Focus on PALLAS | PALLAS in beeld - 3

37 Linda de Wit is a Technical Practitioner at the Antoni van Leeuwenhoek hospital in Amsterdam, an institution specialised in the detection and treatment of cancer. She specialises in nuclear treatment methods of liver cancer and determines customised treatment methods for every individual cancer patient. ‘I personally administer the nuclear medicine to the patient, in close consultation with the interventional radiologist. Prior to administration, I carefully explain to the patient that we intend to treat the tumour with radioactive beads and that I have meticulously determined the exact dosage need- ed to treat that particular tumour. Thus, I maximise the treat- ment’s effect and minimise the risks and adverse events the patient could experience. Beforehand, the patients have been informed at length by their physician. Communication needs to be transparent; the word 'nuclear' still worries some people. In addition to my work involving patients and consulting with colleagues, I am also intrigued by new healthcare techniques, like improved scanners. After all, I am a scientist and I want to stay informed on the latest developments in my area of exper- tise and contribute where I can.’ New area of expertise ‘In 2003, I entered the first class of the new six-year study pro- gram of Technical Medicine at the university of Twente. Why I chose this study? Medicine was my calling, but I felt like the connection between the technical subjects and the education was missing. In high school, I always enjoyed subjects like maths, chemistry and physics. So when I heard about this new educational program Technical Medicine, I was immediately interested. The purpose of this education is to use medical technology faster and more efficiently in patients. Hospitals need to be kept informed about the latest technological innovations in the healthcare industry. Technical practition- ers provide for this need. Soon, my preferred subject was established: the specialisation 'minimally invasive proce- dures and medical imaging' with a special interest in nuclear medicine, visualising the purpose of cells inside of the human body. I think it is fascinating. When I graduated in 2009, I did my research for my doctorate at the nuclear department of the LUMC in Leiden. Then I was employed by the Antoni van Leeuwenhoek hospital as a technical research practitioner at the nuclear medicine department. A few years ago, I became a member of staff, treating patients suffering from cancer of the liver, among others.’ Successful internal radiation therapy ‘Oncological care often is extremely complex. Fortunately, we can effectively help a number of patients with traditional treatments like radiotherapy, chemotherapy or surgery. The group of patients that does not qualify for these treatment methods could benefit from treatment methods based on nuclear medicine. Usually, these patients end up in a spe- cialised treatment centre, like the Antoni van Leeuwenhoek hospital. It also frequently happens that we observe, help and think along with physicians in other hospitals.' 'In our field of expertise, the development of the digital PET/CT scanner is important. This involves administering the patient a small amount of a radioactive substance, allowing the detec- tion of a potential cancer in tissues and organs. By using these new scanners, we can administer substantially less radioactive material to the patient while obtaining quality images at the same time. It is important to properly adjust the scanner, which is one of the responsibilities of a technical practitioner. The rise of new, dedicated, cancer-focused tracers is equal- ly important. Those are non-radioactive molecules that we link to a medical isotope with a limited nuclear charge. This combination is then injected in the patient after which the tracer transports the medical isotope to the cancer cells. As an example, we can name the detection of prostate cancer using the PSMA protein. This protein attaches to prostate cancer cells, thus allowing the detection of the medical isotope and to capture an image. Precise detection of cancer cells is very im- portant in order to start targeted treatment early. The nuclear treatment of prostate cancer is highly advanced: the PSMA protein is bound with the medical isotope lutetium-177. The tracer transports the nuclear therapy to the prostate cancer cells, both inside the prostate and in any potential metastases in the body. Then the medical isotope internally irradiates the cancer cells and destroys them. Currently, this therapy is only used within the scope of a scientific study, but we anticipate the treatment of hundreds of patients a year in the near future in the Netherlands.’ Life extension as a result of nuclear therapy ‘We also use nuclear medicine for the treatment of neuroendocrine tumours. Those are tumours that cause complaints in, among other organs, the small intestines, stomach, pancreas, lungs and liver. Medical isotopes are not only helpful in detecting these kinds of tumours, but they also contribute to the effectiveness of the treatment. Patients who are beyond treatment are also referred to the Antoni van Leeuwenhoek hospital. They no longer qualify for surgery or a standard chemotherapy, but they do qualify for a follow-up treatment involving internal, nuclear radiation. These patients will also first receive a scan with a cancer-specific protein in order to determine the exact location of the tumours. Then we initiate treatment.'

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