Hadron Therapy: A Physicist’s View E. Cisbani Italian National Institute of Health
E. Cisbani VIC ‐ 20/Sep/2017 2 From service to value for-money • Hadron-therapy (proton and ions) has intrinsic physical properties to precisely target the tumors, reducing side effects has remarkable biological effects on tumor cells is relatively expensive • Continuously growing – technologies development Hadron Therapy – improved physics and biological knowledge – extended cost/benefit and clinical outcomes analyses
E. Cisbani VIC ‐ 20/Sep/2017 3 Physics-Biology-Clinics Interplay Clinical outcomes depend on how well we know and control the physics and the biological processes Physics involved in the hadron therapy and how we make them happen Biology Treatment Assessment Machine Patient Preparation • Continuous •On ‐ line / •Design and construction •CT (PET) imaging monitoring Offline •Daily quality checks •Positioning/Alignment imaging • Stop at •Immobilization prescribed dose •Treatment Planning
E. Cisbani VIC ‐ 20/Sep/2017 4 Hadron-therapy facility CNAO Layout Control System (Circular) Accelerator Quality Assessment Beam Trasport Treatment planning Treatment Room Adapted from Bohlen et al. 2013 Beam/Dose Delivery Patient Data Management Beam Physics Characterization Patient positioning … and verification Costs (keuro) Capital Oper./year Fraction Treatment Costs analysis from Surgery: 14 ‐ 57 kUSD A. Peeters et al., Pharmacologic: 1 ‐ 120 kUSD Carbon+Proton 140000 37000 1.1 10 ‐ 30 Rad. & Onc. Note: cost/treatment Proton 95000 25000 0.7 12 ‐ 39 95 (2010) 45 ‐ 53 strongly depends on tumor and modality Photon 23000 10000 0.2 4 ‐ 18
E. Cisbani VIC ‐ 20/Sep/2017 5 Current developments directions Reducing system costs Improved Lower assess ‐ ment power needs Optimal Smaller A dream device dose size delivery (single room facility) Accurate quality Simpler assurance procedures Smaller Improved weight planning Dielectric Wall Accelerator New acceleration technologies: Linear Accelerator , Superconducting, Caporaso et al. (2009) FFAG, Laser Acceleration, Dielectric Wall Accelerator Artistic view
E. Cisbani VIC ‐ 20/Sep/2017 6 Linear Accelerator for Proton Therapy TOP—IMPLART project Compact and lightweight Radiation clean, reduced shielding Power efficient Very Modular : customizable according to needs; can be in operation during its construction Performances : all physics properties (energy, intensity, direction, …) of the particle beam can be varied quickly and actively offering improved precision and larger flexibility on dose delivery to the patient (e.g. optimal intrafraction motion control) Estimated Capital costs: 40 ‐ 70 MEuro Only single ion type can be accelerated Never used before for therapy (but physical modality similar to photon therapy)
E. Cisbani VIC ‐ 20/Sep/2017 7 LinAc for Proton Therapy becoming real Projects on TOP ‐ IMPLART facility LinAc for PT: LIGHT, Erha, TOP ‐ IMPLART Status: Energy: 35 MeV Already in operation for: Already in operation for: (150 MeV in 3 years) • Beam and diagnostics characterization • Beam and diagnostics characterization Current/Pulse: 30 uA • Radiobiology studies • Radiobiology studies • Cultural heritage analyses • Cultural heritage analyses • New development (e.g LiF dosimetry) • New development (e.g LiF dosimetry) Current development total costs: 6 Meuro • Radioprotection optimization studies • Radioprotection optimization studies
E. Cisbani VIC ‐ 20/Sep/2017 8 Robust Treatment Planning The optimal exploitation of a very accurate equipment needs to tackle all details of the involved processes and a carefull plan Accurate (few %) and Radiobiology data Detailed and validated extended low energy Anatomic and Functional accelerator description nuclear physics data nuclear physics data Imaging of the patient Imaging of the patient Physics Processes Biological Effects Planning System • Tracking particles in • Tumor and Normal • Decision support (AI) heterogeneous matter Tissue Biological / • MonteCarlo methods Personalized Response • Computing Power GPU: from games to crucial applications R. Grün et al., Med. Phys . 2013 F. Tommasino et al. Cancers, 2015
E. Cisbani VIC ‐ 20/Sep/2017 9 Nuclear Science and Technologies play a major role in many key aspects of hadron radiation therapies and their improvements are substantial for the ultimate benefit of the patients System System Planning Planning Treatment Treatment Assessment Assessment Delivery Delivery Quality Control Quality Control Online Dose Online Dose Accelerator Accelerator modality modality Delivered Delivered Verification Verification Imaging Imaging Diagnostic Diagnostic Delivery Delivery Devices Devices control control Modeling Modeling Montecarlo Montecarlo Redundancy Redundancy Intra ‐ fractional Intra ‐ fractional validation validation MonteCarlo MonteCarlo and Safety and Safety Motion control Motion control (computing) (computing)
E. Cisbani VIC ‐ 20/Sep/2017 10 Thank You
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