IBA Proton Therapy. Biomed days Vincent Bossier. System Architect Protect, Enhance and Save Lives
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1 Vincent Bossier System Architect IBA Proton Therapy Biomed days 2015 Protect, Enhance and Save Lives 1
2 Agenda AN INTRODUCTION TO IBA WHY PROTON THERAPY CLINICAL WORKFLOW TREATMENT PLANNING PATIENT PREPARATION TREATMENT DELIVERY BEHIND THE SCENE Protect, Enhance and Save Lives 2
3 Protect, Enhance and Save Lives An introduction to IBA 3
4 IBA Founded in 1986, spin-off from UCL Innovative cyclotron design C30 PET+SPECT imaging Focus on cancer diagnostics and treatment Industrial Radiopharma Dosimetry Proton therapy Protect, Enhance and Save Lives Headquarters in Louvain-la-Neuve, Belgium 1200 people worldwide Protect, Enhance and Save Lives 4
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6 Protect, Enhance and Save Lives Why Proton Therapy?
7 Protect, Enhance and Save Lives The Bragg peak Extra dose
8 High risk prostate IMRT Proton Therapy Dose to critical Tissues (mean dose) Photons Protons Rectum 20 Gy 6.5 Gy Bowel 18 Gy 10 Gy Early outcomes with image-guided proton therapy suggest high efficacy and minimal toxicity with only 1.9% Grade 3 GU symptoms and <0.5% Grade 3 GI toxicities (*) Protect, Enhance and Save Lives Images Courtesy of Stefan Both, Ph.D (*) Mendenhall NP, et al. «Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer (low risk prostate trials); Int J Radiat Oncol Biol Phys Jan 1;82(1): Epub 2010 Nov 17 14
9 Pediatric medulloblastoma 3D CRT Proton Therapy Side Effects* Photons Protons Restrictive Lung Disease Reduced exercise capability 60% 0% 75% 0% Abnormal EKGs 31% 0% Growth abnormality 100% 20% IQ drop of 10 points at 6 years Risk of IQ score < % 1.6% 25% 15% * Medulloblastoma Ref: Presentation Dr. Jay S. Loeffler, NPTC/MGH, ASTRO 2001 Protect, Enhance and Save Lives 15
10 The early days of Proton Therapy The first patient treatments took place in the 1950 s and 1960 s Lawrence Berkeley National Laboratory (San Francisco) Uppsala University (Sweden) Harvard Cyclotron Laboratory (Boston) HCL developed present day proton therapy techniques Transfer of activity to first IBA Proton Therapy facility in 2002 Protect, Enhance and Save Lives 20
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12 Protect, Enhance and Save Lives PROTON THERAPY OVERVIEW 22
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14 Proton Therapy workflow overview What Who Outcomes Plan Treatment Preparation & irradiation Physician Dosimetrist Planner Physicist Radiotherapist Treatment position definition and instructions for CT Contouring: GTV, CTV and OAR (organs at risk) Treatment definition (dose & fractionation) Beams definition Monitoring Units (MU) definition Install the patient in TR TR/Align the patient in TR (laser, X-ray) Modify PPD position if needed Launch irradiation Protect, Enhance and Save Lives Follow-up Physician Follow up during whole treatment and life 24
15 Protect, Enhance and Save Lives CLINICAL WORKFLOW TREATMENT PLANNING 25
16 Imaging for planning Computed Tomography (CT) scanning provides reference 3D data made of 2D tomographic images MRI and PET scanning can also be used but CT remains the reference for planning Protect, Enhance and Save Lives 26
17 Fusion of patient information CT Nuclear medicine functional imaging Fusion Protect, Enhance and Save Lives But CT is the only image used for the planification
18 Protect, Enhance and Save Lives CT import in planning tool GTV Gross Tumor Volume
19 Volumes identification CTV Clinical Target Volume PTV Planned Treatment Volume OAR Organ at Risk Protect, Enhance and Save Lives
20 Dose distribution Dose Volume Histogram Highest does in PTV Lowest dose in OAR
21 A typical treatment is 70 Gy Protect, Enhance and Save Lives Fractionation Differential effect 2 Gy Healthy tissues Tumor Dose Cell survival
22 Protect, Enhance and Save Lives CLINICAL WORKFLOW PATIENT PREPARATION 34
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24 Video about imaging modalities 36
25 Patient Positioning System PPS Free moves for laser alignment Tailored for medical applications Correction vector application 6-DOF ROBOT Protect, Enhance and Save Lives 37
26 Immobilization examples Thermoplastic masks Vacuum Bags Head frame with bite block Protect, Enhance and Save Lives
27 Standard Image-Guidance Modalities 2D Bony contrast 3D Soft-tissue contrast Positioning Stereo kv Imaging Positioning Qualitative Anatomy assessment Offline adaptive CBCT In-room CT Protect, Enhance and Save Lives 40
28 Finding the displacement that brings the tumor to the planned location Manual/automatic registration Provides a 6-DOF correction vector 3D/3D or 2D/3D matching 42
29 2D/3D alignment Digitally Reconstructed Radiographs (DRR) generated from plan Position reference Provides x-rays you are supposed to take (DR) AdaptInsight computes a match between DR and DRR Protect, Enhance and Save Lives 43
30 Protect, Enhance and Save Lives CLINICAL WORKFLOW TREATMENT DELIVERY PENCIL BEAM SCANNING 45
31 Protect, Enhance and Save Lives The Conformity Problem 46
32 Protect, Enhance and Save Lives Lateral spreading scanning strategy 47
33 Dose deposition depth control Cyclotron produces protons at fixed energy 235 MeV Incoming proton energy defines Bragg peak depth Proton energy defines dose deposition depth Protect, Enhance and Save Lives 48
34 Longitudinal spreading degrading energy Introduction of carbon & beryllium blocks in the beam path reduces proton energy Beam path Angle Energy Protect, Enhance and Save Lives 49
35 Protect, Enhance and Save Lives Longitudinal spreading cumulated dose 50
36 Protect, Enhance and Save Lives Accurate 51
37 Protect, Enhance and Save Lives BEHIND THE SCENE 52
38 ProteusPLUS
39 ProteusONE
40 Protect, Enhance and Save Lives Beam Production & Transport ACCELERATOR GANTRY BEAM TRANSPORT
41 Driving protons Lorentz F = q (E + v B) B p F v Proton trajectory Protect, Enhance and Save Lives ACCELERATION DEVIATION
42 Cyclotron principles Injection at center Lower radius = lower energy N Constant angular speed N Extraction at max energy Fixed output energy B S S Protect, Enhance and Save Lives
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44 Machining of a C230 59
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46 Protect, Enhance and Save Lives Beam Production & Transport ACCELERATOR GANTRY BEAM TRANSPORT
47 Beam optics: dipoles & quadrupoles OFF ON Protect, Enhance and Save Lives Dipole changing direction Quad refocusing 64
48 Beam optics: different from light N S N S p S N S N Protect, Enhance and Save Lives Pairs of quadrupoles can focus in both planes 65
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51 Isocentric Gantries 360 Compact 220 Protect, Enhance and Save Lives 120 T // 10 m 68
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53 Protect, Enhance and Save Lives HOT 70
54 Recent achievements First Patient treated on Proteus ONE on Sept 9, 2014 at Willis- Knighton Cancer Center s World s First Proton Therapy Specific Cone Beam CT (CBCT) at Penn Medicine New superconducting synchrocyclotron (S2C2) under final validation In-room CT under final validation IBA and PHILIPS Imaging Systems entered into a Strategic Alliance Protect, Enhance and Save Lives 71
55 We are hiring IBA expects a major growth of the proton therapy market We will hire 200 engineers in the two coming years Current needed functions: Java software developer (Treatment front-end application) Requirement engineer (Positioning systems) Defines the specifications of a proton therapy subsystem Defines and performs the validation tests Protect, Enhance and Save Lives 72
56 Vincent Bossier System Architect Thank you! /company/iba /ibaworldwide /ibagroup /iba Protect, Enhance and Save Lives 73
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