HIMAC

NIRS

HIMAC

NIRS

Cancer Treatment by Charged Particles

- Carbon Ion Radiotherapy -

HIMAC

NIRS

TTTTakeshiakeshiakeshiakeshi MurakamiMurakamiMurakamiMurakami

Research Center of Charged Particle TherapyResearch Center of Charged Particle TherapyResearch Center of Charged Particle TherapyResearch Center of Charged Particle Therapy

National Institute of Radiological SciencesNational Institute of Radiological SciencesNational Institute of Radiological SciencesNational Institute of Radiological Sciences

2012.11.21

HIMAC

NIRS

HIMAC

NIRS

Contents

1. Introduction to NIRS 2. Carbon Ion Radiotherapy

1. Why carbon beams?2. Results of clinical trials

3. Outline of HIMAC1. History of HIMAC2. Outline of the facility3. Facilities in the world

4. New Facility1. Why new system?2. Next generation system

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Site of NIRS

Chiba Prefecture

Narita airport

Tokyo

National Institute of Radiological Sciences

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HIMAC

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Contents

1. Introduction to NIRS 2. Carbon Ion radiotherapy

1. Why carbon beams?2. Results of clinical trials

3. Outline of HIMAC1. History of HIMAC2. Outline of the facility3. Facilities in the world

4. New Facility1. Why new system?2. Next generation system

HIMAC

NIRS

HIMAC

NIRSFeature of the Charged Particle Therapy

Physics

Dose distributionHeavy ions, Protons

• Surface = small LET• End point = large LET

Dose concentrates at the end point(Bragg peak)

Gamma-ray, Neutrons• from Surface to End point = constant LET

(LET：Lenear Energy Transfer)

0

20

40

60

80

100

0 5 10 15

Depth in water (cm)

Rel

ativ

e do

se (

%)

C ion

n

gamma-ray

proton

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Dose distribution of xDose distribution of xDose distribution of xDose distribution of x----rays and C beamsrays and C beamsrays and C beamsrays and C beams

tumortumortumortumor tumortumortumortumor

BolusBolusBolusBolus

3 directions3 directions3 directions3 directions

Carbon beamsCarbon beamsCarbon beamsCarbon beamsXXXX----rayrayrayray

9 directions9 directions9 directions9 directions

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Ionization density and damage of DNA

-2.5

0.0

2.5

20 22 24 26 28 30

X (n

m)

Z (nm)

-2.5

0.0

2.5

0 2 4 6 8 10

X (nm)

Z (nm)

-2.5

0.0

2.5

0 2 4 6 8 10

X (nm)

Z (nm)

DNA

Truck structure Lethal damage

X-rays

Protons

Carbons

1.1

1.0

2~3

RBERBERBERBE

2 nm

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Result of clinical trials

Head & Neck cancer

(before / treatment planning / after)

before 36 month after

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Hypo-fractionation

1 day!

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Highlight of Carbon Ion Radiotherapy

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Number of patients, yearly base

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NIRSNumber of patients enrolled for carbon ion radiotherapy

from June 1994 to February 2012

neck

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Details of foreign patients

Russia, 4India, 2

Korea, 10

PRC, 20

Taiwan, 13

Italy, 23

France, 4

Indonesia, 1

Poland, 1

Singapore, 1

USA, 2

Australia, 2

Austria, 2

Britain, 1 Germany, 1

Sweden, 3

Bangladesh, 1

2006-2012

HIMAC

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HIMAC

NIRS

Contents

1. Introduction to NIRS 2. Carbon Ion radiotherapy

1. Why carbon beams?2. Results of clinical trials

3. Outline of HIMAC1. History of HIMAC2. Outline of the facility3. Facilities in the world

4. New Facility1. Why new system?2. Next generation system

HIMAC

NIRS

HIMAC

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History of constructing HIMAC

Heavy Ion Medical Accelerator in Chiba (HIMAC)Heavy Ion Medical Accelerator in Chiba (HIMAC)Heavy Ion Medical Accelerator in Chiba (HIMAC)Heavy Ion Medical Accelerator in Chiba (HIMAC)

� 1984: 10 years strategy for confronting the cancer1984: 10 years strategy for confronting the cancer1984: 10 years strategy for confronting the cancer1984: 10 years strategy for confronting the cancer

� 1986: International Workshop on Heavy Ion Treatment 1986: International Workshop on Heavy Ion Treatment 1986: International Workshop on Heavy Ion Treatment 1986: International Workshop on Heavy Ion Treatment

FacilityFacilityFacilityFacility

� 1989: Start of the construction1989: Start of the construction1989: Start of the construction1989: Start of the construction

� 1993: Commissioning ended, beams were successfully 1993: Commissioning ended, beams were successfully 1993: Commissioning ended, beams were successfully 1993: Commissioning ended, beams were successfully

accelerated.accelerated.accelerated.accelerated.

� 1994: Clinical Trials began1994: Clinical Trials began1994: Clinical Trials began1994: Clinical Trials began....

� 2003: Advanced Medicine (Advanced Medical Therapy).2003: Advanced Medicine (Advanced Medical Therapy).2003: Advanced Medicine (Advanced Medical Therapy).2003: Advanced Medicine (Advanced Medical Therapy).

� ---- June. 2012: 6,512 patients were treated. (AM 3,488)June. 2012: 6,512 patients were treated. (AM 3,488)June. 2012: 6,512 patients were treated. (AM 3,488)June. 2012: 6,512 patients were treated. (AM 3,488)

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Devices of HIMAC

HIMACHIMACHIMACHIMAC

(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)

130m

HIMAC

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Devices of HIMAC

HIMACHIMACHIMACHIMAC

(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)

130m

HIMAC

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HIMAC

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Devices of HIMAC

HIMACHIMACHIMACHIMAC

(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)(Heavy Ion Medical Accelerator in Chiba)

130m

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Beam Delivery System

Wobbling Magnet

Multi Leaf Collimator

Bolus Collimator

Ridge Filter

Range Shifter Cancer Tumor Irradiation area

Scattering material

Controller

Dose monitor

Making of Spread Out Bragg PeakMaking of Spread Out Bragg PeakMaking of Spread Out Bragg PeakMaking of Spread Out Bragg Peak

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HIMAC

NIRSIrradiation system of coincident with a patient‘‘‘‘s

respiratory motion

Irradiation room

Positioning area

Accelerator Treatment control

Gate signal generator

Watch & record system

Beam monitor

Planning simulation

Reference Image

Positioning systemusing x-ray TV images

Compare

X-ray TV

Positioning Image

PSD

Respirationwaveform

Gated beam extraction system(RF knockout method)

Interlock system

Ion beam

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End-expiratory irradiation

Respiration gating for irradiation

Reduction of volumeMinohara et al. IJROBP 47:1097-1103, 2000

No gating Gating

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Heavy ion radiotherapy worldwide

Chiba

Gunma

Hyogo

Lanzhou

Busan

Darmstadt

Lyon

Wiener Neustadt

Pavia

Heidelberg

Rochester

KanagawaTosu

Shanghai

Heavy ion Heavy ion (under construction)

ProtonProton (under construction)

Heavy ion (planning)

Penang

Taipei

HIMAC

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HIMAC

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Contents

1. Introduction to NIRS 2. Carbon Ion radiotherapy

1. Why carbon beams?2. Results of clinical trials

3. Outline of HIMAC1. History of HIMAC2. Outline of the facility3. Facilities in the world

4. New Facility1. Why new system?2. Next generation system

HIMAC

NIRSMotivation of New Treatment

Facility

1 day!

1 day treatment is possible ⇒⇒⇒⇒ Adaptive Cancer Treatment

diagnosis and treatment in a short period

Prepare the treatment planning, and bolus, collimator-> 4-5 days are necessary for machining, transport, inspection

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scatterer

Patient collimatorBolusRidge filter

Broad beam

Scanning

Wobbling

magnets

Scanning

magnets

range shifter

Irradiation Methods

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Comparison of scanning and broad beam method

Broad beam: matured

technology!

Scanning Broad beam

Dose distribution excellent goodMoving target No Yes

Irradiation time long shortDose control Elaborate Easy

Bolus, collimator No YesBeam position < 0.2mm ~ 2 mm

Beam size Control No controlIntensity Low High

� Long treatment time� Sensitive to the device error� Not for moving target

scanningNew scanning system must be developed.

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100 120 140 160 180 200

-40

-20

0

20

40

Non-gatingGating

Gating with rescanning

(8 times)

100 120 140 160 180 200

-40

-20

0

20

40

100 120 140 160 180 200

-40

-20

0

20

40

0

0.1

0.2

0.3

0.4

0.4

0.5

0.6

0.7

0.8

0.9

1.0

1.1

1.1

Motion：7mm in gate

Simulation of moving tumor irradiation

Irradiation on Moving Tumors

In order to avoid hot/cold spot due to target motion, we decided to employ “gating method” with rescanning.

Example:Φ40mmspherical target

( )φφφφππππ −⋅−= stts 2,3/cos3.317.1)( 4

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R&D of Fast Scanning System

New control system

HIMAC SB course

Scanning R&D port

1. Fast scanning system

2. Respiratory motion

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Scanning with extended Flat-Top

SMx

SMy

Beam

Syn. BM

Fluorescent screen

plan

1. Treatment planning for fast scanning ⇒⇒⇒⇒ ××××5

2. Modification of acc. operation ⇒⇒⇒⇒ ××××2

3. Fast scanning magnet ⇒⇒⇒⇒ ××××10

We can save the dead time of synchrotron operation.

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New Particle Therapy Research Facilities

○3D Scanning with Gating (H&V): 2 rooms○Rotating Gantry : 1 room

Iso-center0 1 2m

SMxQM SMy

Monitors

RGF

RSF

Wall

PRN1 PRN2

9.0 m•3D Scanning

New treatment facility

HIMAC building

Hospital

Research Building for Charged Particle Therapy

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New Particle Therapy Research Facilities

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New Particle Therapy Research Facilities 1F

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New Particle Therapy Research Facilities 1F

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New Particle Therapy Research Facilities 1F

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New Particle Therapy Research Facilities B2

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New Treatment Couch, Robotic Arm

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END

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