Lung diseases are one of the leading causes of morbidity and mortality worldwide. Among these, chronic obstructive pulmonary disease (COPD), lung cancers, as well as various infections and respiratory disorders, are particularly widespread. The application of nuclear techniques, such as nuclear medicine and radiotherapy, is essential for early diagnosis, treatment monitoring and, in some cases, direct treatment of these pathologies. These technologies use radioactive substances allowing in-depth visualization of the lungs and other organs, as well as assessment of their function and specific treatment for certain types of lung cancers.
1. The main causes of lung problems
Lung diseases are often associated with environmental and behavioral factors. Smoking remains one of the main risk factors, but other elements, such as air pollution, occupational exposure and genetic predispositions, also play a significant role in the incidence of these disorders.
has. Smoking: the main cause of lung diseases
Smoking is undeniably the leading cause of lung diseases, particularly COPD and lung cancer. Around 85% of lung cancers worldwide are attributable to tobacco, with this percentage exceeding 90% among heavy smokers. Nicotine dependence constitutes a major risk factor, because tobacco causes inflammation of the respiratory tract, destruction of lung tissue and a significant reduction in lung function. According to the World Health Organization (WHO), tobacco causes more than 7 million deaths per year globally, a significant proportion of which are linked to lung diseases.
b. Air pollution
Air pollution, whether indoor or outdoor, is another major risk factor for lung disease. The WHO estimates that 7 million people die each year due to air pollution. This exposure contributes to the worsening of COPD and promotes the development of lung cancer. In Europe, it is estimated that more than 500,000 premature deaths are attributable to diseases linked to air pollution. Fine particulate matter (PM2.5) and other pollutants accelerate the breakdown of lung tissue, particularly in vulnerable populations.
c. Respiratory infections and genetic diseases
Respiratory infections, such as pneumonia or tuberculosis, affect a considerable number of people, particularly in low- and middle-income countries. In addition, genetic diseases such as cystic fibrosis, which affects approximately 70,000 individuals worldwide, cause chronic lung infections. These conditions have a severe impact on patients’ quality of life and lung function.
2. Nuclear techniques in pulmonary diagnosis
Nuclear imaging, which uses radioactive substances to generate detailed images of internal organs, is an essential diagnostic tool in the evaluation of lung diseases.
to. Positron emission tomography (PET)
PET is an advanced technique that allows you to visualize the metabolic activity of lung tissues. It is commonly used to detect lung cancers and assess their extent. By injecting a radioactive tracer that attaches to active cells, such as cancer cells, PET identifies abnormalities not visible on traditional x-rays. This method has transformed the management of lung cancers by making it possible to detect tumors at an early stage and evaluate responses to treatments.
b. Lung scintigraphy
Lung scintigraphy is another widely used nuclear technique to assess lung function by measuring ventilation and perfusion of the lungs. It is particularly useful in the diagnosis of disorders such as pulmonary embolism, COPD and abnormalities of blood flow in the lungs. Using radioactive tracers, this method makes it possible to map blood supply and air distribution in the lungs, which is essential for determining the extent of certain pathologies.
c. Positron emission tomodensitometry (TEP-TDM)
PET-CT combines positron emission tomography and computed tomography, providing a more comprehensive analysis of lung diseases. This hybrid method allows simultaneous visualization of the anatomical structure and metabolic activity of lung tissues, providing essential information for the diagnosis of lung cancer. By improving the accuracy of diagnosis and monitoring, PET-CT helps clinicians adjust treatments in a more targeted manner.
3. Nuclear techniques in the treatment of pulmonary diseases
Nuclear techniques are not limited to diagnosis, they also play a crucial role in the treatment of lung diseases, including lung cancer. For example, radiotherapy using radioactive isotopes can target and destroy cancer cells while minimizing damage. to surrounding healthy tissues. Additionally, some targeted therapies may incorporate radioactive agents to specifically treat tumors. These approaches make it possible to improve the effectiveness of treatments and offer additional options to patients.
has. Internal radiotherapy (brachytherapy)
Brachytherapy is a form of radiotherapy in which a radioactive source is implanted directly inside or near the tumor. Although it is primarily used to treat prostate or breast cancers, this technique can also be applied for some localized lung cancers, particularly when surgery is not an option. By delivering a concentrated dose of radiation directly to the tumor site, brachytherapy can help reduce the size of the tumor or control its growth while preserving surrounding healthy tissue.
b. External radiotherapy
External beam radiotherapy is a method that uses radiation to destroy cancer cells and is commonly used in the treatment of lung cancer, especially when surgery is not an option or as part of palliative treatment. This approach is particularly crucial in cases of advanced lung cancer, as it helps reduce the size of the tumor and relieve symptoms, thereby improving the quality of life of patients.
4. Nuclear techniques in international contexts: Case of Morocco and comparisons
It is true that access to advanced technologies, such as nuclear medicine, remains limited in countries like Morocco, although significant progress has been made recently. Specialized centers, such as the National Center for Radiotherapy and Nuclear Medicine (CNRMN) in Rabat, now offer diagnostic and treatment services for cancers, including those of the lungs.
On the other hand, in developed countries such as the United States or France, the use of nuclear techniques in the treatment of pulmonary diseases is well established, benefiting from advanced infrastructures and better access for patients. According to the American Cancer Society, around 228,000 new cases of lung cancer are diagnosed each year in the United States, while in France the figure is around 47,000.
Differences in access to care and techniques highlight the inequalities in the management of lung diseases between high-income countries and those with low or middle income, such as Morocco. This highlights the importance of improving health infrastructure and resources in these countries to ensure equitable access to necessary treatments.
5. Future prospects
Recent advances in radioactive tracers, imaging and targeted treatments herald significant changes in the management of lung diseases. The future of nuclear medicine is moving towards increasingly personalized approaches, enabling more targeted and effective treatments for patients.
The integration of artificial intelligence (AI) and machine learning into the analysis of nuclear images could also revolutionize the diagnosis and treatment of pulmonary pathologies. These technologies can improve the accuracy of abnormality identification, refine treatment protocols, and even predict patient responses to various therapies. By optimizing the use of imaging data, AI can help further personalize therapeutic approaches, making care more effective and tailored to the unique needs of each patient. This paves the way for significant progress in the field of pulmonology.
