PROTONPHOTON

© 2018 Ion Beam Applications SA. All rights reserved.

Comprehensive approach to motion management

Sofie Gillis

Clinical Solution Group

IBA CONFIDENTIAL2

From translational Research to Clinical adoption & Patients

Short Medium Longer

Treatment of moving targets Proton Arc Therapy Flash Therapy

IBA CONFIDENTIAL

Collaborative research is part of our DNA

Research partners▪ Massachussets General Hospital Burr Proton Therapy center [US]

▪ University of Florida Health Proton Therapy Institute [US]

▪ University of Pennsylvania Roberts Proton Therapy Center [US]

▪ Massachussets Institute of Technology [US]

▪ Northwestern Medecine Chicago Proton Therapy Center [US]

▪ Willis-Knighton Cancer Center [US]

▪ Texas Center for Proton Therapy [US]

▪ Beaumont Health System [US]

▪ Miami Cancer Institute – Baptist Health South Florida [US]

▪ MD Anderson Cancer Center [US]

▪ Memorial Sloan Kettering Cancer Center [US]

▪ Fermilab [US]

Research partners▪ Institut Curie [FR]

▪ Proton Therapy Center Czech [CZ]

▪ APSS Azienda Provinciale per I Servizi Sanitari [IT]

▪ Universitatklinikum Carl Gustav Carus [DE]

▪ Cyclhad – Cyclotron for Hadron Therapy [FR]

▪ Universitair Medisch Centrum Groningen – UMCG [NL]

▪ Universitair Ziekenhuis Leuven [BE]

▪ Centre Oscar Lambret [FR]

▪ Universite Paris-Sud [FR]

▪ Université Lyon 1 [FR]

▪ University College London Hospital [UK]

▪ Université Catholique de Louvain [BE]

▪ Université Libre de Bruxelles [BE]

▪ Université de Liège [BE]

▪ Erasmus Medisch Centrum [NL]

▪ Heidelberg Ion Therapy [DE]

+90

North AmericaClinical partners▪ Massachussets General Hospital Burr Proton Therapy center [US]

▪ University of Florida Health Proton Therapy Institute [US]

▪ University of Pennsylvania Roberts Proton Therapy Center [US]

▪ Hampton University Proton Therapy Institute [US]

▪ Oklahoma Procure Treatment Center [US]

▪ Northwestern Medecine Chicago Proton Therapy Center [US]

▪ New Jersey Procure Treatment Center [US]

▪ Seattle Cancer Care Alliance Proton Therapy Center [US]

▪ Provision Center for Proton Therapy [US]

▪ Willis-Knighton Cancer Center [US]

▪ Texas Center for Proton Therapy [US]

▪ Beaumont Health System [US]

▪ Miami Cancer Institute – Baptist Health South Florida [US]

Europe, Middle East, AfricaClinical partners▪ Institut Curie [FR]

▪ Proton Therapy Center Czech [CZ]

▪ Westdeutsches Protontherapiezentrum Essen [DE]

▪ APSS Azienda Provinciale per I Servizi Sanitari [IT]

▪ Universitatklinikum Carl Gustav Carus [DE]

▪ Skandionkliniken [SW]

▪ Bronowice Cyclotron Center – IFJPAN [PL]

▪ Centre Antoine Lacassagne [FR]

▪ Cyclhad – Cyclotron for Hadron Therapy [FR]

▪ Universitair Medisch Centrum Groningen – UMCG [NL]

▪ Universitair Ziekenhuis Leuven [BE]

▪ Proton Partners International – Newport [UK]

▪ Proton Partners International – Newcastle [UK]

▪ Proton Partners International – London [UK]

▪ Proton Partners International – Reading [UK]

▪ Proton Partners International – Undisclosed [UK]

▪ Proton Partners International – Abu Dhabi [UK]

Asia PacificClinical partners▪ Wanjie Proton Therapy Center [CN]

▪ Korea National Cancer Center [KR]

▪ Apollo Proton Therapy Center [IN]

▪ Changhua Christian Hospital [TW]

▪ Narita Memorial Hospital [JPN]

▪ Kojinkai Hokkaido Ohno Memorial Hospital [JPN]

▪ Guangdong Hen Ju Medical Technologies [CN]

▪ Zhuozhou Proton Therapy Center [CN]

▪ Taipei Medical Hospital [TW]

▪ Tata Memorial Centre [IN]

▪ Qingdao Zhong Jia Lian He Healthcare [CN]

▪ Beijing Proton Medical center [CN]

RussiaClinical partners▪ Federal High-Technology Center for Medical Radiology FMBA [RUS]

+300

Latin AmericaClinical partners▪ Centro de Protonterapia y Tecnicas Avanzadas de

Tratamiento - Insituto de Oncologica Angel Roffo

Hospital [ARG]

▪ LMU [DE]

▪ MedAustron [AT]

▪ Paul Scherrer Institute [CH]

▪ CNAO [IT]

▪ INFN [IT]

▪ ...

Clinical & research

collaborations

Patents

IBA CONFIDENTIAL4

50 partners perfecting

cancer care

Experienced community in proton therapy

IBA CONFIDENTIAL

Collaborative research for the treatment of Moving Targets

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IBA’s Clinical Partners IBA’s Technology Partners

Treatment of moving targets

IBA CONFIDENTIAL

Challenges in moving targets

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Motion of the tumor itself

and its reproducibility

Cold/hot dose spots due to interplay

between tumor and PBS delivery

IBA CONFIDENTIAL

Effect on the dose delivery

Ensure that the dose is well delivered to the tumor

IBA CONFIDENTIAL9

0

1

2

3

4

5

6

7

8

T1 T2 Stage 3

Scattering

Photons

PBS

PBS withRepainting

0 2 4 6 8

Free breathing 50%

Gating 29%

Breath hold 21%

5 mm - all

10 mm - max

4D

CT2D 50%

CBCT 31%

CT 15%

5-10%

100%

of patients basedon CBCT and CT

of centers

Globally

▪ Simulation of motion

▪ Ensure planning hypothesis

US

▪ Patient reimbursement

▪ Standard (2Gy)

▪ Medium hypo fractionation (10-12 F)

▪ Hypo fractionation

Tumor localization Beam delivery technique

Motion management

Dose Planning imaging Treatment imaging Plan adaption Challenges

Accepted motion

For free breathing

Margin

▪ 3.5% + 1mm

▪ 3,5% + 3mm

▪ CTV(8mm) + PTV

(5mm)

▪ CTV robust

▪ MIDP

▪ ITV

▪ In house tool

▪ …

▪ Growing number of patients treated with protons for moving

tumors

▪ High heterogeneity of solutions used

▪ No single solution fits all

▪ Challenges in interplay evaluation and imaging during treatment

IBA CONFIDENTIAL10

Use case at the Texas Center for Proton Therapy

IBA CONFIDENTIAL11

Proteus®CLASS

The most comprehensive integrated solution to treat Moving Targets

▪ Motion Assessment

▪ Motion Control

▪ Motion Irradiation

▪ Motion Imaging

IBA CONFIDENTIAL

IBA personalized approach to motion management

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Motion

management?Not needed

Patient specific

motion mitigation

Verification if

planning hypothesis

remains valid

Apply motion

mitigation as

planned

PLANNING PHASE TREATMENT PHASE

no

yes

IBA CONFIDENTIAL13

Proteus®CLASS

Motion Assessment

IBA CONFIDENTIAL

Interplay is patient and machine specific

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PTV

motion & interplay

motion only

planning

planning motion only motion & interplay

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4D robust optimisation 4D robust optimisationLayer repainting

4D robust optimisationvolumetric repainting

Machine-specific interplay assessment and mitigation*

*Work in progress

IBA CONFIDENTIAL17

Proteus®CLASS

Motion Control

IBA CONFIDENTIAL

Integrated with all major motion management systems

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Manufacturer Technology Integration Workflow Clinical

Camera V* Motion detection through images

acquired with fixed camerasV

Camera V** Motion detection through images

acquired with fixed camerasV

Spirometer V* Patients breathe through the

spirometerV

Laser telemeter V** Motion detection through laser V

Compression belt V Compression belt to be installed

on patientsV

* Formal validation by IBA **Validation tests performed by motion management vendor

IBA CONFIDENTIAL

Example of integration - Possibility to connect to 4 external sources (not simultaneously)

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IBA CONFIDENTIAL20

Proteus®CLASS

Motion Imaging

IBA CONFIDENTIAL

The different use cases for motion imaging

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Use Case Free

breathing

Breath hold Gating

Before beam Movie loop*

4D CBCT*

Fast decision and

beam start*

Breath hold CBCT

Gated X-rays

Movie loop*

4D CBCT*

During beam

pause

Movie loop* Fast decision and

beam start*

Movie loop*

Gated X-rays

*Work in progress

IBA CONFIDENTIAL

Comprehensive imaging solution

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Instantaneous oblique X-Ray imaging Cone Beam CT at isocenter

Ability to acquire CBCT in

breath hold

Ability to do gating

IBA CONFIDENTIAL24

Work in progress

IBA CONFIDENTIAL

4D-CBCT and virtual 4DCT

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Motion-aware 4D-CBCT reconstruction

▪ Breathing motion quantification

▪ Tumor position verification

Virtual 4DCT

▪ Interplay simulation on daily anatomy

▪ Log-based QA for moving targets

▪ Triggers for treatment adaptation

RTK

OpenRegguiWork in progress

IBA CONFIDENTIAL26

Proteus®CLASS

Motion Irradiation

IBA CONFIDENTIAL

Full flexibility of tools available

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RepaintingUniversal beam triggering

interface with Breath hold,

Gating or Free Breathing

Fast irradiation

15seconds

Layer &

volumetric repainting

Breath hold: 2 Gy in a 5 cm

cube in 15 sec

IBA CONFIDENTIAL29

Proteus®CLASS

Comprehensive integrated solutions

IBA CONFIDENTIAL

IBA personalized approach to motion management

30

Motion

management?Not needed

Patient specific

motion mitigation

Verification if

planning hypothesis

remains valid

Apply motion

mitigation as

planned

PLANNING PHASE TREATMENT PHASE

no

yes

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herein in any format or media without the prior and express written permission of Ion Beam Applications SA is prohibited.

Thank you

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