ICRP ref: 4852-9144-9932

Third announcement

Joint FMU-ICRP Workshop on
Radiological Protection in Medicine
Tuesday, October 3, 2017
Organised by Fukushima Medical University (FMU)
and the International Commission on Radiological Protection (ICRP)
with support from the Nippon Foundation
Simultaneous translation by Hirano Co. Ltd.

Abstracts

INTERNATIONAL COMMISSION ON RADIOLOGICAL PROTECTION

Joint FMU-ICRP Workshop on
Radiological Protection in Medicine
Fukushima Medical University
Tuesday, October 3, 2017
Organised by Fukushima Medical University (FMU) and the International Commission on
Radiological Protection (ICRP) with support from the Nippon Foundation
Simultaneous translation by Hirano Co. Ltd.

Background
Fukushima Medical University is under development of radiopharmaceuticals for targeted αparticle therapy. Radionuclide therapy combines therapeutic effect of radiation with the targeting
capability of molecular therapies and is increasingly being utilised as the result of ongoingdevelopment of novel radionuclides and tracer molecules. ICRP Task Group 101 has beenworking on Radiological Protection in Therapy with Radiopharmaceuticals for providing
recommendations related to radiological protection of patients and staff as well as of public. It is
important to alert the medical community of optimising therapeutic use and protection required
for radiopharmaceuticals, particularly for new treatment procedure such as targeted α-particle
therapy. This joint workshop provides an opportunity to exchange information between FMUand ICRP on the advanced scientific findings for the protection of people from the risks ofradiation.

Objectives
FMU and ICRP welcome this opportunity to share information on radiation protection in
medicine including radionuclide therapy with ICRP Task Group 101 members and medicalcommunity.

Venue
Room number 1, the 2nd floor of Bldg. 7, Fukushima Medical UniversityAccess: http://www.fmu.ac.jp/univ/daigaku/campusmap.html

Registration
Attendance at the symposium is free of charge. However, advance registration is required asattendance is limited to 100 participants. Please send your name, affiliation, and e-mail address
to Haruyuki Ogino (ICRP Assistant Scientific Secretary) at rpmed@icrp.org by 29 September
2017.

1

Program
10:30 – 10:40: Opening Address
Koichi Tanigawa(FMU, Japan)
10:40 – 11:30: Session 1 “General Overview and Introduction from FMU”
Radiological Protection in Medicine: Overview and Introduction of TG101Yoshiharu Yonekura(QST, Japan)
New Treatment Facility and Targeted Alpha-particle Therapy in FMU
Noboru Oriuchi(FMU, Japan)
11:30 – 13:00: Lunch
13:00 – 14:00: Session 2 “Risk Estimate for Radiological Protection”
Individual Risk Estimates in Radiology: Is it necessary and possible?
Sören Mattsson(Skåne University Hospital Malmö and Lund University, Sweden)
Pediatric Phantoms for Dosimetry Calculations
Wesley Bolch(University of Florida, USA)
14:00 – 14:30: Coffee break
14:30 – 15:30: Session 3 “Radiological Protection in Radionuclide Therapy”
Individualized Treatment Planning in Radionuclide Therapy
Glenn Flux (Royal Marsden Hospital, UK)
Current Status on Radionuclide Therapy
Makoto Hosono (Kindai University, Japan)
15:30 – 16:30: Panel Discussion
16:30 – 16:40: Closing Remark2

Radiological Protection in Medicine:
Overview and Introduction of TG101
Y. Yonekura
National Institutes for Quantum and Radiological Science and Technology, Anagawa 4-9-1, Inage-ku, Chiba 263-8555, Japan;
e-mail: yonekura@peach.plala.or.jp

Abstract–Medical exposure of ionizing radiation has grown and expanded rapidly during the past century.
It has a unique feature of intentional exposure to provide the clinical benefit, and dose limit is not applied
to medical exposure due to the significant benefit received by patients. In order to ensure the proper useof radiation in medical practice, justification and optimization of the radiological procedure should beconsidered in each patient. Recent progress in radiological technologies has brought various new issues inradiological protection in medicine. The International Commission on Radiological Protection (ICRP) has
published various recommendations in radiological protection, and Committee 3 (C3) has been actively
involved in radiological protection in medicine, providing practical guidance to the medical communityand health care professionals. The use of radiopharmaceutical therapy has a long history, but now attracts
much attention for the treatment of malignant tumors with development of novel radiopharmaceuticals. In
2011, ICRP C3 initiated a new working party (WP) on radiological protection in therapy withradiopharmaceuticals. After having intensive discussion among the WP members, we proposed a task
group (TG) to complete the document, and TG101 was finally approved in February 2016. In radiation
therapy, exposures to the target volume should be individually planned and appropriately verified
considering the dose to non-target tissues. We emphasize the important role of individual dose assessment
and treatment planning in therapy with radiopharmaceuticals as similar to external radiotherapy.

3

New Treatment Facility and Targeted Alpha-particle Therapy in FMU
N. Oriuchi
Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University,
Hikarigaoka 1, Fukushima, 960-1295, Japan; e-mail: oriuchi@fmu.ac.jp

Abstract–FMU has been conducting radionuclide therapy in the affiliated hospital, and developing novel
radionuclide therapy in Advanced Clinical Research Center. In the new hospital building, we have aradionuclide therapy ward with nine-beds. Radioactive iodine (131I) therapy has been done to treat
differentiated thyroid cancer. To fabricate novel radiolabeled compounds for targeted alpha-particle
therapy (TAT) is one of the key objectives of our facility. We have succeeded to produce 211At using a
cyclotron (MP-30) by vertical beam of alpha particles bombardment to bismuth targets via the209
Bi(α,2n)211At nuclear reaction in reasonable yield and purity for clinical application of TAT. FMU willserve as a center of radionuclide therapy in Japan. To achieve these objectives, research frameworks has
been established. Present status and prospect of radionuclide therapy in FMU will be presented.

4

Individual Risk Estimates in Radiology: Is it necessary and possible?
S. Mattssona, M. AnderssonbaMedical Radiation Physics Malmö, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden;
e-mail: soren.mattsson@med.lu.seb
Medical Radiation Physics Malmö, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden;
e-mail: martin.andersson@med.lu.se

Abstract–To inform patients and health-care personnel about risks in diagnostic as well as therapeutic
applications of ionizing radiation, it is desirable that the individual patient’s radiation dose and potential
cancer risk can be prospectively assessed and documented. The current dose and risk reporting is basedon effective dose, which ignores body size and does not reflect the strong dependence of risk on the age atexposure. Risk estimations should better be done through individual organ dose assessments, which needcareful exposure characterization as well as anatomical description of the individual patient. In nuclear
medicine, reference biokinetic models should also be replaced with models describing individual
physiological states and biokinetics. There is a need to adjust population-based cancer risk estimates tothe possible risk for the individual depending on age and gender. One way to do that is to use the U.S.
Environmental Protection Agency (EPA) Lifetime attributable risk (LAR) values. The LAR estimates are
based on the same epidemiological data as ICRP uses for the risk coefficients related to effective dose,
but differentiate the cancer risk into age and gender specific subgroups and have also a clearly defined
detriment in the form of either the excess risk of receiving a cancer or the excess risk to die from thereceived cancer. The presentation summarizes reasons for individual cancer risk estimates and gives
examples of methods and results of such estimates.

5

Pediatric Phantoms for Dosimetry Calculations
Wesley Bolch
Advanced Laboratory for Radiation Dosimetry Studies, J. Crayton Pruitt Family Department of Biomedical Engineering
University of Florida, Gainesville, Florida 32611-6131, USA; e-mail: wbolch@ufl.edu

Abstract–Medical imaging of the infant, child, and adolescent plays an extremely important role in theoverall medical management of this critical component of the medical patient population. The vast majorityof medical images are acquired via use of ionizing radiations (photons) and thus careful optimization ofpatient radiation dose and image quality must be undertaken. Organ doses from medical imaging of thepediatric patient population are difficult to ascertain via experimental measurement, and thus one typically
employs computational anatomic models coupled to Monte Carlo radiation transport simulations. In thispresent, we will review the development of reference phantoms for the ICRP pediatric series – newborn, 1year-old, 5-year-old, 10-year-old, and 15-year-old male and female, as well as series of pregnant female
models. We will also review the use of phantom libraries that cover a broad range patient bodymorphometries such as those of the UF/NCI phantom series, which permit more detailed and patientspecific estimates of organ dose. The presentation will review techniques for organ dose assessment in threekey areas of medical imaging – computed tomography, fluoroscopy (both diagnostic and interventional),and nuclear medical. We will discuss various studies which seek to quantity the accuracy by whichreference phantoms and phantom libraries can provide patient-specific values of internal organ dose.

6

Individualised Treatment Planning in Radionuclide Therapy
G.D. Flux
Joint Department of Physics, Royal Marsden Hospital & Institute of Cancer Research, Sutton, Surrey SM2 5PT, UK;e-mail: Glenn.Flux@icr.ac.uk

Abstract–Radionuclide therapy has been used for the treatment of malignant disease for over 70 years. In
recent years the combination of a range of novel radiotherapeutics, in conjunction with new
methodological and technical developments, have led to rapid developments and promising treatment
options for common, as well as for rare cancers. In the forefront of current developments is the gradualshift from regarding radionuclide therapy as ‘radioactive chemotherapy’, whereby administrations aregoverned by fixed levels of activity, possibly modified by body mass or surface area, to a form ofradiotherapy, with the recognition that treatment outcome is dependent on the absorbed doses delivered totarget volumes, taking into account the absorbed doses delivered to organs at risk. It has been clearly
demonstrated that the former approach leads to a wide variation in inter-patient dosimetry so that
personalised, dosimetry-based treatment planning offers the potential to deliver, for the majority ofpatients, higher tumour absorbed doses that can lead to significant improvements in treatment responseand overall survival. This presentation will review current developments in dosimetry, particularly asapplied to radioiodine treatment for thyroid cancer, I-131 mIBG for neuroblastoma and Ra-223 for bonemetastases from prostate cancer and will consider the impact on clinical and cost-effectiveness resulting
from these ongoing developments.

7

Current Status on Radionuclide Therapy
M. Hosono
Department of Radiology & Institute of Advanced Clinical Medicine, Faculty of Medicine, Kindai University,
Osaka-Sayama, Osaka, 589-8511, Japan; e-mail: hosono@med.kindai.ac.jp

Abstract–Since 1940s I-131 has effectively been applied to hyperthyroidism and metastatic differentiatedthyroid cancer as one of the most representative pharmaceuticals for Radionuclide Therapy (RNT).
Nowadays RNT is an important treatment option alongside surgery, chemotherapy, and external beam
radiation therapy in the management of malignancies, whether curative or palliative. RNT is principally
based on the use of molecules that have high-affinity and specificity to tumors as carriers ofradionuclides, and thus it has the character of being an efficacious molecular targeting method as well asradiation therapeutics. Although RNT has been well established in some malignancies, it has notdemonstrated yet sufficient therapeutic efficacy in others. Recently novel pharmaceuticals andradionuclides have been developed and clinically introduced, which are expanding the application of RNT
to a wide range of malignancies. Lu-177 somatostatin receptor ligand therapy has proven to improvesurvival in patients with neuroendocrine tumors and Ra-223 dichloride has been approved for thetreatment of prostate cancer with bone metastasis. Ra-223 is the first alpha-emitter that has obtained drug
approval, which substantially encourages the research and development of targeted alpha therapy. This

presentation will discuss how we should present radiological protection guidelines to respondand facilitate new technologies of RNT.

8