INTERNATIONAL ATOMIC ENERGY AGENCY

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INTERNATIONAL ATOMIC ENERGY AGENCY

• The IAEA will
• -- accelerate and enlarge the contribution of
  atomic energy to health and prosperity ---

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United Nations Organisations
The International Atomic Energy Agency is a
Nuclear Technology organisation not primarily a
cancer organisation
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IAEA

• NUCLEAR POWER
• Nuclear Energy
• Safeguards

• NUCLEAR TECHNOLOGY
• Technical Co-operation (TC)
• Radiation Safety
• Nuclear Applications (NA)
• (including Health)

Cancer diagnosis and management are supported by
TC NA
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Overall Cancer Problem
Ref. M. Parkin IARC Globocan
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Cancer in Developing Countries

• Cancer Control
• Prevention
• Early diagnosis
• MANAGEMENT
• Palliation

• With a rising incidence of cancer in developing
  countries, management becomes increasingly
  important to the Health ministries

Radiotherapy is a major nuclear technology in the
management of cancer
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Applied Radiobiology Radiotherapy (ARBR)

• Research Development
• through
• Individual Research Contracts
• Coordinated (Group) Research
• Advisory Group Meetings
• etc.

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RESEARCH PROJECTS

• Research directed at clinical problems of
  developing countries
• Oesophagus Brachytherapy /- teletherapy
• Nasopharynx Teletherapy brachytherapy
• 5 or 6 fractions per week?
• Cervix HIV pos Addition chemo?
• Cervix (HIV-) 2 or 4 fractions HDR brachytherapy
• Economics of Radiotherapy

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DEVELOPMENT COMPONENT

• Head Neck immobilisation
• A cost-effective alternative to the current
  swing to disposable thermoplastic masks

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ADVISORY GROUP PUBLICATIONS

• On demand from member states
• Introduction of micro- HDR brachytherapy for
  developing countries
• Mould-room techniques
• The role of radiotherapy in HIV-related cancers
• Design implementation of a radiotherapy program
• Audit of radiotherapy methodology for developing
  countries related to sustainability

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JOURNAL PUBLICATIONS

• Radiotherapy in Africa
• RO 52, (1999) 70-84
• S-E Asia Pacific
• RO 60 (2001) 81-89
• Latin America
• RO 2004 In press
• Economics radiotherapy
• RO 63 (2002) 147-150
• Cost of teletherapy
• RO 71 (2004) 347-355

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SPECIAL INTEREST SERVICES

• Directory of Radiotherapy Services
• DIRAC
• Dosimetry intercomparison
• Radiotherapy Cost Evaluator software

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TECHNICAL CO-OPERATION

• Promotion of nuclear technology in developing
  countries
• by
• National Projects

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RT Services in Africa
lt 2 million/machine
2 - 10 million/machine
gt 10 million/machine
No known operational machines
Ref. Radiotherapy in Africa RO 52, (1999)
70-84 Updated 2004
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INITIATE RADIATION ONCOLOGY

• Uganda
• Ethiopia
• Namibia
• Mongolia
• GHANA (Accra)
• Building
• Zambia
• Yemen
• Borneo

In planning Angola, Haiti, Eritrea
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UPGRADING RADIOTHERAPY

• Concentrate on establishing one aspect of
  radiotherapy at one centre.
• Teletherapy
• Brachytherapy
• Treatment Planning
• Imaging
• Immobilisation

About 50 national projects each biennium
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AGENCY TOOLSfor radiotherapy implementation

• Equipment
• Training
• Expert visits

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SCHEMATIC OF CANCER MANAGEMENT
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EQUIPMENT

• TREATMENT
• Teletherapy
• Brachytherapy
• CLINICAL QA
• Treatment Planning
• Imaging
• Immobilisation

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TRAINING

• Long Term Training for Degree purposes
• Specialised Training
• Fellowships 3 to 6 months
• Training courses 1 to 2 weeks

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Limitation by Personnel
OK Machines OK Staff
Staff OK Too few machines
OK Machines Understaffed
Too few machines Understaffed for these
Ref. Tatsuzaki Levin Radiotherapy Oncology
60 (2001) 81-89
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PERSONNEL LIMITATIONS
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RT Education in Africa
?
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EXPERT VISITS

• CLINICAL
• Develop in-house procedures/protocols
• Instruction on clinical QA in the use of
  specialised equipment

• MEDICAL PHYSICS
• Commissioning of new equipment
• Calibration and dosimetry

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TECHNICAL CO-OPERATION

• Promotion of nuclear technology in developing
  countries
• by
• Regional Projects

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REGIONAL PROJECTS

• Regional projects confine themselves to regional
  needs Primarily training courses with some minor
  equipment.
• Africa AFRA
• Eastern Europe
• Latin America ARCAL
• South East Asia

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AFRICA AGREEMENT

• 56 Countries
• 23 with RT
• 17 in AFRA
• 155 Teletherapy machines
• Training in 6 countries

Radiotherapy in Africa RO 52, (1999) 70-84
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TRAINING COURSES

• Radiation Oncologists
• Medical Physicists
• Therapy Radiographers
• Gynae Nurses

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Total Agency Involvement

• Clinical
• Dosimetry
• Dose Quality Control
• Radiation protection
• Radioactive waste management
• etc. as needed

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Government commitment
Mrs. Patient
Agency commitment
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THE INTERNATIONAL ATOMIC ENERGY AGENCY
ARBR
A PARTNER IN HEALTH
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http//www.iaea.org/worldatom