Early days of Ion Bm Rx in...

B ERKELEY L ABAccelerator and Fusion Research Division Ion Beam Technology Program

Early Days of Ion Beam Therapy in US

Jose R. Alonso,!LBNL (Retired)!


THANKS!!

And many wonderful memories… •  Meinhard Regler!•  Phil Bryant!•  Michael Benedikt!•  Horst Schonauer!•  Thomas Auberger!•  Marius Pavlovic!•  ….!


Early work at Berkeley !E.O. Lawrence placed strong emphasis on medical uses of his cyclotrons (1930ʼs)!

!Robert Wilson proposed

use of Bragg Peak for radiation therapy (1946)

John Lawrence, Cornelius Tobias, Thomas Budinger

and others pioneered biomedical

applications of high-energy beams

(>1950)!


184” SynchroCyclotron

ISAH"(Isocentric Stereotactic "

Apparatus for Humans)"Submillimeter accuracy"

Commissioned ~ 1948"Pituitary ablation – protons"Large field therapy- helium"


Development of the Bevalac

•  In 1974, Transfer Line was completed, connecting the SuperHILAC (built in 1958) to the Bevatron (built in 1954)"

•  Thus was formed the world’s first accelerator capable of producing high-energy (>1 GeV/amu) beams of any element of the periodic table"


Heavy Ions!!

Single Holmium ion (Z=67, A=165) at 1 GeV/amu ""in Streamer Chamber (1 atm He/Ne)"

1 meter"


More like it!


Life-Sciences Programs at Bevalac

•  1/3 of all Bevalac time was dedicated to Life Sciences!•  Dedicated Biomedical area consisted of:!

–  Two therapy rooms"–  One biology/biophysics area"–  Support facilities and staging areas"


From a “Cave” into a “Treatment Room”

(We still referred to it as “Cave I”)!


Therapy Program

•  Neon ions used for majority of patients!

•  Horizontal beam delivery!

•  Large fields (up to 28 cm diameter)!

•  Mechanical field shaping/collimation!


Developed New Beam Delivery Concepts

•  Goals:!–  Better conformation of dose to

irregular shape""–  Better utilization of ions"

•  Decrease in fragmentation losses""

–  Maintaining sharp field edges"•  Reduction in scattering, straggling"


Double-Scattering

•  First Scatterer – < 1 cm Pb (ΔE ~ 100 MeV/amu)!•  Concentric brass rings & 2nd scatterer!•  Brass ridge filters (Spiral)!•  Water column!•  Patient collimator !

"(cerrobend)"


Wobbler

•  Sweep field in circular pattern!–  Several concentric circles make

up full field"•  Lateral, transverse shaping with

collimators, bolus compensators!•  Significant improvements in beam

quality!


Raster Scanner

•  Small beam spot swept in raster pattern across rectangular field!

•  Bevalac system still employed collimators for field shaping!–  Full 3-D system (currently used at GSI) not possible at

Bevalac due to old accelerator technology""


Radioactive Beams! Ne19

Ne20

~1cm Be

Peripheral collision

More central collision (Mess)

Ne20

Be

Be


Radioactive Beams!

PET Image of line beam stopped in phantom!–  ! Stopping point modulated with bolus to simulate "

" "chordoma treatment"


Clinical Experience - 1977-1993

•  1200 patients treated at LBNL!–  184-Inch Synchrocyclotron and Bevalac"

•  433 patients received treatments at Bevalac !–  Mostly neon ions used, either as full treatment or

boost for helium treatments"•  Emphasis on dose-localization, e.g.!

–  Scull-base, sinus cavities"–  Ocular melanoma"

•  And sites benefiting from high LET, e.g.!–  Salivary gland"–  T3-T4 prostate"

•  Clinical results “interesting”!–  Follow-ons continue today!"


Lessons Learned from Bevalac

•  Clinical use of light-ion beams is clearly feasible, and definitely worth pursuing!–  Even with simple delivery techniques, results were

substantially better than current practice"•  Most effective use of light-ion beams requires

very sophisticated beam-delivery technology!–  Achieving 3-D conformation to irregular target

shapes is very difficult to do"•  Sharing major accelerator facility between

different research communities is very difficult!–  Incompatibilities of resource/schedule needs for

optimum conduct of programs"


Current Picture in the US

•  Bevalac shut down in 1993!–  Fiscal constraints on Nuclear Physics program"–  Note: Therapy Grant had been renewed with

excellent (and guaranteed-fundable) score!"•  Today, Proton therapy is thriving!

–  8 operational facilities"–  Many more in the pipeline"

•  No Light-Ion facilities planned!–  Primary hurdle: financial"


Why??

•  Large facilities for health-care research do not receive government subsidies or funding!–  All proton facilities privately funded"

•  Must make money to repay investors"

–  High capital cost of Light-Ion facility is a great problem"

•  Government agencies funding science not optimally structured to address needs for hadron therapy facility construction!–  DOE builds large capital research facilities, but

NOT for health care"–  NIH funds research but does not build facilities"


The Future…

•  Leadership in Ion Beam Therapy now in Japan and Europe!–  Wonderful example here in Wiener Neustadt of

technical/government/community partnership to bring MedAUSTRON to reality"

•  US will have a difficult time catching up, even in presence of overwhelmingly positive clinical evidence!–  It will not happen without major changes in policy

for funding large research clinical facilities"


Congratulations!

Early days of Ion Bm Rx in...

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