Facilities for HADRON-TherapyICFA-2008, Stanford Hartmut Eickhoff, GSI Accelerators for medical...

ICFA-2008, Stanford

1Hartmut Eickhoff, GSI Accelerators for medical applications

Facilities for HADRON-Therapy

Concepts, status, developments

H. Eickhoff GSI/Darmstadt

ICFA-2008, Stanford

ContentsContents

1. Principles, requirements

2. treatment modalities

3. existing and projected facilities for hadrontherapy

4. future developments

ICFA-2008, Stanford

DemandsDemands

Localised tumours: 58% Metastatic tumours: 42%

Surgery: 22%

Radiotherapy: 12%

Chemotherapy: 5%

Palliative treatments: 37%

Surgery+radiotherapy: 6%

Failure of local control: 18%

protons and ions have the potential to cure 30000 patients /year in the EC

ICFA-2008, Stanford

principles, requirementsprinciples, requirements

Radiotherapy principle

Destruction of a localised cancer via irradiation with ionising radiation

and at the same time

Maintaining of dose in the surrounding healthy tissue in tolerable limits

ICFA-2008, Stanford

General requirements

for applied particle species

• adequate depth-dose-profile (large dose at tumour, low dose outside of the tumour),

• low lateral straggeling (better tumour confirmation),

• low side effects (e.g. low fragmentation)

For beam properties• sufficient max. beam intensity for dose request• sufficient energy to achieve requested penetrationdepth (e. g. 30 cm in tissue)• adequate beam widths at the patient

ICFA-2008, Stanford

General requirements

for technical installations

• cost effectiveness (investment and operation costs)

• good availability, reliability

• adequate solution for treatment modalities (e.g. treatment planning programme, patient-, beampositioning control)

• close connection to medical environment (integrationin clinics)

ICFA-2008, Stanford

Treatment modalitiesdepth dose profile

Photons:

Exponential dose-decrease

Protons, Ions:

‚ inverse depth‘-doseprofile (Bragg-peak)

ICFA-2008, Stanford

Treatment modalitiescomparison p, Ions

Treatment with C-Ions Better ratio of dose inside/outside tumor volume (larger RBE-factor)Only small enhancement of beam diameter vs. penetration depth -> better control for deep seated tumors Online dose-control possible (Positron Emission Tomograph)

Treatment with protons Large medical data base for proton treatments available

ICFA-2008, Stanford

Treatment modalitiesComparison photons, ions

Carbon-Treatment (2 fields)Photon-Treatment

(IMRT, 9 fields)

Dose-Distribution

ICFA-2008, Stanford

Treatment modalitiestreatment technique: ‚passive‘

- constant beam properties(accelerator)

- Mechanical devices foradequate manipulations of beam properties

- fragmentations

- not optimal tumouradaption

ICFA-2008, Stanford

Treatment modalitiesSpread out Bragg-peak (SOB)

Sequential treatment Irradiation with different energies => slicing of the tumor in isoenergetic planesIntensity variation per plane to get flat dose distribution

ICFA-2008, Stanford

Treatment modalitiesTreatment technique: Rasterscan-Method

Intensity-controlled Rasterscan-method

ICFA-2008, Stanford

Treatment modalitiesthe rasterscan methodTreatment modalitiesthe rasterscan method

Parameter (GSI-project):

• 255 energy-steps(88-423 MeV/u)

• 15 intensity-steps(106-108 ions/puls)

• 7 beamwidths( 4-10 mm FWHM)

ICFA-2008, Stanford

Treatment modalitiesIntens-contr. Rasterscan-method

Beam-Position feed-backIntensity-distribution (isoenergy-slice)

Feed-back Scanner /MWPC

with feedbackwithout feedback

Preirradiation has to be considered _> highly inhomogenious distribution

ICFA-2008, Stanford

Existing and projected facilitiesfacilities in operation

fac. out of operation

P: 10243

He: 2054

Pions: 1100

C-ions: 433

fac. in operation

P: 39000

C-ions: 3300

ICFA-2008, Stanford

Existing and projected facilitiesfacilities planned / under constr.-1

2009 ?31 gantry2 horiz.

230cyclotron

pSouthAfrica

iThemba

200954 gantries1 horiz.

230cyclotron

pUSAUpenn

230cyclotron

pKoreaNCC, Seoul

2010 ?21 gantry1 horiz.

230cyclotron

pItalyTrento

2007/08(OPTIS2/Gantry2)

3additional Gantry, 2D parallel scanning,

1 horiz.

250sccyclotron

pSwitzerlandPSI, Villingen

200754 gantries withscanning,

1 horiz.

250sccyclotron

pGermanyRPTC, Munich

START OFTREATMENTPLANNED

NO OF TREATM.

BEAMDIRECTION

MAX.CLINICALENERGY(MEV)

PARTICLECOUNTRYWHO,WHERE

ICFA-2008, Stanford

Existing and projected facilitiesfacilities planned / under constr. -2

2009synchrotronP, ionJapanGunma

2010 ?41 45 degr. fixed,

3 horiz.

430/usynchrotron

P, ionGermanyPTC, Marburg

2011 ?3-42 gantries1-2 horiz.

SynchrotronP, ionAustriaMed-Austron

2009 ?3-41 gantry ?3 horiz.1 vert.

430 /usynchrotron

P, ionItalyCNAO, Pavia

200831 gantry,2 horiz.

430 /usynchrotron

P, ionGermanyHIT, Heidelberg

230cyclotron

pGermanyWPE Essen

2009 ?54 gantries1 horiz.

250Sc cyclotron

pGermanyRPTC, Koeln

201142-3 gantries,1-2 hor.

250pUSANorth. Illinois PT, Chicago

2010 ?31 gantry,4 fixed

230cyclotron

pFranceCPO, Orsay

START OFTREATMENTPLANNED

NO OF TREATMENT

BEAMDIRECTION

MAX.CLINICALENERGY(MEV)

PARTICLECOUNTRYWHO,WHERE

ICFA-2008, Stanford

Existing and projected facilitiesProton-Synchro-Cyclotron, Boston

ICFA-2008, Stanford

Existing and projected facilitiesprot.-synchrotron, Shizuoka, Japan

ICFA-2008, Stanford

Existing and projected facilitiesp-Gantry (1)

excentric gantry(PSI/Schweiz)

isocentric gantry(Boston/USA)

ICFA-2008, Stanford

Existing and projected facilitiesp-Gantry (2)

Patient-room protonengantry (Tsukuba/Japan)

ICFA-2008, Stanford

Existing and projected facilitiesHIMAC (carbon), Chiba, Japan

ICFA-2008, Stanford

Existing and projected facilitiesHIT Layout: Requirements

Low LET (proton, helium) and high LET (carbon and oxygen) treatmentIon penetration depth of 20 – 300 mm=> Ion energy range of 50 – 430 MeV/uRasterscan method=> FWHM of beam: 4 – 10 mm in both planes=> Beam intensity: 1·106 – 4·1010 ions/spill=> Extraction time: 1 – 10 sTreatment of 1000 patients per year in hospital environment with about 15 fractions each=> total of 15000 irradiations per year=> three treatment areasOne isocentric gantry

ICFA-2008, Stanford

Existing and projected facilitiesHIT, Univ. Heidelberg (p, carbon)Existing and projected facilitiesHIT, Univ. Heidelberg (p, carbon)

Accelerator sections Two ECR sourcesRFQIH drift tube linacSynchrotronExtraction via RF knock outTwo areas for horizontal treatmentOne isocentricGantryOne quality assurance place

patient-treatment: 2. half 2008

ICFA-2008, Stanford

Existing and projected facilitiesHIT facility

ICFA-2008, Stanford

Existing and projected facilitiesHIT Layout: Injector System

Ion source

IH - model

Features compactLow operation costsFast switching of ions

ICFA-2008, Stanford

Existing and projected facilitiesHIT Facility /realization

Ion-source-section Linac-section

ICFA-2008, Stanford

Existing and projected facilitiesHIT Layout: Synchrotron

Features compactMultiturn injectionMultiple beam extraction

transv. KO-extraction(e. g. respiration gating)

ICFA-2008, Stanford

Existing and projected facilitiesp/C-Facilities, HIT Facility

synchrotron treatment-room

ICFA-2008, Stanford

Existing and projected facilitiesp/C-Gantry (HIT)

First Light ion Gantryweight: 600 to13 m diameterbeam position accuracy at isocenter : 0.5 mmIntegration of hor. and vert. scannermagnets

MT Aerospace

ICFA-2008, Stanford

Existing and projected facilitiesCNAO-Facility Pavia, Italy

Linac (similar to HIT)

PIMMS-synchrotron

3 horiz. Beam lines

1 vert. Beam line

Ion Gantry is option

Commissioning has started

ICFA-2008, Stanford

Future developments(special technical aspects )

• sophisticated positioning techniques (fast, accurate positioning with robotic systems)

• means for treating moveable organs

• Optimized diagnosis systems (e.g. on-line PET)

• compact accelerator devices

•Laser acceleration

•Dielectric wall linac

• FFAG-based accelerator

• compact gantry solutions; sc-gantry, .. )

ICFA-2008, Stanford

Future developmentsMoving organs 3D online motion compensation-tests (GSI)

magnetic scanner system PMMA wedge systemsuitable motion tracking system

dynamic treatment plan

static moving, non-compensated

moving, compensated

real-time, highest precision, passive energy variation

ICFA-2008, Stanford

Future developments(motivation)

Motivations (partly)

Smaller size -> Smaller costs size of photon facility(Electron-linac)

Size of a hadron facility

ICFA-2008, Stanford

Future developments‚Laser acceleration ‘Future developments

‚Laser acceleration ‘

Laser accelarationSmall acceleratorstructures due to large acceleration voltage

Problems:

- Continuous energy-spectrum

-Rel. low energies (fewMeV)

- repetition rate

-Reliability, reproducability

-Long term developmentCreation of ‚monoenergetic beam‘

(A. Noda et al., Kyoto)

ICFA-2008, Stanford

Future developmentsFFAG-Accelerator

(Fixed FieldAlternatingGradient)-

synchrotron

3-stage-FFAG

(T.Mizu, 2004)

400 MeV Carbon

(design study)Very large momentum acceptance

Fast cycling (>100 Hz) possible

ICFA-2008, Stanford

Future developmentsFFAG-Gantry

FFAG-Gantry

Compact sc-magnets

(D.Trbojevic, 2006)

400 MeV Carbon

(design study)

ICFA-2008, Stanford

SummarySummary

Because of the specific biophysical advantages of p and light ionsHadrontherapy-facilities play an increasing role in cancer therapyin addition to optimized photon radiation systems

Planning and realization of new hospital based hadrontherapyfacilities has moved from research institutes to industrial firms

Technical Developments are investigated in institutes and industry to minimize investment and operation costs of hadrontherapy facilities (e. g. size reduction due to newacceleration schemes)

New accelerator developments seem to be a medium /long termprocess; for actual projects conventional technology is applied

ICFA-2008, Stanford

Thanks for your attention

Facilities for HADRON-TherapyICFA-2008, Stanford Hartmut Eickhoff, GSI Accelerators for medical...

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