ion beam facilities from a medical perspectiveerice2009.na.infn.it/talkcontributions/linz.pdf ·...
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
Ute Linz
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• outline •
� Basic Principles
� Recent Developments
� Future Ideas
� Addendum
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• basic guiding principles •
What is best for the patient?What can maximize efficiency?
New technological developments
In the clinic conservatism is an asset!
Clinical specifications
Technical requirements
Phase I Phase II
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• basic design and construction principles •
robustness
fault-tolerance
reliability
flexibility
precision
reproducibility
minimize patient presence and treatment time
w/o sacrificing safety and outcome
Reliability
Safety Flow
IdealCare
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• example: system reliability •
planned uptime: 3600 hours/year
12 hours/day
6 days/week
50 weeks/year
availability: ≥ 98% or ≥3500 hours/year!
breakdown or delay may reduce chance of cure
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
NS-FFAGlength: ≈ 15 mØ: 12 mweight: 5-6 t?range: 25-27 cmfield: Ø 18 cm
7.1
m
16.5 m
• ion gantry •
HIMAC IIlength: 17 mØ: 14 mweight: 300 trange: 25 cmfield: 15x15 cm2
yet to be realizedyet to be realized
HITlength: 25 mdiameter: 13 mweight: 600 trange: 30 cmfield: 20x20 cm2
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• proton tomography •
low attenuation
high density resolution
direct visualization of proton range
more accurate patient positioning
improved dose verification
219 MeV protons
50 kV photons
mod
if. fr
om S
chne
ider
, 199
5
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• proton tomography •
cylinder
75 kV X ray
identical density resolution at ≤ dose
1% relative density resolution at ≤ 10 mGy
mod
if. fr
om S
chul
te e
t al,
2005
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• proton tomography: why not realized? •
cost and priorities
proton gantry necessary to collect 3D patient data
rapid 3D reconstruction methods required for visualizatio n
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
� for X-rays and ions alike
� supporting active and passive irradiation modes
� data from various imaging systems accepted
� accounting for biological response including effects from vascularization and internal organ structure
� accounting for spatial and temporal changes
• treatment planning •
one-fits-all rather than one-for-each
biologically optimized intensity-modulated dose del ivery
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• treatment planning •TRiP
Tomorrow: RBE calculation with individually determined α⁄βα⁄βα⁄βα⁄β?
Today: RBE calculation with averaged published α⁄βα⁄βα⁄βα⁄β
Sch
olz
& E
lsae
sser
, 200
7
Kra
ft &
Kra
ft, 2
009
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• compact accelerator •
Mitsubishi COMPACT
Schönauer, 2007
Ion Energy (MeV/u) Field (T) Ø (m)H 200 3 3.6C 300 4 5.2
yet to be realized!
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• safety issues •
Health problems of pediatric cancer survivors:
2/3 have 1 chronic problem1/4 have ≥ 3 chronic problems
such ascardiovascular diseasekidney diseaseendocrine abnormality cognitive dysfunctionsecond cancer
NCI Bulletin, 2008:30 yrs after primary cancer treatment 70% of childhood c ancer survivors have a late-effect chronic health condition
active and passive safety measures for patients and staff
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• safety issues: neutrons •
author beam range neu/prim ion norm tissue(MeV/u) in water (cm) neu dose(mSv/GyE)
1 1H (177) 30.1 0.025 2.3± 30%
2 12C (200) 12.8 0.54 5.4±20%
Data from:1) Schneider et al, 20022) Gunzert-Marx et al, 2008
C/H ≈ 2x fortotal neutron dose!
for scanned beam*
*for scattered beam: neutron dose ≈ 10x higher!
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• safety issues •
time
shieldingrapid verification of and response to abnormal settings3D dosimetrycorrection for target motion
distance
simulationremote control and
monitoringrobotic assistance
minimize stray radiation and activation
scanning vs. scatteringmaze structures
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• low-cost system •
llnl.g
ov
claims:R < 3 mvariation of• intensity• energy • spot sizeat f > 10 Hz
beam scanningby
distal edge tracking
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• low-cost system •
still
river
.com
superconductingsynchrocyclotron
cost ≤ 30 M US$?
needs FDA approvalbeam scanning?
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
•• lasers for compact lasers for compact IB IB facilitiesfacilities ? ? ••
Malka et al, 2004
crude concept crude concept of a of a compact laser driven proton therapy compact laser driven proton therapy systemsystem
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
•• CNRS CNRS concept concept of of compact lasercompact laser --driven proton therapy driven proton therapy ••
2010?
CN
RS
, 200
6
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
•• the the "" Flagship ThemeFlagship Theme " of PMRC " of PMRC ••
Bolton, 2008
5 m
~ 20 m
JJ--KAREN "table KAREN "table toptop " " laserlaser
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
•• do do lasers help realize compact lasers help realize compact IB IB facilitiesfacilities ? ? ••
required upscaling :
beam energy: 5-10x (H)
energy variation: ≥100x
intensity: ≥ 100x
unsolved issues :
beam control ?
dose control ?
reproducibility ?
reliability ?
safety ?
cost ?
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
•• do do lasers help realize compact lasers help realize compact IB IB facilitiesfacilities ? ? ••
required upscaling :
beam energy: 5-10x (H)
energy variation: ≥100x
intensity: ≥ 100x
unsolved issues :
beam control ?
dose control ?
reproducibility ?
reliability ?
safety ?
cost ?
an ion beam of the proper energy is necessarybut
not sufficient to make a successful IBT system!
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
•• lasers for medical ion beamslasers for medical ion beams : : further reading further reading ••
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• the ideal ion •
high LET in Bragg peak
low LET in entrance channel
minimum fragmentation tail
low neutron dose
low production cost
increase BED to tumor
spare normal tissue
reduce risk of long term damage
improve cost-effectiveness
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• the ideal ion •
1H: 48 µm* 7Li: 4.8 mm*
12C: 51 mm*
Data: Kempe, 2007
*high-LET zone:> 20 keV/µm
25% high LET
low LET
tail dose
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• the ideal ion •
Data: Kempe, 2007
Late
ral P
enum
bra
Nucleons
Longitudinal S
traggling
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• summary: wish list •
flexible beam delivery
biological treatment planning
proton CT
safety
ideal ion
compact accelerator
less bulky ion gantry
Cost reduction
Quality improvement
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Ion Beam Facilities from a Medical Perspective
Linz-MediConsult Forschungszentrum Jülich
• Acknowledgements •
Many Thanks to
Hiroshi Tsujii, NIRS
Reinhard Schulte, LLUMC
Eugen Hug, PSI
and the
Organizers of the Workshop