Past present and future of proton therapy a

Past present and future of proton therapy: a physics perspective George Coutrakon, Ph. D Northern Illinois University Dept. of Physics And Technical advisor of NIPTRC Northern Illinois Proton Therapy and Research Center (West Chicago)

Robert Wilson In: Radiological use of fast protons. Wilson R. R. , Radiology 45, 487 -91, (1946) • Described the advantages of proton and ion beams for radiation therapy. • Suggested several techniques that are still in use today.

Dose vs. Depth for Protons In General, Effective Dose = RBE * Physical dose

50 to 250 Me. V is clinical range of interest Eye Tumors at 50 Me. V; Prostate Tumors at 250

Superposition of Bragg Peaks

Propeller for Range Modulation built at Harvard Cyclotron Lab

Lateral Beam Spreading at HCL circa. 1970

Patient in Treatment Position in Proton Gantry

Synchrotrons

Loma Linda Proton Therapy Facility 130 -150 patients/day

Proton Tx Harvard Cyclotron Lab early 1960’s, No 3 D CT or MRI imaging!

The Harvard Cyclotron Experience 9000 patients(1961 -2002) 1946 Robert Wilson publishes first paper 1961 Harvard Cyclotron Lab ( 160 Me. V) with MGH neurosurgeons treat first patient, small field, Stereotactic Tx’s, high dose, single fraction 1974 HCL begins large field (11 x 14 cm) fractionated treatments with focus on base of skull tumors and AVM’s 1970 s through 1980 s MGH physicians show definitive results for base of skull and eye tumors

The LBL Heavy Ion Beam Experience (1975 -1992) Used the Bevatron Heavy Ion Synchrotron for He, C, Ne, O, and Si nuclei (60 to 640 Me. V/amu) Developed the magnetic wobbler scanning system for lateral beam spreading. Developed the Ridge Filter for SOBP Developed Binary Range shifter for distal edge control. Developed 1 st Isocentric Stereotactic Alignment system , or ISA, in 1958 used at 184 inch cyclotron, later moved to Bevatron

The LBL Experience (con’t) Many new technology advances. 1 st multi-leaf collimator for particles (9 mm Tungsten leaves, 20 x 20 cm field size 1 st beam scanning nozzle for heavy nuclei Developed many new dosimetry devices Developed “state of the art” control system to monitor dose and multiple beam parameters in real time

Approx. 30 PROTON AND 5 CARBON ION THERAPY FACILITIES North America = 7 +2 Europe = 10 + 3 carbon Russia = 3 China = 2 +1 Korea = 2 Japan = 6 + 2 carbon Southern Hemisphere = 1 These include facilities under construction

Current and Future Treatment Sites For Proton Therapy Northern Illinois Univ. & Central Dupage Hospital MPRI MGH - Boston Univ. of Pennsylvania Hampton Univ. Loma Linda Univ. Medical Center Barnes Hospital Oklahoma City 200 18 M MD Anderson Scale Legend 0 Univ. of Florida 400 In Development Existing Site

F = qv. B/c = m (v 2/R) q. B/c = mv/r = m ω = m 2π f f(rev) = (q/2π) (B/m) f(rev) independent of proton velocity and orbit radius R If B(R) = constant and proton mass is constant This condition is called isochronous This allows continuous beam current

Energy Degrader for Fixed Energy Cyclotrons (70 – 250 Me. V)

250 Me. V isochronous cyclotron

160 Me. V Harvard Cyclotron clinical operation 1961 -2002 Weight 700 Tons and 8 meters across

The 230 Me. V IBA Cyclotron More than 10 delivered since 1997 Weight approx. 220 Tons and 4 meter diameter

Varian 250 Me. V superconduction cyclotron , 90 Tons and 3. 2 meter diameter, 2 delivered

Still River System 250 Me. V superconducting cyclotron; 20 Tons 2 meter diameter, 10 Tesla magnet 1 st delivery expected this year in St. Louis , Barnes Hospital and Washington Univ.

Future developments: how to make proton therapy equipment smaller, cheaper, better

Heidelberg Heavy Ion Facility compact design (60 m x 70 m) full clinical integration raster scanning only treatments with various ions: p, He, C, O change within minutes world-wide first scanning ion gantry state of the art med-tech equipment > 1000 patients per year

Rationale for Carbon Beam Therapy

Dose vs. Depth for Protons In General, Effective Dose = RBE * Physical dose

Thank you

Would the ideal proton system look and cost something like this?

A proton CT detector UC Santa Cruz-NIU –LLUMC collaboration

UCR graduates employed at the LLUMC proton treatment center Woo Yong Lee Jojit Torcedo Vincent Ugarte Robert Simpson Bryan Benson Darrin Squire Mike Taber Gung Yur Brandon Weethee Anton Vatnitski Ben Harris Steve Rightnar Eric Rameriz Also, another 4 or 5 from CSUSB, 1 from UCB and 2 from UCLA, 5 from La Sierra University, 1 from Univ. of Redlands

Hopefully, a proton treatment center in West Chicago very soon! Thank for your attention

Du. Page National Technology Park West Chicago, IL

Dose vs. Depth in patient for various Radiation Fields

LBL Nozzles, 1975 and 1990