Future dosimetry issues: protons, hadrons & MR linacs
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1 Future dosimetry issues: protons, hadrons & MR linacs Hugo Bouchard, PhD, MCCPM Senior Research Scientist Radiation dosimetry group National Physical Laboratory May 2014
2 Overview 1. Proton and hadron therapy Why ions? Facility The physics Dosimetry issues Predicting beam range RBE 2. MRI-guided radiotherapy Why MR-linacs? Facility The physics Dosimetry issues
3 1. PROTON AND HADRON THERAPY
4 Why ions? Ions have a very appealing dose distributions for sparing organs at risk D Schulz-Ertner et al., Semin Radiat Oncol 16: , 2006 O Jakel, Radiat Prot Dosimetry Nov;137(1-2):
5 Why ions? Ions have a very appealing dose distribution for sparing organs at risk Proton beam Carbon ion beam H Paganetti et al. Phys. Med. Biol D Schulz-Ertner et al., Semin Radiat Oncol 16: , 2006
6 Proton and carbon ion facilities Requirement of a single synchrotron serving several gantries Gantry is over 100 tons (versus 2 tons for linac) Isocenter accuracy is < 1 mm Prtreatment imaging is crucial!
7 COUNTRY WHO, WHERE PARTICLE S/C/SC* START TOTAL PATIENTS BEAM DIRECTIONS MAX. ENERGY (MeV) OF TREATMENT TREATED DATE OF TOTAL Canada TRIUMF, Vancouver p C 72 1 horiz Dec-13 Czech Republic PTC Czech r.s.o., Prague p C gantries, 1 horiz Dec-13 China WPTC, Wanjie/Zibo p C gantries, 1 horiz Dec-13 China IMP-CAS, Lanzhou C-ion S 400/u 1 horiz Dec-13 England Clatterbridge p C 62 1 horiz Dec-13 France CAL, Nice p C165 1 horiz Dec-13 France CPO, Orsay p S gantry, 2 horiz Dec-13 Germany HZB, Berlin p C horiz Dec-13 Germany RPTC, Munich p C gantries, 1 horiz Dec-13 Germany HIT, Heidelberg p S horiz., 1 gantry** 2009, Dec-13 Germany HIT, Heidelberg C-ion S 430/u 2 horiz., 1 gantry** 2009, Dec-13 Germany WPE, Essen p C gantries***, 1 horiz Dec-13 Italy INFN-LNS, Catania p C 60 1 horiz Dec-13 Italy CNAO, Pavia p S horiz., 1 vertical Dec-13 Italy CNAO, Pavia C-ion S 480/u 3 horiz., 1 vertical Dec-13 Japan HIMAC, Chiba C-ion S 800/u horiz.***, vertical*** Dec-13 Japan NCC, Kashiwa p C gantries*** Mar-13 Japan HIBMC, Hyogo p S gantry Dec-13 Japan HIBMC,Hyogo C-ion S 320/u horiz.,vertical Dec-13 Japan PMRC 2, Tsukuba p S gantries Dec-13 Japan Shizuoka Cancer Center p S gantries, 1 horiz Dec-13 Japan STPTC, Koriyama-City p S gantries, 1 horiz Dec-13 Japan GHMC, Gunma C-ion S 400/u 3 horiz., 1 vertical Dec-13 Japan MPTRC, Ibusuki p S gantries Dec-13 Japan Fukui Prefectural Hospital PTC, Fukui City p S gantries, 1 horiz Dec-13 Japan Nagoya PTC, Nagoya City, Aichi p S gantries, 1 horiz Dec-13 Japan SAGA-HIMAT, Tosu C-ion S 400/u 3 horiz., vertical, 45 deg Dec-13 Poland IFJ PAN, Krakow p C 60 1 horiz Dec-13 Russia ITEP, Moscow p S horiz Dec-13 Russia St.Petersburg p S horiz Dec-12 Russia JINR 2, Dubna p C 200**** 1 horiz Dec-13 South Africa NRF - ithemba Labs p C horiz Dec-13 South Korea NCC, IIsan p C gantries, 1 horiz Dec-13 Sweden Uppsala p C horiz Dec-13 Switzerland PSI, Villigen p C gantries*****, 1 horiz. 1984, 1996, Dec-13 USA, CA. Loma Linda p S gantries, 1 horiz Dec-13 USA, CA. UCSF p C 60 1 horiz Dec-13 USA, MA. NPTC, MGH Boston p C gantries***, 1 horiz Dec-13 USA, IN. IU Health PTC, Bloomington p C gantries***, 1 horiz Dec-13 USA, TX. MD Anderson Cancer Center, Houston p S gantries***, 1 horiz Dec-13 USA, FL. UFPTI, Jacksonville p C gantries, 1 horiz Dec-13 USA, OK. ProCure PTC, Oklahoma City p C gantry, 1 horiz, 2 horiz/60 deg Dec-13 USA, PA. UPenn, Philadelphia p C gantries, 1 horiz Dec-13 USA, IL. CDH Proton Center, Warrenville p C gantry, 1 horiz, 2 horiz/60 deg Dec-13 USA, VA. HUPTI, Hampton p C gantries, 1 horiz Dec-13 USA, NY. ProCure Proton Therapy Center, New Jersey p C gantries Dec-13 USA, WA. SCCA ProCure Proton Therapy Center, Seattle p C gantries Dec-13 USA, MO. S. Lee Kling PTC, Barnes Jewish Hospital, St. Louis p SC gantry Dec-13 USA, CA. PROTON AND CARBON ION FACILITIES Scripps Proton Therapy Center, San Diego p C gantries, 2 horiz Feb-14
8 Proton and hadron physics γ γ γ Photelectric effect Compton effect Pair production γ e+ bremsstrahlung Moeller scatter e+ Bhabha scatter γ e+ p+ p+ ion-electron collisions A A B A C D Nuclear interactions Atomic relaxation γ γ e+ Anhilitation γ γ Nuclear relaxation γ
9 Proton and hadron physics Max electron energy transfer to electrons is very small T max T 4 m e m p = Straggling and scattering 0.2% for p % for C Energy/range straggling Broadening Nuclear buildup and peripheral dose Effect can be significant for high energies
10 Dosimetry issues 2 types of beam Scattered beam Scanning beam Range modulator wheel (SOBP) Range compensator Roelf Slopema, Basics of proton therapy, U Florida
11 Dosimetry issues Graphite calorimetry-based standards Volume and gap corrections Temperature change in scanned beams L. Petrie NPL/U Surrey Ion chamber dosimetry TRS-398 formalism Scattered beam Similar to electrons beam dosimetry Calibration at reference depth where gradient is low Stopping power corrections of primary beam Scanned beam Dose area product for pencil beams LET dependence of other detectors Ex. Radiochromic film W air,q s w,air,q p Q D w,q = M Q N D,w,Q0 W air,q0 s w,air,q0 p Q0
12 Predicting beam range
13 Relative biological effectiveness RBE is a function of LET (restricted SP) which changes with energy IAEA TRS-461, 2008
14 Relative biological effectiveness TRS-461
15 Relative biological effectiveness Average value of 1.1 recommended by TRS- 461 for protons is revised Local Effect Model shows that RBE varies significantly with depth R Grun et al., Med Phys, 40 (11) 2013
16 2. MRI-GUIDED RADIOTHERAPY
17 Why MRI-guided RT? MR provides high contrast in soft tissues No radiation dose! Positioning Accurate structure identification Real time tracking Reduction of margins Jan Lagendijk (UMC), Bas Raaymakers (UMC), Johan Overweg (Philips), Kevin Brown (Elekta)
18 MR-linac facility Philips/Elekta protoype Jan Lagendijk (UMC), Bas Raaymakers (UMC), Johan Overweg (Philips), Kevin Brown (Elekta)
19 Physics related to magnetic fields What is a Magnetic field? It is a relativistic effect due to the motion of electrons (Lorentz length contraction/expansion) It is induced by the motion of electrons with respect to the frame of reference studied Force do no work (Gauss magnetism law) B = 0
20 Physics related to magnetic fields The Lorentz force F B qβcu
21 Dosimetry issues Effect on electron beam dose distributions A F Bielajew, Med Phys 20, 1993 R Nath and R J Schulz, Med Phys 5, 226 (1978)
22 Dosimetry issues Photon dose distributions Single beams and the presence of air A J E Raaijmakers et al., 2005 Phys. Med. Biol
23 Dosimetry issues Photon dose distributions Composite beams and the presence of air Parallel opposed 4 fields (box-type) A J E Raaijmakers et al., 2005 Phys. Med. Biol
24 Dosimetry issues Ion chamber dosimetry in B- fields Corrections up to 10% I Meijsing et al., Phys. Med. Biol. 54 (2009)
25 Dosimetry issues Convolution methods fail in the presence of magnetic fields A. Pfaffenberger PhD thesis Monte Carlo required The only known method to simulate such effects especially in the presence of air/tissue interfaces MS + Lorentz force New way of thinking in the clinic due to uncertainties DVH broadening, isodose noise, etc. RBE needs to be investigated
26 A few references A J E Raaijmakers et al., Phys. Med. Biol (2005) D Schulz-Ertner et al., Semin Radiat Oncol (2006) H Paganetti et al. Phys. Med. Biol. Phys. Med. Biol (2008) I Meijsing et al., Phys. Med. Biol (2009) H Paganetti, Phys. Med. Biol. 57: R99-R117 (2012) H Palmans, Monte Carlo Techniques in Radiotherapy, Chapter 13, CRC Press, 2013 R Grun et al., Med Phys, 40 (11) 2013
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