Volker Schirrmeister ERICE APRIL ¢â‚¬› TalkContributions ¢â‚¬› Volker Schirrmeister Partnering

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  • ERICE APRIL 2009

    Varian Particle Therapy – Why Varian?

    Volker Schirrmeister

  • Partnering with Varian

    � Founded in 1959 & dedicated to Oncology

    � Varian Medical Systems created by Varian Associates in April, 1999

    � Varian Medical Systems � Varian Oncology

    � Varian X-ray Tubes

    � Varian Security Inspection Products � Varian Biosynergy � Ginzton Research Center

    Varian History

  • History of the Proton Program at Varian

    � Proton program started in 1992

    � Eclipse Proton treatment planning, VARiS and ARIA information management systems

    � First Chinese proton center at Zibo uses Eclipse and VARiS

    � MD Anderson, University of Florida; NCC Korea are on line

    � Varian acquires ACCEL Instruments GmbH, 1/07

  • Clinac 600C/D

    DBX, 6EX Clinac DHX, DMX, 2100 C/D, 21EX

    Clinac 2300C/D, 23EX, Silhoutte, iX, Trilogy

    Single Photon Energy

    4 or 6 MV

    Dual Photon Energies

    4 to 20 MV (25 MV)

    5 or 6 Electron Energies 4 to 22 MeV

    Easy to operate

    � Identical Collimator Head

    � Identical Accessories

    � Identical Treatment Couch

    � Identical Operation

    Identical Options

    � Dynamic Wedge

    � Asymmetric Jaws

    � Multileaf Collimator

    � PortalVision

    � 4D Treatment Console

    � Auto Field Sequencing

    � ARIA Oncology Info System

    Low Energy High Energy

    Varian Clinac Family

  • Varian Oncology Products Overview

    � Clinac®: Family of Linear accelerator treatment unit designed to provide quality radiation cancer therapy

    � kV On-Board Imager®: Accelerator based kV radiographic, fluoroscopic and Cone-beam CT imaging capabilities for IGRT

    � Millenium™ Multileaf Collimator (MLC): High-resolution beam shaping device used with Clinac to customize treatment dose

    � PortalVision™: High-resolution, digital flat-panel megavoltage imaging device with robotic position capability

  • Varian Oncology Products Overview

    � Trilogy™: Varian’s top-of-the-line, image-guided delivery system optimized for 3D-CRT, IMRT and Stereotactic Applications

    � Novalis Tx®: The Power of Two. A dedicated solution for Neuro- and Radiosurgical procedures and applications, featuring gantry and room based imaging tools

    � HD120™ MLC: Highest resolution beam shaping to achieve new levels if precision and accuracy (central region with 2.5 mm leaves)

  • Varian Oncology Products Overview

    � Acuity: a comprehensive medical imaging system that integrates planning, simulation, and verification software for treating cancer with radiation therapy

    � Eclipse, Helios & SomaVision: Computer systems for planning, calculating and visualizing dose distribution

    � ARIA: the only fully integrated Oncology Information System (OIS) to manage all aspects of comprehensive cancer care, including radiation oncology, medical oncology and surgery.

    � GammaMed / VariSource: HDR & PDR after-loading system that provides removable, implantable radiation for certain malignancies

  • Why Varian?

    � Highest Uptime Logbook 2004

    King Faisal Hospital, Riyadh, Saudi Arabia

  • Developmental Stages and Trends

    in Radiation Therapy

    Computerization of accelerators, development of MLCs and 3D planning

    1980s

    Why Varian?

    The Technical Vision

    Exploration of high energies & electrons

    1970s Basic Medical Accelerator designs developed & proved

    1960s

    Dynamic conformal techniques Start Proton Therapy Program

    1990s

    IMRT, Integration and

    process enhancement

    1995

    IGRT, full system integration and Dynamic Adaptive Radio Therapy

    2000s

    Biological Imaging & Targeting-Tumor Positioning

    201x

    RapidArc™ – Single Arc IMRT, Proton Therapy System ACCEL

    Enhanced SBRT & Neurosurgical applications

    2007

  • Strategic Acquisitions of Varian

    in Oncology

    TEM Ltd Simulation

    1984

    Acquisitions

    � The Strategic Vision

    Basic Medical Accelerator Teletherapy

    1960s

    ABB Portal Imaging & Data Management

    1990

    Dosetek Treatment Planning

    1993

    OpTx MedOncology Software

    2004

    ACCEL Particle Therapy

    2007

    Omnitron Brachytherapy

    1995

    GammaMed Brachytherapy

    2003

    Sigma Micro Oncology Information System

    2005

  • RPTC Munich

    Accelerator Treatment Rooms with Gantry

    Eye Treatment

    Beam Transfer Line

    First European Commercial Clinical PT Center

  • Superconducting Proton Cyclotron

  • ERICE APRIL 2009

    Proton Beamline for guiding the beam to the treatment rooms

  • The RPTC Gantries

    Constructed by Schär Engineering

  • Mechanical precision requirements as verified in production:

    Beam axis within 0,5 mm radius volume around Isocenter

    Gantry and Patient Positioner

  • Gantry Treatment Room

  • ERICE APRIL 2009

    Unique Proton Beam Scanning Nozzle

    ���� PRECISE BEAM

    ���� LOWEST NEUTRON DOSE

  • Why Varian ?

    Monitor chambers Vacuum chamber

    Scanner-Magnet 1 (y)

    Scanner-Magnet 2 (x)

  • Test of Scanning System at HMI, Berlin

    Nozzle 3D-View

    Scanning Magnets

    Dose and Position Monitors

    Vacuum Chamber

    Diagnostic Flat Panels (Position Verification)

    Patient Specific Devices (Range Shifter, Ripple Filter, Collimator, etc.)

    Scanning Nozzle

  • Scanning Method

    Irradiation of 1-l-Tumor with 2 Gy/min: � Spot scanning with continuous transition in row

    � Beam diameter (FWHM): 10 mm

    � Voxel spacing: 5 mm (20 ×××× 20 ×××× 20 voxels)

    � 5 ms per spot (max. ~ 20 ms, min. ~ 3 ms)

    � Beam switching on/off: 50 µs

    � 1-10 s irradiation period per layer

    � Layer switching time: 1 s

    30 cm

    40 cm

    y-View

    x-View

    30cm

    40cm

    lSC1 d lSC2

    SADSC1 SADSC2

    y-Scanner x-Scanner

  • X: 195 cm (mech. 200 cm) Y: 252 cm (mech. 256 cm)

    50 cm before isocenter

    20 cm behind isocenter

    Effective Proton Source

  • Leakage and neutron doses (Hall, 2006)

  • Scanning: Key Specifications & Measurements

    � Range: Up to 37.6 g/cm²

    � Field size: Up to 30 × 40 cm²

    � Dose Compliance: better than ± 2.5%

    � Beam spot size (FWHM): 4 to 7 mm

    � Repainting

    Dose Distributions measured at HMI, Berlin End-to-end test, RPTC Gantry-1

  • Test Cases Dose Results

    doses [Gy]

    - measured

    - calculated

    Deviations in homogeneous regions ≈≈≈≈1% !!!

    1,007 1,007

    1,000 1,010

    1,008 1,004

    0,750 0,698

    0,030 0,000

    14.5 cm1.007 / 1.007

    1.025 / 1.024

    1.035 / 1.033

    0.750 / 0.698

    0.030 / 0

    depthMeasured vs. calculated doses [Gy]

    1.008 / 1.010

    0.952 / 0.927

    19.5 cm

    6 cm

    0.845 / 0.881

    0.046/ 0.040

    0.007 / 0.002

    0.002 / 0

    0.882 / 0.919

    0.779 / 0.748

    0.379 / 0.376

    0.008 / 0

  • System Performance Test („END TO END“)

    � according to the DIN 6875-1, “Special radiotherapy equipments - Part 1: Percutaneous stereotactic radiotherapy, basic performance characteristics and essential test methods”

    � Demonstration of the overall system performance

    � specification of dose and dose distributions in a t arget volume, simulated in a phantom, for a simple and sophisticated geometry

    � Focus on agreement between planned and measured dos es

    Test steps:

    � CT imaging

    � Therapy Planning System:

    � contouring of target volume

    � definition of irradiation fields

    � dose calculations

    � positioning of the phantoms at Gantry 1 using the X -ray based position verification system

    � Beam application

    � dose measurements

    � comparison between measured and calculated dose dis tributions.

    (published at PTCOG 44, Zurich, June 2006)

  • Test Cases

    RPTC :

    Field 1: 30°, table rotation 90°

    11 layers, ≈≈≈≈1000 spots

    Field 2: 90°, with 57 mm w.e. range shifter

    10 layers, ≈≈≈≈ 800 spots

    QA plan generated for homogeneous PMMA phantom

    Field 1

    Field 2

  • Test Case – Results

    Measured vs. calculated doses [Gy]

    0.529 / 0.547

    Beam 11.148 / 1.161

    0.975 / 0.995

    1.057 / 1.060

    0.910 / 0.851

    Field 1

  • Test Case - Results

    Field 2

    Beam 2 0.286 / 0.323

    0.832 / 0.890

    0.893 / 0.944

    0.838 / 0.888

    0.674 / 0.575

    Measured vs. calculated doses [Gy]