Prof. Dr. Thomas Haberer Scientific-technical Director Heidelberg Iontherapy Center

Transcription

1 The Heidelberg Ion Beam Therapy Center A Hospital-based Facility Dedicated to Precision and Flexibility Prof. Dr. Thomas Haberer Scientific-technical Director Heidelberg Iontherapy Center

2 Carbon Ion GSI Th. Haberer, Heidelberg Ion Therapy Center

3 Beam Scanning! 2D-example for dose modulation original photograph fluence map irradiated radiographic film HIT Courtesy Jakob Naumann (HIT), Martin Bräuer (SIEMENS) 3

4 Key GSI Scanning-ready pencil beam library ( combinations): 253 energies (1mm range steps) x 7 spot sizes x 15 intensity steps Rasterscan method incl. approved controls and safety Beammonitors follow the scanned beams (v <= 40 m/s) in real-time Biological interactionmodel (LEM) based on 25 years of radiobiological research Physical beam transportmodel Planningsystem TRiP In-beam Positron Emission Tomography QA system Prototype of the scanning ion gantry Th. Haberer, Heidelberg Ion Therapy Center

5 Design Phase Proposal 1998 Th. Haberer Technical Design 2000 Feasibility Study 2000

6 HIT Layouts

7 Heidelberg Ion Therapy Center Flexibility and Precision compact design 60m x 70m full clinical integration rasterscanning only world-wide first ion gantry > 1000 patients and > fractions/yr Th. Haberer, Heidelberg Ion Therapy Center low-let modality: Protons (Helium) high-let modality: Carbon (Oxygen) ion selection within minutes R+D in a broad range

8 Clinical Integration Children s Hospital Women s Hospital National Center for Tumour Diseases RadioOncology Neurosurgery Th. Haberer, Heidelberg Ion Therapy Center

9 Germany: Ion Some Facility Facts of the Heidelberg Effective area m² Concrete tons Constructional steel tons Capital Investment 120 M Start of construction: November 2003 Completion of building and acc.: June 2006 First patient treated: Nov. 15th, 2009 Project Partners: University pays, owns and operates the facility GSI: feasibility study, facility design, technical proposal, tendering documents, built the accelerator Siemens supplies all components related to patient environment GSI, DKFZ, Siemens are research partners

10 HIT Facility Ion sources Injector Synchrotron HEBT+Gantry Medical Areas

11 injector ion intensity 20 m energy beam abort gantry focus focus beam abort synchrotron Th. Haberer

12 HIT Pencil Beam Library Parameter ions intensity energy focus protons and carbon (2 ion sources); planned: helium, oxygen (3 ion sources) 2 x 10 6 /s to 8 x 10 7 /s for carbon intensity upgrade in progress 8 x 10 7 /s to 4 x 10 8 /s for protons 10 steps; maximum extraction time 5 s MeV/u for carbon MeV/u for protons 255 steps, mm spacing, 2-30 cm range in water mm FWHM mm FWHM 4 steps protons and carbon: clinically used helium and oxygen: under commissioning : clinical or technical limit a total of 2 x 10 x 255 x 4 = settings per room! the gantry (0.1 steps) adds something

13 Optimized Spillstructure GSI C. Schömers, E. Feldmeier, HIT

14 Accelerator Status Sources, injector and synchrotron fully commissioned for protons, carbon and oxygen (256 energies each) H1 / H2: pencil beam libraries ( E F I ) for protons and carbon in therapeutical quality reached in April, 2008 outstanding beam quality: very high position and focus stability, small intensity fluctuations R+D-cave: protons, carbon and oxygen energy libs established Gantry: protons and carbon commissioned to pre-clinical quality To do: intensity upgrade ( x3 ) under way (sources, LEBT, RFQ) Operation scheme: 2007: 24 h / 5 days : 24 h / 7 days, 330 days, 2 shutdowns 14 days each 2012ff: 24 h / 7 days, 330 days, 1 shutdown 14 days + Availability of the pencil H1/2: 98% 6 mini-shutdowns 4 days

15 Weekly Beam Time Schedule Patient treatment 5-6 days a week 06:00 08:00: Daily QA 08:00 19:00: Patient treatment 19:00 06:00: Treatment plan verification, Gantry dev., experiments, accelerator QA

16 Medical Equipment Identical patient positioning systems fixed beam gantry Workflow optimization automated QA procedures automated patient hand over from shuttle Inroom position verification 2D 3D Cone beam CT Open for future applications and workflows Th. Haberer, Heidelberg Ion Therapy Center

17 HIT / Approval + CE-Label Approval radiation Medical device directive CE-label by protection law In-house-product declaration Siemens Health Care November 2009

18 1st HIT November 15th, 2009, horizontally-fixed beamline #1 rasterscanned carbon ions

19 Patient HIT - center directly connected with the existing department of radiation oncology - specialized clinics for primary contact and for follow-up - outpatient treatment or inpatient on 3 wards - individual positioning devices: head masks etc., patient shuttle - target volume definition on CT, MRI, PET-CT - ICRU-criteria: GTV, CTV, PTV... - Siemens Dosimetrist/Oncologist for target volume definition - Siemens PT Planning, Siemens, Erlangen, Germany for treatment planning - patient positioning prior to each treatment with orthogonal X-rays focussing on bony landmarks (3d/2d-matching) - gating available, anaesthesia

20 The first 80 HIT Indication Number of patients n (%) Skull Base Chordoma 9 (11%) Chondrosarcoma 18 (22%) Malignant Salivary Gland Tumors 29 (36%) Astrocytoma 10 (13%) pilocytic astrocytoma 1 WHO Grade II astrocytoma 2 anaplastic astrocytoma 1 primary glioblastoma 3 recurrent glioblastoma 3 Osteosarcoma 3 (4%) skull and skull base 2 sacrum 1 Sacral Chordoma 5 (6%) Other 6 (8%) recurrent rectal cancer 2 nasopharyngeal cancer 1 rhabdomyosarcoma of the skull base 1 malignant melanoma of the paranasal sinus 1 chondrosarcoma of the left heel 1 Combs SE et al., Acta Oncologica 2010

21 Shuttlesystem - oncolog dignity carrier - connection between PET-CT and treatment room E A B D Combs SE et al., Der Nuklearmediziner, 2011 C

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23 Clinical HIT

24 HIT Dosimetry / PET Lab Animals Radiobiological Lab (S2) Physics / Technology Lab R+D-Cave Th. Haberer, Heidelberg Ion Therapy Center

25 HIT Radiobiology Treatment of moving organs (collaboration with C. Bert /GSI) Particle-tomography Beam characterization (Helium ), precise scattering measurements for TPS-improvements Linac testbench (Helium source, intensity upgrade) Scanning ion gantry Magnetic field feedback for synchrotron and HEBT In-cycle energy variation Dynamic spill shaping

26 Scanning Ion Gantry / Requirements Clinical: Iso-centric set-up and a fixed floor Identical field size in all beamlines of 20 cm x 20 cm Integration of fluoroscopy systems in two planes (IGRT, organ movement) Technical / financial: 2D-parallel scanning mode via edge focussing (large SAD ~ 50m) Full 360 rotation (clinical workflow, minor investment saving) Normal conducting elements (field quality ~10-4 in 90-degree bending magnet, price, 330 days 24/7 op.) Barrell-type (less bending than cork-screw) Scanning upstream to the last bending (radius vs. weight) Truss-based structure

27 Design for HIT isocentric barrel-type world-wide first ion gantry 2D beam scanning upstream to final bending, almost parallel due to edge focussing ± 180 o rotation 3 o / second 13m diameter 25m length 600 to rotating (145 to magnets) MT Mechatronics MT Aerospace

28 Patient Environment / Nozzle

29 Protons PB-Lib Commissioning Carbon FWHM vert MeV FWHM hor. 191 MeV/u Position hor MeV Position hor. 191 MeV/u

30 Next Steps LUTs (feed-forward) for position, focus and angle will be integrated Real-time feed-back already working PPS and IPP integration (LUTs needed again) Risk analysis QA tasks TPS ~ 150 new reqs rasterscan@hit-gantry Courtesy A.v. Knobloch

31 Other Ions: Helium and Oxygen Penumbra comparison (90% => 10%): Protons: Helium3: Helium4: Carbon: 17,4 mm 14,4 mm 10,9 mm 7,4 mm HIT- R+D-Cave Th. Haberer

32 Ionsource #3 / RFQ-Testbench 3rd ion source optimized for Helium4 operation

33 Acknowledgement: Carbon 430 MeV/u Relevant material was provided by: A. von Knobloch, S. Brons, R. Cee, J.Naumann, B.G. Hasch, K. Parodi, C. Bert, A. Mairani, O. Jäkel, M. Ellerbrock, E. Rietzel, A. Gemmel and many more colleagues at GSI, HIT, MT Mechatronics and SIEMENS Thank you! The ULICE project is co-funded by the European Commission under FP7 Grant Agreement Number