oxford - UK
Outline
• Areas of nuclear medical uses
• Medical imaging
• X-ray and CT
• Magnetic Resonance Imaging (MRI)
• SPECT
• PET and PET/CT
• Accelerators applied to medicine
• Treatment therapies
• Summary
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Medical applications
• Diagnostic; Medical imaging (Radiology): creating images
of internal human body or its functions
– X-rays and CT
– Magnetic Resonance Imaging (MRI)
– PET and PET/CT, PEM
• Treatment;
– Conventional radiation therapy
– Brachytherapy
– Hadron therapy
– Antiproton therapy
• Irradiation and sterilization.
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Anatomical Imaging
• X-ray (Radiography and Fluoroscopy)
• Computerized Tomography, CT
• Magnetic Resonance Imaging, MRI
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X-ray Radiography
• Radiography involves the use of an X-ray tube and a photographic plate.
• The patient is placed between the two and an image is produced on the film of the area exposed.
• A common “chest X-ray” is an example of a radiographic X-ray.
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Fluoroscopic x-ray imaging
• In a fluoroscopic X-ray machine the film is substituted with an imaging device (image intensifier) which enables the radiologist to observe the part of the body exposed live on a video monitor.
• A blocking agent, such as barium, is often swallowed by the patient to allow the medical staff to observe internal processes in action.
• A fluoroscopic examination can be used to locate ulcers.
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X-ray image versus CT scan
• A conventional X-ray image gives a shadow of the body
• organs and tissues of different densities show up differently on the radiographic film.
• Depending on where the lamp is, you see the outline of the pineapple or the banana.
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C - RECONSTRUCTION
A – LINEAR SAMPLING
X RAYS
TUBE
DETECTOR
CO
UN
TS
B – ANGULAR SAMPLING
X RAYS
COMPUTERIZED TOMOGRAPHY
This is the basic idea of computer aided tomography. In a CAT scan machine, the X-ray beam moves all around the patient, scanning from hundreds of different angles. The computer takes all this information and puts together a 3-D image of the body.
X-ray computerized tomography (CT)
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MAGNETIC FIELD: 1.5 – 3 Tesla
1H
SPIN
RF
PULS
E
RELAXATION
MRI
SIGNA
L
EXCITATION
M M M
B0
B0
B0
H2O
Magnetic Resonance Imaging (MRI)
Magnetic field applied
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MRI of upper torso (courtesy NASA)
MRI of knee
MRI of shoulder
Magnetic Resonance Imaging: morphology
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Functional Imaging
• Reveal structure
through function
• Image produced
depends on biological
distribution of
compound in vivo
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Scintigraphy by Gamma Camera
• Used to record emitted internal radiation from
injected isotopes to create two dimensional images.
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SPECT (Single photon emission computed tomography)
• Uses gamma cameras, of multi-
heads slowly rotated around the
patient.
• Able to provide true 3D
information.
• Information presented as cross-
sectional slices.
• 85% of all nuclear medicine
examinations use Mo/Tc
Generators for diagnostics of
liver, lungs, bones.
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Medical radionuclides
• Radionuclides are used in medicine
by two general classifications:
– Nuclear Medicine for diagnostic
procedures
– Radiation Oncology for radiation
therapy.
• Nuclides used for
radiopharmaceuticals:
– should decay by emitting only photons
– Should have a short effective half-life.
– Technetium-99m and Indium-113m are
commonly used radiopharmaceuticals.
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Nuclear Medicine
• Radionuclides are used to determine the extent of a medical problem in a patient.
• The radionuclide is “attached” to a pharmaceutical, which has the properties to deposit the radioisotope in the organ of concern for a patient.
• External radiation detectors are used to determine abnormalities in the organ.
• Thyroid scan and lung function tests are examples.
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Tracer techniques
• Different parts of the human body absorb different elements but do not discriminate between different isotopes.
• In tracer techniques a radioactive isotope, such as iodine, is injected.
• The signals coming from the resulting radiation then give an image of the area where the isotope was absorbed.
• Usually isotopes of a relatively short half-life, of the order of minutes or days, are used to minimize long-term radiation damage.
Photo taken from Alan
Walter presentation
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Radiochemistry
• Medical isotopes
separated under sterile
conditions
• Radiation dose to
operator must be
minimized
• Must be completed
quickly (less than one
half-life)
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Sources of radioisotopes
Cyclotron Research Reactor
Use charged particles Use neutral particles
Produce short lived isotopes Produce longer lived isotopes
neutron deficient nuclei neutron rich nuclei
Cyclotrons vs. Reactors
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Mo-99 from reactors
• Mo-99 is the most “in demand” medical isotope
• Mo-99 is shipped around (66 hrs half life)
• Its “decay product” Technetium-99m is used as
tracer
• Comes “easily” from a handful of existing,
publicly funded nuclear research reactors
• Reactors are getting old
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Crisis of 99Mo
• 30 million examinations/year rely on 99Tc
• Worldwide production of 100 kilo curies per
year produced at aging nuclear reactors – BR2 Belgium
– National Research Universal (NRU) Reactor Canada
(50%)
– OSIRIS France
– HFR Netherlands (40%)
– SAFARI-1 South Africa
• Canadian NRU was off for repairs middle of
2009 to August 2010, Netherlands down for
repairs
• Almost 90% of world Mo supplied by the 2
closed reactors
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Effect of 99Mo Crisis
• The price of Molybdenum-99 rose considerably
during the crisis, causing some anxiety among
buyers.
• The two major reactors are now back in operation.
• IAEA helps to close radioisotope production gap.
• Canadian Light Source (CLS) started a project to
explore the technical and economic feasibility of
using electron linear accelerator to produce Mo-99,
the “parent isotope” of Tc-99m.
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Positron Emission Tomography (PET)
• PET (positron emission tomography)
scans involve the injection into the
body of an isotope which decays by
positron emission.
• When this positron encounters an
electron they annihilate each other,
emitting two photons.
• The energy and path of these photons
leaving the body can then be used to
give an accurate picture of the area
where the isotope was absorbed.
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Positron Emission Tomography (PET)
J. Long, “The Science Creative Quarterly”,scq.ubc.ca
Cyclotron
Radiochemistry
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PET
• When a pair of detectors detects
simultaneously one 511keV photon
each, a positron must have annihilated
on a straight line connecting those two
detectors – the so called line of response.
• The multitude of all these lines of
response is used to calculate a slice
image in a certain plane.
• produces a three-dimensional image or
picture of functional processes in the
body
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PET Applications
• Oncology:
– Thyroid
– Sarcoma
– Lung
– Melanoma
– Lymphoma
– Head & neck
– Breast
• Neurological Applications:
– Parkinson’s, Alzheimer’s, Addiction
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[11C] FE-CIT
Normal Subject
Parkinson’s disease
Courtesy HSR MILANO
PET functional receptor imaging
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PET Isotopes
Nuclide Half-life Tracer Application
O-15 2 mins Water Cerebral blood flow
C-11 20 mins Methionine Tumour protein synthesis
N-13 10 mins Ammonia Myocardial blood flow
F-18 110 mins FDG Glucose metabolism
Ga-68 68 min DOTANOC Neuroendocrine imaging
Rb-82 72 secs Rb-82 Myocardial perfusion
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• Most widely used PET tracer
• Glucose utilization allows assessment of glucose
metabolism in the heart, lungs, and the brain
• Taken up readily by most tumours
• Must be completed quickly (less
than one half-life)
FDG (Fludeoxyglucose 18F)
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Mammography PET (PEM)
• Clear Crystal Collaboration (CCC) at CERN working on a dedicated PET for mammography; the Clear PEM.
• The aim is to be able to detect small tumours with a diameter of 1mm to 2mm in the breast and axilla region.
• Many advantages of PEM over x-ray mammography and whole body PETs
• PEM currently employed in hospitals (such as CHU Hopital Nord Marseille, France).
• Since tumour specific pharmaceuticals are used, the probability of false diagnosis due to the presence of inflammation, is reduced considerably.
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PET/CT
• Combines the functional information with the
anatomical detail
• Images from both devices are superimposed (co
registered).
• Higher diagnostic accuracy than PET or CT
alone
• An emerging imaging
technology, not yet available is
PET/MRI.
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Accelerators for all stages
• Isotope production
• Treatment therapy
Types of Accelerators
• Cyclotrons
• Syncrotrons
• Linacs
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Low-energy cyclotrons for production of radionuclides for medical diagnostics
Medium-energy cyclotrons and synchrotrons for hadron therapy with protons (250 MeV) or light ion beams (400 MeV/u 12C-ions)
Electron Linacs for conventional radiation therapy, including advanced modalities:
•Cyberknife •IntraOperative RT (IORT) •Intensity Modulated RT
Three classes of medical accelerators
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Cyclotrons used in medicine
• Baby Cyclotrons (< 18 MeV) in-house facility
• Mainly used for production of short-lived positron emitters
like 18F, 11C, 13N, 15O.
• Medium Energy Cyclotrons (< 40 MeV), centralised
facility
• Majority of the cyclotron produced isotopes are produced
using such machine viz, 123I, 201Tl, 67Ga, 68Ga, 103Pd etc.
• High Energy Cyclotrons (above 40 MeV), centralised
facilities and research institutions: Used for production of
few radioisotopes requiring high energy for production viz, 67Cu, 82Sr, 211At…
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Baby Cyclotrons
• Accelerated protons
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Medium energy cyclotrons
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High-energy cyclotrons
• IBA‟s ARRONAX in
Nantes
• 4 Particles: H- / D- / He2+/
HH+
• Variable energy: 15 MeV-
70 MeV
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Varian Clinac 1800 installed in the S. Anna Hospital in Como (Italy)
Medical accelerators: electron linac
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Radiation and electron therapy
• Radiation is used to destroy
tumors present in an organ.
• Electrons or Cobalt-60 sealed
source are generally used for the
high activity.
• A mechanical device moves the
source to an opening in a
collimator which projects a beam
of photons used for treatment.
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CyberKnife system is a method of delivering radiotherapy, with the intention of targeting treatment more accurately than standard radiotherapy.
http://www.accuray.com/Products/Cyberknife/index.aspx
6 MV Linac mounted on a robotic arm
CyberKnife (CK) Robotic Surgery System
It is a highly precise, image guided radiation
therapy delivery system capable of taking care
of the motion during treatment.
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Brachytherapy
• Brachytherapy represents an effective
treatment option for many types of
cancer. A source is placed inside or next
to the area requiring treatment.
• Tumours can be treated with very high
doses of localised radiation, whilst
reducing the probability of unnecessary
damage to surrounding healthy tissues.
• In some cases radioactive seeds of < 1
mm are injected into the tumour area.
• can be used alone or in combination
with other therapies.
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Protons and ions spare healthy
tissues
• Unlike photons or electrons,
proton beams deposit most of their
energy at the end of their paths in
the so-called Bragg peak.
• Hence, targeting deep-seated
tumours, close to sensitive organs,
with much reduced risk to
surrounding healthy tissue.
• benefit of proton and heavy-ion
therapy is that the beams can be
"tuned" to deliver a high dose of
energy at a precise location
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Proton Therapy
• As well as an accelerator, a
gantry is required; this is a
massive structure that allows
directing the beam to the
tumour from any direction.
• It carries the final section of
the beam line and the beam
spreading ‘nozzle’
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Therapy with carbon ions
• Carbon allows extremely precise targeting of the
tumour.
• lighter particles such as protons, whilst
depositing their energy in the Bragg peak, cause
far fewer double-strand breaks than heavier
ones like carbon.
• Tumours eligible for carbon ion radiotherapy so
far are: skull base tumours and tumours close to
the spinal chord.
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Antiproton Cancer Therapy
• Researchers at CERN found that antiproton, can effectively treat
cancer.
• Antiprotons strip electrons off atoms in cells, causing ionization
and killing the cell they are in.
• A proton beam could also be used for ionization but when
antiproton beam eventually come to a stop at the focus, the
annihilation of both particles will release a huge amount of energy
(in the context of a single cell)....which is much more effective at
killing selected cells than simple ionization.
• Scientists estimate that routine clinical application of matter-
antimatter annihilation to cancer treatment should be a reality in
10-15 years.
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Sterilization
• Medical equipment and Blood
• Sterilization by gamma irradiators or accelerators.
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WNU-SI 2012 Oxford - UK
Conclusions
• Radiotherapy is a proof that the damaging effect of
radiation has itself been of great use.
• New isotope production and separation techniques are
needed to provide a steady supply of medical isotopes.
• Accelerators may solve the technetium crisis.
• Automation, robotics, and technology are necessary
aspects.
• Molecular imaging is enhancing health care by
providing early detection and better treatment of
tumors with less side effects on healthy tissue.
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WNU-SI 2012 Oxford - UK
Takeaway points
• The progress in the field of radiation applications is not only
driven by advancement of nuclear and radiation physics but also
by the development of technology.
• Better planning, research and cooperation worldwide are
required to avoid future radioisotope production crisis such as
Mo-99.
• What seemed to be pure or basic science research in the past have
had large impact on applications of medical imaging such as ion
beam therapy.
• Research is required to find techniques to reduce the damaging
effects on healthy cells and target diseased cells more effectively.
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WNU-SI 2012 Oxford - UK
Issues for consideration
• Cyclotrons versus research reactors for isotope
production.
• Cyclotrons versus synchrotrons for hadron
therapy.
• Dose accuracy and dosimetry: Radiation
protection for workers and patients
• Cost of nuclear medicine!
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WNU-SI 2012 Oxford - UK
Thank you for your attention
Questions?