Radiotherapy and Brachytherapy3A978-90... · devoted to clinical application of 3D conformal...

Radiotherapy and Brachytherapy

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edited by

Radiotherapy and Brachytherapy

Yves Lemoigne

Alessandra Caner

European Scientific InstituteSite d’ArchampsFrance

European Scientific InstituteSite d’ArchampsFrance

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Proceedings of the NATO Advanced Study Institute on

ISBN 978-90-481-3095-5 (HB)

ISBN 978-90-481-3097 -9 (e-book)

ISBN 978-90-481-3096-2 (PB)

Physics of Modern Radiotherapy & Brachytherapy Archamps France15–27 November 2007

Library of Congress Control Number: 2009931108

v

CONTENTS

Preface ................................................................................................................ ix

List of Participants .............................................................................................. xi

Photographs ....................................................................................................... xv

PART I: INTRODUCTION TO RADIOTHERAPY ............................................... 1

Fundamental Radiobiology and Its Application to Radiation Oncology............. 3 Francesca M. Buffa

Accuracy Strategies in Radiotherapy................................................................. 11 Günther H. Hartmann

PART II: X-RAYS TELETHERAPY ......................................................................29

Dosimetry for Photon and Electron Radiation................................................... 31 Günther H. Hartmann

Nomenclature in Radiotherapy .......................................................................... 57 Günther H. Hartmann

Quality Assurance in Radiotherapy ................................................................... 71 Alan McKenzie

Radiotherapy Accidents..................................................................................... 81 Alan McKenzie

Clinical Applications of 3-D Conformal Radiotherapy ..................................... 87 Raymond Miralbell

Treatment Planning: IMRT Optimization – Basic and Advanced Techniques......................................................................................................... 95 Simeon Nill

vi CONTENTS

Treatment Planning: Stereotactic Treatment Techniques ................................ 107 Simeon Nill

Image Guided Radiotherapy ............................................................................ 113 Uwe Oelfke

Clinical Use of 3-D Image Registration........................................................... 127 Peter Remeijer

Geometrical Uncertainties in Radiotherapy..................................................... 135 Peter Remeijer

Delivery of Intensity-Modulated Radiation Therapy Including Compensation for Organ Motion..................................................................... 141 Steve Webb

PART III: HADRONTHERAPY............................................................................163

Hadrontherapy: Cancer Treatment with Proton and Carbon Beams................ 165 Ugo Amaldi and Gerhard Kraft

Proton Therapy ................................................................................................ 173 Uwe Oelfke

PART IV: BRACHYTHERAPY ............................................................................183

Photon Sources for Brachytherapy .................................................................. 185 Alex Rijnders

Calibration of Photon Sources for Brachytherapy ........................................... 195 Alex Rijnders

Cancer of the Cervix: Examples of BT Treatment Techniques ....................... 209 Inger-Lena Lamm

Paris System for Interstitial Brachytherapy ..................................................... 219 Ginette Marinello

CONTENTS vii

Solid State Detectors for Quality Assurance in Brachytherapy....................... 227 Ginette Marinello

Monte Carlo Application in Brachytherapy Dosimetry................................... 239 Jose Perez-Calatayud, Domingo Granero Cabañero and Facundo Ballester Pallarés

Appendix I ....................................................................................................................251

ix

PREFACE

This book reports the majority of lectures given during the NATO AdvancedStudy Institute ASI-982996, which was held at the European Scientific Institute of Archamps (ESI, Archamps – France) from November 15 to November 27, 2007. The ASI course was structured in two parts: the first was dedicated to

the second focused on internal radiotherapy, also called “brachytherapy” or “curietherapy” in honour of Madame Curie who initiated the technique about a century ago. This ASI took place after the European School of Medical Physics, which devoted a 3 week period to medical imaging, a subject complementary to the topics of this book. Courses devoted to nuclear medicine and digital imaging techniques are collected in two volumes of the NATO Science Series entitled “Physics for Medical Imaging Applications” (ISBN 978-1-4020-5650-5) and “Molecular imaging: computer reconstruction and practice” (ISBN 978-1-4020-8751-6).

Every year in autumn ESI organises the European School of Medical Physics, which covers a large spectrum of topics ranging from Medical Imaging to Radiotherapy, over a period of 5 weeks. Thanks to the Cooperative Science and Technology sub-programme of the NATO Science Division, weeks four and five were replaced this year by the ASI course dedicated to “Physics of Modern Radiotherapy & Brachytherapy”. This allowed the participation of experts and students from 20 different countries, with diverse cultural background and pro-fessional experience. A further positive outcome of NATO ASI participation is the publication of this book, containing the lecture series contributed by speakers during the ASI. We hope it will be a reference book in radiotherapy, addressing an audience of young medical physicists everywhere in the world, who are wishing to review the physics foundations of the relevant technologies, catch up with the state of the art and look ahead into future developments in their field, e.g. the emerging technique of “Hadrontherapy”.

This volume starts with an introductory lecture about radiotherapy strategy and accuracy requirement, two aspects which are of the first importance (G. Hartmann). Fundamental radiobiology is reviewed by Francesca Buffa, fol-lowed by G. Hartmann discussing photon and electron dosimetry. G. Hartmann also illustrates the nomenclature in radiotherapy treatment planning, specified in the ICRU-50 document. Three lectures by Steve Webb describe Conformal Radiotherapy (CRT), covering various modern techniques from Multi-Leaf Collimators (MLC) to Intensity Modulated RadioTherapy (IMRT).

what is often called “teletherapy”, i.e. radiotherapy with external beams, while

x PREFACE

Simeon Nill from DKFZ develops two topics: inverse planning and opti-misation techniques first, followed by stereotactic treatment techniques. As well from DKFZ, Uwe Oelfke reviews image guided techniques in radiotherapy. Quality assurance in radiotherapy is everybody’s deep concern and is discussed by A. McKenzie from Bristol.

Despite the quasi totality of patients being presently treated with gamma and X-rays, some novel powerful tools are emerging implementing proton and light ions (e.g. carbon ions) beams, which will progressively gain ground in patient treatment. It was deemed important to introduce this new approach, going under the comprehensive name of Hadrontherapy (protons and light ions, e.g. Carbon ions, all belong to a group of particles called hadrons.). Ugo Amaldi presents an overview of the field, whereas U. Oelfke focuses on proton therapy and its implementation at the Heidelberg Hadron Therapy centre. The role of medical imaging in radiotherapy (clinical applications and geometrical uncertainties) is presented by Peter Remeijer from Amsterdam. Finally, the chief of the radio-therapy service of the “HCUGE Hospital” concludes this section with two lectures devoted to clinical application of 3D conformal radiotherapy.

In the Brachytherapy section, a review of the sources and of the conventional computer calculations used in this field is presented by A. Rijnders (Brussels). Among different dosimetry systems for interstitial brachytherapy, Ginette Marinello privileges a description of the so-called “Paris System”. Cervix cancer treatment is then analysed in details by Inger-Lena Lamm (Lund Sweden). Patient dose calculation using modern Monte-Carlo techniques is presented by J. Perez-Calatayud from Valencia (Spain).

We wish to thank all the participants, who allowed the ASI at Archamps to be a success within an excellent international atmosphere: lecturers, students (who participated actively) and all the ESI team (Manfred Buhler-Broglin, Alessandra Caner, Violaine Presset, Filiz Demolis and Julien Lollierou).

Many thanks to the Hôpital Cantonal de Genève, which hosted us twice (Philippe Nouet) and gave us access to radiotherapy and brachytherapy services (Dr. Miralbell and Dr. Popowski).

Finally, we wish to thank and express the gratitude to the Cooperative Science and Technology sub-programme of the NATO Science Division, lead by Prof. Fausto Pedrazzini, without whom this Advance Study Institute would have not been possible.

Yves Lemoigne1 Co-Director of ASI-982440

1 European School of Medical Physics, European Scientific Institute, Bâtiment Le Salève, Site

d’Archamps F-74166 Archamps (France).

______

xi

LIST OF PARTICIPANTS

Lecturers’ surnames are in bold Surname Name Country City E-mail address

Abate Armando Italy Rome armando.abate@yahoo.it

Acar Hilal Turkish Istanbul hilalacar@hotmail.com

Amaldi Ugo Italy Milano ugo.amaldi@cern.ch

Avitabile Rossella Italy Padova rossella.avitabile@libero.it

Balabanova Anna Bulgaria Sofia abalabanova@gmail.com

Bartesagi Giacomo Italy Milan giacomo.bartesaghi@unimi.it

Bonnet Jacques France Toulouse bonnet.jacques@claudiusregaud.fr

Boubir Messaoud Algeria Batna boubir_mess@yahoo.fr

Bourbia Nadjla Algeria Jijel nj-br@hotmail.com

Bucciarelli Bernard France Sevran bbi@nucletron.fr

Buffa Francesca UK Oxford francesca.buffa@imm.ox.ac.uk

Carrasco Fatima Portugal Porto fcarrasco@fis.ua.pt

Ceric Melisa BiH Sarajevo mceric@epn.ba

Conti Valentina Italy Milano conti.valentina@gmail.com

Djarova Anna Bulgaria Sofia anna.djarova@gmail.com

Dogandjiiska Daniela Bulgaria Sofia d.doganjiiska@abv.bg

Caner Alessandra Italian Archamps alecaner@gmail.com

Demolis Filiz Turkey Izmir filiz@esi.cur-archamps.fr

Derkaoui Jamal Morocco Oujda derkaoui@sciences.univ-oujda.ac.ma

Dries Wim Netherlands Eindhoven wim.dries@catharina-ziekenhuis.nl

Drolc Botajan Slovenia Ljubljana bostajn.drolc@zvd.si

Dzharova Anna Bulgaria Sofia anna.djarova@gmail.com

Dumitriu Irina Romania Bucharest fiorrdaliss@gmail.com

Falie Dragos Romania Bucharest dfalie@alpha.imag.pub.ro

Ferrand Regis France Orsay regis.ferrand@curie.net

Fezov Daniel Bulgaria Sofia daniel_fezov@abv.bg

Fekete Zsolt Romania Cluj drfekete@gmail.com (continued)

xii LIST OF PARTICIPANTS

LIST OF PARTICIPANTS (continued)

Georgiev Ivaylo Bulgaria Sofia iv3georg@yahoo.com Ghitulescu Zoe Romania Bucharest ghitulescuzoe@yahoo.com Goksel

Evren Ozan

Turkey

Istanbul

evrenozangoksel@yahoo.com

Hamdy Abdelmaboud

Ahmed

Egypt

Cairo

Benhamdy@yahoo.com

Hartmann Gunther Germany Heidelberg g.hartmann@dkfz-heidelberg.de

Hristova Julia Bulgaria Sofia jully_84@mail.bg

Ivanova Severina Bulgaria Sofia sevi_ii@yahoo.com Jarry

Patrick

France

Gif-sur-Yvette

patrick.jarry@cern.ch

Jobs J. T. Germany Freiburg ruediger.lauk@ptw.de

Kaufhold Alexander Germany Freiburg alexander.kaufhold@ptw.de

Kaulich Theodor Germany Tübingen theodor.kaulich@med.uni-tuebingen.de Kostova-Lefterova

Desislava

Bulgaria

Sofia

dessi.zvkl@gmail.com

Lafrenière Geneviève UK Yarnton Genevieve.Lafreniere@varian.com

Lamm Inger-Lena Sweden Lund Inger-lena.lamm@skane.se

Lanche Stephanie France Archamps lanchestephanie@gmail.com

Lemoigne Yves France Archamps psf1@orange.fr

Li Pan Germany Heidelberg pan.li@dkfz.de Loja Nunes Pires

Paola

Germany

Berlin

paola.loja@physik.fu-berlin.de

Lollierou Julien France Presilly jlollierou@yahoo.fr

Marinello Ginette France Creteil ginette.marinello@hmn.ap-hop-paris.fr Mazeron

J-Jacques

France

Paris

jean-jacques.mazeron@psl.ap-hop-paris.fr

McKenzie Alan UK Bristol alan.mckenzie@ubht.swest.nhs.uk

Marinov Filip Bulgaria Sofia filip_marinov@abv.bg

Masiuk Mariusz Poland Gdañsk masiuk@amg.gda.pl

Miralbell Raymond Spain Barcelona raymond.miralbell@hcuge.ch

Mukov Mihail Bulgaria Sofia mmukov@gmail.com

Multan Marta Poland Krakow multan@if.uj.edu.pl

Nikollari Ermal Albania Tirana ermal.nikollari@libero.it (continued)

LIST OF PARTICIPANTS xiii

Nikolov Ivaylo Bulgaria Sofia ivo@odigy.com Nill Simeon Germany Heidelberg s.nill@dkfz-heidelberg.de

Nouet Philippe Switzerland Genève philippe.nouet@hcuge.ch

Oelfke Uwe Germany Heidelberg u.oelfke@dkfz-heidelberg.de

Pasciuti Katia Italy Rome ka.pasciuti@libero.it Perez-Calatayud

José

Spain

Valencia

jose.perez-calatayud@uv.es

Popowski Youri Belgium Brussels Youri.popowski@hcuge.ch

Remeijer Peter Netherlands Amsterdam Prem@nki.nl

Rijnders Alex Belgium Brussels a.rijnders@europehospital.be

Ruiz-Bueno Antonio Spain Valladolid aruizbueno@gmail.com

Samet Nina Moldova Chisinau nina_smd@yahoo.com

Saoud Houda Morocco Rabat saoudhanaa@yahoo.fr Shekel

Efrat

Israel

Petach Tikva

efrat.shekel@gmail.com

Smail Hassen Algeria Batna smail_hassen@yahoo.fr

Toschi Nicola Italy Rome toschi@med.uniroma2.it

Zajacova Zuzana Slovakia Bratislava zuzana.zajacova@cern.ch Webb Steve UK London steve@icr.ac.uk

PHOTOGRAPHS

Class room Computer room

G. Hartmann (De) lecturing PC exercises with G. Hartmann

Working group Equipement demonstration

xv

Equipment explanation Steve Webb (UK) Lecturing

Work at Geneva hospital J. Bonnet (Fr) lecturing

Wim Dries (Nl) lecturing T. Kaulich (De) lecturing

PHOTOGRAPHS xvi

PHOTOGRAPHS

G. Marinello (Fr) lecturing Tutorial on Brachytherapy

I. Lamm (Se) at Geneva Hospital

After lunch Coffee

Farewell dances Farewell Dinner

xvii

PHOTOGRAPHS xviii