The pace of advances in medical radiation imaging and treatment is being matched by few other fields of science and technology, world health leaders were told in Vienna last week at an IAEA meeting to ensure that the latest techniques are used safely and effectively.
Every day applications of radiation medicine help millions of patients worldwide. Some techniques enable physicians to see inside the human body creating digital images using short-lived radioisotopes, and not a surgeon´s scalpel. Others enable targeted and precise radiation treatment of cancer. Still others are diagnostic tools applied in nutrition and other health-related areas.
About 500 experts and observers from 68 countries and 13 international organizations participated in an IAEA-sponsored three-day conference on Quality Assurance and New Techniques in Radiation Medicine. They discussed optimizing practices and reducing risks in radiation imaging and treatment while bridging the technology gap between richer and poorer countries.
"Nuclear applications in human health, the majority of which are in the field of radiation medicine, constitute the single largest technical area in which Member States request support," says Ana María Cetto, IAEA Deputy Director General for Technical Cooperation. The applications represent roughly a third of the total resources allocated from the IAEA Technical Cooperation Fund in each one of the four regions: Africa, Asia and the Pacific, Europe and Latin America.
So what exactly is the quality assurance (QA) side of it all? "Quality assurance is a tool to establish confidence in technology, in this case radiation medicine," Werner Burkart, IAEA Deputy Director General for Nuclear Sciences and Applications explains. "A robust system ensures that the technology is being used safely and effectively at the technical level and it enables management to be confident in assuring patients that radiation will be used to their benefit."
The conference underscored the importance of hospital managers to support (and demand) a strong comprehensive QA programme in both radiation imaging and treatment. During the week´s sessions, experts pointed out that quality control of individual components of medical equipment is not enough. They stressed that quality assurance at every step of the process is equally as important, especially as new technologies are developed and introduced, and the QA of the medical process itself including medical decision-making becomes part of the QA chain.
Technologies for medical imaging, for example, include computerized tomography (CT), a medical imaging method using x-rays to generate its three-dimensional image; magnetic resonance imaging (MRI), which uses a strong magnetic field and radio frequency signals to generate cross-sections of tissue in order to create three-dimensional reconstructions of internal anatomy; positron emission tomography (PET), which produces images of the functional processes of the body using positron emitting isotopes injected into patients; and intensity modulated radiation therapy (IMRT) which uses sophisticated treatment-planning software to conform radiation treatment to the 3-D shape of the tumour dynamically.
"New technologies represent advances - better ways to diagnose and treat patients," Mr. Burkart says. But the advances do not come problem free. "Acquiring new technologies can be expensive, not only in the costs of the equipment, but also in terms of the improved infrastructure and training of human resources needed to support it."
Access to these technologies remains a challenge for poorer countries. Participants emphasized a number of problems - the difficulty of having to allocate scarce resources to basic health needs; the cost of technologies that provide for specialized and advanced care; limited availability and unreliable maintenance of equipment that is in place. There is a need to establish adequate, but less expensive techniques that can be sustained locally through a robust QA process including well-defined performance standards and milestones.
One of the Conference participants was Dr. Ntokozo Ndlovu, a radiation oncologist from Zimbabwe. She runs radiotherapy services in a limited resource-setting at a Harare hospital, but her centre cannot accommodate all the cancer patients there who would benefit from radiation therapy. She sees many that are curable, but soon become incurable due to lack of treatment caused by the breakdown of their radiation machines, modern linear accelerators that require daily technical supervision by in-house qualified engineers. Some participants referred to the convenience of relying on simpler and cheaper, but more robust technologies in this type of setting.
Dr. Ntokozo Ndlovu notes that the IAEA´s support, through technical cooperation projects, has gone "a long way towards improving radiotherapy in my country." As importantly, she adds, "It´s also given us a platform to lobby our government about Zimbabwe´s cancer needs."