enlight ++
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08 November 2006 ENLIGHT++ for KnowARC project 1
ENLIGHT ++
Proton and Ion Therapy“e”-infrastructure for health; “e” for “enhanced,
enabled, excellent”example of choice: Hadrontherapy
Hans F. Hoffmann-PH/CMO
08 November 2006 ENLIGHT++ for KnowARC project 2
What is Health
DefinitionHealth is a state of complete physical, mental and social well being and not only the absence of disease or infirmity
WHO Constitution: The enjoyment of the highest attainable standard of health is one of the fundamental human rights of every human being without distinction for race, religion, political belief, economic or social condition
WHO MissionThe attainment by all peoples of the highest possible level of health
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Prospective for cancer therapy…
Primary tumour Metastasis
Surgery
Medical treatments Hormones; Chemotherapy;
Immunotherapy; Cell therapy; Genetic treatments…
Radiotherapy
Novel specific targets (genetics..)
Conformal RT
High LET particles
Local controlSurvival
Quality of life
(?)
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Hadrontherapy vs. Conventional radiotherapy
Physical dose high near surfaceEffect not localisedBiological effect constantEffective in well oxygenated cells
Dose highest at Bragg PeakEffect is localisedDNA damage less repairable Biological effect highest at maximum depth Effective in poorly oxygenated cells (carbon)
Photons and Electrons vs. Hadrons (protons or light-ions)
Bragg Peak
proton
carbon ion
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Hadron therapy
charged hadron beam
that loses energy in matter
28 cmtumour
target
200 MeV200 MeVProtonsProtons
//
480 MeV480 MeVcarbon ionscarbon ions
Photons ProtonsX raysprotons or
carbon ions
GSI
Protons: ocular melanomas, base skull tumours, cancers close to the spinal cordcyclotrons ~ 3-4 m diameter synchrotrons ~ 6-8 m diameter
Carbon ions: subset of patients with radio-resistant tumors synchrotrons ~ 20-25 m diameter
GSI
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Numbers of potential patients
From studies in Austria, France, Germany and Italy
X-ray therapy
every 10 million inhabitants 20'000 pts/year
Proton therapy
12% of X-ray patients 2'400 pts/year
Therapy with Carbon ions for radio-resistant tumour
3% of X-ray patients 600 pts/year
TOTAL of hadron therapy every 10 M
about 3'000 pts/year
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Hadron therapy status
1954 the first patient treated with protons at the 1954 the first patient treated with protons at the University of California, Berkeley, USA University of California, Berkeley, USA
By 2005 about 50000 patients treated. By 2005 about 50000 patients treated.
Europe is moving coherently towards the realisationEurope is moving coherently towards the realisationof a network of Hadron therapy Centres with of a network of Hadron therapy Centres with 1212C C beams:beams:
The two first ones in Heidelberg and Pavia are foreseen to The two first ones in Heidelberg and Pavia are foreseen to start operation in 2007start operation in 2007France and Austria (approved), MarburgFrance and Austria (approved), MarburgSweden, Belgium, Netherlands, Spain, UK ………..Sweden, Belgium, Netherlands, Spain, UK ………..
Japan has 2 carbon facilities and 4 proton facilitiesJapan has 2 carbon facilities and 4 proton facilities
USA has 2 running proton facilities and various others USA has 2 running proton facilities and various others being plannedbeing planned
08 November 2006 ENLIGHT++ for KnowARC project 8
Provide the irradiation technology and the detection systems to optimally use the advantageous properties of heavy charged particles in external radiotherapy
Optimize dose to tumour conformity by beam scanning and adaptation of the delivery to the organ motion
Treat > 1000 patients per year and perform clinical trials using low-LET (p, He) and high-LET (C, O) beams
Conduct technical, physical and clinical R+D
Hadrontherapy goals
tumour-conformaldose distribution
organs at risk
tumour
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What is ENLIGHT
2002-2005 ENLIGHT (European Network for Light Ion Therapy)
ENLIGHT was composed of: Centres in Heidelberg, Lyon, and Pavia, CERN, EORTC, ESTRO, GSI, Karolinska, MedAustron, TERA
Main achievements:•Creation of a European Hadron therapy Community
•Common multidisciplinary platform with a shared vision
•ENLIGHT catalysed the transition from research to the clinical environment
•Served as a vehicle for education and dissemination
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What is ENLIGHT++
In 2006 ENLIGHT++:
+ one “plus” for more hadrons (specifically protons),
++ the second “plus” refers to more Countries (17 countries,
with 60 Institutions
ENLIGHT++ goes beyond being a network:
Main Objective: challenge for quality and success by being more inclusive and
becoming a research network and an FP7 project
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Present European projects on the same scale
ETOILE
HICAT
CNAO / TERA
MedAustron
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ENLIGHT++ strengths
Success of original ENLIGHT and other pre-existing co-operation
Top research institutes
Scientists working at the cutting edge of knowledge and technologies
Expectations of cancer patients
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ENLIGHT++ ingredients
Networking light ion research:
Clinical StudiesRadiobiology Treatment planning for Intensity Modulated Particle Therapy Adaptive ion therapy and treating of moving organs Novel in-beam PET systemsFeasibility study for innovative gantry designs Information and Communication Technologies for Hadron therapy (this presentation!)
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Outlook
Particle therapy will cover the full spectrum of radiotherapeutical indications
Per 10 million inhabitants one particle therapy facility may be required
Treatments will be fully accepted by the health insurance systems
Pilot “European application of e-Health”?
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ENLIGHT++ challenge
A heterogeneous group - 7 different disciplines-
How to a balance between basic research and the clinical needs?
Many partners. How to collaborate effectively and make progress with the main objectives
Is ion therapy more effective? Will practice validate the theory?
Here: Is Hadrontherapy particularly appropriate for a pilot ICT e-health infrastructure??
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e-Health: Health Care enhanced by ICT
“e-Health”, Healthcare “enhanced” by ICT, deals with the use of ICT to develop intelligently connected infrastructures (very likely “ grids”) that provide:"the right information, at the right time, in the right place"
For ubiquitous management of citizens’ healthTo assist health professionalsTo integrate advances in health knowledge into clinical practiceTo streamline the citizens' healthcare system and To empower the patients to take informed decisions for their well-being
e-Health is an obvious necessitye-Health is also excellent business
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There are many issues
“in the German Health care system every institution in itself is an isolated solution, partially in line with the latest scientific research, but singular. As a rule, the limits of ICT are reached where the resources of one’s own institution are exhausted” (BM Gesundheit)
Making data available in electronic patient recordsSecurity, authentication, access control, anonymity...Using the same vocabularies, ontologies...Provision of sufficient computers and networking infrastructure to Doctor’s practices and hospitalsClinical data restrictions, FDA, (21 CFR part 11...), Also , national practices, . . .Adopting ideas of Collaboration in the Health community and many other issues...But the promise is great... ...and the time is right
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Ingredients of e-health infrastructure
e-health infrastructure itemsPatient cardSpecialist cardPatient file PrescriptionMobile diagnostics attached to patients (RFID, Bluetooth, GSM, . . .)Referral system between hospitalsSecurity, privacy, . . .Distributed data storageStandardised data curationStandard interfacesComputersNetworksPatient empowermentNetworked solutions
HealthGrid: Research Vision
An environment, created through the sharing of resources, in which heterogeneous and dispersed health data :
molecular data (ex. genomics, proteomics)cellular data (ex. pathways)tissue data (ex. cancer types, wound healing) personal data (ex. EHR)population ( ex. epidemiology)
as well as applications, can be accessed by all users as an tailored information providing system according to their authorisation and without loss of information.
Knowledge GridIntelligent use of Data Grid for knowledge creation and tools
provisions to all users
Data GridDistributed and optimized storage of
large amounts of accessible data
Computing GridFor data crunching applications
HealthGrid: State-of-the art and next steps
Computing Grid
Data Grid Knowledge Grid
Image storage and accessibilityEx.: MammoGrid
Modeling, simulation, algorithmsEx.: Gemss, Data Grid, CrossGrid
Image analysisEx.: MammoGrid
Bio-informaticsEx. BioGrid
Drug discovery
Disease related Grids
Radiotherapy
Real time operational assistance
Epidemiology
Current applicationsNext application fields
HealthGrid: Research Challenges
Highly Distributed sources of health data, with strong privacy rules Semantic integration - building on the results related to interoperability of Electronic Health Records and research data Algorithms for search, data mining and knowledge retrieval based on advances in language understanding
Privacy and Security Adopting existing solutions to the Grid High reliability of system must be proven
User friendliness and acceptance Need to provide fast and easy to use tool at the point of need Very heterogeneous user community - health professionals,
researchers, authorities, patients Organizational and cultural issues related to new ways of working and virtual collaborations
From technology to a solution in Healthcare Political awareness and understanding Business models Legal and ethical issues
HealthGrid: Implementation questions
1) What could be the role of HealthGrid in meeting the challenges in managing the the rising costs, growing demands from consumers (patients; citizens) and demographic changes, aging population?
2) Can HealthGrid play a role as an enabling tool for reorganisation of the healthcare systems and can the needed training be provided ?
3) How can we assure a maximal user acceptance and user friendly technologiesand standards ?
4) What is needed in order to be able to promise respect of legal, security and privacy ? Do we have convincing proofs today or is there still homework to be done ?
5) Can we convince industry to invest in HealthGrid and which part of it ?
6) Can HealthGrid find its place in the general strategy of health informationnetworks ? Can it become a leader ?
7) Can HealthGrid find its place in the general strategy of online health services ?
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WP 7 – ICT Network for Particle Therapy
ENLIGHT++ - Meeting, CERN, March 24th, 2006
Reflections on requirements of e-hadrontherapy
(T. Auberger‘s (radio-onkologist‘s) slides)
Requirements are the domain of the users of a project:What to achieve
Specialists: How to do it
Execution: in continuous collaboration
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network of European ion therapy centres
national network between user groups and a central ion therapy centre
Two Versions of Network for Particle Therapy
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Questions
Why do we need a network?What is necessary for an European network and for a national network ?What do we have to do?Proposals ?What do we need for our work ?
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Why do we need a network?
I) European Network of Ion Therapy Centres
Communication between European ion therapy centresVideo conferences replace meetingsExchange of know howMutual treatment strategies and protocols
Exchange of technical parameters Unique definition of treatment parametersStandardized technical parameters
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Why do we need a network?
I) European Network of Ion Therapy Centres
Preparation of clinical multi-centre trialsInput of patient and treatment data, diagnostic imaging, image fusion, comparisons of treatment planningonline planning
Mutual data libraryrare tumour entitiesunique statistics
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Why do we need a network?
I) European Network of Ion Therapy Centres
Coordination of non clinical researchMutual scientific proposalsDistribution of beam time and programmes
(i.e. for radiobiological research of countries which don’t have facilities)
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Why do we need a network?
II) National network between user groups and a central ion centres (1)
Information and training of users (peripheral hospitals)Definition of standards on diagnostic and clinical preparation of patientsNationwide and bilateral video tumour boardsRapid exchange of patient and treatment data (mutual electronic patient files?)
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Why do we need a network?
II) National network between user groups and a central ion centres (2)
Adjustment of treatment modalities in combined therapy regimes
(summarizing doses from different treatment plans, online treatment planning )
Patient preparation and follow-up under observation of ion centres
National tumour libraries
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What is necessary for an European network and for a national network ?
Common structure in medical and scientific strategyUnique acquisition of patient and treatment dataUnique definition of beam and planning dataEuropean clinical study protocols
Necessary technical supportTelecommunication systemsUnique electronic patient files ?unique treatment planning systems ?image data and planning data transferone mutual definition on software for international trials
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What do we have to do?
Medical and scientific structure
Evaluation of the national medical infrastructure in various European countries
Technical solution, which regards this existing infrastructure or alternative ways
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What do we have to do?
Medical and scientific Structuremutual treatment strategies and guidelines for preparation of patients, diagnostics, follow-uppreparation of unique clinical trials regarding system not contents (protocols) ?tumour libraries (indications? –what has to be stored and how?)organisation of non-clinical research
(if appreciated?)
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What do we have to do?
Evaluation of national medical infrastructure in various European countries
video tumour boardsorganisation of patient preparation and follow-updocumentation of treatment resultsdata formatspatient files and imaging data (storage, transfer)electronic communication systemsCompatibility of treatment planning systems electronic epidemiologic registriesSoftware for support of clinical studies (ARCS ?, other
commercial and non-commercial systems?)
08 November 2006 ENLIGHT++ for KnowARC project 35
What do we have to do?
Technical solution
commercial and non commercial systems (advantages and disadvantages)
costs and requirements of installationcompatibility with existing infrastructure and
running or planned technical equipment
08 November 2006 ENLIGHT++ for KnowARC project 36
Proposals
Learn from - integrate existing projects:MammogridHealth-e-child . . .
08 November 2006 ENLIGHT++ for KnowARC project 37
What do we need ?
Experts/scientific assistants onradio oncologymedical physicsICT
Reimbursement ofTravelling costsCommunication costsSoftware/hardware ?
(hfh): Connect “stand alone” solutions, solve, satisfy:Private interests of firms providing case solutionsLimited/local perspective of the usersIP
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Conclusion for Enlight++ e-infrastructure
There are various reasons to build up an international network and national networks as well
Step 1 - (medical point)development of a common medical and scientific strategy
Step 2 – (medical, technical)evaluation of current national infrastructure
Step 3 – (technical)evaluation of a technical solution for an international network which goes ahead with national development
Step 4 – (medical, technical)pilot projects which will prove the efficiency of proposed solutions
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