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New Technologiesfor light ion beam therapy facilities

Loïc Grevillot, MPE, Ph.D.

SFPM

1-3 June 2016

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Outline

Accelerators

Beam delivery techniques

Gantries

Patient positioning and imaging

Light Ion Beam Therapy Facilities

New technologies at MedAustron

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Outline

Accelerators

Beam delivery techniques

Gantries

Patient positioning and imaging

Light Ion Beam Therapy Facilities

New technologies at MedAustron

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Accelerators:Producing and accelerating particles

Cyclotrons Synchrotrons

Hadron accelerators for radiotherapy, H. Owen et al., Contemporary Physics, Vol. 55, No. 2, 55–74, 2014

Isochronous cyclotrons / synchro-cyclotrons:• Constant / Variable Electric Field (RF)• Variable / Constant Magnetic field (B)

Synchrotrons:• Beam injected with E [3-7 MeV] (Linac)• RF cavities used for accelerating the beam• Quadrupoles used for beam focusing• Dipoles used for curving the beam• Slow extraction technique

Ernest LawrenceNobel prize 1939

Continuous / Pulsed beam Fixed energy extracted Protons only (currently)

Spill structure Variable extraction time [1-10 s] Variable energy Protons and carbon ions

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Accelerators:Producing and accelerating particles

Cyclotrons Synchrotrons

Hadron accelerators for radiotherapy, H. Owen et al., Contemporary Physics, Vol. 55, No. 2, 55–74, 2014

Isochronous cyclotrons / synchro-cyclotrons:• Constant / Variable Electric Field (RF)• Variable / Constant Magnetic field (B)

Synchrotrons:• Beam injected with E [3-7 MeV] (Linac)• RF cavities used for accelerating the beam• Quadrupoles used for beam focusing• Dipoles used for curving the beam• Slow extraction technique

Continuous / Pulsed beam Fixed energy extracted Protons only (currently)

Spill structure Variable extraction time [1-10 s] Variable energy Protons and carbon ions

Synchrotrons for protons and carbon ionsHIT (GSI) Home Made 25 m P, He, C, OMIT (Siemens) 25 m P, CCNAO, MedAustron PIMMS design (CERN) 25 m P, CHitachi P, CMitsubishi P, C

Synchrotrons for protons and carbon ionsHIT (GSI) Home Made 25 m P, He, C, OMIT (Siemens) 25 m P, CCNAO, MedAustron PIMMS design (CERN) 25 m P, CHitachi P, CMitsubishi P, C

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Accelerators:Protons and Carbon ions Synchrotrons

Synchrotrons for protons onlyLoma Linda 250 MeV (1990–today, first hospital-based facility)Hitachi (synchro) (~ 8 -> 5m) 220 MeV (Wakasa Bay, 2000)Radiance 330, Protom 330 MeV (Mc Laren Hospital, Flint, installed in 2013)Mitsubishi (since 1994 at NIRS)

Synchrotrons for protons onlyLoma Linda 250 MeV (1990–today, first hospital-based facility)Hitachi (synchro) (~ 8 -> 5m) 220 MeV (Wakasa Bay, 2000)Radiance 330, Protom 330 MeV (Mc Laren Hospital, Flint, installed in 2013)Mitsubishi (since 1994 at NIRS)

Protom synchrotron

Hitachi proton synchrotronCNAO proton and carbon ion synchroton

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Accelerators:Proton Cyclotrons

Progresses=

Superconducting technology !

(Miniaturization, Lower consumption, Increased Efficiency)

SynchrocyclotronSC200, CNRS(ORSAY) 700T 201 MeV (1991-2010)

Cyclotron (Isochronous)C230, IBA 220T (4.3 m) 230 MeVSumitomo 230 MeV

Super conducting Cyclotron (Isochronous)Accel/Varian 90T (3.4 m) 250 MeVSC360, ProNova ~200T 230 MeV (Provision Hospital,

Knoxville, installed in 2014)

Super conducting SynchrocyclotronS2C2, IBA 50T (2.5 m) 230/250 MeVS250, Mevion 20T (~1.8 m) 250 MeV

SynchrocyclotronSC200, CNRS(ORSAY) 700T 201 MeV (1991-2010)

Cyclotron (Isochronous)C230, IBA 220T (4.3 m) 230 MeVSumitomo 230 MeV

Super conducting Cyclotron (Isochronous)Accel/Varian 90T (3.4 m) 250 MeVSC360, ProNova ~200T 230 MeV (Provision Hospital,

Knoxville, installed in 2014)

Super conducting SynchrocyclotronS2C2, IBA 50T (2.5 m) 230/250 MeVS250, Mevion 20T (~1.8 m) 250 MeV

C230, IBA

Accel/varian

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Accelerators:Producing and accelerating particles

Isochronous Synchro- SynchrotronsCyclotron Cyclotron

___________________________________________________________

Beam structure Continuous Pulsed SpillIntensity High Medium Low

Energy Fixed Fixed VariableActivation Degrader Degrader NoEnergy change Fast Fast Slow

Size 2-5 m 2-5 m 5-25 mParticle type Protons Protons Protons/Carbon ions

Isochronous Synchro- SynchrotronsCyclotron Cyclotron

___________________________________________________________

Beam structure Continuous Pulsed SpillIntensity High Medium Low

Energy Fixed Fixed VariableActivation Degrader Degrader NoEnergy change Fast Fast Slow

Size 2-5 m 2-5 m 5-25 mParticle type Protons Protons Protons/Carbon ions

SUMMARY

• Each type of accelerator has advantages and drawbacks• All types of accelerators can be used for protons• Only Synchrotrons are currently in use for carbon ions

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Accelerators:Research

Superconducting cyclotron for carbon ionsIBA C400 / ARCHADE Project (700T, ~7m)

Multiple Energy operation with Extended Flat Top SynchrotronFull treatment delivered with one spillVariable extracted spill energy within a single cycle

Rapid Cycling Synchrotron (RCS)Faster energy change expected (not yet constructed for therapy)

Superconducting cyclotron for carbon ionsIBA C400 / ARCHADE Project (700T, ~7m)

Multiple Energy operation with Extended Flat Top SynchrotronFull treatment delivered with one spillVariable extracted spill energy within a single cycle

Rapid Cycling Synchrotron (RCS)Faster energy change expected (not yet constructed for therapy)

Schematic of C400

Archade Project, www.archade.frMultiple-energy operation with extended flattops at HIMAC, Y. Iwata et al., NIM A 624 (2010) 33–38

Variable extracted energyfrom 430 to 80 MeV/u

(147 flattops)

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Accelerators:Research

Fixed Field Alternating Gradient (FFAG)Fixed field (RF) -> High intensity such as Isochronous CyclotronsAlternating gradient -> Reduced Synchrotron orbitVariable energy and different particle types

LinacsVariable energy as synchrotrons and Fast energy change (2-3 ms)Core of research: achieve higher gradients (20-100 MV.m-1)One CERN spin-off: Advanced Oncotherapy (LIGHT accelerator, ADAM)

Dielectric Wall Accelerators (DWA)Technology based on high gradient insulators (up to 20-100 MV.m-1)

LasersMany challenges: beam quality, energy selection, pulse rate, etc.

Fixed Field Alternating Gradient (FFAG)Fixed field (RF) -> High intensity such as Isochronous CyclotronsAlternating gradient -> Reduced Synchrotron orbitVariable energy and different particle types

LinacsVariable energy as synchrotrons and Fast energy change (2-3 ms)Core of research: achieve higher gradients (20-100 MV.m-1)One CERN spin-off: Advanced Oncotherapy (LIGHT accelerator, ADAM)

Dielectric Wall Accelerators (DWA)Technology based on high gradient insulators (up to 20-100 MV.m-1)

LasersMany challenges: beam quality, energy selection, pulse rate, etc.

DWA schematic Pamela Overview and Status, K. Peach et al, Proceedings of IPAC’10

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Outline

Accelerators

Beam delivery techniques

Gantries

Patient positioning and imaging

Light Ion Beam Therapy Facilities

New technologies at MedAustron

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According to ICRU 78:

• Passive beam-delivery techniques:• Single scattering• Double scattering

• Dynamic beam-delivery techniques:• Scanning

• Discrete scanning (spot scanning)• Continuous scanning (raster scanning)• Quasi-discrete scanning

• Wobbling

ICRU report 78, Prescribing Recording and Reporting Proton Beam Therapy, 2007

Beam delivery techniques

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Beam delivery techniques:Broad beam delivery technique

Dose Reporting In Ion Beam Therapy. Technical Report, IAEA 2007.

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Beam delivery techniques:Passive Scattering delivery technique

Upstream and downstream modulator whells.

Passive Beam Spreading in Proton Radiation Therapy, B. Gottschalk, Draft 2004

Range modulator wheel

Second scatterer

Monitoring system

Movable snout with patient

specific aperture and boluses (or

range compensator)

Lepowitz metal aperturePractical Implementation of Light Ion Beam

Treatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012

Wax boluses

The physics of proton therapy, W. D. Newhauser and R. Zhang, Phys. Med. Biol. 60(2015) R155–R209

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Beam delivery techniques:Fixed vs. variable range modulation

Fixed range modulation

Unwanted dose in OAR before the tumor

Practical Implementation of Light Ion BeamTreatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012

Variable range modulation

Reduced dose in OAR!

MLC used to collimate the beam

Energy layer thickness can be adjusted by ridge filters

Energy can be changed at accelerator level or via introduction of range shifter plates.

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Beam delivery techniques:Wobbling: layer stacking scanning

Recent Progress of Heavy-Ion Cancer Radiotherapy with NIRS-HIMAC, K. Noda et al., accapp2013

Fast energy change (11 energy available from the synchrotron)

Energy layer thickness

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Beam delivery techniques:Active scanning delivery technique

Tumor Therapy with Heavy Ions, GSI 2007

Delivery possibilities:• Discrete scanning (spot or voxel scanning)• Continuous scanning (raster scanning)• Quasi-discrete scanning

Scan path optimization

Practical Implementation of Light Ion BeamTreatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012

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Beam delivery techniques:Active scanning delivery technique

Ripple filter design

(single or dual arrangement)

Evaluation of beam delivery and ripple filter design for non-isocentric proton and carbon ion Therapy, L. Grevillot et al., PMB2015

10µm manufacturing accuracy required!

Gate/Geant4

Design of ripple filters

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Beam delivery techniques:Producing a SOBP

Proton SOBP:Fixed RBE Uniform physical dose

Carbon ion SOBP:Variable RBE Non-uniform physical dose

Relative Biological Effectiveness In Ion Beam Therapy. Technical Report, IAEA 2008.

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Beam delivery techniques:Comparisons of the different techniques

ICRU report 78, Prescribing Recording and Reporting Proton Beam Therapy, 2007

Passive scattering Scanning: SFUD Scanning: IMPT

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Beam delivery techniques:

Passive Active scanning___________________________________________________________

Nozzle design complex simpleMaximum range reduced higherBeam efficiency reduced highSecondary dose neutrons lowDose management/QA conventional Large amount of

data required (each spot)Dose distribution extra dose Conformal (IMPT/IMCT)Motion management conventional complex (each spot)

Passive Active scanning___________________________________________________________

Nozzle design complex simpleMaximum range reduced higherBeam efficiency reduced highSecondary dose neutrons lowDose management/QA conventional Large amount of

data required (each spot)Dose distribution extra dose Conformal (IMPT/IMCT)Motion management conventional complex (each spot)

SUMMARY

• Pencil beam scanning is the future of particle therapy• Progresses are expected in terms of delivery efficiency (fast

scanning/rescanning, fast energy change, new RiFi designs, etc.)• Scattering techniques are still the most used worldwide

Wobbling is intermediate

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Outline

Accelerators

Beam delivery techniques

Gantries

Patient positioning and imaging

Light Ion Beam Therapy Facilities

New technologies at MedAustron

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Gantries:Mobile vs. fixed isocenter

PSI gantry 1• First PBS gantry (1992)• Mobile isocenter = reduced

size (only 4 m diameter)

Loma Linda gantry• First proton gantry for

scattering delivery (1991)• Isocentric corkscrew-type

gantry• Most used design worldwide

ICRU report 78, Prescribing Recording and Reporting Proton Beam Therapy, 2007

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Gantries:Rotating protons

PSI Gantry 2 / MedAustron-30/+180 degrees, ~220 T

IBA 360 degrees Gantry,~100 T (mechanical structure), 6m diam.,

Mevion GantryAccelerator integrated in the gantry

Hitachi Proton Gantry

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Gantries:Rotating carbon ions

Heavy-ion tumor therapy: Physical and radiobiological benefits, D. Schardt and T. Elsässer, Rev. Mod. Phys., Vol. 82, No. 1, January–March 2010

HIT carbon ion gantry(first carbon gantry worldwide)

3600 rotating gantry18m length, 7m radius, ~ 630TNormal technology

NIRS/Toshiba superconducting carbon ion

gantry

Twenty Years of Carbon Ion Radiation Therapy at the National Institute of Radiological Sciences: Accomplishments and Prospects, Tadashi Kamada, IJPT, Feb. 2016

3600 rotating gantry13m length, 4m radius, ~200T (~normal proton gantries)Fluid-free cryocooler technology

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Gantries:Rotating particle beams

Considerations to select a gantry

• Particle type• Accelerator type• Technology: normal or superconducting magnets• Precision at isocenter• Rotating angle: 360, 220, 180?• Field size• Treatment modality: passive, active (parallel scanning /deflected beam)• Size in treatment room (space for imaging devices in room)• Size and weight

SUMMARY

• Isocentric gantries are the most used• Rotation from 180 to 360 available• Isocenter Accuracy ~1 mm

Progresses = Superconducting technology ?!(Miniaturization, Lower consumption, Increased Efficiency)

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Gantries:Research

Superconducting technologyAllows reducing the size of the gantryConsequence on energy change speed?

FFAG gantryFaster energy scanning due to FFAG technology

Riesenrad gantryReduced weight, butEntire treatment room is rotated…

Superconducting technologyAllows reducing the size of the gantryConsequence on energy change speed?

FFAG gantryFaster energy scanning due to FFAG technology

Riesenrad gantryReduced weight, butEntire treatment room is rotated…

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Outline

Accelerators

Beam delivery techniques

Gantries

Patient positioning and imaging

Light Ion Beam Therapy Facilities

New technologies at MedAustron

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Patient Positioning Systems

SCARA type robots(Selective Compliance Assemble Robot Arm)Compliant in X-YRigid in Y -> no bending

Other robots

Mainly industrial robots adapted of LIBT facilities

Mevion

IBA

HCL/CPO were pioneer in 1991

HIT PPS

Courtesy of Michel Auger (CPO)

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Patient Positioning Systems

Mainly industrial robots adapted of LIBT facilities

Practical Implementation of Light Ion Beam Treatments, M. F. Moyers and S. M. Vatnitsky, mpp 2012

PPS used for MP QA

NIRS “old” facility PPS

NIRS new facility PPS

Development of fast patient positionverification software using 2D-3D image registration and its clinical experience, S. Mori et al., jrr 2015

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IGRT in LIBT

Historically, LIBT was always delivered with some sorts of imaging and introduced the concept of IGRT to the field of radiation therapy.

Practically, IGRT capabilities are often more advanced in conventional radiation therapy departments.

Target imaging and localization techniques:Markers, room lasers, 2D kV, 3D CBCT, fiducials, surface recognition systems, etc.

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Dose delivery verification

Range uncertainty: a challenges in LIBT delivery!

In vivo proton range verification: a review, A. C. Knopf and A. Lomax, Phys. Med. Biol. 2013

Several techniques investigated:• In-vivo point measurements

(On-line 1D)• Range Probe

(On-line 1D)• Proton radiography and

tomography (On-line 2D/3D)

• Prompt gamma imaging(On-line 2D/(3D))

• PET imaging(On-line/off-line 3D)

• MRI imaging(Off-line 3D)

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Outline

Accelerators

Beam delivery techniques

Gantries

Patient positionning and imaging

Light Ion Beam Therapy Facilities

New technologies at MedAustron

COMMISSIONING OF THE ION BEAM GANTRY AT HIT, M. Galonska et al., IPAC2011

34Recent Progress of Heavy-Ion Cancer Radiotherapy with NIRS-HIMAC, K. Noda et al., accapp2013

Light Ion Beam Therapy Facilities:Dual particle beam facilities

• Synchrotron-based facilities• Large facilities with 3

treatment rooms or more• High costs

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Mitsubishi proton only

Light Ion Beam Therapy Facilities:Dual particle beam facilities

Mitsubishi proton and carbon ions

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Light Ion Beam Therapy Facilities:Multi-room proton therapy facilities

IBA Proteus plus

Varian ProBeam multi-room

• Cyclotron or Synchrotron-based facilities

• Large facilities with 3 treatment rooms or more

• High costs

• All delivery techniques possible• 3600 rotating gantries

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IBA Proteus one2200 rotating gantry

Varian ProBeam single-room3600 rotating gantry

• Compact facilities• Lower costs• Full technology:

Gantry/IMPT/CBCT/Gating capabilities, etc.

Light Ion Beam Therapy Facilities:Compact proton therapy facilities

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Protom Radiance 3301800 rotating gantry

• Synchrotron based• Multi-level building capabilities• 330 MeV towards proton radiography

Light Ion Beam Therapy Facilities:Compact proton therapy facilities

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• Gantry mounted cyclotron• No beam line required• Scanning not yet FDA

Mevion S250 series~1800 rotating gantry

Light Ion Beam Therapy Facilities:Compact proton therapy facilities

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Outline

Accelerators

Beam delivery techniques

Gantries

Patient positionning and imaging

Light Ion Beam Therapy Facilities

New technologies at MedAustron

Excavation material used for radiation protection:

• 25.000 m³ concrete saved• 2.500 tons of reinforcement steel

saved• 6 month construction time saved• 10.000 truck movements saved

New technologies at MedAustron:Sandwich-Technology

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New technologies at MedAustron:Patient positioning and Imaging Ring

• 7D robotic couch positioning• Integrated CBCT on the couch• Non-isocentric CBCT capabilities• Optical tracking system

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New technologies at MedAustron:Patient positioning and Imaging Ring

Optical tracking and positioning accuracy

www.medPhoton.at

ImagingRing

Single source dual energy X-ray 60 – 120 kV

www.medPhoton.at

ImagingRing

Single source dual energy X-ray 60 – 120 kV

Large clearance 78 cm ring

Non-isocentric acquisitions

Large FOV >60 cm diameter

Dose reduction for out-of-beam regions

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New technologies at MedAustron:Patient setup module

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New technologies at MedAustron:Collision avoidance system for planning

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Machine specific parameters optimization - intensity selection, scan path optimization

Beam specific margins - to better account for range uncertainties

CTV-based planning and Robust optimization - to directly account for positioning and density

uncertainties

Automatic spot and energy layer spacing – spacing adapted on a layer basis

Biological optimization for carbon ions - based on LEM model for carbon ions

Multi-criteria optimization / Scripting capabilities / Back up planning …

New technologies at MedAustron:Raysearch TPS with user customizations

LIBT TechnologyLIBT Technology

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• Technological development in Light Ion Beam Therapy (LIBT)

Facility improved significantly over the past decades.

• Compact and more affordable proton solutions are now available.

• Carbon ion technology is still seldom.

• Active scanning delivery is considered as the future of LIBT and

allows IMIT.

• Further developments on hardware and software sides are still

required to maximize the capabilities of the technology.

Conclusion

Medical softwaresystems

Accelerator

Beam deliverytechniques

Gantries

Patient positionningand alignement

systems

Thank you !