Session 4 Summary Ugo Amaldi Ken Peach (Co-chairs) Geneva, 29 th - PowerPoint PPT Presentation

Session 4 Summary Ugo Amaldi Ken Peach (Co-chairs) Geneva, 29 th February 2012 http://www.ptcri.ox.ac.uk Ken.Peach@ptcri.ox.ac.uk

Programme Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 2

Novel Techniques in Proton Therapy • Why do we need new techniques? – Improved clinical outcomes • Better tumour control • Reduced side effects – Improved patient experience • Reduced treatment times • Fewer complications • Improved quality of life – Better “value for money” • Reduced cost of treatment • Reduced cost of treating late effects Marco Schippers/PSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 3

How or What to Improve? Two s & cost Marco Schippers/PSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 4

Need for novel techniques in proton therapy: Do not treat tomorrow ’s patients with yesterday ’s proton technology ! …and One Low: The Five High’s: • Higher quality • Higher accuracy • Higher flexibility • Higher intensity • Higher energy • Low Price => Reduction of size Marco Schippers, ICTR-PHE 2012, Geneva, February 28, 2012 5 Novel Techniques in Proton Therapy

Comments 1. The more we know the more we need to know … and the more accurately we need to know it 2. We do not know how close we are to the optimum treatment and so we do not know the scope for improvement We need novel technologies to realise the potential of Ion Beam Therapy probably … . Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 6

THE ACCELERATOR Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 7

The Accelerator options Marco Schippers/PSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 8

Today’s technology can be improved • Cyclotrons • Synchrotrons Marco Schippers/PSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 9

Examples Proton beam deflection in water David Meer 30 Christian Hilbes Silvan Zenklusen 20 (PSI) 10 Marco Schippers/PSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 10

New developments • Old ideas, new implementations Marco Schippers/PSI Degiovanni/TERA Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 11

New ideas • Laser plasma accelerators – ultrashort bunches same as conventional bunches • only dose matters at the cell level! in vivo??? Laschinsky/Oncoray Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 12

New beams • Very High Energy Electrons ? • Dose distributions Seitz/Glasgow Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 13

ACCELERATOR TO PATIENT Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 14

Can we make it better? — As usual we want everything and its opposite at the same time… ◦ Small aperture final magnet to lower power consumption, but scanning upstream ◦ Small radius, but space around isocenter ◦ Light magnets, but possibly non superconducting ◦ Maximum performance, but cheap ◦ … M. Pullia – Carbon ion gantries – ICTR-PHE 2012 15

Delivering to the patient • Beam Transport & Gantries Large gantry radius Large aperture dipole: and large room size weight and power consumption Pullia/CNAO Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 16

The “Reisenrad” gantry Pullia/CNAO Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 17

Organ motion in radiotherapy A. Constantinescu Heart beat Friday, 9:30h Scale: seconds A. Rucinski Gut motion Prostate Gas Friday, 16:12h Scale: minutes Bert/GSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 18

Mitigation Techniques Bert/GSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 19

organ / tumor motion Possible solutions: Organ motion • Gating • Adaptive scanning (tumor tracking) • Fast rescanning Marco Schippers, ICTR-PHE 2012, Geneva, February 28, 2012 20 Novel Techniques in Proton Therapy Schippers/PSI

Organ Motion Summary Bert/GSI Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 21

Novel dosimetry General purpose device for low currents (nA) and high currents ( µ A) continuous and pulsed beams based on a sensing fibre moved through the beam H - at 2 MeV, pulsed at repetition rate 50 Hz, average current 0.8 µ A, cross section at the detector ≈ 1 cm 2 (circular ) S. Braccini et al., 2012 JINST 7 T02001 and arXiv:1110.1583 Braccini/Bern Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 22

IN THE PATIENT Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 23

Optimising treatment planning Radio-resistant tumors (e.g. hypoxic tumors) need higher doses for same effect oxygen enhancement ratio (OER) Reduces total dose to normal tissue? Sellner/MPI Heidelberg Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 24

Fragmentation - incidental harm 12 C (400 MeV/u) on water Dose over the Bragg-Peak Bragg Peak : p ~ 1-2 % C ~ 15 % Ne ~ 30 % TPC MUSIC IV TOF WALL Beam ALADIN Beam MAGNET Interaction Neutron detector region Patera/Rome & INFN Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 25

What is the “best” ion? Total energy deposited per beam kinetic energy Chin/CERN Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 26

“Escapes” may be useful • But the challenge is to make them useful Chin/CERN Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 27

Simulation: how much detail? Chin/CERN Karamitros/Bordeaux • The body is not water! • 10 10 -10 11 cells – Beam interacts with atoms – Beam interacts with DNA Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 28

GEANT4-DNA: tracking + radiation biology Karamitros/Bordeaux Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 29

GENAT4 challenges & solutions Karamitros/Bordeaux Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 30

Some results … Karamitros/Bordeaux Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 31

SUMMARY OF THE SUMMARY Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 32

Novel Techniques in Proton Therapy • Why do we need new techniques? – Improved clinical outcomes • Better tumour control • Reduced side effects – Improved patient experience • Reduced treatment times • Fewer complications • Improved quality of life – Better “value for money” • Reduced cost of treatment • Reduced cost of treating late effects Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 33

Novel Technologies • Optimum approached asymptotically – The first 80% is “easy” – The next 16% “needs thought” • The last 4% “is difficult” • How near are to the optimum? – Probably still quite far away – Need new ideas, better technologies • Lots more ideas on the posters – and room for much more • Thanks to all contributors! Ken Peach ICTR-PHE 2012 Session 4 Summary 29 th February 2012 34