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Tracking emissions during proton radiotherapy
Adam GibsonUCL Medical Physics and Biomedical Engineering
HEP Seminar 13 Feb 2015
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First things first
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A long history…
‘ If a candle was held behind his head, or the sun happened to be behind it, the cranium appeared semi-transparent and this was more or less evident until he attained his fourteenth year’
Richard Bright, Guy’s Hospital, on a patient with hydrocephalus, 1831.
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High attenuation
500 W m-2 10-14 W m-2
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Optical absorption depends on haemodynamics
Oxygenated Blood
Deoxygenated Blood
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Microchannel plate photomultiplier tubes
Helmet holding 32 sources and detectors
onto the head
Optical tomography
50mW laser. 80 MHz pulses
interlaced at 780 nm and 815 nm
Time-correlated single photon
counting electronics
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Forward model
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[HbO 2]
[HHb]
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Motor evoked responses
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UCL optical topography system
32 laser diodes- 16 at 775 nm - 16 at 850 nm
16 detectors
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Cortical response to heelprick in neonates
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Cortical haemodynamics during neonatal seizures
Singh at al Neuroimage Clin. 2014 5:256-65.
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Current research
• Neonatal epilepsy with Addenbrookes• Psychology research with various collaborators
– Autism– Language development– Effects of malnutrition on brain development– Adult intensive care
• Modular, wireless, wearable, portable system
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Proton therapy
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Intensity modulated radiotherapy
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Depth dose curves
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6 MV photons
24 MV photons
196 MeV protons
Spread out Bragg Peak
Dose
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Pas
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liver
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Nor
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Dos
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BC
M s
igna
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Animation produced by Hassan Bentefour
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Relative biological effectiveness changes with energy
Grun et al (2013) Med. Phys. 40 (11), 111716-1
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The challenge
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Proton therapy requires knowledge of dose distribution relative to tumour and other organs.
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Latest techniques use multiple, rapidly changing beams of photons or protons to conform to tumour
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Current standard QA gives accurate point dosimetry
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Imaging is necessary but not sufficient
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The question:
Can we monitor emissions from a proton beam to provide 3D time-varying dosimetry?
Can we monitor emissions from a proton beam to provide 3D time-varying in vivo dosimetry?
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Interactions of protons with tissue (=water)
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Protons lose energy to orbital electrons
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2c)(
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β∝
dR
dE
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Protons scatter off nuclei elastically
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Protons interact inelastically with nuclei
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Prompt gamma emission from excited nuclei
Helo et al Phys. Med. Biol. 59 (2014) 7107–7123
12C15N
16O
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Prompt gamma emission from excited nuclei
Advantages– Real time verification– No additional dose– Range accuracy ~1 mm
• Disadvantages– Low signal from small, fast-moving beams– Emissions stop 2-3 mm from Bragg peak– Background noise from other emissions
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Positron emission tomography
Offline PET
(a) Treatment planning dose distribution; (b) Monte Carlo simulated dose distribution; (c) Monte Carlo simulated PET distribution; (d) PET measurement.
Zhu and Fakhri Theranostics 2013; 3(10):731-740.
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Positron emission tomography
Advantages– Practical with existing equipment (online or offline)– Range to 1-2 mm accuracy in some regions
• Disadvantages– Biological washout– Short half lives– Depends on elemental composition of tissue– Energy threshold for activation means no signal from
Bragg peak
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Cherenkov imaging
Brian Pogue and team at Dartmouthhttp://cancer.dartmouth.edu/focus/Cherenkov_effect_Radiation_Oncology.html
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Cherenkov imaging
Fast component. From ionisations caused by prompt gamma (and neutrons)
Slow component. From positrons
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Particle Induced X -ray Emission
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Particle Induced X -ray Emission
La Rosa et al (2014) Phys Med Biol 59(11) p2623
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Scintillation
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Scintillation
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Protoacoustics
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Protoacoustics
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BUT range is determined by low energy protons
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Informing a model of proton interactions from measurements
geometryStarting properties physical properties
beam parameters
Monte Carlo model of dose distribution
Error < threshold?
Update properties
Dose distribution
Measure emissionsPredict emissions
No
Yes
Imaging
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It’s worse than that.
Grun et al (2013) Med. Phys. 40 (11), 111716-1
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Informing a model of proton interactions from measurements
geometryStarting properties physical properties
beam parameters
Monte Carlo model of dose distribution
Update properties Predict emissions
Model radiobiology
Biological dose distribution
Physical dose distribution
Error < threshold?
Measure emissions Imaging
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"Sure he was great, but don't forget that Ginger Rogers did everything Fred Astaire did, ... backwards and in high heels."
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AcknowledgementsMansour AlmurayshidSimon ArridgeTopun AustinRob CooperLaura DempseyPaul DoolanDerek D’SouzaNick EverdellJem HebdenYusuf HeloSimon JollyAndrzej KacperekVanessa La RosaIvan RosenbergGary RoyleDavid Vicente