Ocular treatments at CNAO - Agenda (Indico) · 2017-03-04 · Medical Physics Unit, CNAO, Pavia (I)...
Transcript of Ocular treatments at CNAO - Agenda (Indico) · 2017-03-04 · Medical Physics Unit, CNAO, Pavia (I)...
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Ocular treatments at CNAO
M. Ciocca
Medical Physics Unit, CNAO, Pavia (I)
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CNAO: general purpose fixed beam lines
(h&n, pelvis, abdomen)
Treatment chair
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«Only» 3-D active system (synchrotron-based energy
variation + pencil beam scanning)
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Ocular treatments: dedicated beam lines, cyclotron, passive scattering,
pt-specific aperture (brass collimator)
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Existing beam line adaptation to
eye-specific requirements:
Monte Carlo simulations (FLUKA)
Experimental dosimetry (EBT3 film)
Ocular melanoma in Italy:
protontherapy at INFN- LNS CATANA,
about 100 pts/yr sent abroad (Nice, …)
Collaboration started with Galliera H. in
Genova (Dr. C. Mosci, oncol. opht.)
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Slopsema RL et al. Med Phys 41, 2014
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Lateral penumbra optimization:
3x3 cm2 scanning field size
Aperture at 5-6 cm from the skin
Effect of RS-skin distance
Dedicated DDS calibration
curve is needed (fixed 28 mm
water-eq. RS behind DDS)!
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Neutron dose to the
contralateral eye:
3 mSv
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Clinical workflow
Pre-treatment
surgical phase
(ophtalmologist):
clip implantation for
target localization
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Treatment simulation
(pt immobilization and CT scan)
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Varian Eclipse ocular
proton planning
Plan generation
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Fundus viewer SW, IFJ PAN Cyclotron Center, Krakow, Poland
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INFN-Pavia workshop
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Pre-treatment plan verification:
Markus ion chamber or silicon diode detector
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Calculated vs
measured SOBP
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Gaze fixation
monitoring
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Treatment verification(2 orthogonal x-ray images, image registration
based on fiducial markers)
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Treatment delivery
20 pts treated so far (since Aug 2016)
about 3’ delivery time (3 identical fields)
52 Gy (RBE) prescribed in 4 daily fractions