From Physics to Medicine: Hadron Therapy CERN – Bulgarian Industry 28 - 29 November 2012 Manjit Dosanjh, KT-LS

From Physics to Medicine:Hadron Therapy

CERN – Bulgarian Industry 28 - 29 November 2012

Manjit Dosanjh, KT-LS

Knowledge Transfer | Accelerating Innovation

Knowledge and Technology Transfer

• KT is an integral part of CERN’s mission

• PP technologies relevant to key societal issues e.g. Health

• CERN involved in the last 10-15 years in health applicationsfew CERN resourcesattracted significant external funding (EC, MS…) raises impact and profile

beyond the particle physics arenalarge number of collaborating institutes

including medical institutes & hospitals

• Collaborators appreciate facilitation by CERN


Detecting particles

Accelerating particle beams

Large-scale computing (Grid)

First Bern Cyclotron Symposium - June 5-6, 2011 3Manjit Dosanjh

CERN Technologies and innovationaccelerators, detectors and IT to fight cancer

CANCER


Why Cancer ?

• Every year >3 millions new cases in Europe

• About one third of us will have cancer

• Number of patients needing treatment is increasing as people are living longer

• Main cause of death between the ages of 45 and 65 in Europe

• Second most common cause of death in Europe, Canada, USA after heart-disease

[email protected] 4KT-LS 26 May 2011


Cancer incidence increases with age


Cancer is a large and growing challenge Need: Earlier diagnosis, better control, fewer side-effects

How?• new technologies

• Imaging, dosimetry, accelerator & detector technology• Better understanding – genetics, radiobiology…• Advanced healthcare informatics …

• international collaboration• If progress is to be maintained

Although cancer is a common condition, each tumour is individual personalised approach Large patients data to understand the key drivers of the disease

Contribution from CERN is timely


Catalysing collaboration in health field

Challenges:

• Bring together physicists, biologists, medical physicists, doctors

• Cross-cultural at European and global level

Why is CERN well placed to do this?

• It is widely acknowledged as a provider of technologies and as a catalyst for collaboration.

• It is international, non-commercial, not a health facility.


4 Pillars: 3 are the key technologies4th pillar: catalysing and facilitating collaboration

Detecting particles Medical imaging

Large scale computing (Grid) Grid computing for medical data management

and analysis

Particle Therapy

Tumour Target

Accelerating particle beams


Accelerator technologies and health

Looking forward:• LEIR facility: requested by community (>20 countries, >200 people)• Medicis (ISOLDE) exotic isotopes for future R&D• Minicyclotron: commonly used isotopes

Treatment centre in Pavia, Italy. First patient treated in Sept 2011

Treatment centre in Wiener Neustadt, Austria, foundation stone 16 March 2011, will be ready in 2015

PIMMS 2000 (coordinated by

CERN) has led to:


Detector Technologies• Detector technology – improved photon detection

and measurement: Crystal Clear, PET, PEM, Axial PET

• Electronics and DAQ – high performance readout: (Medipix)

• Multimodality imaging: PET-CT (proposed by Townsend, future with PET-MRI)

CT PET PET-CT


Photon detection used for calorimetry

Idea of PET

Positron Emission Tomography

PETtoday

CMS


PET (Positron Emission Tomography)

• Detects pairs of photons emitted by an injected positron-emitting radionuclide

LHC detector systems used in PET Systems

• Images tracer concentration within the body

• Reflects physiological activity• Reconstructed by software


PET CT

PET/CT (David Townsend)


In-beam-PET for Quality Assurance: real time

In-beam-PET GSI- Darmstadt

MC simulated measured

Modelling of beta+ emitters:

Cross section

Fragmentation cross section

Prompt photon imaging

Advance Monte Carlo codes

On-line determination of the dose delivered


Computing Technologies

GRID – data storage, distributed, safe and secure computing

• MammoGrid: European-wide database of mammograms and support collaboration

• Health-e-Child: combining various types (clinical, imaging…) of data and share in distributed, clinical arena.

• HISP: Hadrontherapy Information Sharing Platform


There is no substitute for RT in the near future

The rate of patients treated with RT is increasing

Present Limitation of RT: ~30% of patients treatment fails locally

(Acta Oncol, Suppl:6-7, 1996)

Conventional Radiotherapy in 21st Century

3 "Cs" of Radiation

Cure (~ 45% cancer cases are cured)

Conservative (non-invasive, few side effects)

Cheap (~ 5% of total cost of cancer on radiation)(J.P.Gérard)


Two opposite photon beams

80 3050


110 110100

Two opposite photon beams


• Physics technologies to improve treatment: higher dose

• Imaging: accuracy, multimodality, real-time, organ motion

• Data: storage, analysis and sharing (confidentiality, access)

• Biology: fractionation, radio-resistance, radio-sensitization

• Working together: multidisciplinary

How to decrease failure rate?

Raymond Miralbell, HUG


Hadrontherapy: all started in 1946

In 1946 Robert Wilson:– Protons can be used clinically– Accelerators are available– Maximum radiation dose can be placed into

the tumour– Proton therapy provides sparing of normal

tissues

Depth in the body (mm)

Conventional: X-Rays Ion Radiation


Proton & Ion Beam Therapy: a short history

1989 1990 1991

Proposed by R.R. Wilson

1st patient treated at Berkeley, CA

HIT (carbon), Heidelberg (Germany)1st patient in Europe at Uppsala

2009 2011 2014

CNAO, Pavia (Italy)

MedAustron (Austria)

Eye tumours, Clatterbridge, UK

GSI carbon ion pilot, Germany

1992 1993 1994

CPO (Orsay), CAI (Nice), France

Loma Linda (clinical setting) USA

Boston (commercial centre) USA

NIRS, Chiba (carbon ion) Japan

1946 1954 1957

PIMMS

1996-2000

ENLIGHT

2002

ENLIGHT10th year

1984

PSI, Switzerland


ENLIGHTCERN collaboration philosophy into health field

Common multidisciplinary platform Identify challenges Share knowledge Share best practices Harmonise data Provide training, education Innovate to improve Lobbying for funding

Coordinated by CERN, 80% MS involved

> 150 institutes

> 400 people

> 25 countries

(>80% of MS involved)


EU funded projects• Wide range of hadron therapy projects: training, R&D, infrastructures• A total funding of ~24 M Euros• All coordinated by CERN,(except ULICE coordinated by CNAO• Under the umbrella of ENLIGHT

• Marie Curie ITN• 12 institutions

• Infrastructures for hadron therapy

• 20 institutions

• R&D on medical imaging for hadron therapy

• 16 institutions

• Marie Curie ITN• 12 institutions


Preparing for the Future……

• review the progress in the domain of physics applications for health

• identify the most promising areas for further developments

• explore synergies between physics and physics spin-offs• catalyse dialogue between doctors, physicists, medical

physicists……

24KT-LS 26 May 2011

First workshop on physics for health applications held @ CERN, 2010


International Conference on Translational Research in

Radio-Oncology &

Physics for Health in Europe

February 27 – March 2, 2012 at CICG, Geneva 2 days devoted to physics, 2 days to medicine, 1 common day Over 600 people registered, nearly 400 Abstracts Chairs: Jacques Bernier (Genolier) and Manjit Dosanjh (CERN)

Four physics subjects : Radiobiology in therapy and space Detectors and medical imaging Radioisotopes in diagnostics and therapy Novel technologies

Sensitivestructure (OAR)

Target (PTV)

Normal tissue


3 CERN Initiatives arising from PHE2010

• Biomedical Facility creation of a facility at CERN that provides particle beams of different types and energies to external users

• Medical Accelerator Designcoordinate an international collaboration to design a low-cost accelerator facility, which would use the most advanced technologies

• Radio Isotopes Establish a virtual European user facility to supply innovative radioisotopes (produced at ISOLDE-CERN, ILL, PSI, Arronax,..) for R&D in life sciences


Future Biomedical Facility @ CERN

Using LEIR (low energy ionising ring) 0)) for:

European facility for radiobiology• basic physics studies• radiobiology• fragmentation of ion beam• dosimetry• test of instrumentation

Biomedical facility requested by ENLIGHT Community (> 20 countries, >200 people )

LEIR


CERN contribution• Provider of Know-how and Technologies

• Design studies for Hadron Therapy facilities• Scintillating crystals for PET scanners• Fast detector readout electronics for counting mode CT• Grid middleware for Mammogrid, Health-e-Child

• Driving force for collaboration• Coordinator of the European Network for Light Ion Hadron Therapy

(ENLIGHT) Platform

• Training centre• Coordinator of large EC-ITN funded programs, e.g. Particle

Training Network for European Radiotherapy (PARTNER), ENTERVISION

New ideas being proposed……….

[email protected]

28


Thank you for your attention

[email protected]

Knowledge Transfer | Accelerating Innovation Drag picture to placeholder or click icon to add


R&D isotopes for “Theranostics”

149Tb-therapy 152Tb-PET

155Tb-SPECT161Tb-therapy& SPECT

#177: C. Müller#177: C. Müller et al., Center for Radiopharmaceutical Sciences ETH-PSI-USZ


Preparing Innovative Isotopes

- 1.4GeV protons for spallation & fission reactions on diverse target materials

- Providing a wide range of innovative isotopes such as 61,64,67Cu & rare earth metals such as 47Sc, 149Tb

- 1hr – 1 week t1/2

- Will utilise CERN/EPFL patented nanostructured target material

ISOLDE - MEDICIS

Inventory of isotopes produced in a natural Zr target after proton beam irradiation.


Cancer Treatment Options…

Surgery Radiotherapy

X-ray, IMRT, Brachytherapy, Hadrontherapy

SurvivalQuality of life

Chemotherapy and others

Hormones; Immunotherapy; Cell therapy; Genetic treatments; Novel specific targets (genetics..)

Local control Limited Local control

Local control


Status & Perspectives in Particle Therapy – A. Mazal

Worldwide

Patients

Statistics

26.02.2012

2006 2007 2008 2009 2010 2011 20120

10,00020,00030,00040,00050,00060,00070,00080,00090,000

100,000

TotalProtonsCarbon

M.JermannA.MazalPTCOG

Protons are an (expensive) clinical tool at an institutional level,

Ions are today an (even more expensive) tool for clinical research at a national or multinational level

There is a need for interdisciplinary R&D and synergy with the photon world


Radiobiology in therapy and space : a highlight

Local effects of microbeams of hadrons seen by fluorescent proteins which repair DNA

10 µm 10 µm 10 µm

55 MeV carbon5 × 5 µm² matrix

20 MeV protons randomly distributed

20 MeV protons5 × 5 µm² matrix117 protons per spot

Günther Dollinger - Low LET radiation focused to sub-micrometer shows enhanced radiobiological effectiveness (RBE)

Carbon ions have higher radiobiological effectiveness than protons


Detectors and medical imaging: a highlight

Detectors for Time-Of-Flight PET: the limit of time resolution

With 20 picosecondΔx = 4 mm:

no trackreconstruction

is needed

D. Schaart: Prospects for achieving < 100 ps FWHM coincidence

resolving time in Time-Of-Flight PET


Novel technologies: a roadmap for particle accelerators

What we need to be able to provide beams for therapy

Marco Schippers


Actions needed …

• Establish an appropriate framework @CERN• Identify and secure resources (inside and

outside)• Develop the necessary structure• Facilitate increased cooperation

between disciplines• physics, engineering, chemistry … (physical sciences)• medicine, biology, pharmacology… (life sciences)

within Europe globally


Needs for a radiation facility

• Increase radiobiological knowledge: • Cell response to different dose fractionations• Early and late effects on healthy tissue• Irradiation of cell at different oxygenation levels• Differing radio-sensitivity of different tumours/patients

• Simulations:• Ballistics and optimization of particle therapy treatment planning • Validation of Monte Carlo codes at the energies of treatment

and for selected ion-target combinations

• Instrumentation tests:• Providing a beam line to test dosimeters, monitors and other

detectors used in hadron therapy

Documents

From Physics to Medicine: Hadron Therapy CERN – Bulgarian Industry 28 - 29 November 2012 Manjit Dosanjh, KT-LS