I'm going to talk to you today about using the byproducts of fluoride reactors for medical
care, and in particular because I am an oncologist and treat cancer patients, for the use in
cancer.
Although we might sneak a couple of non-cancer things in there.
So, I am at the University of North Carolina and radiation oncology also in computer science
and today, I'm representing E-Generation.
At the time that X-radiation was discovered there was a competitor, which was radioactive
material coming from natural sources and we're going to see this competition all through
this talk; between the stuff that we build, which is the X-ray machines and stuff that
we buy, which is radioactivity.
What was found in the 19th century, were that there are alpha particles, beta particles
and gamma particles and they had these properties.
After a little while, it was found that alpha particles are in fact just helium stripped
of a couple of electrons and the beta particles which were just electrons and gamma rays,
turned out to be the same as X-rays, which are described by the Maxwell's equations.
I remember as a boy thinking, "Why aren't there other kinds of radiation?
Why aren't protons ejected or positrons ejected?
Why these?"
and I asked my physics teacher who said, "Shut up."
So, It turns out there are materials like that.
Very delicate calculations show that alpha particles are the most likely thing to be
ejected in decay and we're going to talk mostly about them.
At the end of the 19th century, there were some strange reports started to circulate.
People pointed X-ray machines at patients with cancers.
They were getting things like this.
This is a lip cancer and it would go away.
This is a very nasty cancer under the tongue called floor of the mouth cancer.
Unfortunately, still pretty common.
If you point an X-ray at it long enough, it will go away.
It's interesting that these medical reports came out within six months after Röntgen
published his first paper on how to make X-ray machines.
Everybody went off and built them in their home laboratory.
How this was discovered I have no idea, [jokingly] except I think, kind of doctors in those days
sort of, they had something new, they pointed it at you and see what happens.
By the 1930s, what are called orthovoltage machines and I have $5.00 for anybody who
would tell me why tell were called orthovoltage.
Nobody seems to know.
Machines in the 250 keV range and they were used routinely for cancer treatment.
Not very successfully, but they were for palliation.
Occasionally, you cured a patient by accident.
But.
The competitor, which was originally radium later on cesium, inserted into the uterine
cervix of patients with cervix cancer was highly curable, and so cervical cancer became
the first curable cancer without surgery.
In analyzing this, it was discovered that the cervix cancer treatments were getting
a lot more radiation than were the external beam patients.
And so, it was decided to try to see if you could increase the energy of X-rays, which
needs to be done if you want to give higher doses, for a number of reasons.
In the 1960s, the Van de Graaff machine came into being and produced million electron volts
and treated patients successfully.
But nature struck back with radioactive cobalt which was, at one point, (2-7) and one point
( 3-3) Mev.
Its decay process of cobalt and the nickel.
It's a nice way of illustrating it for physicians.
[sarcastically] You guys don't need this.
OK and um?
Yeah, somebody finally got it.
All right.
They don't actually look like this, the decay products.
The radioactive cobalt became...
That was taken actually in Canada, where they built the first machines.
They even put it on a postage stamp over here.
I am old enough so that I trained on treating patients with radioactive cobalt, and we did
cure a lot of cancer with it.
There's no question about that.
But In time, that gave rise to the betatron which would crank energies up to 35 million
electron volts.
I'd like to also point out decibel level to a hundred decibels at least.
My own thought was that the cancer cure came from the noise of the machine rather than
X-rays because it shook the patient to death.
Today, modern linear accelerator that is used to treat cancer patients runs between six
and 15 MeV.
It turns out if you go over 15 MeV, you start making radioactive oxygen and air.
You get neutron contamination.
That's probably not a good idea.
They're versatile, quiet, and reliable.
A few million dollars would buy you one of these things.
Those are now standard treatment.
Why this push for higher energy?
Well, it has to do with the depth-dose curves.
This is 250 keV.
In order to get a hundred to the tumor, you got to crank about 200 into the surface of
the patient.
Their skin falls off after a while.
Medically, this is not a good thing.
Yeah.
The patients get upset.
If you Cobalt-60 though not only do you; it only takes maybe a 150 percent at the skin
level.
In fact, cobalt skips the first few milliliters and that has to do with electron equilibrium.
Which, in fact, when this noted medically, the physicist said, "Impossible."
The physicians kept saying, "But they're not getting skin reactions."
The physicist went back and realized that loss of electronic equilibrium in the first
few millimeters meant the skin dose was low.
It really made it possible to give high doses into the patient.
As you crank up the energy, clearly you get more and more energy into the tumor and less
and less on the surface, so this is better and better.
You get more sparing on the skin too.
Here's some nice pictures.
This is cancer of the larynx.
You see this kind of thing all the time in smokers.
You treat them with radiation.
It's gone.
Here's a small lung cancer that's seen on CT scan right here.
It's treated with a technique called radiosurgery.
After about a year, it all disappears except for a little scar tissue.
Here's an advanced lung cancer which was the thing I specialize in so much where there
were big amounts of tumor right on the mediastinum.
You treat it with radiation and sometimes you get a response like that, and the patient
will be cured.
This is terrible breast cancer.
I saw a lot of these in the early days and treated with radiation.
It cured the disease.
Another particle that was used was the beta particle or electrons.
Electrons have a terrifically nice thing that they just fall off like a waterfall.
They don't go very deep.
Very little skin sparing though.
Somebody with a very extensive skin cancer like this, you treat it with an electron beam
and you cure them.
You don't want to use an X-ray here because if you point X-ray through here, it will go
through the brain.
That's not a good thing.
Can we do better than X-rays?
The answer is yes.
Here is protons.
If you take protons, because of the Bragg peak, they will tend to pump up and then the
dose crashes.
They don't get much pass the Bragg peak.
You have to widen the Bragg peak out a little bit because that's very tight, and the tumors
have some macroscopic dimensions.
The price you pay there is you got an entrance dose.
Protons are great.
They are also horribly expensive.
They're extremely clumsy.
I actually work with these things.
It's very difficult.
There's a big rush now to build proton facilities.
There are about 15 of them in the United States now.
There's one here is in Virginia.
They're private enterprises because they get very, very good reimbursement on these.
Here's one of the earlier use of protons.
This is melanoma in the eye.
You treat it with a proton beam.
You do that so that you can spare the rest of the eye.
The person had about 80 percent of the vision.
Whereas the standard treatment, would be taken out surgically.
Then, you have no vision, right?
Protons aren't better than X-rays.
Biologically, they're the same.
There are a lot of tumors that are still very resistant to X-rays.
Neutrons, on the other hand, are a different deal.
Neutrons are killers.
I mean, they are what are called high-LET radiation.
They don't fall off the way X-rays do.
Gently, but they fall of more like protons.
They're very, very active.
No mammalian cell can really survive a neutron dose, so there's no such thing as tumor resistance
to neutrons.
Here's an example of a patient of mine that had big huge tumor like that of a cell type
that was known to be very, very resistant to X-rays.
I sent him to Seattle where they had a neutron facility.
He came back like that and a very good response, but you can do better.
The trouble with neutrons is they're very difficult to control.
These are uncharged particles.
It's hard to collimate them.
It's hard to deal with them.
Supposing you have high-LET radiation with charged particles?
Let's say, carbon-12, let me go back here.
Then you can get a dose distribution curve like this, where you have no entrance dose
and no exit dose.
It's almost like a surgical knife.
You can go in there with a carbon beam of high-LET particles, and you'll kill everything
in that section.
Here's a schematic of one of them.
I had a little device in here just to kind of show you what the problem was in case you
don't understand what I'm talking about.
Here's a blow up of the picture.
These things are hundreds of millions of dollars.
I suspect when you build the facilities and you add the team of nuclear engineers; [jokingly]
you guys will not work for minimum wage anymore.
It turns out these things are horribly expensive.
As far as I know, there's only one or two in the world.
Because they're so large, they're very difficult to work in the medical environment.
Let's go back to nature.
We've been dealing with this buy and build thing where we build the machines, and nature
retaliates and says, "I have something better."
Could we go back to nature and maybe get it for free?
Are there, in fact, alpha radiation sources in nature?
As you know, I counted recently, but somebody correct me if I'm wrong, I counted a 150.
All right.
Boron neutron capture has been done.
It's where you flood the patient with boron.
You put neutrons in there.
You can kill the tumor very nicely.
It was catastrophic because you can't keep the boron out of other areas, and the patients
died hideous deaths.
This was tried multiple times and given up.
There might be a better way.
Antibodies to the tumor.
Antibodies carrying nuclear weapons to the tumor.
Why does this work?
Alpha particles are deadly because so much energy entering the cell destroys it.
I did a little calculation here.
A stick of dynamite has an energy density of about a thousand joules per cubic meter.
A single alpha particle has a density about the same because it ranges so short that it
will destroy an entire cell.
So, if it only takes one alpha particle to kill a cell.
You're in business.
People consider this for leukemia.
The standard way to treat leukemia these days, if you have aggressive leukemia, is to give
a whole lot of drugs to kill all the bone marrow, and then new bone marrow transplant.
This is not pleasant.
I can tell you that from personal experience because I went through this, three and a half
years ago.
These are not good things to put into people.
An alternative is antibodies attached to nuclear weapons that will destroy the patient's bone
marrow but not much of anything else if the antibodies are primed only to do the bone
marrow, and then transplant them.
There are a lot of research going on this area.
Just one just published a few days ago by Actinium Pharmaceuticals that uses Actinium-225,
which is, in fact, I think the wrong isotope.
The properties the alpha particles have to have availability, a half-life that's medically
usable.
It turns out Bismuth-213, Actinium-225 are among some of the best.
They're only available in LFTRs.
Now here's the decay scheme of Uranium-233, Actinium-225 and Bismuth-213 are prominent
in the decay scheme.
That is about the only way you really can obtain this stuff.
One of the things about the LFTRs is we may be able to make materials that are good for
leukemia, that are good for other kinds of cancers.
Maybe someday that will be the way we treat metastatic cancer disease, by having antibodies
of high specificity carrying little nuclear weapons to destroy the tumors.
Skipping very quickly to diagnostic nuclear medicine.
There is Technetium-99m which is the backbone of the work horse of nuclear medicine.
This is the kind of thing you do.
Here's a patient that we thought was cured.
Then, a few months later, that's what his bone scan looks like.
Very unfortunate for the patient.
The reason this works is that bones have the cells called osteoblast in them.
They take up calcium like crazy if there's inflammation, which there is once the cancer
is in the bone.
They also take up Technetium because they don't know the difference.
They also, by the way, take up radium as well.
There is a drug an alpha emitter, Xofigo, which is out in the market and is FDA approved.
There's a critical shortage of Technetium.
It is made overseas.
It is made in aging reactors that require enriched uranium, which we can no longer export
after some date.
I don't know the exact date is.
We can't export that.
It turns out, this fits into your talk, that one of the byproducts of the LFTR is this
stuff here Molybdenum-99 and Technetium-99 and is just a byproduct and contaminant.
Fish that stuff out and you will solve the problem.
Bill Thesling and I did a calculation back of the envelope.
We thought that one or two LFTRs, just a couple of gigawatt reactors will supply all the Technetium
that the United States needs.
We would no longer be in this severe crises mode by 2018 or 19.
They think there's not going to be any of Technetium back at all.
So, we rest our case.
[laughter] , [applause]
You gave Leukemia is an example of one of the conditions that would be treatable by
some of these advanced ideas, but I'm just wondering if myeloproliferative disease would
be included in that?
The answer is yes.
Mother told you that there was cancer and not cancer.
It turns out mother was not quite telling you the truth.
It turns out that there is a progression from normal cells to frank malignancies.
What he says myeloproliferative disease with a very sophisticated term is, in fact, one
of these intermediate diseases that are very, very bad for the patient and end up transfusion
dependent.
Eventually, most of them degenerate into leukemia.
In my case, that did not happen.
Myelodysplastic diseases are sometimes, when the patients get transfusion dependent, they
do have to have marrow transplant.
It's the only known way to cure them.
To get a marrow transplant means you got to get the old marrow out there.
Because if you just take somebody else's marrow and put it in there, your own bone marrow
will fight it tooth and nail and destroy it, so you got to clear it out.
The only way we know of clearing that out today is to use of these highly toxic drugs.
I had six of them because I failed the first time, and I kind of failed the second time
and it was really the third time before we actually got it cleared up enough so that
I can get a transplant.
The transplants are the thing that actually mop it up, but that clearing out process.
Now, the reason I think Actinium-225 is wrong is I think you need a shorter acting isotope.
Because if we're going to clear this out, you don't want that stuff hanging around,
so that when you put in the donor bone marrow, it has to deal with it.
Bismuth-213 seems to me to be perfect it's a round about an eight hour half-life or something.
About a week, the patient is going to go without marrow and the hospitals can cope with that
and then transplant it.
The Bismuth wouldn't go anywhere else, so the patient wouldn't have two years of recover
from the chemotherapy.
May I make the business case for you, Julian?
With an eight hour half-life, is there any point in trying to get that from a solid fueled
reactor?
You actually get it from Actinium, so I wouldn't do it.
Yeah and If I might add, think about how many millions of dollars per kilo something that
hangs around for only eight hours and is only present in trace amounts like less than one
peco curi in a whole load like of the uranium in the Congo.
Think about how many millions of dollars per kilo that will add up to.
If that's not a business case, I don't know what is.
Well, one of the things I was intrigued about is if you look at the list of things that
are made by a LFTR, they include platinum so that's another waste metal, right?
All right.
Both entertaining and informative.
Thank you very much, Julian.