electron linear accelerator for radiotherapy · electron linear accelerator for radiotherapy...
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Electron linear accelerator for radiotherapy
ChuanxiangTang/HaoZha
TsinghuaUniversity,Beijing100084,China
AtAFAD2018(9thAsianForumforAcceleratorsandDetectors),January28-31,2018,DaejeonConventionCenter,Daejeon,Korea
Jan. 28/Sunday
17:00 – 20:00 Registration and Reception (DCC 201)
Jan. 29/Mon. Jan. 30/Tue. Jan. 31/Wed.
Morning Opening & Plenary Working Group Excursion
(09:00 – 18:00) Afternoon Working Group
(Banquet) Plenary & Closing
(Lab Tour)
Registration Counter & Information Desk
Jan. 28 17:00 –20:00 DCC 201
Jan. 29 08:30 –17:00 DCC 1F
Jan. 30 08:30 –17:00 DCC 1F Conference Venue Plenary session: DCC Conference hall, Room 301 Parallel session: DCC 1F WG1: Room 101, WG2: Room 102, WG3: Room 103, WG4: Room 104 WG5: Room 105, WG6: Room 106, WG7: Room 107
AFAD2018
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Outline
• Briefoverviewofradiotherapy
• Recentdevelopmentsinmedicalelectronlinearaccelerator
• ActivitiesinTsinghuaUniversity
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Cancer worldwide
Cancer
8.8M
Heartdisease
8.76M
Stroke
6.24M
Top3causesofdeathworldwide,2015(DatafromWHO)
2000
10M
2012
14M
2025
19M
Annualcancerincidentworldwide(DatafromWHO)
• Cancerhasbeenthefirstkillertohumanbeings;
• Incidenceofcancerisrisingrapidly.
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Radiotherapy
Factsaboutradiotherapy(Datafromhigh-incomecountries,2012,IAEA) Patientsneedradiotherapy
60%
5%
Costofradiotherapy/Costinallcancertreatments
18%
Patientscuredbyradiotherapy(5-year-survival)
Total5-year-survivalrate(45%)
• Surgery,chemotherapyandradiotherapyarestillthemostlyusedtreatmentsofcancer.
• Radiotherapy(radiationtherapy)hasahighcost-effectivenessratio.
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How does radiotherapy kill the tumor cell?
X-rayIonizing
O-(OH)Freeradicals
DNADNArepair
Damage
Succeed
Failed Death
biologychanged
Trigimmuneresponses
HowdoesX-raykillthetumorcell?
Unabletoreproduce
• RadiotherapyuseionizingradiationtobreaktheDNAoftumorcells(alsoharmsthenormaltissue,whichisthesideeffect).
• Usually,atumorcellshaslessabilitytorepairitsDNAandthusiseasiertobekilled.
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History of X-ray radiotherapy
• X-raywasusedtotreatthecancelpatientin1896.• AfterWW-II,hazardsofionizingradiationweremoreclearlyunderstood.Manytechnologiesweredevelopedtoreducetheradiationdoseonnormaltissues.
1895…1950196019701980199020002010X-raydiscovery LINAC IGRT&SBRT
MLC CBCT
PicfromWikipedia
IMRT&VMATCRT
CT&MRI
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Electron LINAC in radiotherapy
• ElectronLINACswerefirstusedinradiotherapysince1950s.
• NowmostmachinesuseElectronLINACsastheX-raysources.
• 6MVisthemost-oftenchoiceoftheLINACvoltage.
High-energy(e.g.14MV)machine:Duetothediameterlimitation,LINACshouldbeplacedhorizontally.Andamagnetisusedtobendthebeam.
Low-energymachine:LINACisshortandcanbeverticallyplaced.
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Outline
• Briefoverviewofradiotherapy
• Recentdevelopmentsinmedicalelectronlinearaccelerator
• ActivitiesinTsinghuaUniversity
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Recent developments • Spatialresolution(inpositioningthetumor)isacrucialfactorinradiotherapy.
• Higherresolutioncanbring:• Lesssideeffect,increasesthequalityoflife;• Abletodeliverhigherdose,increasesthecurerate.
PTVwithoutimage-guided
PTVwithImage-guided
Tumor
Uncertaintyofthetumorposition
PTV:planningtargetvolume Dp(DimensionofPTV)=Dt(Dimensionoftumor)+5xσ(Spatialresolution,RMS)Ifthesizeofatumor=3cm: σ Dp Volumeof
PTV/tumor 0.5mm 3.25cm 127% 1mm 3.5cm 159% 2mm 4cm 237%
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IGRT: Image-guided radiotherapy
• Sub-millimeteraccuracyisgoingtobeneededinradiotherapy.
• IGRT:twofunctions(imaging,treatment)inonesystem/machine.
Schemeofimaging Precision
Ultra-sound >5mm
Externalmarker(Optical) >2mm
Internalmarker(Magnetical) >1mm
Fluoroscopy Unknown
CTonrail 1mm
PET Unknown
KVX-ray/CBCT 1-2mm
MRI <2mm
Coaxial2DX-ray <2mm
Candeterminepositionandvolumeofthetargetbeforedeliveringthedose(OfflineIGRT)
Cantrackpositionandvolumeofthetargetduringthedosedelivery(Online/real-timeIGRT)
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KV X-ray imaging
• Imagingsystemonthegantry.RotateforCTimaging(Cone-BeamCT).
• Higherresolution;• Largeextradose(ofimaging);• Longertime;
Linactube
KV-Xraysource
Imagingboard
Variantruebeam
• Imagingsystemnotonthegantry.Twoorthogonalimagingdevices:
• Lowerresolution;• Fastandlessdose;• Realtimetracking;
PicfromStonybrookcancercenter
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Coaxial imaging (Dual energy LINAC)
• IfImagingsystemandLINACtubeareindifferentcoordinatesystem→Needtransformation→Systematicerror(~1mm).
• IfLINACcandotheimagingwork,thesystematicerrorcouldbeeliminated.
• However,MVimaginghaspoorquality.
• KV/MVdualenergytubeisunder-developing.
KVimaging MVimaging
Patient
LINAC
Imagingboard Patient
LINAC
Highenergyfortreatment
Lowenergyforimaging
http://dx.doi.org/10.1155/2014/705604
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MRI+LINAC • MRIcouldyieldhighqualityimagingonsofttissueandwithnoextradose.
• MRI+LINACsystemisnowunder-developing.
• Difficulties:• EffectofstrongalternatingB-fieldonthelinactube;• ImagingtimeofMRIisquitelong;• … ElektaMRI+LINAC
RoboticMRI+LINAC(StanfordUniv.)
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SBRT: Stereotactic body radiotherapy.
• Radiotherapytreatmentisdividedintomanyfractions:• letthenormaltissuehavetimetorecover(repairDNA);• Reducetheriskonnormaltissueduetoerrorinpositioning.
• HighresolutionIGRThasasignificantlylessdoseonnormaltissue→allowhigherdoseperfraction(lessfractions)→SBRT.
2Gy 2Gy 2Gy 2Gy
2Gy 2Gy 2Gy 2Gy
…
2Gy 2Gy 2Gy 2Gy
Conventional:60Gy=2Gyx30days
15Gy 15Gy 15Gy 15Gy
SBRT:60Gy=15Gyx4days
Improvetreatmenteffectontumorcells
Lesstreatmenttime
Moreeffective
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Higher dose rate
• SBRTneedlargedoseperfraction→increasingthedoserateoftheLINAC:
• Higherpowersource(magnetron)/OptimizingonRFstructure;• Workonflat-filter-free(FFF)mode→2timeshigheron-axialdose→TPS(dose-planningsystem)ismorecomplex.
E2VMG7095magnetronPeakpower:3.1MW
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Flexible LINAC
• Ifpatientreceiveradiotherapyfrommoredirections,themaximumdoseonnormaltissueisreduced(lesssideeffect).
• C-band/X-bandLINAChaslessweight→moreflexibleframe→providemoredirection.
• lessweightofLINAC→higheraccuracyinpositioning.VeroSBRT:C-band CyberknifeRoboticRT:X-band
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Outline
• Briefoverviewofradiotherapy
• Recentdevelopmentsinmedicalelectronlinearaccelerator
• ActivitiesinTsinghuaUniversity
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History in Tsinghua accelerator lab
• WebuiltfirstmedicalLINACinChina:BJ10(in1970s)
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History in Tsinghua accelerator lab
1974
1977
1987
1993
1998
2003
2006
2009
2012
2016
2018
ü Convened a research group of more than 40 institutes to develop the first medical electron linac in China;
ü BJ-10 travelling wave linac(10 MeV electron) ü 4 MeV axis-coupling linac ü 14 MeV linac ü Multi-energy linac (6~20 MeV) ü Dual-beam linac (X-ray/electron) ü Dual beam energy linac (kV/MV) ü Electron standing wave linac for IMRT ü C-band 6 MeV linac (1000 rad/min, 40 cm) ü High dose rate 6 MeV linac(1400 rad/min) ü X-band 6MeV linac (expected: 800 rad/min)
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kV/MV coaxial LINAC
• Wefabricatedaprototypelinactubein2007andsuccessfullydemonstratedtheenergyswitching(6MVto600kV).However,therearestillsomechallenges:
• Doserateisnothigh(about800cGy/min@1meter)• Linactubeisworkingnotstablyatlowenergystate(600kV)
Fullradiotherapymachineprototype(developedbyNUCTECH.Inc,China) kV/MVLinactube
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S-band large dose-rate LINAC
• AfullmoduleofX-raysource:magnetron+waveguide+linactube(withshielding),weight=500kg.
• Mechanicallyadaptedformanykindofradiotherapymachines;• Controlitlikeastepmotor:trig→trytodeliveradoseunit(1MU)→feedbacktherealdose;
• Pinsarereservedtoalignedthelinactube(bytwistingthem).
Pinsforalignment
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C-band medical LINAC
• WedesignedandtestedaC-band6MeVLINACin2013.
• Thedoserateispromising(1000cGy/min@1m).
Frequency 5712MHz Power 2.1MW Peakbeamcurrent 130mA Doserate(at1mwithdutycycleis0.1%)
1000cGy/min
Captureratio 32.8% SpectrumFWHM 0.1MeV(1.5%) RMSspotsize 1.4mm AcceleratingCellnumber. 13cellsAcc.structurelength 29cm Shuntimpedance 130MΩ/m
ParameterofC-bandmedicallinacdesign C-bandmedicallinactubeTotallength:40cmWeightofthetube:7kg
https://journals.aps.org/prab/pdf/10.1103/PhysRevSTAB.16.090102
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C-band medical LINAC
• TheLINACinstalledatitaniumwindowatitsend.Sothatwecanmeasureparametersoftheoutputelectronbeam:
• Spotsize:lessthan1.5mmJ• SpectrumFWHM:0.4MeVL(expected0.1MeV,mayduetojitterinthepowersource)
1mm
Spectrumvspower
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X-band medical LINAC
• X-bandmedicalLINACiscompactbuthaslowerdoserate.
• WearedevelopingahighdoserateX-bandlinac• 40cmstructurelength• 800cGy/min@1meter
X-band
S-band
C-band
S-band X-band
1250 kg
450 kg
Total weight of Linac
TypicaloutputpowerofX-band(9300MHz)magnetrons
Cyberknife
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X-band medical LINAC
• WedevelopedanX-bandtubeintheyear2000(olddesign).ThenewX-bandtubewillimproved:
• Morepowerfulsource(expect1.7–1.8MW)• Increasetheshuntimpedance• Increasethecaptureratio(lesspowerabsorbedbyun-capturedbeam)• Optimizethebeamspectrum.
Olddesign
Improvepowersource
Optimization
Olddesign:Inputpower=1.2MWDoserate=300cGy/min@1m
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Thanks