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Chinese AI Helps Target Head and Neck Tumors
2019-07-10

Chinese researchers have developed an artificial intelligence (AI) medical tool that can help doctors target head and neck tumor cells faster and more accurately, according to an article published in the international journal Radiology.

Nasopharyngeal carcinoma is cancer that starts in the nasopharynx, which is the upper part of the pharynx behind the nose. Symptoms include lumps in the neck, nasal congestion, headache and hearing loss. About 70 percent of patients were in the later stages when they were diagnosed.

Due to the organ structure and its location in the human body, surgery is always difficult, and radiation therapy is the most common form of treatment.

Radiation, delivered by a linear accelerator, can kill tumor cells but has to pass through about 40 vital organs including the brainstem and eyeballs before reaching the nasopharynx.

"Insufficient radiation exposure may cause cancer recurrence, while excessive exposure may result in brain damage, hearing loss and other side effects," said first author of the article Lin Li, a researcher with the Sun Yat-sen University Cancer Center in Guangzhou.

Accuracy in tumor delineation on diagnostic images is key to radiation therapy. However, manual delineation is labor intensive and highly variable among doctors.

"Generally it will take a senior doctor two to three hours to target the tumor volume on a CT or MRI, but for inexperienced doctors, it will take more than six hours," said lead researcher Sun Ying.

Researchers from Sun Yat-sen University, along with computer experts from the Chinese University of Hong Kong, constructed an AI contouring tool that could automatically delineate the gross tumor volume on patient's MRI data.

In the study, researchers collected MRI data sets covering the nasopharynx from 1,021 patients between 2016 and 2017 and applied the AI tool with a 3D convolutional neural network, a new medical image segmentation technique. The AI was trained to automatically delineate the tumor volume with images in 818 patients and were defined by the consensus of two human experts.

In a competition with eight qualified doctors from renowned hospitals, the AI contouring accuracy reached 79 percent with 203 patients, taking 20 to 50 minutes per case, outperforming the accuracy of human competitors.

To further explore the clinical value of the research, two months after the competition, the eight doctors were asked to correct the AI-only automated contouring results, which is a process called AI assisted contouring. The result showed that it improved manual tumor contouring accuracy by 5 percent.

Reviewers of the journal Radiology were impressed by the sample size used in the paper, and commented that such an AI contouring tool for tumor targeting was "rare and challenging."

The AI contouring tool can help inexperienced doctors reach expert level, raising their work efficiency, which could have a positive impact on tumor control and patient survival, said Sun, adding that the tool is expected to be put into clinical test in more places.

The disease is common in southern China, particularly in Guangdong Province, where the incidence rate is 40 times that of the world average. Therefore, it is sometimes referred to as "Cantonese cancer."

Scientists believe it is caused by a combination of viruses, genes and environment.

The university's cancer center admits more than 5,000 patients with Nasopharyngeal carcinoma every year, accumulating medical data on more than 10,000 cases. (Xinhua)


A doctor reviewing CT scan images at Vienna General Hospital in Austria. (Photo: L. Dojcanova/IAEA)Experts at a recent IAEA meeting proposed measures to ensure medical benefits always exceed risks for patients who need frequent radiological imaging exams for diagnosing and monitoring their diseases. New data presented at the meeting based on 2.5 million patients in 15 countries showed that more than 1% of patients receive cumulative doses above 100 mSv from multiple exams in their lifetime. This is significantly higher than previously thought. Receiving radiation in significant doses increases the risk of cancer later in life.Around 50 experts from 26 countries and nine international organisations and professional and industrial bodies met at the IAEA in Vienna from 4 to 6 March to explore the issue. New data on exposure has surfaced thanks to the introduction of automatic exposure tracking systems in many hospitals in recent years.“The medical community should find a way to improve safety of patients who need recurrent imaging exams, while not limiting their medical benefits,” said Madan M. Rehani, Director of Global Outreach for Radiation Protection at the Massachusetts General Hospital in the United States, who presented some of the new data.Medical imaging like computed tomography (CT), X-rays and interventional procedures have provided immense medical benefits in diagnosis and follow-up of diseases to better manage health conditions of millions of patients worldwide. A patient can get exposed to 100 mSv from 10-12 CT exams, which is required in different chronic conditions or malignant diseases or when treatment requires frequent follow-up examinations.Participants at the meeting agreed that several steps could be taken to improve protection of patients who need frequent imaging exams:CT scanners capable of achieving adequate image quality at sub-mSv radiation dose.Physicians need to ensure the appropriate use of imaging exams when dealing with diseases that require frequent tests.Strengthen guidelines by professional medical bodies for those treating patients who require frequent imaging studies.Integrated technological solutions for monitoring patient exposure data within the electronic healthcare records.Concrete radiation protection recommendations on how to avoid high level of exposures without curtailing medical benefits.“The new data show that all stakeholders must come together to find suitable strategies and solutions with focus on radiation protection of this specific group of patients,” Jenia Vassileva, IAEA Radiation Protection Specialist. “The IAEA will continue coordinating international efforts by engaging with the medical industry, by organizing multi-stakeholder’s meetings and by taking action to raise awareness of and educate healthcare providers and patients.”

Food irradiation, using X-rays or gamma rays, helps countries prevent fruit and vegetables from going to waste. With the support of the IAEA, a food irradiation facility in Havana, Cuba has reopened after 20 years. Click link to watch video:https://www.iaea.org/newscenter/multimedia/videos/making-fruit-and-vegetables-last-longer-with-food-irradiation19 March 2019Story and Editing: Alejandra Silva Camera: Martin Klingenboeck

The Aedes albopictus is the world’s most invasive mosquito species. A successful pilot trial for controlling this insect pest recently concluded and the results were published in Nature on 17 July 2019. (Photo: N. Culbert/IAEA)For the first time, a combination of the nuclear sterile insect technique (SIT) with the incompatible insect technique (IIT) has led to the successful suppression of mosquito populations, a promising step in the control of mosquitoes that carry dengue, the Zika virus and many other devastating diseases. The results of the recent pilot trial in Guangzhou, China, carried out with the support of the IAEA in cooperation with the Food and Agriculture Organization of the United Nations (FAO), were published in Nature on 17 July 2019.SIT is an environmentally-friendly insect pest control method involving the mass-rearing and sterilization of a target pest using radiation, followed by the systematic area-wide release of sterile males by air over defined areas. The sterile males mate with wild females, resulting in no offspring and a declining pest population over time. IIT involves exposing the mosquitoes to the Wolbachia bacteria. The bacteria partially sterilizes the mosquitoes, which means less radiation is needed for complete sterilization. This in turn better preserves the sterilized males’ competitiveness for mating.While SIT, as part of area-wide insect management strategies, has been successfully used to control a variety of plant and livestock pests such as fruit flies and moths, the control of mosquitoes still had to be demonstrated.The main obstacle in scaling up the use of SIT against various species of mosquitoes has been overcoming several technical challenges with producing and releasing enough sterile males to overwhelm the wild population. Researchers at Sun Yat-sen University, and its partners, in China, have now successfully addressed these challenges, with the support of the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture, which is leading and coordinating global research in SIT.For example, the researchers used racks to rear over 500 000 mosquitoes per week that were constructed based on models developed at the Joint FAO/IAEA Division’s laboratories near Vienna, Austria. A specialized irradiator for treating batches of 150 000 mosquito pupae was also developed and validated with close collaboration between the Joint FAO/IAEA Division and the researchers.Mosquito larval rearing racks at a mosquito mass-rearing facility at the Wolbaki Biotech Company in Guangzhou, China, in May 2019. The company is using the most advanced mass-rearing technology for mosquitoes. These racks are based on models developed by the Joint FAO/IAEA Insect Pest Control Laboratory. Each has the capacity of producing about 500 000 males per week. (Photo: J. Bouyer/IAEA)The results of this pilot trial, using SIT in combination with the IIT, demonstrate the successful near-elimination of field populations of the world’s most invasive mosquito species, Aedes albopictus (Asian tiger mosquito). The two-year trial (2016-2017) covered a 32.5-hectare area on two relatively isolated islands in the Pearl River in Guangzhou. It involved the release of about 200 million irradiated mass-reared adult male mosquitoes exposed to Wolbachia bacteria.The study has also shown the importance of socioeconomic aspects for the successful use of the IIT/SIT approach. Social acceptance, for example, increased during the study as support of the local community went up following mosquito releases and the resulting decrease in nuisance biting; for the IIT/SIT approach to be successful, the local community needs to be on board and work together to ensure consistent and integrated use of the approach over the entire area in order to effectively counteract and control the movement of the insects. Another aspect is the cost-effectiveness; overall future costs of a fully-operational intervention are estimated at US$ 108-163 per hectare per year, which is considered cost-effective in comparison with other control strategies.Experts in China plan to test the technology in larger urban areas in the near future using sterile male mosquitoes from a mass-rearing facility in Guangzhou, said Zhiyong Xi, Director of Sun Yat-sen University-Michigan State University’s Joint Center of Vector Control for Tropical Diseases and Professor at Michigan State University in the United States. The company operating the facility uses advanced mosquito mass-rearing and irradiation equipment that have been developed in collaboration with the Joint FAO/IAEA Division.Global cooperation on the development of SIT to control mosquitoes intensified following the Zika epidemic in 2015 to 2016. The incidence of dengue is on the rise, with the number of cases reported to the World Health Organization (WHO) increasing from 2.2 million in 2010 to over 3.3 million in 2016. The actual incidence is much higher, and one estimate, according to the WHO, indicates 390 million new infections each year.https://www.iaea.org/newscenter/news/mosquito-population-successfully-suppressed-through-pilot-study-using-nuclear-technique-in-china

Food products undergo irradiation processes at VINAGAMMA using an electron beam irradiator, pictured here, and a gamma irradiator. (Photo: E. Marais/IAEA)Ho Chi Minh City, Viet Nam – Each morning hundreds of boxes filled with frozen seafood, dried fruits and vegetables, oriental medicines and health foods are queued up in a store room in Ho Chi Minh City, Viet Nam. They will undergo a process similar to security screening at airports, but with higher intensity beams of photons or electrons – in a food irradiation programme installed with IAEA support in the last two decades.Depending on the dose, food irradiation will ensure that the root vegetables and fruits do not sprout or ripen prematurely; that parasites are killed and spices are decontaminated; that salmonella are destroyed and that fungi that could spoil meat, poultry and seafood is eliminated.The process was first introduced in Viet Nam in 1999 with the help of the IAEA and the Food and Agriculture Organization of the United Nations (FAO), and a large market for irradiated products has since opened up, significantly increasing the ability of companies to export their food products. Food irradiation has matured into a mainstay of the country’s food industry and is an important contributor to the country’s agricultural competitiveness.“In 1999 we were irradiating 259 tonnes of food per year, and this has grown to 14,000 tonnes by 2017,” said Cao Van Chung, Head of the Electron Beam Department of the Viet Nam Atomic Energy Institute’s Research and Development Center for Radiation Technology, VINAGAMMA. “This shows a real boom in demand for our work. Today we are one of the leading facilities in the country in the field of radiation technology – pioneering in food irradiation.”Introduction of gamma and electron beam irradiationThis growth has been possible thanks to the introduction of two irradiation methods. A gamma irradiator introduced in 1999, which uses ionizing energy from a radiation source shielded in a concrete room, and an electron beam (EB) irradiator has been in use since 2013. EB irradiators do not rely on a radioactive source, using instead streams of highly charged electrons produced from specialized equipment such as a linear electron accelerator. The food never comes into contact with radioactive material, and the irradiation both maintains the quality and increases the safety of the food while leaving no residual radioactivity.While the process of irradiation for the two methods is the same, each brings distinct and complementary advantages, Chung said. The gamma irradiator uses tall aluminum boxes, which can accommodate a broad range of product sizes, and the boxes are moved through the irradiation chamber around the radioactive source suspended on an overhead monorail system. Products require two rounds of irradiation to ensure all sides of the packaged product have been treated.    Tall aluminum boxes filled with food products await irradiation using the gamma irradiator. (Photo: E. Marais/IAEA)The EB irradiator, on the other hand, contains double sided beams, which makes the irradiation process three times quicker than the use of the gamma irradiator, because all areas of the product can be irradiated in a single round. However, the EB irradiator has a limited dimension, with a maximum box size of 60x30x50 cm and weight of 15 kg, so for larger and heavier products gamma irradiation must be used. The machines work side by side, running 24 hours a day seven days a week, only stopping over the Vietnamese New Year period.Before the introduction of the gamma irradiator and EB accelerator, spoilage prevention of food products such as seafood, fruits and vegetables was carried out using traditional methods including canning, refrigeration and freezing and chemical preservatives, which due to lower effectiveness, hindered the manufacturers’ ability to export their products.The irradiation machines were acquired with support from the IAEA’s technical cooperation programme, which also supplied training for staff and expert advice. Viet Nam is one of 40 countries that the IAEA is supporting in this area.Growth in the use of radiation technologyVINAGAMMA has grown from 20 employees when the Center was set up in 1999 to 79 today. Besides food irradiation services, it provides radiation sterilization of medical products and pasteurized foodstuffs, and commercializes its research and development products, such as plant protectors used in agriculture and gold and silver nanogels used in medicine.The Center also carries out research and development and provides training in the field of radiation technology. It also works with international partners to research ways of improving irradiation technology further.THE SCIENCEIrradiationIrradiation is the exposure of a substance to beams of electromagnetic radiation. For example, microwaving food involves exposing it to beams that have just enough energy to cause water molecules in the food to rub against each other and generate heat by friction. But food irradiation involves higher frequency beams that have enough energy to give atoms positive and negative electrical charges (ionization) for an instant. It is used to improve food safety and to maintain its quality. During irradiation, energy is transferred into the treated product just like when food is heated, but it doesn’t involve a significant increase in temperature.The most important irradiation process parameter is the amount of energy absorbed per unit mass of food, which is termed ‘absorbed dose’ or simply ‘dose’. The technology can be used to destroy microbes that cause food poisoning; it can help keep food fresher for longer because it reduces the numbers of spoilage organisms; it also slows down ripening and prevents sprouting in foods like onions, garlic and potatoes.  Therefore, it improves food safety and reduces waste.In gamma irradiators the source of radiation is a radionuclide, usually cobalt-60 (60Co).  Gamma rays are electromagnetic waves and hence they can pass through dense materials. Products can be irradiated in large sacks or shipping cartons, carried through the irradiator in boxes or stacked on a pallet that will be transported to and from the irradiator in hanging carriers or on roller bed conveyors. It may take an hour or so to irradiate a large pallet of products.In electron beam irradiators the beams are produced by electricity in a machine. Electrons have a negative charge and a small but appreciable mass and so readily interact with atoms in food, transferring all their energy over a relatively short distance. Therefore, electron beams can only be used to irradiate smaller food packets that they can easily penetrate. However, the energy can be delivered quickly, and the process takes a fraction of a second as the beam is scanned over the food.

CNNC (China National Nuclear Corporation has developed advantageous positions in the fields of isotope products, radiation processing products and service, and ray application instrumentation. It has cultivated a number of major high-tech enterprises and created remarkable benefits.CNNC’s isotope products have a lion’s share of the domestic market, supplying 70 percent of radiopharmaceuticals and radioactive sources.The explosive detection system developed by CNNC goes a long way to solving the global problem of explosive security inspection. It is one of the most advanced and practical explosive detection techniques in the world. It has been successfully applied to large public activities including the Beijing Olympic Games, Shanghai World Expo, and the 60th Chinese National Day.    The self-shielded mail irradiation sterilization device can kill hazardous bacteria like bacillus anthraces, and has been applied to key national departments.Co-60 production with HWR and large power irradiation accelerators has been industrialized. Key projects including nuclear power seawater desalination have made important progress.The China Isotope Radiation Co Ltd (CIC) is the biggest nuclear technological enterprise inChinaintegrating R&D, production, sales and service. It is involved with preparation of isotopes, production of radiopharmaceuticals, preparation of radioactive sources, irradiation project and processing. The corporation owns about 50 various production lines and provides 70-plus nuclides and 300-plus products for a variety of clients.CIC keeps in long-term close cooperation with worldwide nuclear medical research and development institutions and companies, actively introduces and communicates the latest radiopharmaceutical technology and products, and meets the demand of nuclear medical development.Nuclear pharmaceutical centers have been built in about 20 cities, and the network of radiopharmaceutical sales and technical services covers the country.

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CRT 2019 China Radiation Technology Conference

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