1. Application of Radiation in
Medicine and Research
Acknowledgements
Dr. N. Raman, Chairman, INSPIRE Science Camp -2013, KASC, Erode
Dr. A. K. Vidya & Dr. Deepa, and the Team Members of INSPIRE Science
Camp, KASC, Erode
Google Team
Dr.R.M.Nehru
IAEA, WHO, NCI, DST & AERB
Information and Technical Services Division
Atomic Energy Regulatory Board
Niyamak Bhavan, Mumbai – 400 094
TMH
&
YOU
AERB
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Note: Delivered at the Department of Science & Technology (DST), Govt. of India sponsored Innovation in Scientific
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Pursuit for Inspired Research (INSPIRE) Science Internship Camp on Dec.30, 2013 at KASC, Erode
nehru@aerb.gov.in
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Outline…..
1.Introduction
Pioneers
•What is Radiation?
•What is Cancer?
2. Application of Radiation in
•
•
Diagnostic Radiology
Nuclear medicine
N l
di i
•
Antoine Henri Becquerel
Radiation Therapy
3. Research Applications
4. Radiation Accidents
5.Conclusion
Ernest Rutherford
(1871-1937)
Pierre Curie (1859-1906)
Marie Curie (1867-1934)
5
Wilhelm Conrad
Roentgen
(1845-1923)
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1

2. RMN, 2013
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The Electromagnetic Spectrum
What is Radiation?
Waveform of Radiation
• Radiation is a form of energy.
• It is emitted by either the nucleus of an
atom or an orbital electron.
• It is released i th f
i
l
d in the form of
f
electromagnetic waves or particles.
NONIONIZING
IONIZING
Radio
Infrared
Microwaves
Ultraviolet
Visible light
Gamma rays
X-rays
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2

3. Important Questions
1. How “artificial” radioisotopes are produced?
Cyclotron / Nuclear Reactors
2. Who
2 Wh supplies the “artificial” radioisotopes?
li th “ tifi i l” di i t
?
Board of Radiation Isotope Technology, Mumbai
or Suppliers from abroad
3. Who supplies the radiation-generating equipment?
Local suppliers or Suppliers from abroad
Ref: http://www.britatom.gov.in/images/animated_webmaster.gif
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Basic Safety Factors
TIME
DISTANCE
SHIELDING
Ref: www.nrc.gov
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4. Ref: http://www.slideshare.net/prayarhin/cancer2
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Ref: NCI website
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Ref: NCI website
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14 million cancer cases
Diagnosed in 2012
8.2 million cancer deaths
in 2012
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5. Ref: http://www.slideshare.net/prayarhin/cancer2
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C
A
U
T
I
O
N
Ref: http://www.slideshare.net/prayarhin/cancer2
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5

6. Ref: http://www.slideshare.net/prayarhin/cancer2
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Ref: http://www.slideshare.net/prayarhin/cancer2
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Applications of Radiation in
Medicine
Radiation in Medicine
Diagnostic
Radiography
Therapy
Nuclear Medicine
Radiotherapy
Teletherapy
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Brachytherapy
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Nuclear Medicine
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Technological Challenges in Clinical
management of tumours
Justification of practice
KEY ISSUES
Net benefit positive
Accurate diagnosis
Optimization of protection
Benign or malignant / grading
ALARA
Selection of appropriate therapies
Dose limitation
Surgical resection without compromising
the neurological functions (gross / partial)
Never to exceed Dose
Limits
Tumour response to treatment
Tumour recurrence or radiation necrosis
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Courtesy: Dr. Rama Jayasundar, Dept. of NMR, AIIMS, New Delhi 36
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7. Background of Diagnostic Radiology
Diagnostic x-rays have been used in medicine since the
late 19th century with steady and continual advances:
1895 : Discovery of x-rays (Röntgen), first clinical images
1920s : Barium contrast studies
1930s : Intravenous contrast media
1940s : Angiography
1950s :Fluoroscopic image intensifiers / catheterization techniques
1960s :Early work on rare-earth intensifying screens
1970s :Computed Tomography (CT)
1990s :Interventional radiological techniques;
helical and multi-slice scanners
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Image processing
Diagnostic Radiology
X-ray photons transmitted through the structures
under examination comprise the “x-ray (or
radiological) image” that must then be converted into a
visual image by interaction with an appropriate
detector (image receptor)
FILM
IN
Modern X-ray tube
“Earlier” X-ray tube
X-RAY TUBE HOUSING
(ASSEMBLY)
FILM
OUT
HIGH
VOLTAGE
CABLES
Mobile unit
LIGHT
BEAM
COLLIMATO
R
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General Radiography X-ray facility
X• provides static images
using x-ray film and
intensifying screens or
digital image receptors.
•
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Fluoroscopy
• provides dynamic (real-time) images using electronic or
digital imaging. It is used for the dynamic evaluation of
functional disorders, guidance during biopsies, surgical
procedures, etc.
Chest stand
It is commonly used
for examinations of
most body parts
including the thorax,
abdomen, pelvis,
skull, spine,
extremities, etc.
Mobile unit
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8. Fluoroscopy for interventional radiology
DR- Digital Radiography
Interventional radiology is a procedure in which fluoroscopic
x-ray imaging guides the radiologist (or other specialist
medical practitioner) during medical or therapeutic treatments
such as:
CR- Computed Radiography
•
•
•
•
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Computed Tomography (CT)
Mammography
•Mammography is the most reliable method by which to
detect lesions in the breast. This x-ray technique can
detect small tumors before clear clinical symptoms
appears.
• Breast examinations are
carried out either by
individual medical referral,
p
g
or as part of a screening
program.
X-RAY TUBE
ASSEMBLY
cardiovascular and
endovascular radiology
neuroradiology
(biopsies, embolization, etc.)
percutaneous gastrointestinal
interventions; and
genitourinary radiology (biopsies,
tumor ablation, stent placement, etc.)
The early “translate-rotate”
scanner developed into “rotaterotate” technology where both the
x-ray tube and radiation detectors
rotate around the patient. A thin
(~1-10 mm) fan-shaped x-ray
beam produce images as “slices”
through the patient’s body.
• Mammography x-ray
systems use dedicated
equipment (low potential
generators, special anode
x-ray tube and filtration,
etc.)
OPERATOR’S
PROTECTIVE
SCREEN
COMPRESSION
PLATE
IMAGE
RECEPTOR
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2.Technological advances
2.Technological advances
Multi-slice Spiral CT
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9. What is Nuclear Medicine?
• uses radioactive materials for both diagnosis and
treatment
Nuclear
Medicine
• imaging documents organ function and structure
• uses relatively small amounts of radioactive materials
(radiopharmaceuticals) to diagnose and treat disease
• radiopharmaceuticals are substances that are localized
in specific organs, bones, or tissues
• radiopharmaceuticals can be detected externally by
special types of cameras: gamma or PET cameras.
• cameras work in conjunction with computers
to form images that provide data and information
about the area of body being imaged
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What is Nuclear Medicine?
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Radiopharmaceuticals Most Commonly Used
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TechnetiumTechnetium-99m
• In short, 99mTcO4- is added to a vial containing a
chemical compound that will bind to the radionuclide
and the result is a radiopharmaceutical which, after
administration, will localize in the desired patient organ
to later be stud ed/ aged with a ga
ate
studied/imaged t
gamma ca e a
a camera.
• The primary radionuclide used for
diagnostic Nuclear Medicine procedures
is technetium-99m (99mTc). Others are I3 &Th-201
0
131 &
• The primary radionuclide used for
therapeutic Nuclear Medicine
procedures is Iodine-131 (131I). Others
are Sr-89, Sm-153 and Rh-186.
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10. IodineIodine-131
Scintillation Cameras
• Commonly known as
a “Gamma Cameras”
• Can be administered
in capsule or liquid
solution form.
• Are used to show how the
radiopharmaceutical
p
administered to a patient
distributes itself
throughout the body or in
specifically targeted
organs.
• Special precautions
must be implemented
when administering
this radionuclide.
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SPECT Cameras
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RESEARCH APPLICATIONS
• Single Photon Emission
Computed Tomography
(SPECT)
• The SPECT camera looks
at a patient from different
angles and is able to
demonstrate very precise
detail within the patient.
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The Science of Radiation Therapy
• What does ionising radiation do?
Radiotherapy
py
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– Ionizing radiation deposits energy that
injures or destroys cells by damaging their
genetic material (DNA) making it impossible
(DNA),
for these cells to continue to grow.
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11. Radiation damages normal cells too!
Then what is the rationale for its
use?
• Radiation damages both cancer cells
and normal cells, however the latter are
able to repair themselves and function
properly.
properly
• Cancer cells are more sensitive to
radiation than normal cells and will,
therefore, be destroyed at a greater rate
• The radiation is confined, as much as
possible, to the cancer
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Radiation Facilities in India
(2011(2011-2012)
Teletherapy Centres
Teletherapy Facilities
Co-60 Units
Linear Accelerators
Gamma Knife
Tomotherapy /Cyberknife
: 237
: 232
: 7
: 3+2
Brachytherapy Facilities
Remote Afterloading Units (HDR/LDR) : 200/14
Manual Afterloading kits (Cs-137)
: 61
Manual Afterloding Interstitial Applications (Ir-192): 20
Opthalmic Applicator
: 42
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Kilovoltage Equipment (150 - 400
kVp)
: 319
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Tele -Gammatherapy equipment
The Greek word “tele”
means “far away”
• Typical “deep xray unit”
Movement
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Bhabhatron Co-60 Teletherapy Machine
GammaGamma-ray equipment
Tele = Distance
•Indigenously developed in
India
•Typical source activity used
= 370 TBq (200 RMM)
• Cobalt 60
– Very popular
• Cesium 137
– Not popular
• Principles are the
same
Front view
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Side view
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12. Growth Rate of Radiation Therapy Facilities in
India : 1990 - 2012
1990
Type of Unit
Teletherapy
py
(Co-60+LAs)
RAL Brachy
(LDR & HDR)
MIC Brachy
MIS Brachy
2000
2006
2012
170
267
378
484
31
66
119
214
30
10
77
29
89
34
61
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• Modern accelerators
have a lot of treatment
options, for example
– X-rays or electrons
(
(dual mode)
)
– multiple energies
• 3 X-ray energies
• 5 or more
electron
energies
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Medical Linear Accelerator
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Radiation Therapy
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Courtesy: Meditronix Cor
rporation, India
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Electron Accelerators
Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013
radiotherapy
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13. Radiotherapy
py
Simulator
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Gamma Stereotactic Radiosurgery
“Gamma Knife”
• Uses numerous high-activity Cobalt-60
sealed sources whereby the radiation beams
converge at a specified point of treatment.
• Used for Cerebral Tumors
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radiotherapy
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The Greek word “brachy”
means “short”
Brachytherapy
Radionuclide
Half-life
Photon Energy (MeV)
Half-value Layer (mm lead)
226
Ra
1600 years
0.047 - 2.45 (0.83 ave)
8.0
222
Rn
3.83 days
0.047 - 2.45 (0.83 ave)
8.0
60
Co
5.26 years
1.17, 1.33
11.0
5.5
55
137
30.0
30 0 years
0.662
0 662
Ir
74.2 days
0.136 - 1.06 (0.38 ave)
2.5
Au
2.7 days
0.412
2.5
Cs
192
198
125
I
60.2 days
0.028 ave
0.025
Pd
17.0 days
0.021 ave
0.008
103
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Brachytherapy Applications
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High Dose Rate Brachytherapy
Brachy = Short
Co-60
• Surface Mould
• Intracavitary
• Interstitial
Dose rate >12 Gy/hr
Ir-192
(370 GBq)
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14. Isotopes for endovascular
brachytherapy
Endovascular Brachytherapy
• uses radioactive catheters, pellets,
and stents to treat coronary and
peripheral vascular problems.
• radiation can be ion implanted,
plated, or encapsulated in a sealed
source device attached to a guide
wire used in the angioplasty
procedure.
• radioactive device can be either
permanently implanted or removed
via the guide wire following treatment
of the effected vessel wall
• Gamma sources: 192-Ir
• Beta sources: 32-P, 90-Sr/Y, 188-Rh
(Rhenium)
February 1998
August 1998
Post-PTCA
6 Months Later
Pre-PTCA
Dose calculation
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TELETHERAPY
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•
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Head complexity to handl
multiple energies and
multiple modalities
– different flattening
filters and scatterin
foils on a ‘carousel’
– monitor chambers
– collimators
Cs-137/Co-60
based
Teletherapy
Phasing out
to
Advanced
Medical Linear
M di l Li
accelerators
/Cyberknife
systems
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Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013
radiotherapy
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Advantages of MR
non-invasive biochemical characterisation
particularly useful in a sensitive organ like
brain
surgical resection without compromising the
neurological functions can be done using
functional MRI
tumour response to treatment
tumour recurrence or radiation necrosis
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Courtesy: Dr. Rama Jayasundar, Dept. of NMR, AIIMS, New Delhi 83
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15. PET Scanning
• Positron Emission Tomography (PET).
• Used to study physiologic and
biochemical processes within the body.
• Processes studies are blood flow,
oxygen, glucose and fatty acid
metabolism, amino acid t
t b li
i
id transport, pH
t H
and neuroreceptor densities
• PET scanning is, however, in very
limited usage because of the high cost
of setting up a PET department.
Courtesy: IAEA
Ref:
http://www.cyberphysics.co.uk/topics/atomic/Accelerators
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Positron Emission Tomography (PET)
Ref: http://www.sepscience.com/images//Articles/Issues/0212/Steinbach/FIG-1.jpg
Courtesy: IAEA
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Figure 5 Treatment monitoring with fluorodeoxyglucose (FDG) PET and CT
in a patient with locally advanced distal esophageal cancer (arrows)
Permission obtained from the American Society of Clinical Oncology © Weber WA (2006) Positron
emission tomography as an imaging biomarker. J Clin Oncol 24: 3282–3292
Weber WA et al. (2008) Technology Insight: novel imaging of molecular targets is an emerging area
crucial to the development of targeted drugs
Nat Clin Pract Oncol 5: 44–54 doi:10.1038/ncponc0982
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Ref: http://cancergrace.org/cancer-101/tag/petscans/
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16. Ref: http://www.slideshare.net/santam/new-techniques-inRMN, 2013
radiotherapy
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What is 3D?
Target
delineation
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Ref: www.unmc.edu
Comparison of Conventional and IMRT Treatment Planning
What is IMRT?
IMRT stands for
“Intensity Modulated Radiation Therapy”
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17. Proven Promises of IMRT
● Dose conformity & Dose Escalation
● Ability to treat complex shaped (concave or
convex) structures
● Sparing of critical normal structures
● Differential dose intensity delivery with altered
fractionation
Conventional
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IMRT/IGRT FLOW CHART
Diagnosis
Images:
• X-ray
• CT Scanner
• Ultrasound
• MRI
•PET
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Immobilization
Virtual Simulation
Contouring
Treatment
Delivery
dMLC
Optimization
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EPID
•
•
•
•
•
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Treatment
Planning
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INTENSITY MODULATED RADIATION THERAPY
(IMRT)
• Treatment delivery step and Shoot method in Siemens ARTISTE
Simulation
Film
Camera based EPID
aSi based EPID (kV & MV)
Orthogonal images
BEV Matching
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18. KV X-RAY ONBOARD
XIMAGING
Ref: Khan: The Physics of Radiation Therapy, 4th Ed. (2009), Ch. 25
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Dose escalation &
decrease of risk of side
effect
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3D CRT
IMRT /IGRT
Ref: Khan: The Physics of Radiation Therapy, 4th Ed. (2009), Ch. 25
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Ref: www.unmc.edu
RADIATION ACCIDENTS
Ref: IAEA report on “THE RADIOLOGICAL ACCIDENT IN SAMUT PRAKARN”
(2002)
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19. 3.Radiation Protection
Radiological Accident at Goiania
ICRP 85
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QA frequency of each test
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QA test equipments..
•Probability of an error occurring.
•Clinical consequences of the error.
Daily or
y
weekly
Monthly
6-Monthly
3 or 4Monthly
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Annual
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Research Applications
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20. Radioisotopes + Molecular Imaging + Nanotechnology + Research Applications
CONCLUSIONS
•
The invaion of Scientific technology is inevitable in
medical specialties and continues to pose many challenges
and issues
•
Best benefits using radiation could be derived by
•
•
•
•
Understanding the strengths and limitations of systems,
Proper Training /Education
Following Stringent QA procedures
Strict adherence to the Regulatory Compliance /Safety
Culture
• Bright Future is there for Scientific areas such
as General and Applied Sciences (Radiological,
Biochemical, Molecular Biology, Nanoscience ++)
Ref: http://www.rikenresearch.riken.jp/images/figures/hi_4501.jpg
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