New Technologies for light ion beam therapy facilities

Transcription

1 New Technologies for light ion beam therapy facilities Loïc Grevillot, MPE, Ph.D. SFPM 1-3 June

2 Outline Accelerators Beam delivery techniques Gantries Patient positioning and imaging Light Ion Beam Therapy Facilities New technologies at MedAustron 2

3 Outline Accelerators Beam delivery techniques Gantries Patient positioning and imaging Light Ion Beam Therapy Facilities New technologies at MedAustron 3

4 Accelerators: Producing and accelerating particles Cyclotrons Synchrotrons Ernest Lawrence Nobel prize 1939 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 4

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 5

6 Accelerators: Protons and Carbon ions Synchrotrons Synchrotrons for protons only Loma 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 and carbon ions HIT (GSI) Home Made 25 m P, He, C, O MIT (Siemens) 25 m P, C CNAO, MedAustron PIMMS design (CERN) 25 m P, C Hitachi P, C Mitsubishi P, C Protom synchrotron CNAO proton and carbon ion synchroton Hitachi proton synchrotron 6

7 Accelerators: Proton Cyclotrons Synchrocyclotron SC200, CNRS(ORSAY) 700T 201 MeV ( ) Cyclotron (Isochronous) C230, IBA 220T (4.3 m) 230 MeV Sumitomo 230 MeV Super conducting Cyclotron (Isochronous) Accel/Varian 90T (3.4 m) 250 MeV SC360, ProNova ~200T 230 MeV (Provision Hospital, Knoxville, installed in 2014) Super conducting Synchrocyclotron S2C2, IBA 50T (2.5 m) 230/250 MeV S250, Mevion 20T (~1.8 m) 250 MeV C230, IBA Accel/varian Progresses = Superconducting technology! (Miniaturization, Lower consumption, Increased Efficiency) 7

8 Accelerators: Producing and accelerating particles Isochronous Synchro- Synchrotrons Cyclotron Cyclotron Beam structure Continuous Pulsed Spill Intensity High Medium Low Energy Fixed Fixed Variable Activation Degrader Degrader No Energy change Fast Fast Slow Size 2-5 m 2-5 m 5-25 m Particle 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 8

9 Accelerators: Research Superconducting cyclotron for carbon ions IBA C400 / ARCHADE Project (700T, ~7m) Multiple Energy operation with Extended Flat Top Synchrotron Full treatment delivered with one spill Variable extracted spill energy within a single cycle Rapid Cycling Synchrotron (RCS) Faster energy change expected (not yet constructed for therapy) Variable extracted energy from 430 to 80 MeV/u (147 flattops) Schematic of C400 Multiple-energy operation with extended flattops at HIMAC, Y. Iwata et al., NIM A 624 (2010) Archade Project, 9

10 Accelerators: Research Fixed Field Alternating Gradient (FFAG) Fixed field (RF) -> High intensity such as Isochronous Cyclotrons Alternating gradient -> Reduced Synchrotron orbit Variable energy and different particle types Linacs Variable energy as synchrotrons and Fast energy change (2-3 ms) Core of research: achieve higher gradients ( MV.m -1 ) One CERN spin-off: Advanced Oncotherapy (LIGHT accelerator, ADAM) Dielectric Wall Accelerators (DWA) Technology based on high gradient insulators (up to MV.m -1 ) Lasers Many challenges: beam quality, energy selection, pulse rate, etc. DWA schematic Pamela Overview and Status, K. Peach et al, Proceedings of IPAC 10 10

11 Outline Accelerators Beam delivery techniques Gantries Patient positioning and imaging Light Ion Beam Therapy Facilities New technologies at MedAustron 11

12 Beam delivery techniques 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,

13 Beam delivery techniques: Broad beam delivery technique Dose Reporting In Ion Beam Therapy. Technical Report, IAEA

14 Beam delivery techniques: Passive Scattering delivery technique Range modulator wheel Second scatterer Monitoring system Movable snout with patient specific aperture and boluses (or range compensator) The physics of proton therapy, W. D. Newhauser and R. Zhang, Phys. Med. Biol. 60(2015) R155 R209 Upstream and downstream modulator whells. Passive Beam Spreading in Proton Radiation Therapy, B. Gottschalk, Draft 2004 Wax boluses Practical Implementation of Light Ion Beam Treatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012 Lepowitz metal aperture 14

15 Beam delivery techniques: Fixed vs. variable range modulation Fixed range modulation Unwanted dose in OAR before the tumor Variable range modulation Practical Implementation of Light Ion Beam Treatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012 MLC used to collimate the beam Energy can be changed at accelerator level or via introduction of range shifter plates. Reduced dose in OAR! Energy layer thickness can be adjusted by ridge filters 15

16 Beam delivery techniques: Wobbling: layer stacking scanning Energy layer thickness Fast energy change (11 energy available from the synchrotron) Recent Progress of Heavy-Ion Cancer Radiotherapy with NIRS-HIMAC, K. Noda et al., accapp

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 Beam Treatments, M. F. Moyers and S. M. Vatnitsky, mpp

18 Beam delivery techniques: Active scanning delivery technique Design of ripple filters Gate/Geant4 Ripple filter design (single or dual arrangement) Evaluation of beam delivery and ripple filter design for nonisocentric proton and carbon ion Therapy, L. Grevillot et al., PMB µm manufacturing accuracy required! 18

19 Beam delivery techniques: Producing a SOBP Relative Biological Effectiveness In Ion Beam Therapy. Technical Report, IAEA Proton SOBP: Fixed RBE Uniform physical dose Carbon ion SOBP: Variable RBE Non-uniform physical dose 19

20 Beam delivery techniques: Comparisons of the different techniques Passive scattering Scanning: SFUD Scanning: IMPT ICRU report 78, Prescribing Recording and Reporting Proton Beam Therapy,

21 Beam delivery techniques: Passive Active scanning Nozzle design complex simple Maximum range reduced higher Beam efficiency reduced high Secondary dose neutrons low Dose management/qa conventional Large amount of data required (each spot) Dose distribution extra dose Conformal (IMPT/IMCT) Motion management conventional complex (each spot) Wobbling is intermediate 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 21

22 Outline Accelerators Beam delivery techniques Gantries Patient positioning and imaging Light Ion Beam Therapy Facilities New technologies at MedAustron 22

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,

24 Gantries: Rotating protons PSI Gantry 2 / MedAustron -30/+180 degrees, ~220 T Mevion Gantry Accelerator integrated in the gantry IBA 360 degrees Gantry, ~100 T (mechanical structure), 6m diam., Hitachi Proton Gantry 24

25 Gantries: Rotating carbon ions HIT carbon ion gantry (first carbon gantry worldwide) NIRS/Toshiba superconducting carbon ion gantry Heavy-ion tumor therapy: Physical and radiobiological benefits, D. Schardt and T. Elsässer, Rev. Mod. Phys., Vol. 82, No. 1, January March rotating gantry 18m length, 7m radius, ~ 630T Normal technology Twenty Years of Carbon Ion Radiation Therapy at the National Institute of Radiological Sciences: Accomplishments and Prospects, Tadashi Kamada, IJPT, Feb rotating gantry 13m length, 4m radius, ~200T (~normal proton gantries) Fluid-free cryocooler technology 25

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) 26

27 Gantries: Research Superconducting technology Allows reducing the size of the gantry Consequence on energy change speed? FFAG gantry Faster energy scanning due to FFAG technology Riesenrad gantry Reduced weight, but Entire treatment room is rotated 27

28 Outline Accelerators Beam delivery techniques Gantries Patient positioning and imaging Light Ion Beam Therapy Facilities New technologies at MedAustron 28

29 Patient Positioning Systems Mainly industrial robots adapted of LIBT facilities SCARA type robots (Selective Compliance Assemble Robot Arm) Compliant in X-Y Rigid in Y -> no bending Other robots HCL/CPO were pioneer in 1991 Courtesy of Michel Auger (CPO) Mevion HIT PPS IBA 29

30 Patient Positioning Systems Mainly industrial robots adapted of LIBT facilities NIRS old facility PPS PPS used for MP QA Practical Implementation of Light Ion Beam Treatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012 NIRS new facility PPS Development of fast patient position verification software using 2D-3D image registration and its clinical experience, S. Mori et al., jrr

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. 31

32 Dose delivery verification Range uncertainty: a challenges in LIBT delivery! 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) In vivo proton range verification: a review, A. C. Knopf and A. Lomax, Phys. Med. Biol

33 Outline Accelerators Beam delivery techniques Gantries Patient positionning and imaging Light Ion Beam Therapy Facilities New technologies at MedAustron 33

34 Light Ion Beam Therapy Facilities: Dual particle beam facilities COMMISSIONING OF THE ION BEAM GANTRY AT HIT, M. Galonska et al., IPAC2011 Recent Progress of Heavy-Ion Cancer Radiotherapy with NIRS- HIMAC, K. Noda et al., accapp2013 Synchrotron-based facilities Large facilities with 3 treatment rooms or more High costs 34

35 Light Ion Beam Therapy Facilities: Dual particle beam facilities Mitsubishi proton only Mitsubishi proton and carbon ions 35

36 Light Ion Beam Therapy Facilities: Multi-room proton therapy facilities Cyclotron or Synchrotronbased facilities Large facilities with 3 treatment rooms or more High costs IBA Proteus plus All delivery techniques possible rotating gantries Varian ProBeam multi-room 36

37 Light Ion Beam Therapy Facilities: Compact proton therapy facilities IBA Proteus one rotating gantry Compact facilities Lower costs Full technology: Gantry/IMPT/CBCT/Gating capabilities, etc. Varian ProBeam single-room rotating gantry 37

38 Light Ion Beam Therapy Facilities: Compact proton therapy facilities Protom Radiance rotating gantry Synchrotron based Multi-level building capabilities 330 MeV towards proton radiography 38

39 Light Ion Beam Therapy Facilities: Compact proton therapy facilities Mevion S250 series ~180 0 rotating gantry Gantry mounted cyclotron No beam line required Scanning not yet FDA 39

40 Outline Accelerators Beam delivery techniques Gantries Patient positionning and imaging Light Ion Beam Therapy Facilities New technologies at MedAustron 40

41 New technologies at MedAustron: Sandwich-Technology Excavation material used for radiation protection: m³ concrete saved tons of reinforcement steel saved 6 month construction time saved truck movements saved

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 42

43 New technologies at MedAustron: Patient positioning and Imaging Ring Optical tracking and positioning accuracy 43

44 ImagingRing Single source dual energy X-ray kv

45 ImagingRing Single source dual energy X-ray 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 46

47 New technologies at MedAustron: Collision avoidance system for planning 47

48 New technologies at MedAustron: Raysearch TPS with user customizations 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 48

49 Conclusion 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. LIBT Technology Patient positionning and alignement systems Medical software systems Accelerator Beam delivery techniques Gantries 49

50 Thank you!