Introduction to Medical Physics
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1 Introduction to Medical Physics Ab branch of applied physics concerning the application of physics to medicine or, in other words The application of physics techniques to the human health Marco Silari, CERN Summer Students 2007 M. Silari Introduction to Medical Physics 1
2 Introduction to Medical Physics Physics discoveries Tools for physics applied to medicine Medical imaging Magnetic Resonance Imaging (MRI) CT PET and PET/CT Conventional radiation therapy Hadron therapy Summer Students 2007 M. Silari Introduction to Medical Physics 2
3 The beginnings of modern physics and of medical physics 1895 discovery of X rays Wilhelm Conrad Röntgen J.J. J Thompson 1897 discovery of the electron Summer Students 2007 M. Silari Introduction to Medical Physics 3
4 The beginnings of modern physics and of medical physics Henri Becquerel ( ) 1896: Discovery of natural radioactivity Thesis of Mme. Curie 1904 α,, β, γ in magnetic field 1898 Discovery of polonium and radium Hundred years ago Marie Curie Pierre Curie ( ) ( ) Summer Students 2007 M. Silari Introduction to Medical Physics 4
5 Tools for (medical) physics: the cyclotron 1930 Ernest Lawrence invents the cyclotron M. S. Livingston and E. Lawrence with the 25 inch cyclotron Summer Students 2007 M. Silari Introduction to Medical Physics 5
6 The beginnings of modern physics and of medical physics 1932 Discovery of the neutron James Chadwick ( ) Summer Students 2007 M. Silari Introduction to Medical Physics 6
7 The beginnings of modern physics and of medical physics 1932 C. D. Anderson Slown-down particle Discovery of the positron Layer of lead Inserted in a cloud chamber Fast positive particle coming from below Summer Students 2007 M. Silari Introduction to Medical Physics 7
8 Tools for (medical) physics: the electron linac Sigmur Varian William W. Hansen Russell Varian 1939 Invention of the klystron 1947 first linac for electrons 4.5 MeV and 3 GHz Summer Students 2007 M. Silari Introduction to Medical Physics 8
9 Tools for (medical) physics: the synchrotron 1945: E. McMillan and V.J.Veksler discover the principle p of phase stability 1 GeV electron synchrotron Frascati - INFN GeV proton synchrotron Bevatron - Berkeley Summer Students 2007 M. Silari Introduction to Medical Physics 9
10 CERN accelerators Large Hadron Collider 7 TeV + 7 TeV Start in km The PS in 1959 In 1952 the strong-focusing method invented at BNL (USA) was chosen for the CERN PS Summer Students 2007 M. Silari Introduction to Medical Physics 10
11 Tools for (medical) physics: Nuclear Magnetic Resonance Felix Bloch and Edward Purcell discover and study NMR In 1954 Felix Bloch became the first CERN Director General Summer Students 2007 M. Silari Introduction to Medical Physics 11
12 Medical imaging TECHNIQUE YEAR ENERGY PHYSICAL PROPERTY IMAGING RADIOLOGY X RAYS IMAGING 1895 X RAYS ABSORPTION ECHOGRAPHY ULTRASOUND IMAGING 1950 US REFLECTION TRANSMISSION NUCLEAR RADIOISOTOPE RADIATION 1950 γ RAYS MEDICINE IMAGING EMISSION Summer Students 2007 M. Silari Introduction to Medical Physics 12
13 Medical imaging TECHNIQUE YEAR ENERGY PHYSICAL PROPERTY IMAGING X RAYS COMPUTERIZED TOMOGRAPHY CT 1971 X RAYS ABSORPTION MORPHOLOGY MAGNETIC RESONANCE IMAGING MRI 1980 RADIO WAVES MAGNETIC RESONANCE MORPHOLOGY /FUNCTION POSITRON EMISSION TOMOGRAPHY PET 1973 γ RAYS RADIATION EMISSION FUNCTION Summer Students 2007 M. Silari Introduction to Medical Physics 13
14 Medical imaging Summer Students 2007 M. Silari Introduction to Medical Physics 14
15 Medical imaging: x-ray generator and image intensifier X-ray tube Image intensifier Summer Students 2007 M. Silari Introduction to Medical Physics 15
16 X-ray image versus CT scan A conventional X-ray image is basically a shadow: you shine a light on one side of the body, and a piece of film on the other side registers the silhouette of the bones (to be more precise, organs and tissues of different densities show up differently on the radiographic film). Shadows give an incomplete picture of an object's shape. Look at the wall, not at the person. If there's a lamp in front of the person, you see the silhouette holding the banana, but not the pineapple as the shadow of the torso blocks the pineapple. If the lamp is to the left, you see the outline of the pineapple, but not the banana. Summer Students 2007 M. Silari Introduction to Medical Physics 16
17 X-ray computerized tomography (CT) DETECTOR COUNTS X RAYS TUBE A LINEAR SAMPLING B ANGULAR SAMPLING C - RECONSTRUCTION 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 RAYS COMPUTERIZED TOMOGRAPHY Summer Students 2007 M. Silari Introduction to Medical Physics 17
18 Volumetric CT < 0,4 sec/rotation Organ in a sec (17 cm/sec) Whole body < 10 sec Summer Students 2007 M. Silari Introduction to Medical Physics 18
19 Cardiac CT DYNAMIC CT ACQUISIION ECG PHASES OF A CARDIAC CYCLE EJECTION FRACTION CARDIAC OUTPUT REGIONAL WALL MOTION.. V FUNCTIONAL PARAMETERS VOLUME RENDERED IMAGE OF HEART AND VESSELS Summer Students 2007 M. Silari Introduction to Medical Physics 19 msec
![2π] B 0 B 0 B 0 B 0 M RF](/docs-images/87/95560177/images/20-2.jpg "PULSE M M MRI SIGNAL")
20 Magnetic Resonance Imaging (MRI) MAGNETIC FIELD: Tesla 1 H SPIN LARMOUR FREQUENCY H 2 O ν 0 = [γ / 2π] B 0 B 0 B 0 B 0 M RF PULSE M M MRI SIGNAL EXCITATION RELAXATION Summer Students 2007 M. Silari Introduction to Medical Physics 20
21 Magnetic Resonance Imaging (MRI): morphology T1 T2 PD SCAN TIME to cover an entire organ: SPATIAL RESOLUTION: CONTRAST RESOLUTION: ~ min ~mm very high for soft tissues Courtesy HSR MILANO Summer Students 2007 M. Silari Introduction to Medical Physics 21
22 Magnetic Resonance Imaging (MRI): morphology MRI of upper torso (courtesy NASA) MRI of knee MRI of shoulder Summer Students 2007 M. Silari Introduction to Medical Physics 22
23 Magnetic Resonance Imaging (MRI): activation studies Control condition Motor stimulation Visual stimulation bla bla bla... Cognitive stimulation Summer Students 2007 M. Silari Introduction to Medical Physics 23
24 Positron Emission Tomography (PET) ISOTOPES Half-Life 11-C 20.4 min, natural 13-N 10.0 min natural 15-O 2.0 min natural 18-F min pseudo-natural Cyclotron Radiochemistry J. Long, The Science Creative Quarterly,scq.ubc.ca ca Summer Students 2007 M. Silari Introduction to Medical Physics 24
25 Positron Emission Tomography (PET) COVERAGE: ~ cm SPATIAL RESOLUTION: ~ 5 mm SCAN TIME to cover an entire organ: ~ 5 min CONTRAST RESOLUTION: depends on the radiotracer Summer Students 2007 M. Silari Introduction to Medical Physics 25
26 PET functional receptor imaging Normal Subject Parkinson s s disease [ 11 C] FE-CIT Courtesy HSR MILANO Summer Students 2007 M. Silari Introduction to Medical Physics 26 HSR MILANO
27 PET coverage and axial sampling FIRST GENERATION PET CURRENT GENERATION PET 1 SLICE 2 cm > 40 SLICES 6 mm Axial FOV: cm Summer Students 2007 M. Silari Introduction to Medical Physics 27
28 PET: total body studies TRANSAXIAL IMAGES SAGITTAL CORONAL Summer Students 2007 M. Silari Introduction to Medical Physics 28
29 PET/CT scanner CT PET Summer Students 2007 M. Silari Introduction to Medical Physics 29
30 PET/CT scanner CT PET Courtesy HSR MILANO Summer Students 2007 M. Silari Introduction to Medical Physics 30 HSR MILANO
31 PET/CT scanner CT PET CT PET Courtesy HSR MILANO Summer Students 2007 M. Silari Introduction to Medical Physics 31
32 18 F-FDG PET/CT Courtesy HSR MILANO Summer Students 2007 M. Silari Introduction to Medical Physics 32 HSR MILANO
33 Summary of accelerators running in the world CATEGORY OF ACCELERATORS High Energy acc. (E >1GeV) Synchrotron radiation sources Medical radioisotope production Radiotherapy accelerators Research acc. included biomedical research Industrial processing and research Ion implanters, surface modification TOTAL NUMBER IN USE (*) ~120 >100 ~200 > ~1000 ~1500 >7000 > (*) W. Maciszewski and W. Scharf: Int. J. of Radiation Oncology, 2004 Summer Students 2007 M. Silari Introduction to Medical Physics 33
34 Three classes of medical accelerators Electron linacs for conventional radiation therapy, including advanced modalities: Cyberknife IntraOperative RT (IORT) Intensity Modulated RT 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 12 C-ions) Summer Students 2007 M. Silari Introduction to Medical Physics 34
35 X-rays in radiation therapy: medical electron linacs e - + target X Electron Linac 3 GHz 6-20 MeV [1000 x Röntgen] targett Summer Students 2007 M. Silari Introduction to Medical Physics 35
36 Medical accelerators: electron linac Varian Clinac 1800 installed in the S. Anna Hospital in Como (Italy) Summer Students 2007 M. Silari Introduction to Medical Physics 36
37 CyberKnife (CK) Robotic Surgery System 6 MV Linac mounted on a robotic arm No flattening filter Uses circular cones of diameter 0.5 to 6 cm Non-Isocentric Average dose delivered per session is 12.5 Gy 6 sessions/day Dose 80 cm = 400 cgy/min com/products/cyberknife/index aspx Summer Students 2007 M. Silari Introduction to Medical Physics 37
38 Intensity Modulated Radiation Therapy An example of intensity modulated treatment planning with photons. Through the addition of 9 fields it is possible to construct a highly hl conformal dose distribution with good dose sparing in the region of the brain stem (courtesy of T. Lomax, PSI). E. Pedroni, Europhysics News (2000) Vol. 31 No. 6 Summer Students 2007 M. Silari Introduction to Medical Physics 38
39 Intensity Modulated Radiation Therapy Yet X-rays have a comparatively poor energy deposition X rays Photons IMRT (Intensity Modulated Radiation Therapy) with 9 crossing beams the dose is not neglibile tumour target Fraction of dose Tumour between the eyes Summer Students 2007 M. Silari Introduction to Medical Physics 39
40 Radiobiological effectiveness (RBE) Summer Students 2007 M. Silari Introduction to Medical Physics 40
41 Hadrontherapy: n, p and C-ion beams electron e hadrons are made of quarks atom carbon ion = 6 protons + 6 neutrons Proton or neutron quark u or d Summer Students 2007 M. Silari Introduction to Medical Physics 41
42 Hadrontherapy Charged hadrons have a much better energy deposition with respect to X-rays 200 MeV protons 4800 MeV carbon ions which control radioresistant tumours 27 cm charged hadron beam that loses energy in matter tumour target X rays Photons protons or Protons carbon ions cobalt linac tail httt://global.mitsubishielectric.com/bu/particlebeam/index_b.html b.html Summer Students 2007 M. Silari Introduction to Medical Physics 42
43 Proton radiation therapy Summer Students 2007 M. Silari Introduction to Medical Physics 43
44 Loma Linda University Medical Center (LLUMC) Summer Students 2007 M. Silari Introduction to Medical Physics 44
45 Loma Linda University Medical Center (LLUMC) Summer Students 2007 M. Silari Introduction to Medical Physics 45
46 Acknowledgements I am indebted to Ugo Amaldi (TERA Foundation and University of Milano Bicocca, Italy) and Maria Carla Gilardi (University of Milano Bicocca, Italy) for providing me with many of the slides that I have shown you today. I also wish to thank David Bartlett (formerly Health Protection Agency, UK) for pointing me to the very interesting book shown on slide 14. Summer Students 2007 M. Silari Introduction to Medical Physics 46
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