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INTRODUCTION TO RADIOTHERAPY AND NUCLEAR MEDICINE

Academic year and teacher
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Versione italiana
Academic year
2022/2023
Teacher
GIOVANNI DI DOMENICO
Credits
5
Didactic period
Primo Semestre

Training objectives

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Modulo: 53362 - FISICA NELLA MEDICINA NUCLEARE E NELLA RADIOTERAPIA
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NUCLEAR PHYSICS IN MEDICINE AND RADIOTHERAPY
The main knowledge gained will be:
•The physical principles of operation of a gamma camera, the image formation, the reconstruction methods of 3D distribution
of the radiopharmaceutical, the attenuation and scatter correction techniques. The principles of operation of a 99mTc generator.
•The physical principles of the dosimetric calculation in internal dosimetry, the tracer modeling and the radiopharmaceutical
kinetic, the MIRD method.
•The physical principles of protontherapy, the interaction of protons with the matter, the techniques for beam delivering.
•The physical principles of radiation therapy, a linear accelerator block diagram, isocenter calculation,
treatment plan creation, the definition of the various types of volumes.
•The accelerator commissioning, monitors systems, calculation of dose on the patient.
•The physical principles and clinical objectives of IGRT.
•Special techniques in radiotherapy.

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Modulo: 53363 - RADIOFARMACI
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RADIOPHARMACEUTICALS
The main knowledge will be:
•basics of radiopharmaceutical chemistry necessary to take a global view of the preparation and quality of radiopharmaceuticals
for clinical and experimental use control process;
•knowledge of the requirements of quality, purity, safety and efficacy of radiopharmaceuticals and quality
assurance systems in their preparation and verification;
•knowledge of current legislation in the field radiopharmaceutical.
The main skills (ie the ability to apply their knowledge) will be:
•understand the dynamics of the processes of preparation and quality control of radiopharmaceuticals;
•understand a quality assurance system.

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Modulo: 53404 - APPARECCHIATURE DI MEDICINA NUCLEARE E RADIOTERAPIA
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EQUIPMENT OF NUCLEAR MEDICINE AND RADIOTHERAPY
The course is specifically dedicated to prepare the student to "technical" of the founding principles
of nuclear medicine and radiotherapy and to the management of rooms, equipment and instruments used for the synthesis
of the radiopharmaceutical preparations according to the regulations.
The main knowledge gained will be:
•The characteristics of the gamma camera collimator, scintillator crystal, light guide, photomultiplier,
electronics chain, porta cot patient, type of gammacamere modern: 1, 2, 3 head systems; notes on thyroid sensor.
•Tomographs Spect and Spect / Tc and acquisition protocols: Static, dynamic, Wholebody, tomographic and gated.
•The principles of positron emission tomography, tomography Pet, Pet-Tc and acquisition protocols.
•Equipment for external and internal radiation therapy.
•Equipment for centering and for set-up patient.
•Custom Screens, Multi-Leaf-Collimator, wedge filters, filters homogenizer, for electrons applicator.
•Overview of tomoterapy, Cyberknife, IORT, gamma knife, hadron therapy, plesioterapia and roentgentherapy.
•Basic elements for classifying and work areas of a radiopharmacy: description of facilities and rooms, identification
of the critical factors, tools and methods for monitoring, cleaning, dressing personnel and material handling.
•Key features of the tools and equipment found in a radiopharmacy: workspaces, synthesis modules, dose calibrators,
HPLC, GC, centrifuges, gammacromatographer, fractionators dose.
•Basic elements of the qualification process of the rooms, tools and equipment.
The main skills (the ability to apply knowledge acquired) will be:
•ability to analyze the adequacy of a room or a tool / equipment in accordance with the law.
•ability to manage the flow of personnel and materials through classified rooms.
•identify and follow the steps of a plan of qualification of environments and tools/equipment.

Prerequisites

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Modulo: 53362 - FISICA NELLA MEDICINA NUCLEARE E NELLA RADIOTERAPIA
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Prerequisites are not required.

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Modulo: 53363 - RADIOFARMACI
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Prerequisites are not required.

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Modulo: 53404 - APPARECCHIATURE DI MEDICINA NUCLEARE E RADIOTERAPIA
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Prerequisites are not required.

Course programme

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Modulo: 53362 - FISICA NELLA MEDICINA NUCLEARE E NELLA RADIOTERAPIA
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The course includes 16 hours of lectures:
•Gamma camera physical principles:
collimators and their main characteristics: spatial resolution and efficiency. The electronics of detection system.
Projections sampling.Images econstruction: filtered backprojection and few.
Attenuation correction: Chang method, attenuation coefficient measurement. The 99mTc generator.
•Internal Dosimetry: Tracer modeling. Radiopharmaceutical kinetic. MIRD method.
•Protontherapy physical principles: Proton interaction with matter, the Bragg peak. Bethe-Bloch formula, range calculation. Multiple scattering, nuclear interactions.
Pencil Beam, Broad beam, modulated beam. Proton beam scanning, dose planning.
•Radiotherapy physical principles:
Linear accelerator block diagram. Energy Control. Gantry Rotation and ISO computation. Treatment plan: DDR, portal film, imaging verify pre-treatment, virtual simulation. Volume Definitions: GrossTumor Volume (GTV), Clinical Target Volume (CTV),
Planning target Volume (PTV). Gated Radiotherapy Acceptance test and commissioning of linear accelerator.
Monitors Units computations and Quality Control. Patient dose computation.
•IGRT Image Guided Radiotherapy: physical theory and clinical targets.
•Special methods in radiation therapy:
Intensity Modulated Radiation Therapy (IMRT). Intensity Modulated Arc Terapy (IMAT). Tomotherapy.
KVCT versus MVCT. Brachytherapy. Total Body Irradiation (TBI). Stereotassic surgery.

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Modulo: 53363 - RADIOFARMACI
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EQUIPMENT OF NUCLEAR MEDICINE AND RADIOTHERAPY
The course includes 24 hours of lectures:
•Nuclear Medicine equipment: gamma camera, tomography spect and spect / tc, tomography pet and pet / tc, hybrid Waste Equipment.
•Equipment for external and internal radiation: cobalt, linear accelerators, Cyberknife, IORT, gamma knife, hadron therapy,
plesioterapia and x-ray therapy, brachytherapy equipment.
•Classification of the rooms and work areas, technical solutions and practices for keeping them and their monitoring.
•Description technical rooms, instruments and equipment.
•Description of the processes of environmental evaluation, tools and equipment.
NUCLEAR PHYSICS IN MEDICINE AND RADIOTHERAPY
The course includes 24 hours of lectures:
•Gamma camera physical principles:
collimators and their main characteristics: spatial resolution and efficiency. The electronics of detection system.
Projections sampling.Images econstruction: filtered backprojection and few.
Attenuation correction: Chang method, attenuation coefficient measurement. The 99mTc generator.
•Internal Dosimetry: Tracer modeling. Radiopharmaceutical kinetic. MIRD method.
•Protontherapy physical principles: Proton interaction with matter, the Bragg peak. Bethe-Bloch formula, range calculation. Multiple scattering, nuclear interactions.
Pencil Beam, Broad beam, modulated beam. Proton beam scanning, dose planning.
•Radiotherapy physical principles:
Linear accelerator block diagram. Energy Control. Gantry Rotation and ISO computation. Treatment plan: DDR, portal film, imaging verify pre-treatment, virtual simulation. Volume Definitions: GrossTumor Volume (GTV), Clinical Target Volume (CTV),
Planning target Volume (PTV). Gated Radiotherapy Acceptance test and commissioning of linear accelerator.
Monitors Units computations and Quality Control. Patient dose computation.
•IGRT Image Guided Radiotherapy: physical theory and clinical targets.
•Special methods in radiation therapy:
Intensity Modulated Radiation Therapy (IMRT). Intensity Modulated Arc Terapy (IMAT). Tomotherapy.
KVCT versus MVCT. Brachytherapy. Total Body Irradiation (TBI). Stereotassic surgery.
RADIOPHARMACEUTICALS
The course includes 12 hours of lectures:
•atom and radioactive decay
•Nuclear medicine and radiopharmaceuticals for diagnostic and therapeutic molecular imaging: general concepts:
radiopharmaceuticals labeled with 99mTc and the traditional nuclear medicine
radiopharmaceuticals labeled with positron emitters and positron emission tomography (PET)
radiopharmaceuticals for therapy
•Quality control of radiopharmaceuticals: general concepts
•Regulatory issues in the preparation of radiopharmaceuticals for clinical and experimental use.
Radiopharmaceutical quality assurance systems (Standards of Good Preparation of radiopharmaceuticals for nuclear medicine and GMP references)


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Modulo: 53404 - APPARECCHIATURE DI MEDICINA NUCLEARE E RADIOTERAPIA
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The course includes 12 hours of lectures:
•atom and radioactive decay
•Nuclear medicine and radiopharmaceuticals for diagnostic and therapeutic molecular imaging: general concepts:
radiopharmaceuticals labeled with 99mTc and the traditional nuclear medicine
radiopharmaceuticals labeled with positron emitters and positron emission tomography (PET)
radiopharmaceuticals for therapy
•Quality control of radiopharmaceuticals: general concepts
•Regulatory issues in the preparation of radiopharmaceuticals for clinical and experimental use.
Radiopharmaceutical quality assurance systems (Standards of Good Preparation of radiopharmaceuticals for nuclear medicine and GMP references)

Didactic methods

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Modulo: 53362 - FISICA NELLA MEDICINA NUCLEARE E NELLA RADIOTERAPIA
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Lectures on all the course’s topics.

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Modulo: 53363 - RADIOFARMACI
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Lectures on all the course’s topics.

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Modulo: 53404 - APPARECCHIATURE DI MEDICINA NUCLEARE E RADIOTERAPIA
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Lectures on all the course’s topics.

Learning assessment procedures

EQUIPMENT OF NUCLEAR MEDICINE AND RADIOTHERAPY
The aim of the exam is to verify at which level the learning objectives previously described have been acquired.
The test consists of a quiz (33 multiple choice questions) on all topics. The time allowed for this test is 1 hour.
It is not allowed consulting any textbook or using any PC, smart phone. The assessment of the questions is as follows:
1 point for each correct answer, 0 points for each wrong answer, for answers not given or dubious.
If you get a score of 33, you to get the "lode".
To pass the exam it is Necessary to get at least 18 points out of 30.
NUCLEAR PHYSICS IN MEDICINE AND RADIOTHERAPY
The aim of the exam is to verify at which level the learning objectives previously described have been acquired.
The test consists of a quiz (15 questions: both multiple choice or open) on all topics. The time allowed for this test is 1.5 hours.
It is not allowed consulting any textbook or using any PC, smart phone.
The assessment of the questions is as follows: 2 point for each correct answer,
0.5 points for each wrong answer, 0 points for answers not given or dubious.
To pass the exam it is necessary to get at least 18 points out of 30.
RADIOPHARMACEUTICALS
The aim of the exam is to verify at which level the learning objectives previously described have been acquired.
The test consists of a quiz (33 multiple choice questions) on all topics. The time allowed for this test is 1 hour.
It is not allowed consulting any textbook or using any PC, smart phone. The assessment of the questions is as follows:
1 point for each correct answer, 0.5 points for each wrong answer, 0 points for answers not given or dubious.
If you get a score of 30, a number of three further quiz allows you to get the "lode", if the answers are correct.
To pass the exam it is Necessary to get at least 18 points out of 30.

Reference texts

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Modulo: 53362 - FISICA NELLA MEDICINA NUCLEARE E NELLA RADIOTERAPIA
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Slides provided by the teacher.
“The Physics of radiation therapy” F. M. Khan – Lippincott Williams & Wilkins, a Wolter Kluwer Business (2010).

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Modulo: 53363 - RADIOFARMACI
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EQUIPMENT OF NUCLEAR MEDICINE AND RADIOTHERAPY
Slides provided by the teacher.
Specific topics can be explored on the following
•Dondi, Giubbini - Medicina Nucleare nella pratica clinica; Ed. Patron
•Monetti Fanti Lopci - Compendio di Medicina Nucleare Ed. Esculapio
•G. Lucignani; La Qualità nelle preparazione dei Radiofarmaci; Edito da Springer, 2011.
NUCLEAR PHYSICS IN MEDICINE AND RADIOTHERAPY
Slides provided by the teacher.
“The Physics of radiation therapy” F. M. Khan – Lippincott Williams & Wilkins, a Wolter Kluwer Business (2010).
RADIOPHARMACEUTICALS
Slides provided by the teacher.
•G. Lucignani; La Qualità nelle preparazione dei Radiofarmaci; Edito da Springer, 2011


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Modulo: 53404 - APPARECCHIATURE DI MEDICINA NUCLEARE E RADIOTERAPIA
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Slides provided by the teacher.
Specific topics can be explored on the following
•Dondi, Giubbini - Medicina Nucleare nella pratica clinica; Ed. Patron
•Monetti Fanti Lopci - Compendio di Medicina Nucleare Ed. Esculapio
•G. Lucignani; La Qualità nelle preparazione dei Radiofarmaci; Edito da Springer, 2011.