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IAEAInternational Atomic Energy Agency
Nuclear Sciences and Medicine
Rethy Chhem, MD, PhD (Edu), PhD (His), FRCPC
Division of Human Health
Guest Professor, Medical University of Vienna
IAEA
Medical Imaging
• X-rays
• CT, Micro-CT
• CT (3D images, Virtual reality )
• MRI
IAEA
World 1st X-ray of Mummy
1896 - Frankfurt, Germany
IAEA
1979
World 1st CT
Egyptian Mummy Toronto, Canada
Harwood-Nash DF
CT of Egyptian mummies.
JCAT, 3, 6, 768-773, 1979
IAEA
IAEA
IAEA
Hetep Bastet
IAEA
IAEA
Micro-CT Vertebra
IAEA
Micro-CT Vertebra
Normal Vs Hemangioma
IAEA
Did Ramesses II really have AS?
IAEA
1976
IAEA
IAEA
IAEA
1979
IAEA
Ramesses II
IAEA
Ramesses II
IAEA
Ramesses II
IAEA
Did Ramesses II really have AS?
No….!
It’s D.I.S.H.
2004
IAEA
New ScientistNovember 13, 2004
IAEA
PREVENTION
CLINICAL
ASSESSMENT
DIAGNOSIS
PROGNOSIS
STAGING
TREATMENT
RESTAGING
CT
MRI
US
Rx
NM(SPECT,
Markers)
PET
Chemotherapy RadTher
Surgery NM
CT
PET
NM(Markers)
Cancer Management
Oncology
IAEA
Division of Human Health
Nuclear Medical Technology in Cancer
Cancer
• Diagnostic
• Staging
• Response to treatment
IAEA
Detecting Cancer
IAEA
Division of Human Health
Ewing Tumor
IAEA
Division of Human Health
Ewing Tumor
IAEA
Staging tumor
IAEA
Division of Human Health
Ewing Tumor
IAEA
Division of Human Health
Metastases
IAEA
Division of Human Health
PET & CT
IAEA
Planning treatment
IAEA
Division of Human Health
CT vs PET/CT
IAEA
Response to treatment
IAEA
Division of Human Health
Tumor Response to Treatment
IAEA
Neurology
5%
Oncology
89%
Cardiology
3%
Others
2%
IAEA
• Diagnosis of malignancy
• Staging
• Assessing response to treatment
• Diagnosis & restaging of recurrence
• Therapy planning
• Predicting prognosis
Oncologic applications for FDG
PET/CT:
IAEA
Present Non-Oncological Indications (USA)
• Alzheimer’s disease
• Refractory seizures
• Myocardial viability
• Myocardial perfusion (Rb-82)
IAEA
Widespread metastases Single tumor site Normal study
FDG-PET in Cancer Patients
IAEA
Metabolism Anatomy Image fusion
The process of determining the geometric relationship between multiple imaging studies, in order to use information provided by
one test in the context of the other modality
PET/CT
IAEA FDG PET/CT
- Precise localization of malignant sites
IAEA
Brown fat and
muscle uptake
Differential diagnosis
of benign vs.
malignant sites
IAEA
Esophageal carcinoma with nodal metastases
674480
IAEA
• 71 year old male
• History of severe chronic obstructive pulmonary disease
• Suspicious lymph nodes were seen in routine chest X-ray and follow-up CT
• PET/CT scan found a 2x2cm solitary nodule in upper right lung
IAEA
M, 84, primary colon ca, S/a resection, elevated CEA
Gastric adenocarcinoma on gastroscopy
IAEA
Increase
uptake in
bone marrow
IAEA
Lung Cancer, RUL
FDG-PET for staging
Physiologic uptake in esophagus
PET/CT
Accurate localization of
metastatic adenopathy
and exclusion of N3 disease
IAEARP
11/07/03
Rectum cancer resected in 08/2002, followed by chemo and radiation therapy until 01/2003.
Hepatic metastases resected in 04/2003.
05/2003 – CT scan - solitary pulmonary nodule
10/2003 – CT scan – unchanged
CEA level = 5,00.
Asymptomatic.
37 year old male
IAEARP
11/07/03
IAEA
Initial study - July 2.00 Evaluation post therapy
May 2005
Lymphoma
Treatment chemotheraphy
IAEAInternational Atomic Energy Agency
Science and development
Science and diplomacy
IAEAInternational Atomic Energy Agency
What exactly does the IAEA do?
IAEA
Mission
Three pillars:
• Safeguards & verification
• Safety & security
• Science & technology
Maximizing the contribution of nuclear technology to society,
while verifying its peaceful use
IAEA
Department of Safeguards
Ensuring that nuclear material is not diverted from peaceful
nuclear activities by verifying Member State declarations
IAEA
Department of Safety & Security
Helping countries upgrade nuclear safety and
prepare for and respond to emergencies
SafetyInternational safety standards for the
management and regulation of nuclear and
radioactive material activities
Security
Help States prevent, detect, and respond
to terrorist or other malicious acts and
protect nuclear installations and transport
against sabotage
IAEA
Department of Nuclear Energy
Fostering the efficient and safe use of nuclear power
Support Member States with respect to:
• nuclear power programmes
• advanced nuclear technologies
• nuclear fuel cycle and waste management programmes
• energy system development, energy investment planning and
energy-environment policy formulation
• Nuclear knowledge management
IAEA
Department of Technical Cooperation
• Goal: contributing directly to sustainable development priorities
• How? provide skills and equipment
• Who benefits? 112 recipient countries in 2006
• When? When nuclear technology is a better or complementary solution
Transferring nuclear and related technologies for
peaceful uses to countries throughout the world
IAEA
Department of Management
Services:
• Budget and finance
• Human resources
• Information technology
• Conference and document services
• General services
• Common services
• Public Information
Contributing to the effective and efficient running of the
Agency’s programmes and services
IAEA
Dept of Nuclear Sciences and Applications
Programmes in:• food and agriculture (with FAO)
• human health
• industry
• water resource management
• protection of marine and terrestrial environment
• Special programme: PACT
Contributing to sustainable development through the
use of nuclear sciences and their applications
IAEA
IAEA’s Role Today
• UN watchdog in non-proliferation of nuclear
weapons
• Set international safety and security
standards
• Contribute to the advancement of science
and human development
IAEA
2005 Nobel Peace PrizeIAEA and Dr Mohamed ElBaradei
“for their efforts to prevent nuclear energy from being used for military purposes and to ensure that nuclear energy for peaceful
purposes is used in the safest possible way.”
IAEA
Division of Human Health
Mission
Enhancing human health
using nuclear knowledge through
• Service
• Education
• Research
IAEA
Division of Human Health
• Primary objective: To enhance capacity of
MS to meet basic human needs
• Primary outcomes: Efficient use by MS of
nuclear knowledge in human health
IAEA
Division of Human Health
Human Diseases
• Communicable diseases
• Non-communicable diseases:
- Cardiovascular D
- Cancer
- Musculoskeletal
- Metabolic, etc
IAEA
Division of Human Health
Research
• Building capacity in research through
Coordinated Research Projects, with a few
leading to a doctoral degree in collaboration
with academic partners
IAEA
Division of Human Health
Services
• Dosimetry: Accurate measurement of
radiation exposure
• QA of equipments
• Good practice of medical imaging and
radiotherapy in hospital settings,
• etc
IAEA
Division of Human Health
Education
Goals: Building capacity in nuclear knowledge
for HH through
• Seminars and workshops
• International, regional conferences
• Teaching materials
• Technical and scientific publications
IAEA
Division of Human Health
4 Sections
1. Nutritional and Health-related
Environmental Studies
2. Nuclear Medicine/Medical Imaging
3. Dosimetry and Medical Radiation Physics
4. Applied Radiation Biology and
Radiotherapy
IAEA
Division of Human Health
1. Nutrition and infectious diseases
Aim: To enhance Member States capability to use
nuclear techniques in strategies to combat malnutrition
and to prevent and control infectious diseases
IAEAInternational Atomic Energy Agency
IAEA
Division of Human Health
2. Medical Imaging and NM
Coronary Artery Disease
• Diagnosis
• Severity
• Risk stratification
• Prognosis
• Response to treatment
IAEA
2. Medical Imaging and NM
Neurology
• Integrated diagnosis
• Therapy assessment
• Early detection of
degenerative diseases
MRI 18-FDG-PET 3D
E Tremor ParkinsonControl MSA
IAEA
Nuclear Medicine
Diagnosis Oncology
Cardiology
Neurology
TherapyLaboratoryTumor markers
Molecular biology
Gene expression
2. Medical Imaging and NM
IAEA
Division of Human Health
3. QA & Metrology in Radiation Medicine
Radiotherapy, NM and Radiology
Accuracy of dose for optimal diagnostic and
therapeutic purpose and for radioprotection
IAEA
Division of Human Health
3. QA & Metrology in Radiation Medicine
Worldwide QA and standardization in Diagnostic
Radiology
New X-ray calibration facility
IAEA
3. QA & Metrology in Cancer Treatment
IAEA7/17/2009 75
• Regular Programme (50%)
Coordinated Research Projects
Treatment guides for common cancers
Teaching syllabi, technical reports
• Technical Co-operation (50%)
Training courses
Fellowships, scientific visits
Provision of equipment, experts
4. Radiotherapy & Radiobiology
IAEA
4. Radiotherapy & Radiobiology
•100 TC projects in RT/70
countries.
•Capacity building through
“educating the educators”
•QA
IAEAThank you