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PROTONPHOTON
© 2018 Ion Beam Applications SA. All rights reserved.
Comprehensive approach to motion management
Sofie Gillis
Clinical Solution Group
IBA CONFIDENTIAL2
From translational Research to Clinical adoption & Patients
Short Medium Longer
Treatment of moving targets Proton Arc Therapy Flash Therapy
IBA CONFIDENTIAL
Collaborative research is part of our DNA
Research partners▪ Massachussets General Hospital Burr Proton Therapy center [US]
▪ University of Florida Health Proton Therapy Institute [US]
▪ University of Pennsylvania Roberts Proton Therapy Center [US]
▪ Massachussets Institute of Technology [US]
▪ Northwestern Medecine Chicago Proton Therapy Center [US]
▪ Willis-Knighton Cancer Center [US]
▪ Texas Center for Proton Therapy [US]
▪ Beaumont Health System [US]
▪ Miami Cancer Institute – Baptist Health South Florida [US]
▪ MD Anderson Cancer Center [US]
▪ Memorial Sloan Kettering Cancer Center [US]
▪ Fermilab [US]
Research partners▪ Institut Curie [FR]
▪ Proton Therapy Center Czech [CZ]
▪ APSS Azienda Provinciale per I Servizi Sanitari [IT]
▪ Universitatklinikum Carl Gustav Carus [DE]
▪ Cyclhad – Cyclotron for Hadron Therapy [FR]
▪ Universitair Medisch Centrum Groningen – UMCG [NL]
▪ Universitair Ziekenhuis Leuven [BE]
▪ Centre Oscar Lambret [FR]
▪ Universite Paris-Sud [FR]
▪ Université Lyon 1 [FR]
▪ University College London Hospital [UK]
▪ Université Catholique de Louvain [BE]
▪ Université Libre de Bruxelles [BE]
▪ Université de Liège [BE]
▪ Erasmus Medisch Centrum [NL]
▪ Heidelberg Ion Therapy [DE]
+90
North AmericaClinical partners▪ Massachussets General Hospital Burr Proton Therapy center [US]
▪ University of Florida Health Proton Therapy Institute [US]
▪ University of Pennsylvania Roberts Proton Therapy Center [US]
▪ Hampton University Proton Therapy Institute [US]
▪ Oklahoma Procure Treatment Center [US]
▪ Northwestern Medecine Chicago Proton Therapy Center [US]
▪ New Jersey Procure Treatment Center [US]
▪ Seattle Cancer Care Alliance Proton Therapy Center [US]
▪ Provision Center for Proton Therapy [US]
▪ Willis-Knighton Cancer Center [US]
▪ Texas Center for Proton Therapy [US]
▪ Beaumont Health System [US]
▪ Miami Cancer Institute – Baptist Health South Florida [US]
Europe, Middle East, AfricaClinical partners▪ Institut Curie [FR]
▪ Proton Therapy Center Czech [CZ]
▪ Westdeutsches Protontherapiezentrum Essen [DE]
▪ APSS Azienda Provinciale per I Servizi Sanitari [IT]
▪ Universitatklinikum Carl Gustav Carus [DE]
▪ Skandionkliniken [SW]
▪ Bronowice Cyclotron Center – IFJPAN [PL]
▪ Centre Antoine Lacassagne [FR]
▪ Cyclhad – Cyclotron for Hadron Therapy [FR]
▪ Universitair Medisch Centrum Groningen – UMCG [NL]
▪ Universitair Ziekenhuis Leuven [BE]
▪ Proton Partners International – Newport [UK]
▪ Proton Partners International – Newcastle [UK]
▪ Proton Partners International – London [UK]
▪ Proton Partners International – Reading [UK]
▪ Proton Partners International – Undisclosed [UK]
▪ Proton Partners International – Abu Dhabi [UK]
Asia PacificClinical partners▪ Wanjie Proton Therapy Center [CN]
▪ Korea National Cancer Center [KR]
▪ Apollo Proton Therapy Center [IN]
▪ Changhua Christian Hospital [TW]
▪ Narita Memorial Hospital [JPN]
▪ Kojinkai Hokkaido Ohno Memorial Hospital [JPN]
▪ Guangdong Hen Ju Medical Technologies [CN]
▪ Zhuozhou Proton Therapy Center [CN]
▪ Taipei Medical Hospital [TW]
▪ Tata Memorial Centre [IN]
▪ Qingdao Zhong Jia Lian He Healthcare [CN]
▪ Beijing Proton Medical center [CN]
RussiaClinical partners▪ Federal High-Technology Center for Medical Radiology FMBA [RUS]
+300
Latin AmericaClinical partners▪ Centro de Protonterapia y Tecnicas Avanzadas de
Tratamiento - Insituto de Oncologica Angel Roffo
Hospital [ARG]
▪ LMU [DE]
▪ MedAustron [AT]
▪ Paul Scherrer Institute [CH]
▪ CNAO [IT]
▪ INFN [IT]
▪ ...
Clinical & research
collaborations
Patents
IBA CONFIDENTIAL4
50 partners perfecting
cancer care
Experienced community in proton therapy
IBA CONFIDENTIAL
Collaborative research for the treatment of Moving Targets
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IBA’s Clinical Partners IBA’s Technology Partners
Treatment of moving targets
IBA CONFIDENTIAL
Challenges in moving targets
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Motion of the tumor itself
and its reproducibility
Cold/hot dose spots due to interplay
between tumor and PBS delivery
IBA CONFIDENTIAL
Effect on the dose delivery
Ensure that the dose is well delivered to the tumor
IBA CONFIDENTIAL9
0
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T1 T2 Stage 3
Scattering
Photons
PBS
PBS withRepainting
0 2 4 6 8
Free breathing 50%
Gating 29%
Breath hold 21%
5 mm - all
10 mm - max
4D
CT2D 50%
CBCT 31%
CT 15%
5-10%
100%
of patients basedon CBCT and CT
of centers
Globally
▪ Simulation of motion
▪ Ensure planning hypothesis
US
▪ Patient reimbursement
▪ Standard (2Gy)
▪ Medium hypo fractionation (10-12 F)
▪ Hypo fractionation
Tumor localization Beam delivery technique
Motion management
Dose Planning imaging Treatment imaging Plan adaption Challenges
Accepted motion
For free breathing
Margin
▪ 3.5% + 1mm
▪ 3,5% + 3mm
▪ CTV(8mm) + PTV
(5mm)
▪ CTV robust
▪ MIDP
▪ ITV
▪ In house tool
▪ …
▪ Growing number of patients treated with protons for moving
tumors
▪ High heterogeneity of solutions used
▪ No single solution fits all
▪ Challenges in interplay evaluation and imaging during treatment
IBA CONFIDENTIAL10
Use case at the Texas Center for Proton Therapy
IBA CONFIDENTIAL11
Proteus®CLASS
The most comprehensive integrated solution to treat Moving Targets
▪ Motion Assessment
▪ Motion Control
▪ Motion Irradiation
▪ Motion Imaging
IBA CONFIDENTIAL
IBA personalized approach to motion management
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Motion
management?Not needed
Patient specific
motion mitigation
Verification if
planning hypothesis
remains valid
Apply motion
mitigation as
planned
PLANNING PHASE TREATMENT PHASE
no
yes
IBA CONFIDENTIAL13
Proteus®CLASS
Motion Assessment
IBA CONFIDENTIAL
Interplay is patient and machine specific
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PTV
motion & interplay
motion only
planning
planning motion only motion & interplay
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4D robust optimisation 4D robust optimisationLayer repainting
4D robust optimisationvolumetric repainting
Machine-specific interplay assessment and mitigation*
*Work in progress
IBA CONFIDENTIAL17
Proteus®CLASS
Motion Control
IBA CONFIDENTIAL
Integrated with all major motion management systems
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Manufacturer Technology Integration Workflow Clinical
Camera V* Motion detection through images
acquired with fixed camerasV
Camera V** Motion detection through images
acquired with fixed camerasV
Spirometer V* Patients breathe through the
spirometerV
Laser telemeter V** Motion detection through laser V
Compression belt V Compression belt to be installed
on patientsV
* Formal validation by IBA **Validation tests performed by motion management vendor
IBA CONFIDENTIAL
Example of integration - Possibility to connect to 4 external sources (not simultaneously)
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IBA CONFIDENTIAL20
Proteus®CLASS
Motion Imaging
IBA CONFIDENTIAL
The different use cases for motion imaging
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Use Case Free
breathing
Breath hold Gating
Before beam Movie loop*
4D CBCT*
Fast decision and
beam start*
Breath hold CBCT
Gated X-rays
Movie loop*
4D CBCT*
During beam
pause
Movie loop* Fast decision and
beam start*
Movie loop*
Gated X-rays
*Work in progress
IBA CONFIDENTIAL
Comprehensive imaging solution
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Instantaneous oblique X-Ray imaging Cone Beam CT at isocenter
Ability to acquire CBCT in
breath hold
Ability to do gating
IBA CONFIDENTIAL24
Work in progress
IBA CONFIDENTIAL
4D-CBCT and virtual 4DCT
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Motion-aware 4D-CBCT reconstruction
▪ Breathing motion quantification
▪ Tumor position verification
Virtual 4DCT
▪ Interplay simulation on daily anatomy
▪ Log-based QA for moving targets
▪ Triggers for treatment adaptation
RTK
OpenRegguiWork in progress
IBA CONFIDENTIAL26
Proteus®CLASS
Motion Irradiation
IBA CONFIDENTIAL
Full flexibility of tools available
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RepaintingUniversal beam triggering
interface with Breath hold,
Gating or Free Breathing
Fast irradiation
15seconds
Layer &
volumetric repainting
Breath hold: 2 Gy in a 5 cm
cube in 15 sec
IBA CONFIDENTIAL29
Proteus®CLASS
Comprehensive integrated solutions
IBA CONFIDENTIAL
IBA personalized approach to motion management
30
Motion
management?Not needed
Patient specific
motion mitigation
Verification if
planning hypothesis
remains valid
Apply motion
mitigation as
planned
PLANNING PHASE TREATMENT PHASE
no
yes
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Thank you
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