2023 HICARE/IAEA Internship Report

Merumo Teraguchi
4th grade student, Department of Medicine, Hiroshima University

1. Overview
Period: April 1st, 2023 〜 June 30th, 2023
Dispatch source: Hiroshima International Council for Health Care of the RadiationExposed (HICARE)
Dispatch destination: International Atomic Energy Agency (IAEA)
Assigned department: Director’s office, Division of Human Health,
Department of Nuclear Sciences and Applications
Purpose: To understand the significance and necessity of medical treatment for the victimof the atomic bomb from a global point of view. To develop human resources
who will inherit the research results and results of medical treatment for theradiation-exposed in Hiroshima.
With the recommendation and support of HICARE, I did a three-month internship at theInternational Atomic Energy Agency (IAEA) in Vienna, Austria.
I applied for this internship because I was born and raised in Hiroshima, and I am
interested in the peaceful use of nuclear energy and the effects of radiation on the humanbody as I have had many opportunities to hear stories about the atomic bomb since I wasa child.

2. Activities during the InternshipThe main activities I did during the internship were the following four things.
(1) Writing a Review Paper on SBRT for Oligometastatic Prostate Cancer(2) Helping to Publish the Handbook(3) Attending Meetings

(4) Visiting the Sibersdorf Laboratory
Details are as follows.

(1) Writing a Review Paper on SBRT Treatment for Oligometastatic Prostate Cancer
I talked with Dr. May Abdel Wahab who is the director of the Division of Human Health,
Department of Nuclear Science and Application (NAHU), and she told me to work on areview paper on SBRT (Stereotactic body radiotherapy) treatment for oligometastatic
prostate cancer. Oligometastasis is a relatively new concept, referring to localized, small
numbers of metastases (typically one to five) of cancer, but there is still no unified
definition of the number and location of metastases.
In oligometastasis, treatment aimed at radical control of metastatic lesions, such asradiotherapy or surgery, can improve prognosis. SBRT is one of the most precise types ofradiotherapy and is said to be highly effective in oligometastasis, but its effectiveness has
not yet been well-researched, so I was assigned to review this topic. I worked on this paper
throughout my internship. I conducted a search of the literature by setting keywords in
PubMed, and then extracted and compared the results. It was my first time writing a paper
and it was difficult, but thanks to Dr. May's careful guidance in her busy schedule, I wasable to work on it little by little. I was impressed when Dr. May told me that “Theinternship experience itself does not remain in a visible form, but by writing a review
paper, the experience can be preserved in a way that is tangible.” The experience ofwriting the paper on my own was very good training in logical thinking based on medicalfindings.
After I returned to Japan, I prepared for the medical research presentation at Hiroshima
University by making posters and PowerPoint presentations under the supervision of Dr.
Yuji Murakami, a radiation oncologist at Hiroshima University.

(2) Helping to prepare for the publication of a handbook
I was involved in the preparation of a handbook under the guidance of Dr. Uwe Scholz.
The handbook was about the guidance for medical practitioners communicating with

returning populations to former evacuation sites. It was a bit of a challenge at first, assome of the tools were new to me, but thanks to his careful guidance, I acquired new skills
and gradually improved the speed of my work.

① Applying for Permission to Cite Figures and Tables
I asked UNSCEAR, Fukushima Prefecture, Japan's Ministry of the Environment, andothers for permission to quote the figures and photos used in the handbook. Dr. Uwe had
been working on the Fukushima nuclear accident for some time and has many Japaneseacquaintances, so we sometimes contacted the relevant authorities through them.

② Correcting Grammar and Style of Writing
IAEA publications have a lot of regulations on format, such as font size and how to cite
figures and tables, and so on. Many of the chapters in this handbook were written bypeople outside the IAEA, and some of them were not in line with the IAEA rules, so I
corrected them. Also, some of the chapters had been written a little while ago, so I checked
whether the references and links were correct. Some of the referenced figures and tables
were not in the reference source or had incorrect links, so it was hard to find the correct
ones. In addition, I corrected some grammatical errors.

③ Creating a revised version of the Reference section
I created a revised version of the References section, as some of them did not follow theIAEA's rules. If the referenced item was a paper, I searched for it using Web of Scienceand dropped it into an Endnote set in IAEA style, and used what was displayed. Some ofthe items were output incorrectly, so I checked everything myself afterward. If thereferenced item was a book or report, I did an internet search, checked the necessary
information such as title, year of publication, and so on again by myself, and revised themanuscript.
As the handbook was about the Fukushima nuclear accident, there were many Japanesepublications in the references. Some of the Japanese publications had titles and names ofpublishing organizations that had to be translated from Japanese into English, and some
had publication years in the Japanese calendar, so I think I was able to contribute as aJapanese speaker, especially in this aspect.

(3) Attending Meetings① Human Health Seminar
The Division of Human Health where I worked sometimes holds seminars on radiationand human health. During my three-month internship, two seminars were held.
The first one was entitled "Latest update on X-ray angiography technology and quality
assurance" and was given by Prof. Kevin Wunderle, Diagnostic medical physicist at theCleveland Clinic. Medical imaging technology is crucial for accurate diagnosis andimproved patient care, and many types of X-ray equipment are used for a variety of clinicalapplications. In this presentation, he gave an update on the latest information and future
perspectives on the technology of X-ray equipment specifically for interventional
treatment under X-ray fluoroscopy.
The second one was entitled "Artificial Intelligence in Radiation Medicine; Opportunities
and Challenges" and was given by Dr. Issam El Naqa, founding chair of the Machine
Learning department. Artificial intelligence (AI) and machine learning (ML) have been
proven to improve efficiency not only in diagnosis and treatment in radiology but also intreatment planning and assurance of treatment quality. However, especially in low- andmiddle-income countries, ethical concerns and financial resources have been a barrier,and have limited its application in healthcare. Therefore, in this presentation, he talked
about current applications and real challenges in this context, as well as about new
approaches to solve these issues. The first seminar was held face-to-face and the second
was online, and there was a lively discussion after each presentation. Both seminars werevery valuable opportunities to gain various insights from experts who are currently
working extensively in the medical field.

② ARBR Section MeetingWeekly ARBR (Applied Radiation Biology and Radiotherapy) section meetings were held
under the chairmanship of Dr. May. They reported on the progress of their respective
projects and confirmed plans.

③ Topical Session on Radiation Induced Second Primary Cancer Following
Radiotherapy and Associated Imaging
I attended Day 3 of the Topical Session on Radiation Induced Second Primary Cancer
Following Radiotherapy and Associated Imaging on 15 June 2023. Second primary cancer
is a cancer that occurs in a person who has previously experienced malignancy and it isindependent of the previous cancer. The main cause of second primary cancer has been
considered to be radiotherapy, but in recent years it has become clear that a patient'sgenetic predisposition and lifestyle also have a significant impact on second primarycancer. According to the conference, the mechanisms of radiation induction of secondary
primary cancers are still unclear in some areas, so further research is needed. It wasimpressive that some persons from the Nuclear Regulation Authority from Japan werealso present and they asked some questions.

(4) Visiting the Sibersdorf Laboratory
Ms. Sumi, Laboratory Head of the Nuclear Material Laboratory (NML), SafeguardDepartment of the Sibersdorf Laboratory, guided me to visit the Environmental Sample
Laboratory (ESL) and the NML in the laboratory. The Sibersdorf Laboratory is owned by
the IAEA, and it has eight nuclear application laboratories. The ESL and NML arelaboratories that aim to investigate whether nuclear material is used only for peacefulactivities by analyzing samples collected by the IAEA inspectors at nuclear facilities
around the world. The ESL verifies that no undeclared nuclear activities are taking place,while the NML verifies that the uranium and plutonium content in the samples matches
what has been declared to the IAEA.
I was impressed to know that the samples collected are initially assembled at a specificlocation and are handed over to the experimenter after keeping the place and time ofcollection secret so that bias is eliminated and the verification is carried out from a neutral
and impartial perspective. It was a valuable opportunity to get in touch with the scientificaspects of nuclear security.

3. What I Learned from the InternshipI had many valuable experiences and learned a lot during this internship. Before coming
to the IAEA, I thought that international organizations like the IAEA were a distantworld that had nothing to do with me. However, I was able to see how the IAEA
functions by working with many people there.
I was surprised because I was often asked what my expertise was when I introduced
myself. Most of the IAEA staff members had Ph.Ds., which made me realize that a highlevel of expertise is required to work in the international organization.
In addition, through interaction with the staff members and interns, I realized that tounderstand foreign cultures, it is necessary to understand Japanese culture first as acomparison.
Furthermore, I found it important to be willing to take on challenges without being
afraid of making mistakes. At first, I was so afraid of making mistakes that I sometimes
slowed down my work speed by checking things one by one, and refrained fromexpressing my opinions, fearing that my ideas might not be conveyed properly.
However, my intern friends pointed out to me to stop doing this, and I started to shift
my focus toward completion rather than perfection.
In this way, I learned a lot of things both from the internship at the IAEA and from theinteraction with the staff members and interns from all over the world.

4. Acknowledgments
I would like to thank many people who helped me to do this internship.
I sincerely appreciate HICARE, Hiroshima Prefecture, and Hiroshima University forgiving me this wonderful opportunity, and the staff members and interns I was able towork with at the IAEA.

With Dr. May Abdel Wahab, the director of NAHU

With my intern friends

IAEA Buildings (Vienna, Austria)