基于IAEA TRS-398的医用电子直线加速器剂量校准方法

国际原子能机构第398号报告（IAEA TRS-398）的推出,为医用电子直线加速器（LA）剂量校准提供了新的方法。主要特点是以基于吸收剂量校准因子替代基于照射量的校准因子,具有更多优点而成为LA剂量校准的发展趋势。作为军队大型医疗设备的技术主管部门,全军大型医疗设备检测研究中心依据IAEA TRS-398采用新的剂量校准方法,在军队范围率先推广使用。     

Establishing IR in Emerging Countries—A Skill Development Initiative

Integrating interventional radiology (IR) into clinical practice faces challenges in emerging countries in Asia and Africa. Overcoming them requires innovative solutions customized to local needs. After an in-depth gap analysis of these challenges, we began an organized skill development initiative in late 2015 offering radiologists and their supporting staff fully paid scholarships for IR training. Its concept, structure, and progress are reported here. This initiative covered 8 countries, IR specialists (n = 51), senior residents (n = 24), and 15 educational events (training institute [n = 3]; participating countries [n = 12]). This initiative is intended to develop a global network of trained personnel who can support IR programs in challenging locations of emerging countries.     

参加IAEA关于正电子放射性药品会议后的思考

目的为加强我国正电子放射性药品的监督管理提供参考。方法简要介绍了国际原子能机构于2008年3月在泰国曼谷举行的＂建立回旋加速器放射性药物生产设施和实施GMP的主题会议＂有关情况。结果与结论通过参加这次国际会议,认识到我国医疗机构制备正电子放射性药品管理上的不足,并提出了相关建议以加强正电子放射性药品的管理。     

Adverse event reporting and developments in radiation biology after normal tissue injury: International Atomic Energy Agency consultation

PURPOSE: Recent research has enhanced our understanding of radiation injury at the molecular-cellular and tissue levels; significant strides have occurred in standardization of adverse event reporting in clinical trials. In response, the International Atomic Energy Agency, through its Division of Human Health and its section for Applied Radiation Biology and Radiotherapy, organized a consultation meeting in Atlanta (October 2, 2004) to discuss developments in radiobiology, normal tissue reactions, and adverse event reporting. METHODS AND MATERIALS: Representatives from cooperative groups of African Radiation Oncology Group, Curriculo Radioterapeutica Ibero Latino Americana, European Organization for Research and Treatment of Cancer, National Cancer Institute of Canada Clinical Trials Group, Radiation Therapy Oncology Group, and Trans-Tasman Radiation Oncology Group held the meeting discussion. RESULTS: Representatives of major radiotherapy groups/organizations and prominent leaders in radiotherapy discussed current understanding of normal tissue radiobiologic effects, the design and implementation of future clinical and translational projects for normal tissue injury, and the standardization of adverse-event reporting worldwide. CONCLUSIONS: The consensus was to adopt NCI comprehensive adverse event reporting terminology and grading system (CTCAE v3.0) as the new standard for all cooperative group trials. Future plans included the implementation of coordinated research projects focusing on normal tissue biomarkers and data collection methods.     

State of the art in benefit-risk analysis: Environmental health

Environmental health assessment covers a broad area: virtually all systematic analysis to support decision making on issues relevant to environment and health. Consequently, various different approaches have been developed and applied for different needs within the broad field. In this paper we explore the plurality of approaches and attempt to reveal the state-of-the-art in environmental health assessment by characterizing and explicating the similarities and differences between them. A diverse, yet concise, set of approaches to environmental health assessment is analyzed in terms of nine attributes: purpose, problem owner, question, answer, process, use, interaction, performance and establishment. The conclusions of the analysis underline the multitude and complexity of issues in environmental health assessment as well as the variety of perspectives taken to address them. In response to the challenges, a tendency towards developing and applying more inclusive, pragmatic and integrative approaches can be identified. The most interesting aspects of environmental health assessment are found among these emerging approaches: (a) increasing engagement between assessment and management as well as stakeholders, (b) strive for framing assessments according to specific practical policy needs, (c) integration of multiple benefits and risks, as well as (d) explicit incorporation of both scientific facts and value statements in assessment. However, such approaches are yet to become established, and many contemporary mainstream environmental health assessment practices can still be characterized as relatively traditional risk assessment.     

Safety in Radiation Oncology: The Role of International Initiatives by the International Atomic Energy Agency

The International Atomic Energy Agency (IAEA) has a wide range of initiatives that address the issue of safety. Quality assurance initiatives and comprehensive audits of radiotherapy services, such as the Quality Assurance Team for Radiation Oncology, are available through the IAEA. Furthermore, the experience of the IAEA in thermoluminescence dosimetric audits has been transferred to the national level in various countries and has contributed to improvements in the quality and safety of radiotherapy. The IAEA is also involved in the development of a safety reporting and analysis system (Safety in Radiation Oncology). In addition, IAEA publications describe and analyze factors contributing to safety-related incidents around the world. The lack of sufficient trained, qualified staff members is addressed through IAEA programs. Initiatives include national, regional, and interregional technical cooperation projects, educational workshops, and fellowship training for radiation oncology professionals, as well as technical assistance in developing and initiating local radiation therapy, safety education, and training programs. The agency is also active in developing staffing guidelines and encourages advanced planning at a national level, aided by information collection systems such as the Directory of Radiotherapy Centers and technical cooperation project personnel planning, to prevent shortages of staff. The IAEA also promotes the safe procurement of equipment for radiation therapy centers within a comprehensive technical cooperation program that includes clinical, medical physics, and radiation safety aspects and review of local infrastructure (room layout, shielding, utilities, and radiation safety), the availability of qualified staff members (radiation oncologists, medical physicists, and radiation technologists and therapists), as well as relevant imaging, treatment planning, dosimetry, and quality control items. The IAEA has taken the lead in developing a comprehensive program that addresses all of these areas of concern and is actively contributing to the national and international efforts to make radiation therapy safer in all settings, including resource-limited settings.     

Reference Dosimetry according to the New German Protocol DIN 6800-2 and Comparison with IAEA TRS 398 and AAPM TG 51

The preceding DIN 6800-2 (1997) protocol has been revised by a German task group and its latest version was published in March 2008 as the national standard dosimetry protocol DIN 6800-2 (2008 March). Since then, in Germany the determination of absorbed dose to water for high-energy photon and electron beams has to be performed according to this new German dosimetry protocol. The IAEA Code of Practice TRS 398 (2000) and the AAPM TG-51 are the two main protocols applied internationally. The new German version has widely adapted the methodology and dosimetric data of TRS-398. This paper investigates systematically the DIN 6800-2 protocol and compares it with the procedures and results obtained by using the international protocols. The investigation was performed with 6 MV and 18 MV photon beams as well as with electron beams from 5 MeV to 21 MeV. While only cylindrical chambers were used for photon beams, the measurements of electron beams were performed by using cylindrical and plane-parallel chambers. It was found that the discrepancies in the determination of absorbed dose to water among the three protocols were 0.23% for photon beams and 1.2% for electron beams. The determination of water absorbed dose was also checked by a national audit procedure using TLDs. The comparison between the measurements following the DIN 6800-2 protocol and the TLD audit-procedure confirmed a difference of less than 2%. The advantage of the new German protocol DIN 6800-2 lies in the renouncement on the cross calibration procedure as well as its clear presentation of formulas and parameters. In the past, the different protocols evoluted differently from time to time. Fortunately today, a good convergence has been obtained in concepts and methods.     

The role of science in treaty verification

Technologically advanced nations are currently applying more science to treaty verification than ever before. Satellites gather a multitude of information relating to proliferation concerns using thermal imaging analysis, nuclear radiation measurements, and optical and radio frequency signals detection. Ground stations gather complementary signals such as seismic events and radioactive emissions. Export controls in many countries attempt to intercept materials and technical means that could be used for nuclear proliferation. Nevertheless, we have witnessed a plethora of nuclear proliferation episodes, that were undetected (or were belatedly detected) by these technologies—the Indian nuclear tests in 1998, the Libyan nuclear buildup, the Iranian enrichment program and the North Korea nuclear weapons program are some prime examples. In this talk, we will discuss some of the technologies used for proliferation detection. In particular, we will note some of the issues relating to nuclear materials control agreements that epitomize political difficulties as they impact the implementation of science and technology.     

IAEA consultancy meeting on low-dose radiation for patients and population

This paper reports on the IAEA’s Consultancy Meeting on “low-dose radiation for patients and population —Science, Technology and Society (STS) concepts for communication and perception among medical doctors and stakeholders—”, which was held on October 21 and 22, 2020. The meeting consisted of seven presentation sessions, with a total of 27 presentations and 39 participants from seven countries. The meeting focused on various areas including environmental, food, and personal dosimetry; radiation and other secondary health effects after nuclear disasters; communication between medical professionals and patients or residents; and medical education on nuclear accidents. This meeting was convened to discuss STS perspectives related to nuclear emergencies, to share the findings of the Fukushima Health Management Survey and the current situation in Fukushima with international experts. The meeting confirmed the importance of coordinated recovery of affected areas and global preparedness in the aftermath of nuclear accidents.     

Twinning partnerships through International Atomic Energy Agency (IAEA) to improve radiotherapy in common paediatric cancers in low- and mid-income countries

Purpose

The article summarises the current use of radiotherapy (RT) in childhood cancer and suggests methods to improve current practice in regions where outcomes of paediatric cancer patients are inferior to those of high-income countries.

Methods and materials

The International Atomic Energy Agency (IAEA) is supporting low- and mid-income countries (LMICs) in upgrading cancer care where nuclear applications, particularly RT, are used. A consensus meeting of experts was invited to advise IAEA on the needs for RT in paediatric cancer patients. The current indications for RT were reviewed, together with regional differences in access, practice and outcome.

Results

Regional variations in the use of evidence-based multidisciplinary care including RT were associated with varying outcomes of paediatric cancer patients. The contribution of modern and investigational technology to these differences is uncertain and should be determined in clinical trials. Adequate resources are required to support children through the acute phase of treatment and to permit early recognition and management of late effects. An IAEA sponsored project for prospective data collection to assess the current and future status of radiation treatment in childhood cancer in LMICs has commenced.

Conclusion

RT remains an essential component of the multidisciplinary management of many paediatric cancers. Excessive variations in outcome are inappropriate and call for action on harmonising training programmes and compliance with evidence-based recommendations. Training projects targeting paediatric cancer care are being implemented and clinical studies comparing new technologies against evidence-based approaches are needed to achieve this goal. The IAEA has an important role in these activities and has commenced prospective data collection in 13 LMICs to monitor trends in treatment techniques and outcomes.