Progress in the Application of Hadron Therapy protons

Progress in the Application of Hadron Therapy (protons or ions) Marco Schippers Progress in Application of Hadron Therapy Venice July 8, 2017 1 Marco Schippers EPS

The boost in particle therapy more mostly in labs hospital based Loma Linda (Ca, USA) Particle therapy group: until 2015 > 150. 000 patients treated www. ptcog. ch Progress in Application of Hadron Therapy Venice July 8, 2017 2 Marco Schippers EPS

Contents • Introduction: particle therapy • Accelerators • Synchrotron • Cyclotron • Treatment facilities • What is so special? Progress in Application of Hadron Therapy Venice July 8, 2017 3 Marco Schippers EPS

X-ray dose X-ray beams (IMRT ) from 7 directions X-rays heart lung Spinal cord Progress in Application of Hadron Therapy Venice July 8, 2017 4 Marco Schippers EPS

Dose profile of protons Dose (a. u. ) Bragg peak 0 2 4 6 8 10 12 14 16 18 Depth in tissue (cm) Progress in Application of Hadron Therapy Venice July 8, 2017 5 Marco Schippers EPS

X-rays vs. Protons X-ray beams (IMRT ) from 7 directions Proton beams from 3 directions Protons X-rays heart lung Spinal cord pictures: Medaustron Progress in Application of Hadron Therapy Venice July 8, 2017 6 Marco Schippers EPS

Biological effect of Carbon ions RBE>1: RBE= 1. 1 Less dose for RBE≈ 3 same cell killing electron track (or energy) density at nm scale effects RBE ( this means: RBE≠ 1 ) Progress in Application of Hadron Therapy Venice July 8, 2017 7 Marco Schippers EPS

Pencil beam scanning Spot scanning: step&shoot Continuous scanning allows fast target repainting: 15 -30 scans / 2 min. Progress in Application of Hadron Therapy Venice July 8, 2017 8 intensity k. Hz-Intensity modulation 0 time (ms) Marco Schippers 10 EPS

Present accelerator choice e. g: Boston Florida Seoul Wanjie e. g. : PSI München Loma Linda 3. 5 m Houston Orsay Tsukuba cyclotron Protons Carbon ions synchrotron in use, 3. 5 -5 m in use, 8 -10 m in design, 6 m in use, 25 m Progress in Application of Hadron Therapy Venice July 8, 2017 9 Marco Schippers EPS

Synchrotron Hitachi Ltd Protons only: Extracted beam synchrotron ( ~8 m) Proton source + injector synchrotron Ions (p-C): Extrac ted be am ( ~25 m) Injector Ion sources Heidelberg Progress in Application of Hadron Therapy Venice July 8, 2017 10 Marco Schippers EPS

Beam intensity Synchrotron beam structure in time 0. 5 -1 sec 1 -10 sec Time in development “spill” time • fill ring with ~1011 particles • accelerate to desired energy • extract slowly during 1 -10 sec • decelerate and dump unused particles Progress in Application of Hadron Therapy Venice July 8, 2017 11 Marco Schippers EPS

Cyclotron 230 Me. V (IBA, SHI, 1996) 250 Me. V (ACCEL/Varian, 2005) iam. 5 m, 200 tons SC coils: diam 3. 5 m, 100 tons Progress in Application of Hadron Therapy Venice July 8, 2017 12 Marco Schippers EPS

E-adjustment with cyclotron 250 Me. V cyclotron At PSI: Graphite degrader 238 -70 Me. V Progress in Application of Hadron Therapy Venice July 8, 2017 13 All following magnets: 1% field change in 50 -80 ms Marco Schippers EPS

Small cyclotron very strong magnetic field: Synchro-Cyclotron f. RF B decreases with radius Tcircle increases with radius. SO: decrease f. RF with radius and extract time Repeat 1000 x per sec 1 ms Each pulse: set intensity at source within ms (=> typ 10 -30% accuracy) => Spot scanning requires >2 pulses per spot. Progress in Application of Hadron Therapy Venice July 8, 2017 14 Marco Schippers EPS

Synchro-Cyclotron 8 -10 T 250 Me. V Synchro-cyclotron on a gantry First system installed in 2013 Progress in Application of Hadron Therapy Venice July 8, 2017 15 Marco Schippers EPS

=> Quality Current Useability Accelerator status (protons) n o r t lo n c y o c r ot r ch n all sy m s or h c syn otron l c y linac c FFAG laser Dielectr. wall linac Plasma wake field Now Mañana Time until useable Progress in Application of Hadron Therapy Venice July 8, 2017 16 Marco Schippers EPS

Proton therapy: multi-room facility Cyclotron or synchrotron gantrie s At cyclotron: degrader+ energy selection beam IBA Progress in Application of Hadron Therapy Venice July 8, 2017 17 transp ort Marco Schippers EPS

10 -12 m Gantries IBA ~90 t Progress in Application of Hadron Therapy Venice July 8, 2017 18 Marco Schippers Loma Linda (Optivus) EPS

PSI Gantry-2: fast 3 D scanning PSI-”Gantry-2” Eros Pedroni David Meer Progress in Application of Hadron Therapy Venice July 8, 2017 19 Marco Schippers EPS

Gantry for carbon-therapy HIT, Heidelberg Progress in Application of Hadron Therapy Venice July 8, 2017 20 Marco Schippers EPS

NEW: SC gantries SC s ipole SC d an ni les Sc o dip NIRS, Japan ng XY Pronova, Knoxville, USA Progress in Application of Hadron Therapy Venice July 8, 2017 21 Marco Schippers EPS

PSI’s superconducting gantry design Collimators Degrader Scanning magnets Rotation axis Isocenter combined function, achromatic bending • Degrader mounted on the gantry • Momentum acceptance of approx. ± 12. 5 % • Treatment of the small tumors without change of the SC magnet field Progress in Application of Hadron Therapy Venice July 8, 2017 22 Marco Schippers EPS

Acc. Lab Hospital What is so special? Operators Technicians Radiologist operates Experienced workshops CE/FDA-certification: PROCEDURE More improvised actions Local technicians: only small repairs Service by equipment company Progress in Application of Hadron Therapy Venice July 8, 2017 23 Marco Schippers EPS

Safety Availability Separate interlock systems e. g. : Machine interlocks: Area access & area dose: Doors closed, dose rate < µSv/h More specially for treatments all components technically OK Patient safety: Dose delivery as planned Progress in Application of Hadron Therapy Venice July 8, 2017 24 Marco Schippers EPS

Redundancy measurement el stop lev Al ar m BEAM off stop Redundancy m ar Al el lev Redundancy Patient safety interlock system stop Progress in Application of Hadron Therapy Venice July 8, 2017 25 Marco Schippers EPS

Operation: non-accelerator experts What has happened ? Strong need for ERGONOMIC display of: NO BEAM Status Instructions Progress in Application of Hadron Therapy Venice July 8, 2017 26 Marco Schippers EPS

Accelerators for Medical Application What is so special? • Technics: dedicated, but not on the limit of technology …. but… Reliable, Reproducible, Reliable, Reproducible • Operation: by non-accelerator experts strictly according procedures • Control and safety: VERY DEDICATED and SPECIAL : Reliable & Redundant, but not too sensitive Progress in Application of Hadron Therapy Venice July 8, 2017 27 Marco Schippers EPS

SUMMARY • Dose: • finite range • maximum dose at end of track • Apply the dose by Pencil Beam Scanning • Accelerators for Medical Application: • Cyclotron • Synchrotron • Medical applications: VERY Special Operation • Facilities: Gantry aims the beam from all directions • Recent development: SC magnets Progress in Application of Hadron Therapy Venice July 8, 2017 28 Marco Schippers EPS

…. Motivation …. first scanning gantry : PSI, 1996 Thank you !! Gantry: Eros Pedroni Progress in Application of Hadron Therapy Venice July 8, 2017 29 Tumours in kids: Beate Timmermann, Gudrun Goitein Marco Schippers EPS