Ion Beam Facilities from a Medical Perspectiveerice2009.na.infn.it/TalkContributions/Linz.pdf · Ion Beam Facilities from a Medical Perspective Linz-MediConsult Forschungszentrum

Ion Beam Facilities from a Medical Perspective

Linz-MediConsult Forschungszentrum Jülich

Ute Linz



• outline •

� Basic Principles

� Recent Developments

� Future Ideas

� Addendum



• basic guiding principles •

What is best for the patient?What can maximize efficiency?

New technological developments

In the clinic conservatism is an asset!

Clinical specifications

Technical requirements

Phase I Phase II



• basic design and construction principles •

robustness

fault-tolerance

reliability

flexibility

precision

reproducibility

minimize patient presence and treatment time

w/o sacrificing safety and outcome

Reliability

Safety Flow

IdealCare



• example: system reliability •

planned uptime: 3600 hours/year

12 hours/day

6 days/week

50 weeks/year

availability: ≥ 98% or ≥3500 hours/year!

breakdown or delay may reduce chance of cure



NS-FFAGlength: ≈ 15 mØ: 12 mweight: 5-6 t?range: 25-27 cmfield: Ø 18 cm

7.1

m

16.5 m

• ion gantry •

HIMAC IIlength: 17 mØ: 14 mweight: 300 trange: 25 cmfield: 15x15 cm2

yet to be realizedyet to be realized

HITlength: 25 mdiameter: 13 mweight: 600 trange: 30 cmfield: 20x20 cm2



• proton tomography •

low attenuation

high density resolution

direct visualization of proton range

more accurate patient positioning

improved dose verification

219 MeV protons

50 kV photons

mod

if. fr

om S

chne

ider

, 199

5



• proton tomography •

cylinder

75 kV X ray

identical density resolution at ≤ dose

1% relative density resolution at ≤ 10 mGy

mod

if. fr

om S

chul

te e

t al,

2005



• proton tomography: why not realized? •

cost and priorities

proton gantry necessary to collect 3D patient data

rapid 3D reconstruction methods required for visualizatio n



� for X-rays and ions alike

� supporting active and passive irradiation modes

� data from various imaging systems accepted

� accounting for biological response including effects from vascularization and internal organ structure

� accounting for spatial and temporal changes

• treatment planning •

one-fits-all rather than one-for-each

biologically optimized intensity-modulated dose del ivery



• treatment planning •TRiP

Tomorrow: RBE calculation with individually determined α⁄βα⁄βα⁄βα⁄β?

Today: RBE calculation with averaged published α⁄βα⁄βα⁄βα⁄β

Sch

olz

& E

lsae

sser

, 200

7

Kra

ft &

Kra

ft, 2

009



• compact accelerator •

Mitsubishi COMPACT

Schönauer, 2007

Ion Energy (MeV/u) Field (T) Ø (m)H 200 3 3.6C 300 4 5.2

yet to be realized!



• safety issues •

Health problems of pediatric cancer survivors:

2/3 have 1 chronic problem1/4 have ≥ 3 chronic problems

such ascardiovascular diseasekidney diseaseendocrine abnormality cognitive dysfunctionsecond cancer

NCI Bulletin, 2008:30 yrs after primary cancer treatment 70% of childhood c ancer survivors have a late-effect chronic health condition

active and passive safety measures for patients and staff



• safety issues: neutrons •

author beam range neu/prim ion norm tissue(MeV/u) in water (cm) neu dose(mSv/GyE)

1 1H (177) 30.1 0.025 2.3± 30%

2 12C (200) 12.8 0.54 5.4±20%

Data from:1) Schneider et al, 20022) Gunzert-Marx et al, 2008

C/H ≈ 2x fortotal neutron dose!

for scanned beam*

*for scattered beam: neutron dose ≈ 10x higher!



• safety issues •

time

shieldingrapid verification of and response to abnormal settings3D dosimetrycorrection for target motion

distance

simulationremote control and

monitoringrobotic assistance

minimize stray radiation and activation

scanning vs. scatteringmaze structures



• low-cost system •

llnl.g

ov

claims:R < 3 mvariation of• intensity• energy • spot sizeat f > 10 Hz

beam scanningby

distal edge tracking



• low-cost system •

still

river

.com

superconductingsynchrocyclotron

cost ≤ 30 M US$?

needs FDA approvalbeam scanning?



•• lasers for compact lasers for compact IB IB facilitiesfacilities ? ? ••

Malka et al, 2004

crude concept crude concept of a of a compact laser driven proton therapy compact laser driven proton therapy systemsystem



•• CNRS CNRS concept concept of of compact lasercompact laser --driven proton therapy driven proton therapy ••

2010?

CN

RS

, 200

6



•• the the "" Flagship ThemeFlagship Theme " of PMRC " of PMRC ••

Bolton, 2008

5 m

~ 20 m

JJ--KAREN "table KAREN "table toptop " " laserlaser



•• do do lasers help realize compact lasers help realize compact IB IB facilitiesfacilities ? ? ••

required upscaling :

beam energy: 5-10x (H)

energy variation: ≥100x

intensity: ≥ 100x

unsolved issues :

beam control ?

dose control ?

reproducibility ?

reliability ?

safety ?

cost ?



•• do do lasers help realize compact lasers help realize compact IB IB facilitiesfacilities ? ? ••

required upscaling :

beam energy: 5-10x (H)

energy variation: ≥100x

intensity: ≥ 100x

unsolved issues :

beam control ?

dose control ?

reproducibility ?

reliability ?

safety ?

cost ?

an ion beam of the proper energy is necessarybut

not sufficient to make a successful IBT system!



•• lasers for medical ion beamslasers for medical ion beams : : further reading further reading ••



• the ideal ion •

high LET in Bragg peak

low LET in entrance channel

minimum fragmentation tail

low neutron dose

low production cost

increase BED to tumor

spare normal tissue

reduce risk of long term damage

improve cost-effectiveness




1H: 48 µm* 7Li: 4.8 mm*

12C: 51 mm*

Data: Kempe, 2007

*high-LET zone:> 20 keV/µm

25% high LET

low LET

tail dose




Data: Kempe, 2007

Late

ral P

enum

bra

Nucleons

Longitudinal S

traggling



• summary: wish list •

flexible beam delivery

biological treatment planning

proton CT

safety

ideal ion

compact accelerator

less bulky ion gantry

Cost reduction

Quality improvement



• Acknowledgements •

Many Thanks to

Hiroshi Tsujii, NIRS

Reinhard Schulte, LLUMC

Eugen Hug, PSI

and the

Organizers of the Workshop

Documents

Ion Beam Facilities from a Medical Perspectiveerice2009.na.infn.it/TalkContributions/Linz.pdf · Ion Beam Facilities from a Medical Perspective Linz-MediConsult Forschungszentrum