Cancer, Partikel Terapi and PT accelerators Look! Borg get upgrade already! 1 Cancer, Partikel Terapi and PT accelerators Basic requirements to PT accelerator Accelerators for PT Siemens PT maskinen 2
Fractionated treatment Why fractionation of the treatment? For a high abrupt dose the healthy tissue is not able to repair the radiation damage (both cancer cells and healthy cells die). Cancer cells are only more sensitive to radiation at small doses (~2 Gy and less) After ~6 hours the healthy tissue have repaired most of the radiation damage. A curative treatment is divided into 20-40 fractions of ~2 Gy with typically one day between subsequent treatments (5 days per week). 3 Therapeutic window Therapeutic window for curative treatment: Dose: Compromise between cure and toxicity to healthy tissue 4
Hardware for photon radiotherapy Proton therapy Bragg peak for protoner Photons ENERGY
Radiation cancer therapy Photons IMRT protons 7 Linear Energy Transfer Stopping Power 8
Dose deposition profiles Linear Energy Transfer Stopping Power 6 2 =36! 10
SpreadOutBraggPeak tumor raster scan treatment
Raster scanning 13 C therapy Heavy Ion Therapy Advantages (relative to protons): Higher LET -> larger RBE (and lower OER). Monitoring of dose deposition via PET (2 mm accuracy) Better conformity due to less radial straggling Slightly improved dose deposition for SOBP
Relative Biological Efficiency γ, p Biologisk effekt af stråling
PR 17 Comments about particle cancer therapy deposit dose in tumor but spare surrounding healthy tissue with photons, the maximal dose (determined by the surrounding tissue) is given in many (10 s of) fractions cancer cells are less resistant to radiation than normal cells with (high RBE) particles, few (1?!) fractions are sufficient with particles, additional treatment is possible IMRT redistribuerer dosis til det raske væv, men reducerer ikke integral dosis. Protoner kan halvere integral dosis Reducere risiko for sekundær cancer (BØRN) Potentiale for dosiseskalation C(p)-boost? Hypoxiske tumorer
Dose and intensity Range of Proton energy: Carbon energy: 30 cm (50-)250 MeV (100-)430 MeV/u=5GeV Dose of 2 Gy (=J/kg) in 2(10) l in 2 min. Particle intensity 6 10 11 p in 2 min or 2 10 10 C in 2 min Acceleratorer til PT Lineær accelerator Synkrotron Cyclotron 20
LINAC Too expensive Little flexibility Energy variation difficult No linacs for PT has been built Though: energy variation by LINAC 21 VARIAN (SC proton ) 22
IBA facility 23 Energy degradation Carbon? 24
OPTIVUS proton synchrotron 10m 25 Mitsubishi Electric proton synchrotron 26
HIT (Heidelberg) 27 HIT gantry 28
HIT gantry 29 Preassembly of structure in Egypt
SAG patient treatment room 31 Gantries vs. fixed beamlines Beamlines: horisontal semi-vertikal vertical 32
Faciliteter til Partikel Terapi WHO, WHERE COUNTRY PARTICLE MAX. CLINICAL BEAM START OF ENERGY (MeV) DIRECTION TREATMENT TOTAL PATIENTS TREATED DATE OF TOTAL ITEP, Moscow Russia p 250 horiz. 1969 4119 Dec-08 St.Petersburg Russia p 1000 horiz. 1975 1327 Dec-07 PSI, Villigen Switzerland p 72 horiz. 1984 5076 Dec-08 Dubna Russia p 200**** horiz. 1999 489 Dec-08 Uppsala Sweden p 200 horiz. 1989 929 Dec-08 Clatterbridge England p 62 horiz. 1989 1803 Dec-08 Loma Linda CA.,USA p 250 gantry,horiz. 1990 13500 Dec-08 Nice France p 65 horiz. 1991 3690 Dec-08 Orsay France p 200 horiz. 1991 4497 Dec-08 ithemba Labs South Africa p 200 horiz. 1993 503 Dec-08 MPRI(2) IN.,USA p 200 horiz. 2004 632 Dec-08 UCSF CA.,USA p 60 horiz. 1994 1113 Dec-08 HIMAC, Chiba Japan ion 800/u horiz.,vertical 1994 4504 Feb-09 TRIUMF, Vancouver Canada p 72 horiz. 1995 137 Dec-08 PSI, Villigen Switzerland p** 250* gantry 1996 426 Dec-08 G.S.I. Darmstadt Germany ion** 430/u horiz. 1997 384 Dec-07 HZB (HMI), Berlin Germany p 72 horiz. 1998 1227 Dec-08 NCC, Kashiwa Japan p 235 gantry 1998 607 Dec-08 HIBMC,Hyogo Japan p 230 gantry 2001 2033 Dec-08 HIBMC,Hyogo Japan ion 320 horiz.,vertical 2002 454 Dec-08 PMRC(2), Tsukuba Japan p 250 gantry 2001 1367 Dec-08 NPTC, MGH Boston USA p 235 gantry,horiz. 2001 3515 Oct-08 INFN-LNS, Catania Italy p 60 horiz. 2002 174 Mar-09 Shizuoka Japan p 235 gantry, horiz. 2003 692 Dec-08 WERC,Tsuruga Japan p 200 horiz.,vertical 2002 56 Dec-08 WPTC, Zibo China p 230 gantry, horiz. 2004 767 Dec-08 MD Anderson Cancer Center, Houston, USA p*** 250 gantry, horiz. 2006 1000 Dec-08 TX FPTI, Jacksonville, FL USA p 230 gantry, horiz. 2006 988 Dec-08 NCC, IIsan South Korea p 230 gantry, horiz. 2007 330 Dec-08 RPTC, Munich Germany p** 250 gantry, horiz. 2009 treatment started Mar-09 Oklahoma City, OK USA p 230 gantry, horiz. 2009 treatment started Jul-09 33 WHO, WHERE COUNTRY PARTICLE MAX. CLINICAL ENERGY (MeV) PSI, Villigen* Switzerland p 250 SC UPenn, Philadelphia, PA* Med-AUSTRON, Wiener Neustadt USA p 230 Austria p, C-ion 400/u synchrotron Trento Italy p 230 CNAO, Pavia* Italy p, C-ion 430/u synchrotron HIT, Heidelberg* Germany p, C-ion 430/u synchrotron ithemba Labs South Africa p 230 RPTC, Koeln Germany p 250 SC WPE, Essen* Germany p 230 CPO, Orsay* France p 230 PTC, Marburg* Germany p, C-ion 430/u synchrotron Northern Illinois PT USA p 250 Res.Institute, W. SC Chicago, IL* NRoCK, Kiel Germany p, C-ion 430/u synchrotron Chang Gung Memorial Taiwan p 235 Hospital, Taipei* Gunma University, Japan C-ion 400/u Maebashi* synchrotron PCPTC, Chicago, IL* USA p 230 HUPBTC, Hampton, VA* USA p 230 PMHPTC, Protvino* Russia p 250 synchrotron CCSR, Bratislava Slovak Rep. p 72 CMHPTC, Ruzomberok* Slovak Rep. p 250 synchrotron SJFH, Beijing China p 230 Skandion Clinic, UppsalaSweden p 250 BEAM DIRECTION Additional gantry, with 2D parallel scanning, 1 horiz fixed beam 4 gantries, 1 horiz fixed beam 1 gantry (protons) 1 fixed 90 deg, 1 fixed 90 + 45 deg 1 gantry 1 horiz fixed beam 1 gantry? 3 horiz. 1 vertical 1 gantry (C-ions), with raster scanning, 2 fixed beams 1 gantry 2 horiz. 4 gantries 1 horiz. 3 gantries 1 horiz. 1 gantry 4 fixed beams 3 horiz. fixed beams 1 45 deg fixed beam 2 gantries 2 fixed beams NO. OF TREATMENT ROOMS Cancerandradiationtherapy START OF TREATMENT PLANNED Søren 1+2 Pape Møller 2009 5 2010 3 2013 2 2011? 3-4 2010? 3 2010 3? 5? 4 2010 3 2010 4 2010 4 2011 1 90 deg fixed beam 1 90+45 deg fixed beam 1 90+0 deg fixed beam 3 2012 4 gantries 4 2011 1 experimental room 1 90 deg fixed beam 3 2010 1 0 deg fixed beam 1 0+90 deg fixed beam 2 horiz., 2 dual fixed beams 4 2011 4 gantries 5 2010 1 horiz. 1 horiz. 1 2010 1 horiz. 1 2010? 1 horiz. 1 2010 1 gantry 2 2010 1 horiz. 2 gantries 2 2012?
Partikel terapi i DK I forbindelse med eksperimenter med cancer terapi med antiprotoner er der ved Århus Universitet lavet eksperimenter specielt med dosimetri af partikelbeams DANLITE Kanon kampen! Initial tests with 70 MeV p in Århus 36
Tests ved ASTRID Injektion af H - ved 150 kev Acceleration til 50-70 MeV Stripning i elektronkøler H - + e H 0 + e + e Max strøm: få 10 6 per cycle 37 DANLITE DANLITE er et dansk nationalt initiativ, med det formål at etablere et partikelterapianlæg til kræftbehandling i Danmark. Deltagerne er fra universitetshospitalernes onkologiske og billeddiagnostiske afdelinger, Århus, Odense og Københavns Universitet og DTU, samt DANFYSIK.
Kampen om kanonen 39 Kampen om kanonen 40
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