facilities for hadron-therapyicfa-2008, stanford hartmut eickhoff, gsi accelerators for medical...
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ICFA-2008, Stanford
1Hartmut Eickhoff, GSI Accelerators for medical applications
Facilities for HADRON-Therapy
Concepts, status, developments
H. Eickhoff GSI/Darmstadt
ICFA-2008, Stanford
2Hartmut Eickhoff, GSI Accelerators for medical applications
ContentsContents
1. Principles, requirements
2. treatment modalities
3. existing and projected facilities for hadrontherapy
4. future developments
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DemandsDemands
Localised tumours: 58% Metastatic tumours: 42%
Surgery: 22%
Radiotherapy: 12%
Chemotherapy: 5%
Palliative treatments: 37%
Surgery+radiotherapy: 6%
Failure of local control: 18%
protons and ions have the potential to cure 30000 patients /year in the EC
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principles, requirementsprinciples, requirements
Radiotherapy principle
Destruction of a localised cancer via irradiation with ionising radiation
and at the same time
Maintaining of dose in the surrounding healthy tissue in tolerable limits
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principles, requirementsprinciples, requirements
General requirements
for applied particle species
• adequate depth-dose-profile (large dose at tumour, low dose outside of the tumour),
• low lateral straggeling (better tumour confirmation),
• low side effects (e.g. low fragmentation)
For beam properties• sufficient max. beam intensity for dose request• sufficient energy to achieve requested penetrationdepth (e. g. 30 cm in tissue)• adequate beam widths at the patient
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principles, requirementsprinciples, requirements
General requirements
for technical installations
• cost effectiveness (investment and operation costs)
• good availability, reliability
• adequate solution for treatment modalities (e.g. treatment planning programme, patient-, beampositioning control)
• close connection to medical environment (integrationin clinics)
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Treatment modalitiesdepth dose profile
Treatment modalitiesdepth dose profile
Photons:
Exponential dose-decrease
Protons, Ions:
‚ inverse depth‘-doseprofile (Bragg-peak)
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Treatment modalitiescomparison p, Ions
Treatment modalitiescomparison p, Ions
Treatment with C-Ions Better ratio of dose inside/outside tumor volume (larger RBE-factor)Only small enhancement of beam diameter vs. penetration depth -> better control for deep seated tumors Online dose-control possible (Positron Emission Tomograph)
Treatment with protons Large medical data base for proton treatments available
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Treatment modalitiesComparison photons, ions
Treatment modalitiesComparison photons, ions
Carbon-Treatment (2 fields)Photon-Treatment
(IMRT, 9 fields)
Dose-Distribution
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Treatment modalitiestreatment technique: ‚passive‘
Treatment modalitiestreatment technique: ‚passive‘
- constant beam properties(accelerator)
- Mechanical devices foradequate manipulations of beam properties
- fragmentations
- not optimal tumouradaption
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Treatment modalitiesSpread out Bragg-peak (SOB)
Treatment modalitiesSpread out Bragg-peak (SOB)
Sequential treatment Irradiation with different energies => slicing of the tumor in isoenergetic planesIntensity variation per plane to get flat dose distribution
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Treatment modalitiesTreatment technique: Rasterscan-Method
Treatment modalitiesTreatment technique: Rasterscan-Method
Intensity-controlled Rasterscan-method
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Treatment modalitiesthe rasterscan methodTreatment modalitiesthe rasterscan method
Parameter (GSI-project):
• 255 energy-steps(88-423 MeV/u)
• 15 intensity-steps(106-108 ions/puls)
• 7 beamwidths( 4-10 mm FWHM)
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Treatment modalitiesIntens-contr. Rasterscan-method
Treatment modalitiesIntens-contr. Rasterscan-method
Beam-Position feed-backIntensity-distribution (isoenergy-slice)
Feed-back Scanner /MWPC
with feedbackwithout feedback
Preirradiation has to be considered _> highly inhomogenious distribution
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Existing and projected facilitiesfacilities in operation
Existing and projected facilitiesfacilities in operation
fac. out of operation
P: 10243
He: 2054
Pions: 1100
C-ions: 433
fac. in operation
P: 39000
C-ions: 3300
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Existing and projected facilitiesfacilities planned / under constr.-1
Existing and projected facilitiesfacilities planned / under constr.-1
2009 ?31 gantry2 horiz.
230cyclotron
pSouthAfrica
iThemba
200954 gantries1 horiz.
230cyclotron
pUSAUpenn
200732 gantries1 horiz.
230cyclotron
pKoreaNCC, Seoul
2010 ?21 gantry1 horiz.
230cyclotron
pItalyTrento
2007/08(OPTIS2/Gantry2)
3additional Gantry, 2D parallel scanning,
1 horiz.
250sccyclotron
pSwitzerlandPSI, Villingen
200754 gantries withscanning,
1 horiz.
250sccyclotron
pGermanyRPTC, Munich
START OFTREATMENTPLANNED
NO OF TREATM.
ROOMS
BEAMDIRECTION
MAX.CLINICALENERGY(MEV)
PARTICLECOUNTRYWHO,WHERE
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Existing and projected facilitiesfacilities planned / under constr. -2
Existing and projected facilitiesfacilities planned / under constr. -2
2009synchrotronP, ionJapanGunma
2010 ?41 45 degr. fixed,
3 horiz.
430/usynchrotron
P, ionGermanyPTC, Marburg
2011 ?3-42 gantries1-2 horiz.
SynchrotronP, ionAustriaMed-Austron
2009 ?3-41 gantry ?3 horiz.1 vert.
430 /usynchrotron
P, ionItalyCNAO, Pavia
200831 gantry,2 horiz.
430 /usynchrotron
P, ionGermanyHIT, Heidelberg
200943 gantries1 horiz.
230cyclotron
pGermanyWPE Essen
2009 ?54 gantries1 horiz.
250Sc cyclotron
pGermanyRPTC, Koeln
201142-3 gantries,1-2 hor.
250pUSANorth. Illinois PT, Chicago
2010 ?31 gantry,4 fixed
230cyclotron
pFranceCPO, Orsay
START OFTREATMENTPLANNED
NO OF TREATMENT
ROOMS
BEAMDIRECTION
MAX.CLINICALENERGY(MEV)
PARTICLECOUNTRYWHO,WHERE
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Existing and projected facilitiesProton-Synchro-Cyclotron, Boston
Existing and projected facilitiesProton-Synchro-Cyclotron, Boston
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Existing and projected facilitiesprot.-synchrotron, Shizuoka, Japan
Existing and projected facilitiesprot.-synchrotron, Shizuoka, Japan
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Existing and projected facilitiesp-Gantry (1)
Existing and projected facilitiesp-Gantry (1)
excentric gantry(PSI/Schweiz)
isocentric gantry(Boston/USA)
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Existing and projected facilitiesp-Gantry (2)
Existing and projected facilitiesp-Gantry (2)
Patient-room protonengantry (Tsukuba/Japan)
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Existing and projected facilitiesHIMAC (carbon), Chiba, Japan
Existing and projected facilitiesHIMAC (carbon), Chiba, Japan
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Existing and projected facilitiesHIT Layout: Requirements
Existing and projected facilitiesHIT Layout: Requirements
Low LET (proton, helium) and high LET (carbon and oxygen) treatmentIon penetration depth of 20 – 300 mm=> Ion energy range of 50 – 430 MeV/uRasterscan method=> FWHM of beam: 4 – 10 mm in both planes=> Beam intensity: 1·106 – 4·1010 ions/spill=> Extraction time: 1 – 10 sTreatment of 1000 patients per year in hospital environment with about 15 fractions each=> total of 15000 irradiations per year=> three treatment areasOne isocentric gantry
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Existing and projected facilitiesHIT, Univ. Heidelberg (p, carbon)Existing and projected facilitiesHIT, Univ. Heidelberg (p, carbon)
Accelerator sections Two ECR sourcesRFQIH drift tube linacSynchrotronExtraction via RF knock outTwo areas for horizontal treatmentOne isocentricGantryOne quality assurance place
patient-treatment: 2. half 2008
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Existing and projected facilitiesHIT facility
Existing and projected facilitiesHIT facility
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Existing and projected facilitiesHIT Layout: Injector System
Existing and projected facilitiesHIT Layout: Injector System
Ion source
IH - model
Features compactLow operation costsFast switching of ions
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Existing and projected facilitiesHIT Facility /realization
Existing and projected facilitiesHIT Facility /realization
Ion-source-section Linac-section
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Existing and projected facilitiesHIT Layout: Synchrotron
Existing and projected facilitiesHIT Layout: Synchrotron
Features compactMultiturn injectionMultiple beam extraction
transv. KO-extraction(e. g. respiration gating)
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Existing and projected facilitiesp/C-Facilities, HIT Facility
Existing and projected facilitiesp/C-Facilities, HIT Facility
synchrotron treatment-room
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Existing and projected facilitiesp/C-Gantry (HIT)
Existing and projected facilitiesp/C-Gantry (HIT)
First Light ion Gantryweight: 600 to13 m diameterbeam position accuracy at isocenter : 0.5 mmIntegration of hor. and vert. scannermagnets
MT Aerospace
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Existing and projected facilitiesCNAO-Facility Pavia, Italy
Existing and projected facilitiesCNAO-Facility Pavia, Italy
Linac (similar to HIT)
PIMMS-synchrotron
3 horiz. Beam lines
1 vert. Beam line
Ion Gantry is option
Commissioning has started
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Future developments(special technical aspects )
Future developments(special technical aspects )
• sophisticated positioning techniques (fast, accurate positioning with robotic systems)
• means for treating moveable organs
• Optimized diagnosis systems (e.g. on-line PET)
• compact accelerator devices
•Laser acceleration
•Dielectric wall linac
• FFAG-based accelerator
• compact gantry solutions; sc-gantry, .. )
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Future developmentsMoving organs 3D online motion compensation-tests (GSI)
magnetic scanner system PMMA wedge systemsuitable motion tracking system
dynamic treatment plan
static moving, non-compensated
moving, compensated
real-time, highest precision, passive energy variation
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Future developments(motivation)
Future developments(motivation)
Motivations (partly)
Smaller size -> Smaller costs size of photon facility(Electron-linac)
Size of a hadron facility
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Future developments‚Laser acceleration ‘Future developments
‚Laser acceleration ‘
Laser accelarationSmall acceleratorstructures due to large acceleration voltage
Problems:
- Continuous energy-spectrum
-Rel. low energies (fewMeV)
- repetition rate
-Reliability, reproducability
-Long term developmentCreation of ‚monoenergetic beam‘
(A. Noda et al., Kyoto)
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Future developmentsFFAG-Accelerator
Future developmentsFFAG-Accelerator
(Fixed FieldAlternatingGradient)-
synchrotron
3-stage-FFAG
(T.Mizu, 2004)
400 MeV Carbon
(design study)Very large momentum acceptance
Fast cycling (>100 Hz) possible
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Future developmentsFFAG-Gantry
Future developmentsFFAG-Gantry
FFAG-Gantry
Compact sc-magnets
(D.Trbojevic, 2006)
400 MeV Carbon
(design study)
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SummarySummary
Because of the specific biophysical advantages of p and light ionsHadrontherapy-facilities play an increasing role in cancer therapyin addition to optimized photon radiation systems
Planning and realization of new hospital based hadrontherapyfacilities has moved from research institutes to industrial firms
Technical Developments are investigated in institutes and industry to minimize investment and operation costs of hadrontherapy facilities (e. g. size reduction due to newacceleration schemes)
New accelerator developments seem to be a medium /long termprocess; for actual projects conventional technology is applied
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Thanks for your attention