Loïc’s work in the MP department -...
Transcript of Loïc’s work in the MP department -...
1
New Technologiesfor light ion beam therapy facilities
Loïc Grevillot, MPE, Ph.D.
SFPM
1-3 June 2016
2
Outline
Accelerators
Beam delivery techniques
Gantries
Patient positioning and imaging
Light Ion Beam Therapy Facilities
New technologies at MedAustron
3
Outline
Accelerators
Beam delivery techniques
Gantries
Patient positioning and imaging
Light Ion Beam Therapy Facilities
New technologies at MedAustron
4
Accelerators:Producing and accelerating particles
Cyclotrons Synchrotrons
Hadron accelerators for radiotherapy, H. Owen et al., Contemporary Physics, Vol. 55, No. 2, 55–74, 2014
Isochronous cyclotrons / synchro-cyclotrons:• Constant / Variable Electric Field (RF)• Variable / Constant Magnetic field (B)
Synchrotrons:• Beam injected with E [3-7 MeV] (Linac)• RF cavities used for accelerating the beam• Quadrupoles used for beam focusing• Dipoles used for curving the beam• Slow extraction technique
Ernest LawrenceNobel prize 1939
Continuous / Pulsed beam Fixed energy extracted Protons only (currently)
Spill structure Variable extraction time [1-10 s] Variable energy Protons and carbon ions
5
Accelerators:Producing and accelerating particles
Cyclotrons Synchrotrons
Hadron accelerators for radiotherapy, H. Owen et al., Contemporary Physics, Vol. 55, No. 2, 55–74, 2014
Isochronous cyclotrons / synchro-cyclotrons:• Constant / Variable Electric Field (RF)• Variable / Constant Magnetic field (B)
Synchrotrons:• Beam injected with E [3-7 MeV] (Linac)• RF cavities used for accelerating the beam• Quadrupoles used for beam focusing• Dipoles used for curving the beam• Slow extraction technique
Continuous / Pulsed beam Fixed energy extracted Protons only (currently)
Spill structure Variable extraction time [1-10 s] Variable energy Protons and carbon ions
Synchrotrons for protons and carbon ionsHIT (GSI) Home Made 25 m P, He, C, OMIT (Siemens) 25 m P, CCNAO, MedAustron PIMMS design (CERN) 25 m P, CHitachi P, CMitsubishi P, C
Synchrotrons for protons and carbon ionsHIT (GSI) Home Made 25 m P, He, C, OMIT (Siemens) 25 m P, CCNAO, MedAustron PIMMS design (CERN) 25 m P, CHitachi P, CMitsubishi P, C
6
Accelerators:Protons and Carbon ions Synchrotrons
Synchrotrons for protons onlyLoma Linda 250 MeV (1990–today, first hospital-based facility)Hitachi (synchro) (~ 8 -> 5m) 220 MeV (Wakasa Bay, 2000)Radiance 330, Protom 330 MeV (Mc Laren Hospital, Flint, installed in 2013)Mitsubishi (since 1994 at NIRS)
Synchrotrons for protons onlyLoma Linda 250 MeV (1990–today, first hospital-based facility)Hitachi (synchro) (~ 8 -> 5m) 220 MeV (Wakasa Bay, 2000)Radiance 330, Protom 330 MeV (Mc Laren Hospital, Flint, installed in 2013)Mitsubishi (since 1994 at NIRS)
Protom synchrotron
Hitachi proton synchrotronCNAO proton and carbon ion synchroton
7
Accelerators:Proton Cyclotrons
Progresses=
Superconducting technology !
(Miniaturization, Lower consumption, Increased Efficiency)
SynchrocyclotronSC200, CNRS(ORSAY) 700T 201 MeV (1991-2010)
Cyclotron (Isochronous)C230, IBA 220T (4.3 m) 230 MeVSumitomo 230 MeV
Super conducting Cyclotron (Isochronous)Accel/Varian 90T (3.4 m) 250 MeVSC360, ProNova ~200T 230 MeV (Provision Hospital,
Knoxville, installed in 2014)
Super conducting SynchrocyclotronS2C2, IBA 50T (2.5 m) 230/250 MeVS250, Mevion 20T (~1.8 m) 250 MeV
SynchrocyclotronSC200, CNRS(ORSAY) 700T 201 MeV (1991-2010)
Cyclotron (Isochronous)C230, IBA 220T (4.3 m) 230 MeVSumitomo 230 MeV
Super conducting Cyclotron (Isochronous)Accel/Varian 90T (3.4 m) 250 MeVSC360, ProNova ~200T 230 MeV (Provision Hospital,
Knoxville, installed in 2014)
Super conducting SynchrocyclotronS2C2, IBA 50T (2.5 m) 230/250 MeVS250, Mevion 20T (~1.8 m) 250 MeV
C230, IBA
Accel/varian
8
Accelerators:Producing and accelerating particles
Isochronous Synchro- SynchrotronsCyclotron Cyclotron
___________________________________________________________
Beam structure Continuous Pulsed SpillIntensity High Medium Low
Energy Fixed Fixed VariableActivation Degrader Degrader NoEnergy change Fast Fast Slow
Size 2-5 m 2-5 m 5-25 mParticle type Protons Protons Protons/Carbon ions
Isochronous Synchro- SynchrotronsCyclotron Cyclotron
___________________________________________________________
Beam structure Continuous Pulsed SpillIntensity High Medium Low
Energy Fixed Fixed VariableActivation Degrader Degrader NoEnergy change Fast Fast Slow
Size 2-5 m 2-5 m 5-25 mParticle type Protons Protons Protons/Carbon ions
SUMMARY
• Each type of accelerator has advantages and drawbacks• All types of accelerators can be used for protons• Only Synchrotrons are currently in use for carbon ions
9
Accelerators:Research
Superconducting cyclotron for carbon ionsIBA C400 / ARCHADE Project (700T, ~7m)
Multiple Energy operation with Extended Flat Top SynchrotronFull treatment delivered with one spillVariable extracted spill energy within a single cycle
Rapid Cycling Synchrotron (RCS)Faster energy change expected (not yet constructed for therapy)
Superconducting cyclotron for carbon ionsIBA C400 / ARCHADE Project (700T, ~7m)
Multiple Energy operation with Extended Flat Top SynchrotronFull treatment delivered with one spillVariable extracted spill energy within a single cycle
Rapid Cycling Synchrotron (RCS)Faster energy change expected (not yet constructed for therapy)
Schematic of C400
Archade Project, www.archade.frMultiple-energy operation with extended flattops at HIMAC, Y. Iwata et al., NIM A 624 (2010) 33–38
Variable extracted energyfrom 430 to 80 MeV/u
(147 flattops)
10
Accelerators:Research
Fixed Field Alternating Gradient (FFAG)Fixed field (RF) -> High intensity such as Isochronous CyclotronsAlternating gradient -> Reduced Synchrotron orbitVariable energy and different particle types
LinacsVariable energy as synchrotrons and Fast energy change (2-3 ms)Core of research: achieve higher gradients (20-100 MV.m-1)One CERN spin-off: Advanced Oncotherapy (LIGHT accelerator, ADAM)
Dielectric Wall Accelerators (DWA)Technology based on high gradient insulators (up to 20-100 MV.m-1)
LasersMany challenges: beam quality, energy selection, pulse rate, etc.
Fixed Field Alternating Gradient (FFAG)Fixed field (RF) -> High intensity such as Isochronous CyclotronsAlternating gradient -> Reduced Synchrotron orbitVariable energy and different particle types
LinacsVariable energy as synchrotrons and Fast energy change (2-3 ms)Core of research: achieve higher gradients (20-100 MV.m-1)One CERN spin-off: Advanced Oncotherapy (LIGHT accelerator, ADAM)
Dielectric Wall Accelerators (DWA)Technology based on high gradient insulators (up to 20-100 MV.m-1)
LasersMany challenges: beam quality, energy selection, pulse rate, etc.
DWA schematic Pamela Overview and Status, K. Peach et al, Proceedings of IPAC’10
11
Outline
Accelerators
Beam delivery techniques
Gantries
Patient positioning and imaging
Light Ion Beam Therapy Facilities
New technologies at MedAustron
12
According to ICRU 78:
• Passive beam-delivery techniques:• Single scattering• Double scattering
• Dynamic beam-delivery techniques:• Scanning
• Discrete scanning (spot scanning)• Continuous scanning (raster scanning)• Quasi-discrete scanning
• Wobbling
ICRU report 78, Prescribing Recording and Reporting Proton Beam Therapy, 2007
Beam delivery techniques
13
Beam delivery techniques:Broad beam delivery technique
Dose Reporting In Ion Beam Therapy. Technical Report, IAEA 2007.
14
Beam delivery techniques:Passive Scattering delivery technique
Upstream and downstream modulator whells.
Passive Beam Spreading in Proton Radiation Therapy, B. Gottschalk, Draft 2004
Range modulator wheel
Second scatterer
Monitoring system
Movable snout with patient
specific aperture and boluses (or
range compensator)
Lepowitz metal aperturePractical Implementation of Light Ion Beam
Treatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012
Wax boluses
The physics of proton therapy, W. D. Newhauser and R. Zhang, Phys. Med. Biol. 60(2015) R155–R209
15
Beam delivery techniques:Fixed vs. variable range modulation
Fixed range modulation
Unwanted dose in OAR before the tumor
Practical Implementation of Light Ion BeamTreatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012
Variable range modulation
Reduced dose in OAR!
MLC used to collimate the beam
Energy layer thickness can be adjusted by ridge filters
Energy can be changed at accelerator level or via introduction of range shifter plates.
16
Beam delivery techniques:Wobbling: layer stacking scanning
Recent Progress of Heavy-Ion Cancer Radiotherapy with NIRS-HIMAC, K. Noda et al., accapp2013
Fast energy change (11 energy available from the synchrotron)
Energy layer thickness
17
Beam delivery techniques:Active scanning delivery technique
Tumor Therapy with Heavy Ions, GSI 2007
Delivery possibilities:• Discrete scanning (spot or voxel scanning)• Continuous scanning (raster scanning)• Quasi-discrete scanning
Scan path optimization
Practical Implementation of Light Ion BeamTreatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012
18
Beam delivery techniques:Active scanning delivery technique
Ripple filter design
(single or dual arrangement)
Evaluation of beam delivery and ripple filter design for non-isocentric proton and carbon ion Therapy, L. Grevillot et al., PMB2015
10µm manufacturing accuracy required!
Gate/Geant4
Design of ripple filters
19
Beam delivery techniques:Producing a SOBP
Proton SOBP:Fixed RBE Uniform physical dose
Carbon ion SOBP:Variable RBE Non-uniform physical dose
Relative Biological Effectiveness In Ion Beam Therapy. Technical Report, IAEA 2008.
20
Beam delivery techniques:Comparisons of the different techniques
ICRU report 78, Prescribing Recording and Reporting Proton Beam Therapy, 2007
Passive scattering Scanning: SFUD Scanning: IMPT
21
Beam delivery techniques:
Passive Active scanning___________________________________________________________
Nozzle design complex simpleMaximum range reduced higherBeam efficiency reduced highSecondary dose neutrons lowDose management/QA conventional Large amount of
data required (each spot)Dose distribution extra dose Conformal (IMPT/IMCT)Motion management conventional complex (each spot)
Passive Active scanning___________________________________________________________
Nozzle design complex simpleMaximum range reduced higherBeam efficiency reduced highSecondary dose neutrons lowDose management/QA conventional Large amount of
data required (each spot)Dose distribution extra dose Conformal (IMPT/IMCT)Motion management conventional complex (each spot)
SUMMARY
• Pencil beam scanning is the future of particle therapy• Progresses are expected in terms of delivery efficiency (fast
scanning/rescanning, fast energy change, new RiFi designs, etc.)• Scattering techniques are still the most used worldwide
Wobbling is intermediate
22
Outline
Accelerators
Beam delivery techniques
Gantries
Patient positioning and imaging
Light Ion Beam Therapy Facilities
New technologies at MedAustron
23
Gantries:Mobile vs. fixed isocenter
PSI gantry 1• First PBS gantry (1992)• Mobile isocenter = reduced
size (only 4 m diameter)
Loma Linda gantry• First proton gantry for
scattering delivery (1991)• Isocentric corkscrew-type
gantry• Most used design worldwide
ICRU report 78, Prescribing Recording and Reporting Proton Beam Therapy, 2007
24
Gantries:Rotating protons
PSI Gantry 2 / MedAustron-30/+180 degrees, ~220 T
IBA 360 degrees Gantry,~100 T (mechanical structure), 6m diam.,
Mevion GantryAccelerator integrated in the gantry
Hitachi Proton Gantry
25
Gantries:Rotating carbon ions
Heavy-ion tumor therapy: Physical and radiobiological benefits, D. Schardt and T. Elsässer, Rev. Mod. Phys., Vol. 82, No. 1, January–March 2010
HIT carbon ion gantry(first carbon gantry worldwide)
3600 rotating gantry18m length, 7m radius, ~ 630TNormal technology
NIRS/Toshiba superconducting carbon ion
gantry
Twenty Years of Carbon Ion Radiation Therapy at the National Institute of Radiological Sciences: Accomplishments and Prospects, Tadashi Kamada, IJPT, Feb. 2016
3600 rotating gantry13m length, 4m radius, ~200T (~normal proton gantries)Fluid-free cryocooler technology
26
Gantries:Rotating particle beams
Considerations to select a gantry
• Particle type• Accelerator type• Technology: normal or superconducting magnets• Precision at isocenter• Rotating angle: 360, 220, 180?• Field size• Treatment modality: passive, active (parallel scanning /deflected beam)• Size in treatment room (space for imaging devices in room)• Size and weight
SUMMARY
• Isocentric gantries are the most used• Rotation from 180 to 360 available• Isocenter Accuracy ~1 mm
Progresses = Superconducting technology ?!(Miniaturization, Lower consumption, Increased Efficiency)
27
Gantries:Research
Superconducting technologyAllows reducing the size of the gantryConsequence on energy change speed?
FFAG gantryFaster energy scanning due to FFAG technology
Riesenrad gantryReduced weight, butEntire treatment room is rotated…
Superconducting technologyAllows reducing the size of the gantryConsequence on energy change speed?
FFAG gantryFaster energy scanning due to FFAG technology
Riesenrad gantryReduced weight, butEntire treatment room is rotated…
28
Outline
Accelerators
Beam delivery techniques
Gantries
Patient positioning and imaging
Light Ion Beam Therapy Facilities
New technologies at MedAustron
29
Patient Positioning Systems
SCARA type robots(Selective Compliance Assemble Robot Arm)Compliant in X-YRigid in Y -> no bending
Other robots
Mainly industrial robots adapted of LIBT facilities
Mevion
IBA
HCL/CPO were pioneer in 1991
HIT PPS
Courtesy of Michel Auger (CPO)
30
Patient Positioning Systems
Mainly industrial robots adapted of LIBT facilities
Practical Implementation of Light Ion Beam Treatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012
PPS used for MP QA
NIRS “old” facility PPS
NIRS new facility PPS
Development of fast patient positionverification software using 2D-3D image registration and its clinical experience, S. Mori et al., jrr 2015
31
IGRT in LIBT
Historically, LIBT was always delivered with some sorts of imaging and introduced the concept of IGRT to the field of radiation therapy.
Practically, IGRT capabilities are often more advanced in conventional radiation therapy departments.
Target imaging and localization techniques:Markers, room lasers, 2D kV, 3D CBCT, fiducials, surface recognition systems, etc.
32
Dose delivery verification
Range uncertainty: a challenges in LIBT delivery!
In vivo proton range verification: a review, A. C. Knopf and A. Lomax, Phys. Med. Biol. 2013
Several techniques investigated:• In-vivo point measurements
(On-line 1D)• Range Probe
(On-line 1D)• Proton radiography and
tomography (On-line 2D/3D)
• Prompt gamma imaging(On-line 2D/(3D))
• PET imaging(On-line/off-line 3D)
• MRI imaging(Off-line 3D)
33
Outline
Accelerators
Beam delivery techniques
Gantries
Patient positionning and imaging
Light Ion Beam Therapy Facilities
New technologies at MedAustron
COMMISSIONING OF THE ION BEAM GANTRY AT HIT, M. Galonska et al., IPAC2011
34Recent Progress of Heavy-Ion Cancer Radiotherapy with NIRS-HIMAC, K. Noda et al., accapp2013
Light Ion Beam Therapy Facilities:Dual particle beam facilities
• Synchrotron-based facilities• Large facilities with 3
treatment rooms or more• High costs
35
Mitsubishi proton only
Light Ion Beam Therapy Facilities:Dual particle beam facilities
Mitsubishi proton and carbon ions
36
Light Ion Beam Therapy Facilities:Multi-room proton therapy facilities
IBA Proteus plus
Varian ProBeam multi-room
• Cyclotron or Synchrotron-based facilities
• Large facilities with 3 treatment rooms or more
• High costs
• All delivery techniques possible• 3600 rotating gantries
37
IBA Proteus one2200 rotating gantry
Varian ProBeam single-room3600 rotating gantry
• Compact facilities• Lower costs• Full technology:
Gantry/IMPT/CBCT/Gating capabilities, etc.
Light Ion Beam Therapy Facilities:Compact proton therapy facilities
38
Protom Radiance 3301800 rotating gantry
• Synchrotron based• Multi-level building capabilities• 330 MeV towards proton radiography
Light Ion Beam Therapy Facilities:Compact proton therapy facilities
39
• Gantry mounted cyclotron• No beam line required• Scanning not yet FDA
Mevion S250 series~1800 rotating gantry
Light Ion Beam Therapy Facilities:Compact proton therapy facilities
40
Outline
Accelerators
Beam delivery techniques
Gantries
Patient positionning and imaging
Light Ion Beam Therapy Facilities
New technologies at MedAustron
Excavation material used for radiation protection:
• 25.000 m³ concrete saved• 2.500 tons of reinforcement steel
saved• 6 month construction time saved• 10.000 truck movements saved
New technologies at MedAustron:Sandwich-Technology
42
New technologies at MedAustron:Patient positioning and Imaging Ring
• 7D robotic couch positioning• Integrated CBCT on the couch• Non-isocentric CBCT capabilities• Optical tracking system
43
New technologies at MedAustron:Patient positioning and Imaging Ring
Optical tracking and positioning accuracy
www.medPhoton.at
ImagingRing
Single source dual energy X-ray 60 – 120 kV
www.medPhoton.at
ImagingRing
Single source dual energy X-ray 60 – 120 kV
Large clearance 78 cm ring
Non-isocentric acquisitions
Large FOV >60 cm diameter
Dose reduction for out-of-beam regions
46
New technologies at MedAustron:Patient setup module
47
New technologies at MedAustron:Collision avoidance system for planning
48
Machine specific parameters optimization - intensity selection, scan path optimization
Beam specific margins - to better account for range uncertainties
CTV-based planning and Robust optimization - to directly account for positioning and density
uncertainties
Automatic spot and energy layer spacing – spacing adapted on a layer basis
Biological optimization for carbon ions - based on LEM model for carbon ions
Multi-criteria optimization / Scripting capabilities / Back up planning …
New technologies at MedAustron:Raysearch TPS with user customizations
LIBT TechnologyLIBT Technology
49
• Technological development in Light Ion Beam Therapy (LIBT)
Facility improved significantly over the past decades.
• Compact and more affordable proton solutions are now available.
• Carbon ion technology is still seldom.
• Active scanning delivery is considered as the future of LIBT and
allows IMIT.
• Further developments on hardware and software sides are still
required to maximize the capabilities of the technology.
Conclusion
Medical softwaresystems
Accelerator
Beam deliverytechniques
Gantries
Patient positionningand alignement
systems
Thank you !