CURRENT DEVELOPMENTS IN MEDICAL RADIATION PHYSICS AND RADIATION PROTECTION

Abstract

The paper reviews current trends and future directions for diagnostics and therapy with ionizing radiation. Recent advances in medical physics applied to radiation therapy, diagnostic radiology, nuclear medicine, MRI, and radiation safety are summarized. Today, much of the development is concentrated on providing conditions for individualized diagnostics and therapy for the patient, which requires increased precision and accuracy in both radiological diagnostics and radiotherapy. Areas of active development are the use of artificial intelligence (AI) for improved and more efficient diagnostics and therapy, theranostics, radiomics and dosiomics. All these approaches are parts of the so-called precision or personalized medicine. The ongoing revision of the ICRP's radiation protection recommendations is also commented on. For dose and risk estimates in diagnostic applications (X-ray imaging, CT, interventional radiology, diagnostic nuclear medicine) a change from population-based average phantoms, calculation methods and risk figures to patient-specific calculation methods, phantoms and risk figures (as is done in radiotherapy) is proposed.

References

Bäck, A., Nordström, F., Gustafsson, M., Götstedt, J., & Karlsson Hauer, A. (2017). Complexity metric based on fraction of penumbra dose – initial study. Journal of Physics Conference Series, 847, 012002. https://doi.org/10.1088/1742-6596/755/1/011001

Clement, C., Rühm, W., Harrison, J., Applegate, K., Cool, D., Larsson, C.-M., Cousins, C., Lochard, J., Bouffler, S., Cho, K., Kai, M., Laurier, D., Liu, S., & Romanov, S. (2021). Keeping the ICRP recommendations fit for purpose. J. Radiol. Prot., 41, 1390–1409. https://doi.org/10.1088/1361-6498/ac1611

Decazes, P., Hinault, P., Veresezan, O., Thureau, S., Gouel, P., & Vera, P. (2021). Trimodality PET/CT/MRI and radiotherapy: A mini-review. Frontiers in Oncology, 10, 614008. https://doi.org/10.3389/fonc.2020.614008

Fromherz, M.R., & Makary, M.S. (2022). Artificial intelligence: Advances and new frontiers in medical imaging. Artif Intell Med. Imaging, 3(2), 33–41. https://doi.org//10.35711/aimi.v3.i2.33

Giuliano, L., Franciosini, G., Palumbo, L., Aggar, L., Dutreix, M., Faillace, L., Favaudon, V., Felici, G., Galante, F., Mostacci, A., Migliorati, M., Pacitti, M., Patriarca, A., & Heinrich, S. (2023). Characterization of ultra-high-dose rate electron beams with electronflash linac. Appl. Sci., 13, 631. https://doi.org/10.3390/app13010631

Götstedt, J., Karlsson, A., & Bäck, A. (2023). Evaluation of measures related to dosimetric uncertainty of VMAT plans. J. Appl. Clin. Med. Phys., 24(4), e13862.

IAEA. (2024, Mar 4–6). Technical Meeting on the Radiation Protection of Patients in the New Era of Medical Imaging. Vienna, Austria. https://www.iaea.org/events/evt2303935

ICRP. (2007). The 2007 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP: Publication103. Ann. ICRP 37 (2-4). https://www.icrp.org/publication.asp?id=ICRP%20Publication%20103

ICRP. (2012). ICRP Statement on Tissue Reactions ICRP Publication 118. Ann. ICRP 41(1/2). https://www.icrp.org/publication.asp?id=ICRP%20Publication%20118

Kojima, S., & Hata, M. (2023). Laser-driven ion accelerator. In T. Shirai, T. Nishio, K. Sato (Eds.), Advances in accelerators and medical physics (pp. 343-352). AP B023.

Koka, K., Verma, A., Dwarakanath, B.S., & Papineni, R.V.L. (2022). Technological advancements in external beam radiation therapy (EBRT): An indispensable tool for cancer treatment. Cancer Management and Research, 14, 1421–1429. https://doi.org/10.2147/CMAR.S351744

Laurier, D., Rühm, W., Paquet, F., Applegate, K., Cool, D., & Clement, C. (2021, Oct 17). Areas of research to support the system of radiological protection. (On behalf of the ICRP). Radiat. Environ. Biophys., 60, 519–530. https://doi.org/10.1007/s00411-021-00947-1

Liu, X., Li, Z., & Yin, Y. (2023). Clinical application of MR-linac in tumor radiotherapy: A systematic review. Radiation Oncology, 18(1), 52. https://doi.org/10.1186/s13014-023-02221-8

Mattsson, S., & Adlienė, D. (2013). Current developments and future of medical physics. Challenges and opportunities. In: III International Workshop Medical Physics – the current status, problems, the way of development. Innovation technologies. Kiev, Ukraine.

Mattsson, S., Adlienė, D. & Laurikaitienė, J. (2023). Current trends in medical physics. In D. Adlienė (Ed.), Medical Physics in the Baltic States: Proceedings of the 16th International Conference on Medical Physics (pp. 3–8.). Kaunas University of Technology.

McCague, C., Ramlee, S., Reinius, M., Selby, I., Hulse, D., Piyatissa, P., Bura, V., Crispin-Ortuzar, M., Sala, E., & Woitek, R. (2023). Introduction to radiomics for a clinical audience. Review. Clinical Radiology, 78, 83–98.

Moores, M., & Mattsson, S. (2023). Comments on the System of Radiological Protection. https://icrp.org/page.asp?id=531

Nyholm, T., & Jonsson, J. (2015). Technical aspects of MR-only radiotherapy. MAGNETOM Flash 2, 78–83. www.siemens.com/magnetom-world

Pini, C., Gelardi, F., & Sollini, M. (2022). Present and future of target therapies and theranostics: refining traditions and exploring new frontiers – Highlights from Annals of Nuclear Medicine. Editorial. European Journal of Nuclear Medicine and Molecular Imaging, 49, 3613–3621. https://doi.org/10.1007/s00259-022-05921-7

Pratt, E.C., Lopez-Montes, A., Volpe, A., Crowley, M.J., Carter, L.M., Mittal, V., Pillarsetty, N., Ponomarev, V., Udías. J.M., Grimm, J., & Herraiz, J.L. (2023). Simultaneous quantitative imaging of two PET radiotracers via the detection of positron–electron annihilation and prompt gamma emissions. Nature Biomedical Engineering, 7, 1028–1039. https://doi.org/10.1038/s41551-023-01060-y

Rehani, M. M., & Nacouzi, D. (2020). Higher patient doses through X-ray imaging procedures. Physica Medica, 79, 80–86.

Rehani, M., & Xu, X.G. (2024). Dose, dose, dose, but where is the patient dose? Rad. Prot. Dosim., 200(10), 945–955.

Rühm, W., Clement, C., Cool, D., Laurier, D., Bochud, F., Applegate, K., Schneider, T., Bouffler, S., Cho, K., Hirth, G., Kai, M., Liu, S., Romanov, S.,  & Wojcik, A. (2022). Summary of the 2021 workshop on the future of radiological protection. J. Radiol. Prot., 42, 023002. https://doi.org/10.1088/1361-6498/ac670e

Rühm, W., Cho, K., Larsson, C.-M., Wojcik, A., Clement, C., Applegate, K., Bochud, F., Bouffler, S., Cool, D., Hirth, G., Kai, M., Laurier, D., Liu, S., Romanov, & S., Schneider, T. (2023). Vancouver call for action to strengthen expertise in radiological protection worldwide. Radiation and Environmental Biophysics, 62, 175–180. https://doi.org/10.1007/s00411-023-01024-5

Zhang, W., Oraiqat, I., Litzenberg, D., Chang, K.-W., Hadley, S., Sunbul, N.B., Matuszak, M.M., Tichacek, C.J., Moros, E.G., Carson, P.L, Cuneo, K.C., Wang, X., & El Naqa, I. (2023). Real-time, volumetric imaging of radiation dose delivery deep into the liver during cancer treatment. Nature Biotechnology, 41, 1160–1167. https://doi.org/10.1038/s41587-022-01593-8