G. Cuttone Laboratori Nazionali del Sud - Catania

INFN-LNS e Centro di AdroTerapia e
Applicazioni Nucleari Avanzate
G. Cuttone
Laboratori Nazionali del Sud - Catania
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
Why clinical
clinical proton
proton beam
beam?
Why
?
Why clinical
clinical proton
proton beam
beam?
Why
?
• penetration depth is well-defined and adjustable
• most energy at end-of -range
• protons travel in straight lines
• dose to normal tissue minimised
• no dose beyond target
PROTONS PERMIT TO DELIVER AN HIGH DOSE TO
THE TUMOUR SPARING THE SOURRONDING TISSUES
IMRT vs
vs PROTONS
PROTONS
IMRT
Between the eyes
Abdomen
Brain
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
INFN && Hadrotherapy
Hadrotherapy
INFN
• In 90’ years INFN supported TERA in R&D project.
• INFN, in collaboration with University of Catania, realized in
its laboratory (Lab. Naz. Del Sud) the first Italian
protontherapy facility.
• INFN has UNIQUE capability in Italy in accelerators
development.
• Considering its particular features, INFN was involved in
CNAO to guarantee the necessary expertise.
• In 2005 INFN was encharged by Health Minister to produce
a document about protontherapy in our country.
In Catania we developed a
facility
(named CATANA)
for the treatment of ocular
tumours with 62 AMeV proton
beams
CATANA collaboration
Centro di AdroTerapia e Applicazioni Nucleari
Avanzate
INFN-Laboratori Nazionali del
Sud
Physics Department,
University of Catania
CSFNSM
G. Cuttone
G.A.P. Cirrone
L. Calabretta
D. Rifuggiato
A. Amato
M.G. Sabini
S. Lo Nigro
F. Di Rosa
P.A. Lojacono
V. Mongelli
I.V. Patti
L.M. Valastro
Ophthalmologic Institute
University of Catania
A. Reibaldi
J. Ott
G.Profeta
M.L. Rallo
Radiologic Institute
University of Catania
G. Privitera
V. Salamone
L. Raffaele
C. Spatola
LNS
Superconducting
Cyclotron is the
unique machine in in
Italy and South
Europe used for
protontherapy
Treatment of the
choroidal and iris
melanoma
In Italy about 300 new
cases for year
Laboratori Nazionali del Sud –INFN Catania, Italy
Cyclotron
Location
Treatment
Room
Location
Proton
Beam
LNS Accelerator Layout
Ocular Protontherapy
Unique Italian Facility
CATANA
CATANA proton
proton therapy
therapy beam
beam line
line ((until
untilJune
June2004
2004))
CATANA
CATANA proton
proton therapy
therapy beam
beam line
line ((new
newlocation
location))
CATANA
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
CATANA proton
proton therapy
therapy beam
beam line
line
CATANA
Ligth
field
Laser
Modulator &
Range shifter
Monitor
chambers
Scattering
system
Lateral dose
dose distribution
distribution
Lateral
DOUBLE SCATTERER FOIL
WITH CENTRAL STOPPER
15 µm + 25 µm + 7 mm thick
copper beam stopper
Lateral dose
dose distribution
distribution in
in aa clinical
clinical proton
proton beam
beam
Lateral
120
100
Relative dose
95 %
80
60
50 %
40
20 %
20
0
-20
-15
-10
-5
0
5
10
15
20
Distance from central axis (mm)
Lateral penumbra :
d 80 % → 20 %
Field ratio :
H =
90 % field size
50 % field size
Flatness :
ϕ = 25 mm ⇒ ≥ 0 . 90
ϕ = 25 mm ⇒ > 20 mm
w 95 % :
Simmetry
Tolleranze
≤ 1 . 50 mm
( Area ratio ) :
ABS ( a − b ) × 200 %
a+b
P − Pmin
RT % = max
× 100 %
Pmax + Pmin
Sr =
≤ 3%
≤ 3%
Depth dose
dose distribution
distribution –– Energy
Energy modulation
modulation
Depth
Generation of the Spread Out Bragg Peak (SOBP)
Modulated clinical
clinical proton
proton beam
beam
Modulated
110
100
90
SOBP
Dose (%)
80
70
60
Rres
50
40
30
20
Rp(10%)
10
Z REF
0
0
5
10
15
20
25
30
35
Depth in water (mm)
MODULATION REGION (SOBP) = W95%
ENTRANCE DOSE = D(z=0)
DISTAL PENUMBRA = d80%→
→20%
LONGITUDINAL UNIFORMITY
Rl = [( Dmax / Dmin ) × 100]%
Experimental SOBP
SOBP curves
curves
Experimental
120
90
95%
100
Relative Dose (%)
R e la tiv e Io n iz z a tio n (% )
100
80
Markus Ionization Chamber
70
60
50
40
30
20
10
0
80%
80
60
Modulated Region
40
20%
20
0
0
5
10
15
20
25
30
35
R90%
0
Depth in water (mm)
10
20
Depth in water (mm)
30
DETECTOR
Peak
Depth
Peak-Plateu
Ratio
F.W.H.M.
Distal dose
falloff
d80%-20%
Practical Range
(d10%, ICRU 59)
MARKUS
30.14
4.68
3.19
0.50
31.15
DETECTOR
Modulation
(SOBP)
Maximum
Dose (%)
Distal dose
falloff
d90%-10%
Distal dose
falloff
d80%-20%
Beam Range
(90% Distal)
MARKUS
21.31
103.9
0.84
0.57
28.39
40
Experimental lateral
lateral dose
dose distribution
distribution
Experimental
FULL ENERGY BEAM
S ig n al [ % ]
100
Radiochromic Film
80
60
40
20
0
-20
-15
-10
-5
0
5
10
15
20
Distance from axis [ mm ]
DETECTOR
Field
Ratio
P80% - 20%
(mm)
Simmetry
(%)
Width of 95%
level (mm)
0.85
2.40
22
90% / 50%
GAF HS
(ISP)
0.92
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
Dosimetric commissioning
commissioning:: absolute
absolute&&relative
relativedosimetry
dosimetry
Dosimetric
Absolute Dosimetry: Energy Released in Water (Gray)
Relative Dosimetry: Three dimensional dose distribution
measurements
⇓
Considering the high gradient dose, conformation and
small fields often used the detectors have to be kindly
characterized in terms of spatial resolution, energy or
fluence dependence to be used in protontherapy.
Relative and Absolute Dosimetry are
fundamental for:
Customizing of TPS
Monitor Unit Calculation
Quality Control
Dosimetric commissioning
commissioning:: absolute
absolute&&relative
relativedosimetry
dosimetry
Dosimetric
ICRU 59 AND TRS 398 IAEA
RECOMMENDATION
⇓
“ FOR MEASUREMENTS OF DEPTH-DOSE
DISTRIBUTION IN PROTON BEAMS
THE USE OF PLANE-PARALLEL CHAMBERS IS
RECOMMENDED”
⇓
Parallel plate MARKUS PTW is the golden
standard for depth dose measurements
Dosimetric commissioning
commissioning:: absolute
absolute&&relative
relativedosimetry
dosimetry
Dosimetric
ADVANCED MARKUS CHAMBER
VP = 400 V V×
×cm-1 = 4000 Pressure equilibrium ≤ 10 sec
Temperature equilibrium = 2-3 min./K
kS = 1.00 (1÷
÷100 Gy/min.).
Response: 670 pC/Gy
Directional dependence: smaller than 0.1% for tilting of the chamber by up to 10º
Electrode Acrylic (PMMA), graphite coated 5 mm Ø
Leakage current ± 4 fA
Dosimetric commissioning
commissioning:: absolute
absolute&&relative
relativedosimetry
dosimetry
Dosimetric
1
2
5
4
1) Film Kodak: XV and EDR2
4) Scanditronix Diode
•
3
2) TLD
5) PTW Natural Diamond
6
3) Radiochromic Film
6) Mosfet
In collaboration with ISS (S. Onori..) and DFC Florence (M. Bucciolini…)
THE MOPI
MOPI ONLINE
ONLINE MONITOR
MONITOR
THE
2 ionization chambers with anode segmented in strips (x,y)
anode
cathode
electronics card
horizontal strips
spacer
beam
cathode
anode
aluminized mylar
15µm Al
strips
Sensitive area
Total thickness
Number of strips/chamber
Strip width
Pitch
Readout rate
35µm kapton
12.8X12.8 cm2
~ 200 µm H2O equiv.
256
400 µm
500 µm
up to 4 kHz (1 Hz)
THE MOPI
MOPI ONLINE
ONLINE MONITOR:TEST
MONITOR:TEST SET
SET-UP
THE
-UP
x-y ion. strip chambers
MOPI
p beam
ionization chambers
GEANT4Complete
Completesimulation
simulationof
ofthe
theCATANA
CATANAbeam
beam line:
line:
GEANT4
Design possibility of a
general hadron therapy
beam line
Optimization of its
elements
GEANT4 simulation
TPS check respect the very
precise Monte Carlo method
GEANT4Simulation
Simulation
GEANT4
Monte Carlo Simulation of the entire beam line using GEANT4:
Improvement of our beam line and dosimetry
Give a general purpose tool for the design of new hadrontherapy beam line
Validation of the treatment system software
GEANT4 simulation
Physicsmodels
models
Physics
Standard +
hadronic
Standard
Processes
Kolmogorov test
process
P-value
Test
Standard.
0.069
OK
Standard + Had.
0.40
Low Energy
0.51
OK
Low Energy
OK
+ hadronic
Low En. + Had
0.699
OK
Low Energy
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
Surgical Phase
Phase (Tantalum
(Tantalum clips
clips insertions)
insertions)
Surgical
CLIPS: characterize
position and size of
tumour volume
typical treatment
treatment
AA typical
The Surgical Phase
The Treatment Planning Phase
The Verification Phase
The Treatment Phase
Two orthogonal X-Rays tubes for the visualization of the clips
Treatment Planning
Planning System
System Phase
Phase
Treatment
EYEPLAN
Originally developed by Michael Goitein and Tom
Miller (Massachussetts General Hospital), is now
maintained by Martin Sheen (Clatterbridge Center
for Oncology) and Charle Perrett (PSI)
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Patient’s follow up
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
Fixation Point
Point Choice
Choice
Fixation
This point is chosen in order to spare the organs at risk,
and to maintain the best polar angle.
Fixation Point
Point
Fixation
Isocenter
Fixation
Light
θ
φ
θ Polar Angle
φ Azimuthal Angle
Introduction of
of data
data in
in the
the simulation
simulation phase
phase
Introduction
Treatment Planning
Planning System
System Output
Output
Treatment
Isodoses curves for different planes
Fixation Point
Point
Fixation
Patiens look the fixation light
during the treatment
PROTON BEAM
Treatment Phase
Phase
Treatment
At the end of patient positioning phase the radiotherapist
draws the eye’s contour on a dedicated monitor in order to
monitoring in any moment the eye’s position during the
treatment.
TREATMENT MODALITIES
Dose: 15.0 CGE per day
Treatment Time: 45-60 sec.
Total Dose: 60 CGE
Fractions: 4
OUTLINE
OUTLINE
1. Why proton beams in tumour radiation treatment
2. INFN & HADRONTHERAPY:
THE CATANA PROTON THERAPY CENTER
•
Beam line elements
•
The DOSIMETRIC COMMISIONING:
Absolute and relative dosimetry
•
Treatment procedure
•
Clinical results
3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF
Patient Distribution
Distribution by
by Pathologies
Pathologies
Patient
Uveal Melanoma
92 patients (89.89 %)
Conjunctival Melanoma
4 patients (4.04 %)
Conjunctival
rhabdomyosarcoma
1 patient (1.01 %)
Eyelid Carcinoma
and metastases
2 patient (2.02 %)
Conjunctival MALT-NHL
1 patient (1.01 %)
Conjunctival Papilloma
2 patient (2.02 %)
Patient Distribution by Origin Region
9
1
1
Total
number of
patients :
150
3
1
15
2
16
6
1
8
14
60
Patient Distribution
Distribution by
by Sex
Sex
Patient
Women
Men
51%
49%
The patients’age ranges between 14yrs and 81yrs
(the mean age is 48 yrs)
PATIENTS FOLLOW
FOLLOW-UP
PATIENTS
-UP
(March 2002
2002 –– November
November 2007)
2007)
(March
PatientsTotal Number
(June 2007)
150
Patients with Follow up
128
TUMORAL THICKNESS
ECOGRAPHIC
REFLECTIVITY
Reduced
Stable
70 % Increased
24 % Stable
77 %
18 %
Increased
2 % Not evaluable
5%
Not evaluable
2%
SURVAIVAL RESULTS
PatientsTotal Number
(November 2007)
128
Dead patients
4
Metastatis
3
Other
1
Eye retention rate
95 %
TOTAL SURVIVAL
98 %
LOCAL CONTROL
95 %
CATANASpin
Spin-off:
SICILIANPROTONTHERAPY
PROTONTHERAPYProject
Project
CATANA
-off: SICILIAN
The realization of a ProtonTherapy center in Catania has been stated in the Health
Framework Agreement Document signed on 23 dec. 2003 by:
Ministero della Salute
Regione Siciliana
Ministero dell’
dell’Economia e delle Finanze
Omissis
Articolo 6
Centro di protonterapia nell’area di Catania
Le parti si impegnano ad effettuare le verifiche di ordine programmatico e
tecnico-sanitario ai fini della realizzazione di un centro di protonterapia
nell’area di Catania, in conformità alle indicazioni contenute in un recente
studio dell’AIRO (Associazione Italiana di Radioterapia Oncologica)
nell’ambito della nascente rete italiana dei centri di adroterapia e ad
individuare le fonti finanziarie cui attingere per la relativa copertura.
Omissis
CATANA Spin
Spin-off:
Some Important
Important Milestones
Milestones
CATANA
-off: Some
In 2002, the First Italian Protontherapy Facility Funded by INFN
and Catania University started in Catania at INFN-Laboratori
Nazionali del Sud
In 2003, the 5th Scientific Commission of INFN funded SCENT, an
R&D project studying a Superconducting Cyclotron for Medical
Applications
On March 7th 2003 Sicilian Region has approved to realize an
HadronTherapy Center in Catania, based on a Cyclotron for
protons and heavy charge particles. It has to be realized as
“Scientific collaboration between Region, INFN and University of
Catania also open to private contributions”
SCENT
“A New Cyclotron for Hadron Therapy”
Superconducting Cyclotron for Exotic Nuclei and Therapy
February 2003: the 5th CSN-INFN approve SCENT experiment
March 2003: the Sicily region, inside its developing plane for the
health, decided to include the realization of a centre for
hadrotherapy in Catania area
April 2006: contact between IBA and INFN to find out a
collaboration agreement
July 2006: agreement of cooperation between IBA and INFN for
marketing and construction of a SCENT Cyclotron
Whyproposing
proposingaacyclotron?
cyclotron?
Why
• A vast majority of the tumors treated in MGH, Chiba or GSI do
not require the very highest energy of a synchrotron
• The minority of tumours located too deep to be treated in
Carbon (Prostate, Uterus) could also be treated with lighter
ions such as Helium or Protons
• A cyclotron offers the best beam current control for ultra-fast
pencil beam scanning
• The cyclotron is a much simpler machine, with most of the
parameters constants. It does not require a large team of Ph.
D. physicists to operate
• A cyclotron is significantly smaller (6 m vs. 20 m in diameter)
and significantly less costly than the synchrotron.
SCENT: AA SC
SC for
for Medical
Medical Applications
Applications
SCENT:
SC able to accelerate H2+ and light ions up to 300 A MeV
The magnetic field is produced by twin coils
The isochronous fields for H2+ and for light ions fully stripped are very similar
(±0.4%)
Ions
qac→qe
Emax
A MeV
Bρ
ρ
T×
×m
RF*
MHz
Isource
nA
Iextr.
nA
Pex
W
H2
1
2
250
4.883
91
2500
500
125
12C
6
300
4.890
91
2000
100 +
50
* armonich h=4,
+without
buncher & extraction efficiency 50%
Range in water:
Protons 250 MeV 374 mm
Carbon 300 A MeV 174 mm
Whyis
isitituseful
useful to
to get
get 300
300AMev
AMevCarbon
CarbonIons?
Ions?
Why
AIRO Report on Hadrontherapy states that in Italy more than
3600 patients are elegible for carbon ions treatment.
In the framework of SCENT we defined some pathologies taking
clinical advantages from the availability of 300 AMeV Carbon
Ions:
Base of skull and Brain tumors
NSCLT
Spinal Cord tumors
Soft Tissue Sarcoma
SC(EN)T
Max. Energy for
Proton, 6Li, C
Sectors
a Superconducting Cyclotron
for Therapy
(250)
300 AMeV
4
Rpole
132 cm
Bo
3.07 T
<Bmax>
4.22 T
Spiral angle
(73°) 80°
Hill gap
(50) 30 mm
Valley gap
(105) 90 cm
RF frequency
(93)97 MHz
Outer Diameter
5100 mm
Weight
≈ 420 tons
6Li
@ 300 AMeV 339 mm, 100% of patients
12C
@ 300 AMeV,Max. depth
174mm, 74% of targets
Distribution of maximum depths in HIMAC treatments
patients 1750, N° targets 6323
SC(EN)T
E. D. inside RF DEE, width= 34°,
Electric Field 92 kV/cm
Proton Beam
Extracted by
stripper
@ 250 Mev
Carbon beam extracted be E.D. @ 300A MeV
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Catania Project at Cannizzaro Hospital
Funded in the specific line
“COMBATING CANCER”
INFN: LNS & Turin sect.
WP4 Medical Applications and
QA Definition
That’s all, folks
LNS
Thank You for Your Attention !!!