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AUSTRON – meeting 15-03-2011 1
MedAustron
Research aspects
Dietmar GeorgDivision of Medical Radiation Physics
Department of Radiotherapy,Medical University of Vienna / AKH Viennaand Comprehensive Cancer Center (CCC)
Verein AUSTRON – meeting 15-03-2011
MedAustron - Overview● Cancer Treatment Facility
Ion therapy with protons and carbon ions
● Research FacilityMedical Radiation Physics, Radiation Biology, Exp. Physics
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White Book – Physics Opportunities
● Education and training
● Particle detectors
● Proton scattering
● Other physics applications
Proton CT
Radiation damage
Dosimetry / simulation of cosmic ray components
Single-hit ion micro probe
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White Book – Med Rad Phys & Rad Biology
● Education and training
● Medical Radiation Physics Basic and applied dosimetry
Dose calculation & optimization
Treatment planning
Image guided & adaptive ion beam therapy
In situ monitoring
Quality assurance
Improving existing technologies
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White Book – Med Rad Phys & Rad Biology
● Radiation Biology Characterization of biological
effects
RBE and modeling
Biomarkers and Bio-imaging
Modulation of radiation response
Combination therapies
● Infrastructure and research environment
Verein AUSTRON – meeting 15-03-2011
Non-clinical Research
● Workspace for researchers
● One irradiation room exclusively for research synergistic use of the 3 medical irradiation rooms for medical
radiation physics
● Increase of proton energy for experimental physics (250 800 MeV)
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Infrastructure
Radiation Biology
Main laboratory Chemical laboratory Cell culture Storage room Cold storage room
Infrastructure
Med. Radiation Physics
Dosimetry laboratory Software development
room (TPS; IGRT; MC;..)
Storage room
Infrastructure
Experimental Physics
Preparation room Decay room Two large storage
room
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“Disclaimer”● 2009 – 2013: „ENVISION – European Novel Imaging Systems
for Ion therapy‟, EC-project in FP7. WP 5 „The combination of in-vivo dosimetry, treatment
planning, and clinical relevance.
● 2009 – 2011„RegIonCo - Regional Ion Therapy Co-operation‟, EC-project for structural development. WP2 „Treatment Planning with Helium Ions„.
● 2009 – 2013: „ULICE – Union of Light Ion therapy Centers in Europe‟, EC-project in FP7. WP4 „Ion therapy for intra-fractionally moving targets‟ and
WP 5 „Adaptive treatment planning for ion beam therapy‟
● 2008 – 2012: „PARTNER – Particle Training Network for European Radiotherapy‟. Adaptive Radiotherapy
● 2006 – 2007: „Scanned Intensity Modulated Proton Beams –evaluation of clinical potential‟, OeNB Project
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“Disclaimer”● 2009 – 2013: „ENVISION – European Novel Imaging Systems
for Ion therapy‟, EC-project in FP7. WP 5 „The combination of in-vivo dosimetry, treatment
planning, and clinical relevance.
● 2009 – 2011„RegIonCo - Regional Ion Therapy Co-operation‟, EC-project for structural development. WP2 „Treatment Planning with Helium Ions„.
● 2009 – 2013: „ULICE – Union of Light Ion therapy Centers in Europe‟, EC-project in FP7. WP4 „Ion therapy for intra-fractionally moving targets‟ and
WP 5 „Adaptive treatment planning for ion beam therapy‟
● 2008 – 2012: „PARTNER – Particle Training Network for European Radiotherapy‟. Adaptive Radiotherapy
● 2006 – 2007: „Scanned Intensity Modulated Proton Beams –evaluation of clinical potential‟, OeNB Project
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.
Clinical trials at LBNL, 1975 – 1992
● 1st He patient 6/75
● 1st C patient 5/77
● 1st Ne patient 11/77
● 1st Ar patient 3/79
● 1st Si patient 11/82
● Total number of patients treated: 1314
● 1977–1992
He patients 858
Heavier ions 456
J.R. Castro, MD, conducted the LBNL clinical trials
Verein AUSTRON – meeting 15-03-2011
„Novel“ Ion species
● Range straggling and dose fall-off is 1 / M
Low LET range: Helium Ions are interesting particles
● Research @ MUW: PB kernel for He based on MC data
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Ströbele et al
Verein AUSTRON – meeting 15-03-2011
Absorbed dose determination
● Reduce uncertainties in basic quantities for absorbed dose determination for protons and carbon ions
Wair, stopping powers, chamber correction factors
● Get research started for novel ion species
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Calibration point for scanning ?
Verein AUSTRON – meeting 15-03-2011
Wair value
New ICRU/IAEA – Jones 2006 (Rad Phys Chem 75:541-50)
Medin et al 2006 (Phys Med Biol 51:1503-21)
ICRU Report 78
Courtesy H Palmans
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External dosimetric Audits
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0 1000 2000 3000 4000 5000 60000.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Year
1970 1980 1990 2000 2005 2008
Number of beam checks
DT
LD/D
sta
tTLD audits, hospitals: 1969 - 2007 (
60Co and X-rays)
±5%
Courtesy J Izweska IAEA
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Dosimetry Audit for proton facilities
● Polystyrene Phantom:
20 Alanine pellets
2 GafChromic films
IC (for the first tests)
● Alanine dosimeters:
Suitable for absolute dosimetry of hadrons
Dose uncertainty for 10 Gy is around 1% (1σ)
Provided by NPL,
● Pilot run in passive scattering and active scanning beams
Quelle: www.npl.co.uk
PTV: 8 x 8 x 12 cm³
Verein AUSTRON – meeting 15-03-2011
Treatment plan robustness
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Original proton treatment plan
Simulated effect due to a 3 mm shift of the patient
● Ion beams very sensitive to heterogeneity changes
Organ filling, patient positioning, ….
● Include uncertainties in optimization process and make plan “robust” against heterogeneity effects
Positions AB C
Urie et al PMB 31, 1983
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RT is a four dimensional problem
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Images to monitor
temporal & spatial
changes
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Medical image processing
● Improvements related to algorithms
● Improvements related to code implementation
● Large potential for improving workflow efficiency
● Facilitate Adaptive Radiotherapy
Birkfellner et al
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Voxel tracking and 4D planning
● ART and combined modality treatments suffer from efficient tools for dose mapping
● Deformable registration options commercially available, but not all models are critically assessed or discussed…..
Do bones behave like honey?
● Treating moving targets
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Featurelet approach proposed by Söhn et al
Feature-let algorithm verification
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In-situ dosimetry for QA
● Clear interest due to the GSI pilot studies with PET monitoring of C-ion beams (started in the 90-ies)
● Basic work was also done for protons (e.g. MGH, Hyogo)
● Drawback: metabolic washout K. Parodi 2004
Verein AUSTRON – meeting 15-03-2011
Novel Imaging systems for QA
● Real-time monitoring of the Bragg-peak position in ion therapy by means of single photon detection Testa et al, Radiat Environ Biophys 49,2010
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● Does not suffer from metabolic washout
● Research issues: Detector material
and design
Reconstruction algorithm
Feedback to TPS
…..
prompt photonpeak (2.5ns)
Verein AUSTRON – meeting 15-03-2011
Relative dosimetry
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● Standard equipment for RT dosimetry extensively tested Cylindrical IC; parallel plate IC, TLD, diamond detectors,
semiconductor detectors, films, gels, scintillation detectors, ….
● Little prototype development activities for particle therapy
● Urgent need for 2.X D detectorsJäkel et al, MP 2003
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Summary
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● Large playground for research related to ion beam therapy
● Networking will be a key issue !
● Competition in research at the international level w.r.t ion beam therapy
● Critical mass of “trained” researcher required Example: OncoRay
Annual report 2010
Verein AUSTRON – meeting 15-03-2011
Thank you for your attention !
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Acknowledgements
Thomas Schreiner Markus Stock
Stan Vatnitsky Hugo Palmans
Wolfgang BirkfellnerAlbert Hirtl
Julia StröbeleValentina Zambrano
Joanna GoraIsabell Simmat
Peter KuessJohannes HopfgartnerAlexander Ableitinger
Hermann Fuchs
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Scattering – carbon ions versus protons
0.0
1.0
2.0
3.0
4.0
0 50 100 150
depth in water / mm
bro
ad
en
ing
of
the b
ea
m s
/ m
m
photons 21 MeVC-12 ions 270 MeV/uprotons 148 MeV
Weber 1996, PhD thesis University KasselCourtesy H Palmans
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Effects of density variations
● Well known problem for a long time……
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Positions AB C
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Effects of density variations
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Single Bragg Peak
SPOB
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Research Software @ MUW
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Fabri, Zambrano
et al