Motion Simulator for Proton Therapy Paul Morel November, 17 2014 ´ Ecole Doctorale MSTIC Paul Morel MSPT 1 / 45
Doctoral thesis: Directed by St´ ephane Vialette (LIGM, Universit´ e Paris-Est Marne La Vall´ ee, France) Co-directed by Xiaodong Wu (University of Iowa, USA) and Co-supervised by Guillaume Blin (LaBRI, Universit´ e de Bordeaux, France) Paul Morel MSPT 2 / 45
Main problematic: How can we improve the robustness of proton therapy treatments when the patient moves during the delivery ( intra-fraction motions )? Paul Morel MSPT 3 / 45
Proton therapy MSPT: Motion Simulator for Proton Therapy Motion compensation Conclusion Acknowledgments References Outline: Proton Therapy MSPT: Motion Simulator for Proton Therapy Motion Compensation Conclusion Paul Morel MSPT 4 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Proton-Therapy Cancer treatment relying on ionizing radiation aiming at killing cancerous cells using proton beams. Paul Morel MSPT 5 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Why protons? Paul Morel MSPT 6 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Why protons? Comparison of irradiation: photons (upper panels) versus protons (lower panels) [Kirsch and Tarbell, 2004] Paul Morel MSPT 7 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Why not only protons? Proton accelerator Gantry Nozzle Patient Beamline Courtesy of V. Collignon, IBA Paul Morel MSPT 8 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Why not only protons? Paul Morel MSPT 9 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Proton therapy - an analogy Water pressure = Proton energy ( ⇒ depth of Bragg Peak) Water quantity = Dose ( ! Quantity of protons) Water drops are deposited on the way = Dose is cumulative along the way Paul Morel MSPT 10 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Proton therapy - an analogy Water pressure = Proton energy ( ⇒ depth of Bragg Peak) Water quantity = Dose ( ! Quantity of protons) Water drops are deposited on the way = Dose is cumulative along the way Paul Morel MSPT 10 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Proton therapy - an analogy Water pressure = Proton energy ( ⇒ depth of Bragg Peak) Water quantity = Dose ( ! Quantity of protons) Water drops are deposited on the way = Dose is cumulative along the way Paul Morel MSPT 10 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Proton therapy - an analogy Water pressure = Proton energy ( ⇒ depth of Bragg Peak) Water quantity = Dose ( ! Quantity of protons) Water drops are deposited on the way = Dose is cumulative along the way Paul Morel MSPT 10 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Proton therapy - an analogy Water pressure = Proton energy ( ⇒ depth of Bragg Peak) Water quantity = Dose ( ! Quantity of protons) Water drops are deposited on the way = Dose is cumulative along the way Paul Morel MSPT 10 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Main principle: energy layers Energy layers Paul Morel MSPT 11 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Pencil beam scanning Discrete scanning : The beam is turned o ff between the spot positions. Paul Morel MSPT 12 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Treatment planning Paul Morel MSPT 13 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Treatment planning Paul Morel MSPT 13 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Treatment planning Paul Morel MSPT 13 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Treatment Planning weight ! dose ! quantity of protons ! duration Paul Morel MSPT 14 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Sensitivity to motion Inter-fraction motions: loss/gain of weight, tumor swelling/shrinkage, bladder, intestinal gas... Intra-fraction motions: breathing, heart beat ... Results of irradiations without (left) and with (right) motion on a radiographic film.[Bert et al., 2012] ⇒ Treatment quality reduced Paul Morel MSPT 15 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Motion mitigation techniques Motion reduction: abdominal press, breath-hold, breath coaching, anesthesia. Motion mitigation: beam-gating, repainting, beam tracking. Paul Morel MSPT 16 / 45
Why protons? Proton therapy Why not only protons? MSPT: Motion Simulator for Proton Therapy Proton therapy - an analogy Motion compensation Delivery techniques Conclusion Treatment planning Acknowledgments Motion References Problematic Problematic: How can we improve the robustness of proton therapy treatments in case of intra-fraction motions? Paul Morel MSPT 17 / 45
Overview Proton therapy About MSPT MSPT: Motion Simulator for Proton Therapy Patient data Motion compensation Physical data Conclusion Dose calculation Acknowledgments Model evaluation References Motion MSPT: Motion Simulator for Proton Therapy Paul Morel MSPT 18 / 45
Overview Proton therapy About MSPT MSPT: Motion Simulator for Proton Therapy Patient data Motion compensation Physical data Conclusion Dose calculation Acknowledgments Model evaluation References Motion MSPT overview Main objective Render the impact of intra-fraction motions for given treatment plans. ⇒ Assess the treatment quality and develop new strategies. Paul Morel MSPT 19 / 45
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