"Approaches on the role of medical physicists in implementing the hybrid technologies in Nuclear Medicine". Papel de la FM en la implementación de los sistemas híbridos en MN Adlin López Díaz

SPECT/CT

Medical Physicist are in general involved in four areas of activities: Clinical services and consultation Research and developement Teaching Administration

NO BOUNDARIES BETWEEN SPECIALITIES MULTIMODALITY MULTIDISCIPLINARY APROACHS NO BOUNDARIES BETWEEN SPECIALITIES EVERYBODY PLAY A KEY ROLE CHEMISTRY PHARMACY PHYSICS BIOLOGY Engineering MEDICINE MATHEMATIC He is the same!!!

Before radioguided surgery After radioguided surgery SPECT/CT radioguided surgery

MP in hybrid technology Roles I Push hard, supporting and facilitate all the decision making process .. Convince administrators of the hybrid tecnology importance and their implication in healthcare delivery Provide evidence and guidance during all the proccess

Verifying flour level

MP in hybrid technology Roles II Usually MP conducts the planning and design phases to follows the current regulatory climate of radiopharmaceutical drug preparation and production, radiation safety issues including shielding details, effective working flow, etc.. Acceptance test and set up the hybrid facility The establishment of the quality control and quality assurance program.

MP in hybrid technology (Roles III) Warranty the robust registration algorithms and the quality of image display across such modalities. The optimization of acquisition and processing protocols: Correction of physical/ technical/biological efects, Study and solve instrumentations problems, Develop reconstruction/modelling/quantification /coregistration/segmentation/simulation algorithms

MP in hybrid technology (Roles IV) Optimization of radiation protection issues: patient and workers point of views. Optimization of clinical and physics dosimetry and quantification Harmonization with the rest of concurrent techniques (Radiotherapy planning, radioguided surgery, etc.)

Developed Medicine Tendency: Preventative Personalized Molecular ► Nano Physiology + Anatomy Diagnostic + Therapeutics Combination Revolution: NEW CONCEPTUAL AND TECHNOLOGICAL PLATAFORM

Correction of physical/ technical/biological efects, study and solve instrumentations problems, reconstruction/modelling/quantification /coregistration/segmentation/simulation algorithms, quality assurance, etc… Optimized Radiotherapy and/or Radionuclide Therapy Planning and Treatment Providing the key link among diagnosis, treatment, and response assessment

Biological adapted therapy: to modulate the dose distribution in the target corresponding to the profile of varying radiation sensitivity throughout the tumour (dose painting or dose sculpting). The essential steps of this concept are: (1) selecting appropriate biomarkers, (2) imaging the biological tumour subvolumes, (3) transforming the image data sets into a dose prescription, (4) optimizing the dose distribution and finally (5) delivering the modulated dose distribution. Molecular Image-guided treatment delivery Treatment monitoring and response assessment: the benefits for clinical outcome are the adaption of the treatment to the response…

Change in Planning Target Volume (PTV) with Incorporation of PET Information in Target Delineation Arnold C. Paulino et al. PET-CT in Radiotherapy Treatment Planning, 1st ed. 2008. Saunders, An Imprint of Elsevier ISBN: 978-1-4160-3224-3

SPECT/CT imaging based tumor dosimetry in a non-Hodgkin lymphoma patient undergoing 131I radioimmunotherapy. (A) Inguinal tumor outline shown on superimposed SPECT/CT images. Tumor volumes at the 3 time points were 77, 63, and 39 mL. (B) Tumor time–activity curves. (C) Tumor absorbed dose map, showing isodose contours in units of cGy. (D) Tumor dose–volume histogram. MIRD PAMPHLET NO. 24: 131I SPECT • Dewaraja et al. J Nucl Med. 2013; 54:2182–2188

Conclusions … Medical physicist is not a “technicien de luxe”, is much more than that: is an essential part of the multidisciplinary team responsible to specialized healthcare delivery. MP should be a clinical service scientist, and also should has plenty of skill to be able to handle efficiently complex issues. Traditional medical physics (radiation MP) is slowly mutating towards biomedical physics.

Cuban Medical Physicist

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