Facilities for HADRON-TherapyICFA-2008, Stanford Hartmut Eickhoff, GSI Accelerators for medical applications 2 ContentsContents 1. Principles, requirements 2. treatment modalities

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

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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

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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

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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

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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)

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Treatment modalitiesdepth dose profile

Treatment modalitiesdepth dose profile

Photons:

Exponential dose-decrease

Protons, Ions:

‚ inverse depth‘-doseprofile (Bragg-peak)

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Treatment modalitiescomparison p, Ions

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

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Treatment modalitiesComparison photons, ions

Treatment modalitiesComparison photons, ions

Carbon-Treatment (2 fields)Photon-Treatment

(IMRT, 9 fields)

Dose-Distribution

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Treatment modalitiestreatment technique: ‚passive‘

Treatment modalitiestreatment technique: ‚passive‘

- constant beam properties(accelerator)

- Mechanical devices foradequate manipulations of beam properties

- fragmentations

- not optimal tumouradaption

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Treatment modalitiesSpread out Bragg-peak (SOB)

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

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Treatment modalitiesTreatment technique: Rasterscan-Method

Treatment modalitiesTreatment technique: Rasterscan-Method

Intensity-controlled Rasterscan-method

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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)

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Treatment modalitiesIntens-contr. Rasterscan-method

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

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Existing and projected facilitiesfacilities in operation

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

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Existing and projected facilitiesfacilities planned / under constr.-1

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.

ROOMS

BEAMDIRECTION

MAX.CLINICALENERGY(MEV)

PARTICLECOUNTRYWHO,WHERE

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Existing and projected facilitiesfacilities planned / under constr. -2

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

ROOMS

BEAMDIRECTION

MAX.CLINICALENERGY(MEV)

PARTICLECOUNTRYWHO,WHERE

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Existing and projected facilitiesProton-Synchro-Cyclotron, Boston

Existing and projected facilitiesProton-Synchro-Cyclotron, Boston

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Existing and projected facilitiesprot.-synchrotron, Shizuoka, Japan

Existing and projected facilitiesprot.-synchrotron, Shizuoka, Japan

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Existing and projected facilitiesp-Gantry (1)


excentric gantry(PSI/Schweiz)

isocentric gantry(Boston/USA)

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Patient-room protonengantry (Tsukuba/Japan)

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Existing and projected facilitiesHIMAC (carbon), Chiba, Japan

Existing and projected facilitiesHIMAC (carbon), Chiba, Japan

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Existing and projected facilitiesHIT Layout: Requirements

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

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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

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Existing and projected facilitiesHIT facility

Existing and projected facilitiesHIT facility

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Existing and projected facilitiesHIT Layout: Injector System

Existing and projected facilitiesHIT Layout: Injector System

Ion source

IH - model

Features compactLow operation costsFast switching of ions

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Existing and projected facilitiesHIT Facility /realization

Existing and projected facilitiesHIT Facility /realization

Ion-source-section Linac-section

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Existing and projected facilitiesHIT Layout: Synchrotron

Existing and projected facilitiesHIT Layout: Synchrotron

Features compactMultiturn injectionMultiple beam extraction

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

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Existing and projected facilitiesp/C-Facilities, HIT Facility

Existing and projected facilitiesp/C-Facilities, HIT Facility

synchrotron treatment-room

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Existing and projected facilitiesp/C-Gantry (HIT)

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

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Existing and projected facilitiesCNAO-Facility Pavia, Italy

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

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Future developments(special technical aspects )

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, .. )

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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

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Future developments(motivation)

Future developments(motivation)

Motivations (partly)

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

Size of a hadron facility

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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)

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Future developmentsFFAG-Accelerator

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

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Future developmentsFFAG-Gantry

Future developmentsFFAG-Gantry

FFAG-Gantry

Compact sc-magnets

(D.Trbojevic, 2006)

400 MeV Carbon

(design study)

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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

Documents

Facilities for HADRON-TherapyICFA-2008, Stanford Hartmut Eickhoff, GSI Accelerators for medical applications 2 ContentsContents 1. Principles, requirements 2. treatment modalities