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Biomedical physics Erika Garu4 Florian Grüner 1 The course structure Friday 8:30 – 10:00 Lecture Friday 10:15 – 11:45 Journal club / exercise Web page: hIp://www.desy.de/garu4/LECTURES/BioMedical/LecturesWS2014‐15.htm Journal Club: ‐ Begin 24.10.14 ‐ One paper / week ‐ Everybody read / understand / prepare a quesXon / discuss ‐ During exercise hours one person introduces the paper ON THE BOARD / all discuss (no slides required) 2/29 66‐278 Seminar on biomedical physics 3LP • AddiXonal not mandatory for biomedical physics • Does not require to follow the course on biomedical physics • Start on 31/10, Wed. 12:00 – 13:30, sem. room 3 Part 1 6 invited seminars from medical doctors and medical industry • RadiaXon physics/biology • Image‐guided therapy • Radio‐oncology • magneXc parXcle imaging • intervenXonal imaging • ultrasound Part 2 seminars from students on topics related to the invited seminars The seminars are prepared in presentaXon format (slides required) of about 15‐20 minutes / student. 3/29 Biomedical physics • Fundamentals of RadiaXon Physics • Medical DiagnosXc Techniques medical imaging • Imaging technics (basic) • RadiaXon Therapy Not covered in the course (but belonging to biomedical physics): • Advanced Imaging • RadiaXon ProtecXon and Dosimetry • Radiobiology • Anatomy and Physiology • Molecular and cellular oncology Some of the missing topics will be covered in: 66‐278 Seminar on Biomedical Physics 4/29 Medical imaging Structure of the course 1) IntroducXon 2) DetecXon of photons (physics and detectors) principles / tools 3) Therapy with proton and ion beams 4) X‐ ray sources sources 5) Sources for nuclear medicine 6) Image quality objec5ve 7) X‐ray imaging 8) Computed tomography 9) Planar scinXgraphy imaging modali5es 10) Emission tomography 11) MagneXc Resonance Imaging 12) MulXmodal systems The course will not cover ultrasound and opXcal imaging 5/29 Literature Based on Prince and Links, Medical Imaging Signals and Systems and Lecture Notes by Prince. Figures are from the book. and lectures from Yao Wang (NYU‐Poly) AddiXonal suggested literature: • C.Grupen and I.Buvat: Handbook of ParXcle DetecXon and Imaging; • W.R.Leo: Techniques for Nuclear and ParXcle Physics Experiments, Springer; 6/29 What is the added value of physics for medicine ….or why should YOU study biomedical physics …or why should senior physicists care about medical research …and why care medical researchers/industry about physics First answer….synergy X‐ray source image physics reconstrucXon accelerator physics detector physics medical doctors Second answer….overcoming limits single molecule imaging imaging of diagnosXc agents not possible in‐vivo CERN‐sized detector reduced to paXent‐size 3D protein structure Biomedical Physics = joint research Physicists don‘t know the limits of current medical technologies medical doctors don‘t have insight into possibiliXes of physics What can HEP do for medical physics From HEP we are used to: • Work on large complex systems • Challenging integraXon condiXons • Technology fronXer soluXon for: materials, electronics, data acquisiXon, data volume, processing/analysis techniques, simulaXon 11 A calorimeter for HEP / PET PET calorimeter system (a laying human ﬁts into the detector bore) CMS calorimeter system (the humans are not part of the experiment) A calorimeter for HEP calorimeter Huge detector volume: • segmented in single ch. O(10M) • Inside 4T magneXc coil Single channel: • PlasXc scinXllator • Analog silicon‐photomulXplier (SiPM) Readout electronics: Single channel • MulX‐channel r/o chip • Energy Xme measurement Number of sellable apparatus: 1 SiPM 3 cm erika.garu4desy.de 13 A calorimeter for PET Medium detector volume: • segmented in single ch. O(100‐1000) • For PET/MRI next to 1T coil + 7T gradient ﬁeld 1m Single channel: • Inorganic scinXllator (crystal) • Currently photomulXplier tubes or Avalanche PhotoDiode GE Discovery VCT Single channel Readout electronics: • MulX‐channel r/o chip • Energy Xme measurement 3 4 Number of sellable apparatus: 10 ‐10 APD erika.garu4desy.de 14 Siemens ConvenXonal X‐ray sources convenXonal/industrial X‐ray tubes • broad energy spectrum • large divergence („ 2 pi“) • not tunable • large spot size, lower spaXal resoluXon Brilliant X‐ray sources…way too large for clinical applicaXon Synchrotron XFEL Laser‐driven X‐ray sources Ø advantages: § quasi‐monochroma5c (few ) → high CNR/dose high § laminar beam geometry → scaRer reduc5on brilliance § low divergence → high spa5al resolu5on § tunable energy Diagnosis Main applicaXon of medical imaging techniques in disease diagnosis, e.g.: • cancer • cardiovascular disease • neurological disorders (e.g., Alzheimer’s disease) and in drug development (small animal imaging with microPET or microSPECT, microCT, microMRI, bioluminescence and ﬂuorescence imaging systems) Next three slides are from: Nuclear Medicine Imaging in Diagnosis and Treatment Advancing Nuclear Medicine Through InnovaXon. NaXonal Research Council (US) and InsXtute of Medicine (US) CommiIee on State of the Science of Nuclear Medicine. Washington (DC): NaXonal Academies Press (US); 2007. 18/29 Copyright © 2007, NaXonal Academy of Sciences. Staging of lung cancer with FDG and PET/CT. The whole‐body image (Panel A) shows normal FDG uptake in the brain and the urinary bladder. In addiXon, several regions of intensely increased FDG uptake are seen in the chest. On the cross‐secXonal images of chest (Panels B through E), the primary tumor (PT, Panel B) is seen in the right lung (Ln) (arrow) with several malignant lymph nodes on the same side. There are addiXonal malignant lymph nodes on the opposite side of the paXent’s chest (Panel E, arrows). 19/29 SOURCE: Courtesy of Wolfgang Weber, University of California at Los Angeles (UCLA). Monitoring the eﬀects of chemotherapy on tumor volume and glucose uptake with serial mulXslice computed tomography (MSCT) and PET imaging in a paXent with cancer of the esophagus. The large tumor seen on the MSCT image (yellow arrow) is associated with intense FDG uptake on the pre‐treatment PET image (red arrow). At 2 weeks, the tumor volume decreased only mildly (decrease in diameter from 21 mm to 19 mm), while the FDG uptake declined by about 50 percent (reﬂected by the decrease in the standardized uptake value of FDG from 16.8 to 8.5). At 2 months, the tumor volume has strikingly decreased and the FDG uptake is only faintly visible. 20/29 SOURCE: Reprinted by permission of the Society of Nuclear Medicine from Wieder et al. 2005. DFG‐ PET brain images in a normal volunteer (lez panel) and in a paXent with Alzheimer’s disease (right panel). Tomographic slices through the brain at the level of inferior parietal/superior temporal cortex are shown. The color displayed in each part of the brain reﬂects the concentraXon of FDG corresponding to the metabolic acXvity of the neurons in that region. Red, orange, and yellow areas are (in decreasing order) the most acXve, while green, blue, and violet areas are progressively less acXve. Note that in neurologically healthy individuals, the enXre cerebral cortex has a moderately high level of metabolism. In the paXent with Alzheimer’s disease, the arrows indicate areas of diminished metabolic acXvity in the paXent’s parietotemporal cortex, a region important for processing of language and associaXve memories. SOURCE: Courtesy of Daniel Silverman, UCLA. 21/29 Radiotherapy Azer diagnosis some diseases like hyperthyroidism, cancer, blood disorders, etc… can be treated using radiotherapy. Three main methods: • Unsealed source radiotherapy • Brachytherapy (sealed source therapy) è • External beam: x‐rays, electrons, p, n, heavy ions • Stages in the radiotherapy process: QA, imaging, planning, simulaXon, treatment, veriﬁcaXon, modelling outcome "seeds" ‐ small radioacXve rods implanted directly Physics, engineering, imaging, technology based into the tumor. 22/29 Beneﬁts of Radiotherapy • Breast Cancer • Mastectomy • Compare surgery and chemotherapy (CMF) with and without radiotherapy • 10 year survival improved by 10 23/29 What is medical imaging Every non‐invasive technique that allows to look inside the human body. Invasive techniques surgery, endoscopy Non‐invasive magneXc resonance imaging, ultrasound techniques projecXon radiography, computed tomography, nuclear medicine but exposure to radia5on In addiXon see things that are not visible to the eye (blood ﬂow, organ metabolism, receptor binding) Diﬀerent techniques (modaliXes) allow to look inside the human body in diﬀerent ways (looking at diﬀerent signals) 24/29 Signals and ModaliXes Signal Modality Property imaged X‐ray transmission projecXon radiography aIenuaXon coeﬃcient through the body or CT to X‐ray Gamma‐ray emission Planar scinXgraphy or DistribuXon of induced from within the body emission tomography radio sources Nuclear magneXc MagneXc resonance Hydrogen proton resonance inducXon imaging density, spin precession in large magneXc ﬁeld Ultrasound echoes Ultrasound imaging Sound reﬂecXvity 25/29 ProjecXon vs. Tomography ProjecXon: A single 2D image “shadow” of the 3D body (one dimension is integrated è loss of informaXon) Tomography: A series of images are generated, one from each slice of 3D body in a parXcular direcXon (no integraXon) 26/29 axial or transverse / coronal or frontal / sagiIal Anatomical vs. FuncXonal imaging Some modaliXes are very good at depicXng anatomical structures (bones): ‐ X‐ray and CT ‐ MRI Some modaliXes are less good with anatomical structure but reﬂect the funcXonal status (blood ﬂow, oxygenaXon, etc… ) ‐ Ultrasound ‐ PET, funcXonal MRI 27/29 Common imaging modaliXes • ProjecXon radiography (X‐ray) • Computed tomography • Nuclear medicine (SPECT, PET) • MagneXc resonance Imaging (MRI) • Ultrasound imaging • OpXcal imaging 28/29 ProjecXon radiography ScinXllator screen and detector (ﬁlm, camera, solid‐state) X‐ray tube cone beam 29/29 ProjecXon radiography 30/29 Computed tomography X‐ray in a 2‐D “fan beam” rotated around the subject The image of one cross‐secXon is computed from all projecXons (digital) Whole body scan in less than one minute Slice of the liver (1 sec data taking) 31/29 Computed tomography 32/29 Nuclear medicine Emission images: • RadioacXve substances (radio tracers) have to be introduced into the body that emit gamma‐rays or positrons. • Radiotracers move within the body according to the natural uptake • InvesXgated is the local concentraXon of radio tracer within the body è FuncXonal imaging as oppose to structural/anatomical imaging Three techniques: ‐ Radionuclide imaging or scinXgraphy (2D projecXon Detect single γ‐rays (rather than intensity equivalent to projecXon radiography) as in CT) with a ‐ Single photon emission tomography (SPECT) scinXllator detector ‐ Positron emission tomography (PET) called Anger camera 33/29 SPECT Anger camera Cardiac scans: the blood ﬂows through the heart muscle 34/29 Nuclear medicine 35/29 MagneXc resonance imaging In a magneXc ﬁeld protons (H) align themselves along the ﬁeld lines An addiXonal gradient ﬁeld can locally disturb the alignment To reestablish the alignment protons precess and generate detectable EM‐waves Human knee 2 Tesla super‐ conducXve magnet 36/29 MagneXc resonance imaging 37/29 Ultrasound imaging • High frequency sound are emiIed into the imaged body, Xme and strength of the returned sound pulses are measured • ComparaXve inexpensive and completely non‐invasive • Image quality is relaXvely poor 11‐weeks‐old human embryo 38/29 Ultrasound imaging 39/29 ElectromagneXc waves used in medical imaging larger than 1 Å high aIenuaXon from the body, ‐2 shorter than 10 Å = too high energy (1MeV) for direct detecXon 40/29 41/29
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