Characterization and implementation of Pencil Beam Scanning proton therapy techniques: from spot scanning to continuous scanning
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1 Characterization and implementation of Pencil Beam Scanning proton therapy techniques: from spot scanning to continuous scanning Supervisors Prof. V. Patera PhD R. Van Roermund Candidate Annalisa Patriarca Dottorato in fisica degli acceleratori 1
2 Introduction o Physics and biology principles of protontherapy o Medical accelerators and delivery systems o Context and motivations of the PhD Outline Spot vs continuous scanning o Dose calculations models and measurements comparisons o Treatment time evaluation Future applications of continuous scanning Conclusions 2
3 Introduction 66 particle therapy facilities in operation More then 100 expected by the end of 2020 ~ treated patients with protons (~19000 with C-ions) 3
4 o Why protontherapy? Introduction D=Evol/mvol [Gy=J/kg] Protons dose distribution Photons dose distribution (SOBP) Entrance dose Max dose to the tumour Less dose to the nearby healthy tissues effectiveness of the treatment toxicity limitations Reduction of the integral doses second cancers reduction D D photons Higher Radiobiological Effectiveness RBE 1. 1 protons Survival 4
5 Introduction o Hadrontherapy accelerators : protontherapy solutions Cyclotron: the most compact solution Drawback fixed energy/energy degrader Conventional cyclotron (isochronous) 446 kw 220 tons ~ 60% cyclotrons wrt synchrotrons (~ 20% C-ions) Synchrotron: Different particles Drawback Size/cost 4.3m 5
6 o Delivery systems: passive spreading Introduction Need for beam spreading elements to laterally and in-depth shape the beam Need for specific patient devices to conform the beam to the tumor 6
7 o Delivery systems: pencil beam scanning Introduction Optimized dose distribution Better beam conformation Increase clinical indications The tumour is scanned through iso-energy layers Absence of personalized accessories faster beam set-up neutron reduction at the patient level less radioprotection issues 7
8 Introduction o Delivery systems: pencil beam scanning strategies Discrete dose delivery Continuous dose delivery Typical of cyclotrons and synchrotrons Typical of synchrotrons Possible with cyclotrons Proposed for cyclotron in this PhD work Possible with synchrotrons 8
9 Introduction o Physics and biology principles of protontherapy o Medical accelerators and delivery systems o Context and motivations of the PhD Outline Spot vs continuous scanning o Dose calculations models and measurements comparisons o Treatment time evaluation Future applications of continuous scanning Conclusions 9
10 Introduction o Context of the PhD : Characterization and implementation of PBS proton therapy techniques at Institut Curie Centre de Protonthérapie d Orsay More then 8000 patients treated since1991 IBA 230 MeV cyclotron 3 treatment rooms: 2 fixed horizontal and 1 gantry 10
11 o Motivations of the PhD : Introduction Implementation of the Pencil Beam Scanning at ICPO for clinical use : data acquisition and dose modeling. Exploring the potential use of active scanning with the IBA system : - Mobile tumors treatments with pencil beam scanning presents the inconvenience of interplay effects due to the similar time scale between the beam delivery and the breathing cycle periodicity. - A continuous irradiation technique could be a valid solution to deliver a homogeneous dose distribution in mobile tumors cases (by speeding up the treatment time and by using repainting in a reasonable treatment duration). - What are the capabilities of the IBA system to perform continuous scanning irradiation pointing out what is achievable and what still need to be done. High dose rate and hypo-fractionation for radiobiological studies. 11
12 Introduction o Physics and biology principles of protontherapy o Medical accelerators and delivery systems o Context and motivations of the PhD Outline Spot vs continuous scanning o Dose calculations models/measurements comparisons o Treatment time evaluation Future applications of continuous scanning Conclusions 12
13 Materials and Methods o Dose calculations models and measurements comparisons Dose planning in protontherapy : deliver Bragg peaks to cover a target volume homogeneously Delivered dose D(x,y,z) Depth dose (Bragg peak) Measurements to validate Analytical models Monte Carlo simulations Transverse dose distributions Beam size (E) and divergence dependence Analytical models Monte Carlo simulations Measurements to characterize the beam broadening in the patient 13
14 Materials and Methods o Dose calculations measurements Measurements device Ionization chambers (PTW, IBA) In water depth-dose measurements (green) and analytical model (blue) Lynx : Scintillator + CCD camera In air spot profile measurements set-up 14
15 Materials and Methods o Dose calculations models and measurements comparisons Lateral dose : spot scanning model Sum of Gaussian functions Lateral dose profile of 160 MeV proton beam (sigma in air of 5 mm) in water at depth 8.5 cm. Transverse dose distribution for different secondary components are also shown. Data are from GEANT4.9.3/GATE6.2 simulations. 15
16 Materials and Methods o Dose calculations models and measurements comparisons Lateral dose : continuous scanning model Integration of a 2D Gaussian along a straight line assuming σx = σy 16
17 Materials and Methods o Dose calculations models comparisons : spot vs continuous Penumbra evaluation : study on the ballistic properties of the irradiation P Energy dependent Indication of the beam enlargement due to scattering in air and patient Important to control the dose distribution around critical organs 17
18 Materials and Methods o Dose calculations measurements comparisons How do we perform continuous measurement? - study of the scanning architecture - development of source files for the irradiations IBA ScanAlgo Scanning Controller IBA Hardware 18
19 Results o Dose calculations models vs measurements comparisons Penumbra evaluation : simple line ~6% is the maximum difference observed ~ 3% when only measurements are considered Normalized penumbras (with respect to the penumbra of a single spot) evolution with energy. Studies on more complex cases should confirm these preliminary optimistic results on the ballistic properties of a continuous irradiation 19
20 Materials and Methods o Dose calculations measurements comparisons Dosimetry evaluation : defining the continuous scanning irradiation strategy to obtain the same dose for the two irradiations modalities Reduce scanning magnet speed ~ 80% less Increase the beam current ~50% more Continuous irradiation strategy could be the combination of decreasing scanning magnets speed and increasing current 20
21 o Dose calculations measurements comparisons Results Continuous irradiation with beam current doubled wrt spot scanning case Dose comparison between spot and continuous irradiation at the same scanning speed and modified beam current (I_cont = 2* I_spot)). Upper plots shows the fluence maps and lower plots are the correspondent dose profiles. 21
22 o Dose calculations measurements comparisons Gamma index (3% - 3 mm) analysis on 2D square surface Results Dose levels differences included in the gamma index interval Dose rate measured on the ionization chamber exceed the tolerances ( > 3.5x10-7 C/s) 22
23 Introduction o Physics and biology principles of protontherapy o Medical accelerators and delivery systems o Context and motivations of the PhD Outline Spot vs continuous scanning o Dose calculations models and measurements comparisons o Treatment time evaluation Future applications of continuous scanning Conclusions 23
24 o Treatment time evaluation Materials and Methods Development of a code to compute the total irradiation time in spot scanning dose move layer 24
25 Materials and Methods o Treatment time evaluation Time to deliver the dose Dependence on : Treatment plan Monitor Units (UM), Number of spots Ionization chambers charge rate reading (ChargeperUM = 1.5 nc for 1MU, ChargeRateMax = C/s ) Time to have beam from the ion source (TypicalTurnONtime = 1.5e-3 s) 25
26 Materials and Methods o Treatment time evaluation Time to move the beam Dependence on : Energy, spots spacing Technical specifications of the magnets (L = ( , ) [H], R = ( , ) [Ω], frequency: 30Hz e 3Hz) Feedbacks and settling times 26
27 Materials and Methods o Treatment time evaluation Time to change a energy layer Dependence on Settling times of the beamline magnets Speed of degrader positioning 27
28 Materials and Methods o Treatment time evaluation Continuous scanning irradiation time From the spot scanning time irradiation definition total dose move layer Treatment time gain G factor for the continuous scanning irradiation G = 1 max ( dose, move ) / ( ) dose move G = max, if τ dose = τ move dose / move In continuous scanning the dose is delivered while moving the beam 28
29 Results o Treatment time evaluation : spot vs continuous scanning Irradiation of 10 cm line In spot scanning, τ dose ~ 3 τ move, means decreasing the scanning speed and/or increasing the beam current to obtain, τ dose ~ τ move and a maximum gain in continuous scanning (50%). Measurements agree within 10% with respect to the model 29
30 Results o Treatment time evaluation : spot vs continuous scanning Spot scanning: comparison between our code and the reference from IBA on clinical cases Continuous scanning model estimations Dose to deliver : 2 Gy Differences in the two computing approaches is < 1% Most of the irradiation time is used to change energy layers (~67% to 90%) According to the model, a continuous irradiation should be around 50% faster 30
31 Introduction o Physics and biology principles of protontherapy o Medical accelerators and delivery systems o Context and motivations of the PhD Outline Spot vs continuous scanning o Dose calculations models and measurements comparisons o Treatment time evaluation Future applications of continuous scanning Conclusions 31
32 17 Gy o Future applications of continuous scanning FLASH radiotherapy : dose delivery time < 500 ms and dose rate > 40 Gy/s Tests on mice lung tumors with a 4.5 MeV electron linac have shown: Same anti-tumoral efficiency and enhancement of the differential responses between normal and tumor tissues wrt CONV (dose rate < 0.03 Gy/s) radiotherapy Potential benefits on malignancies requiring improved tolerability of radiation: CONV FLASH Uveal melanoma : toxicity reduction Gliomas : increased dose at the tumor for better local control Increase in the cell proliferation index 3 hours after thoracic irradiation with a 200 MeV proton beam at ICPO. 32
33 Introduction o Physics and biology principles of protontherapy o Medical accelerators and delivery systems o Context and motivations of the PhD Outline Spot vs continuous scanning o Dose calculations models and measurements comparisons o Treatment time evaluation Future applications of continuous scanning Conclusions 33
34 Company Hospital University collaboration Conclusions Implementation of Pencil Beam Scanning : caracterization of the established spot scanning technique for clinical use dose models for spot and continuous scanning continuous scanning irradiation strategy definition comparison between models and measurements : penumbra evaluations tend to confirm a viable utilisation of the continuous approach Treatment time in Pencil Beam Scanning : calculation algorithm for spot scanning : comparison with the IBA software on clinical cases : results agree within 1% model to evaluate the treatment time in continuous scanning measurements of treatment time for spot and continuous scanning : time reduction of around 40% 34
35 Perspectives Complete the evaluation of continuous scanning for more complex case Dose models implementation in a Treatment Planning System Robustness of the technique towards mobile tumors treatments Industrial work on energy layer time reduction Dose monitoring improvement to allow a safe continuous irradiation Biological caracterization of high dose rate irradiation if a constraint on irradiation time is assessed to be beneficial on healthy tissues while treating cancer, continuous irradiation could be a solution to treat a large volume in shorter time compared to spot scanning (e.g. in FLASH radiotherapy) 35
36 GRAZIE 36
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