1. Atoms for Health Prof. Dr. Werner Burkart Skolkovo Conference on: Accelerators and Radiation Technologies for the Future of Russia Saint Petersburg, 28-29 September 2012

3. Radiation Medicine is the Cornerstone of Atoms for Peace All 156 IAEA Member States use some elements of Radiation Medicine but only 30 Member States have Nuclear Power Plants, less than 20% Radiation Medicine contributes in unique ways to screening, diagnosis, therapy and control, palliation Socio-Economic Aspects of Radiation Medicine: PET/CT> € 1,000 proton Therapy> € 50,000 but still competitive with Chemotherapy

4. What do 80 Millionen People Need? Health Care 800,000 Hospital Beds 260,000 Practicing Physicians 50,000 X-ray Machines 240 Radiation Therapy Units with Complex Imaging, Planning Hardware Annual costs: € 320 billion (4 k€ capita -1 a -1 in Norway  10% of GNP) Nuclear part: up to 15%?

5. Serving Basic Human Needs5 Treating Cancer: Nuclear Technologies Today Improved cancer diagnosis using multimodality imaging ‘fusion’ of PET (left) and CT (right) images.  The bottom picture shows the combined (fused) image Fused image

6. CT versus PET/CT Role of Radiation Medicine in Cancer Management: Planning Treatment

7. Serving Basic Human Needs7 Atoms for Health Here: External Beam Radiotherapy

8. DIAGNOSIS CLINICAL ASSESSMENT STAGING PROGNOSIS TREATMENT FOLLOW UP CT MRI US XRay NM PET Chemotherapy, Radiotherapy, Surgery CT PET NM Role of Radiation Medicine in Cancer Management

9. Radiotherapy programmes offered by the IAEA are an essential part of the treatment of cancer There is a shortfall of over 5 000 radiotherapy machines in developing countries Radiotherapy Treatment Units per Million

10. Recommendation would be 4-5 teletherapy units per million. Each teletherapy units can comfortably treat 500 radiotherapy patients/year Radiotherapy Treatment Units per Million

11. Positron ( ß + ) emission P P N N N N N P P P N P P N N N N N P P P N N X Z A Y Z-1 A  + + e + ++ + + _ _ _ _- e e + 180o 511 keV Positron combines with Electron and annihilates   Two anti-parallel 511 keV Photons produced Unstable parent nucleus Proton decays to Neutron in nucleus – positron and neutrino emitted

12. Properties of commonly used positron emitting radio- isotopes IsotopeHalf-life (min) Maximum positron energy (MeV) Positron range in water (FWHM in mm) Production method 11 C 13 N 15 O 18 F 68 Ga 82 Rb 20.30 9.97 2.03 109.80 67.80 1.26 0.96 1.19 1.70 0.64 1.89 3.15 1.1 1.4 1.5 1.0 1.7 cyclotron generator

13. Radiation Medicine and Beyond Challenges Ahead : RT has to show comparative advantage Improve attractiveness with other modalities: SPECT/MRI, PET/CT/MRI Costs, human resources limiting Partner with IT for Imaging etc. Nuclear Medicine ready for Therapy, but bottleneck specific delivery  partner with genomics, proteomics platforms Open for input by Nanotechnologies Convince Health Care System

14. Nanotechnology in Radiation Medicine Bottom Up: Create self- assembling systems (copy nature) at the molecular scale  Drugs, skin, structural re- placements, targeted delivery Radiation technologies to analyze, understand nanostructures New diagnoses, therapies through nanostructures loaded with radionuclides

15. Role of Radiation Medicine in Cancer Management: QA Publications

16. Sources: WHO, GLOBOCAN (2008) Cancer: a Growing Epidemic

17. The disciplines of Radiation Medicine are central and indispensible elements of medical imaging, therapy and palliation. Technical progress is rapid but deployment in depth hampered by steep increases in costs and limited human resources. Further market penetration depends on partnering with other modalities, cross-fertilization with nano- science, genomics, proteomics. Good practice and a sound regulatory framework to protect patients and medical staff is imperative.  Atoms for Health are unique, and at the centre stage of Atoms for Peace. Conclusions

18. Давайте сделаем это Thank you Большое спасибо