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From Physics to Medicine: Hadron Therapy

From Physics to Medicine: Hadron Therapy. CERN – Bulgarian Industry 28 - 29 November 2012 Manjit Dosanjh, KT-LS. Knowledge and Technology Transfer. KT is an integral part of CERN’s mission PP technologies relevant to key societal issues e.g. Health

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From Physics to Medicine: Hadron Therapy

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  1. From Physics to Medicine:Hadron Therapy CERN – Bulgarian Industry 28 - 29 November 2012 Manjit Dosanjh, KT-LS

  2. Knowledge and Technology Transfer • KT is an integral part of CERN’s mission • PP technologies relevant to key societal issues e.g. Health • CERN involved in the last 10-15 years in health applications • few CERN resources • attracted significant external funding (EC, MS…) • raises impact and profile • beyond the particle physics arena • large number of collaborating institutes • including medical institutes & hospitals • Collaborators appreciate facilitation by CERN

  3. First Bern Cyclotron Symposium - June 5-6, 2011 CERN Technologies and innovation accelerators, detectors and IT to fight cancer Detecting particles Large-scale computing (Grid) Accelerating particle beams CANCER

  4. Life.Sciences@cern.ch Why Cancer ? • Every year >3 millions new cases in Europe • About one third of us will have cancer • Number of patients needing treatment is increasing as people are living longer • Main cause of death between the ages of 45 and 65 in Europe • Second most common cause of death in Europe, Canada, USA after heart-disease

  5. Cancer incidence increases with age

  6. Cancer is a large and growingchallengeNeed: Earlier diagnosis, better control, fewer side-effects Although cancer is a common condition, each tumour is individual • personalised approach • Large patients data to understand the key drivers of the disease Contribution from CERN is timely How? • new technologies • Imaging, dosimetry, accelerator & detector technology • Better understanding – genetics, radiobiology… • Advanced healthcare informatics … • international collaboration • If progress is to be maintained

  7. Catalysing collaboration in health field • Challenges: • Bring together physicists, biologists, medical physicists, doctors • Cross-cultural at European and global level • Why is CERN well placed to do this? • It is widely acknowledged as a provider of technologies and as a catalyst for collaboration. • It is international, non-commercial, not a health facility.

  8. 4th pillar: catalysing and facilitating collaboration 4 Pillars: 3 are the key technologies Particle Therapy Accelerating particle beams Medicalimaging Detecting particles Tumour Target Large scale computing (Grid) Gridcomputingformedicaldata management and analysis

  9. Accelerator technologies and health PIMMS 2000 (coordinated by CERN)has led to: Treatment centre in Pavia, Italy. First patient treated in Sept 2011 Treatment centre in Wiener Neustadt, Austria, foundation stone 16 March 2011, will be ready in 2015 • Looking forward: • LEIR facility: requested by community (>20 countries, >200 people) • Medicis (ISOLDE) exotic isotopes for future R&D • Minicyclotron: commonly used isotopes

  10. Detector Technologies • Detector technology – improved photon detection and measurement: Crystal Clear, PET, PEM, Axial PET • Electronics and DAQ – high performance readout: (Medipix) • Multimodality imaging: PET-CT (proposed by Townsend, future with PET-MRI) PET-CT PET CT

  11. Positron Emission Tomography Idea of PET Photon detection used for calorimetry PET today CMS

  12. PET (Positron Emission Tomography) • Detects pairs of photons emitted by an injected positron-emitting radionuclide • Images tracer concentration within the body • Reflects physiological activity • Reconstructed by software LHC detector systems used in PET Systems

  13. PET/CT (David Townsend) CT PET

  14. measured MCsimulated In-beam-PET for Quality Assurance: real time On-line determination of the dose delivered • Modelling of beta+ emitters: • Cross section • Fragmentation cross section • Prompt photon imaging • Advance Monte Carlo codes In-beam-PET GSI- Darmstadt

  15. Computing Technologies • GRID – data storage, distributed, safe and secure computing • MammoGrid: European-wide database of mammograms and support collaboration • Health-e-Child: combining various types (clinical, imaging…) of data and share in distributed, clinical arena. • HISP: Hadrontherapy Information Sharing Platform

  16. Conventional Radiotherapy in 21st Century 3 "Cs" of Radiation Cure (~ 45% cancer cases are cured) Conservative (non-invasive, few side effects) Cheap (~ 5% of total cost of cancer on radiation) (J.P.Gérard) • There is no substitute for RT in the near future • The rate of patients treated with RT is increasing • Present Limitation of RT: • ~30% of patients treatment fails locally (Acta Oncol, Suppl:6-7, 1996)

  17. Two opposite photon beams 30 80 50

  18. 110 110 100 Two opposite photon beams

  19. Howto decrease failure rate? • Physics technologies to improve treatment: higher dose • Imaging: accuracy, multimodality, real-time, organ motion • Data: storage, analysis and sharing (confidentiality, access) • Biology: fractionation, radio-resistance, radio-sensitization • Working together: multidisciplinary Raymond Miralbell, HUG

  20. Hadrontherapy: all started in 1946 • In 1946 Robert Wilson: • Protons can be used clinically • Accelerators are available • Maximum radiation dose can be placed into the tumour • Proton therapy provides sparing of normal tissues Conventional: X-Rays Ion Radiation Depth in the body (mm)

  21. Proton & Ion Beam Therapy: a short history Proposed by R.R. Wilson MedAustron (Austria) 1st patient treated at Berkeley, CA CNAO, Pavia (Italy) 1st patient in Europe at Uppsala HIT (carbon), Heidelberg (Germany) 1984 2002 1989 1991 1993 1990 1992 1994 1996-2000 1946 2009 2011 2014 1954 1957 PIMMS PSI, Switzerland Eye tumours, Clatterbridge, UK ENLIGHT 10th year ENLIGHT GSI carbon ion pilot, Germany CPO (Orsay), CAI (Nice), France Loma Linda (clinical setting) USA Boston (commercial centre) USA NIRS, Chiba (carbon ion) Japan

  22. ENLIGHTCERN collaboration philosophy into health field Common multidisciplinary platform Identify challenges Share knowledge Share best practices Harmonise data Provide training, education Innovate to improve Lobbying for funding Coordinated by CERN, 80% MS involved > 150 institutes > 400 people > 25 countries (>80% of MS involved)

  23. EU funded projects • Infrastructures for hadron therapy • 20 institutions • Marie Curie ITN • 12 institutions • R&D on medical imaging for hadron therapy • 16 institutions • Marie Curie ITN • 12 institutions Wide range of hadron therapy projects: training, R&D, infrastructures A total funding of ~24 M Euros All coordinated by CERN,(except ULICE coordinated by CNAO Under the umbrella of ENLIGHT

  24. Preparing for the Future…… • review the progress in the domain of physics applications for health • identify the most promising areas for further developments • explore synergies between physics and physics spin-offs • catalyse dialogue between doctors, physicists, medical physicists…… First workshop on physics for health applications held @ CERN, 2010

  25. February 27 – March 2, 2012 at CICG, Geneva • 2 days devoted to physics, 2 days to medicine, 1 common day • Over 600 people registered, nearly 400 Abstracts • Chairs: Jacques Bernier (Genolier) and ManjitDosanjh (CERN) Four physics subjects : • Radiobiology in therapy and space • Detectors and medical imaging • Radioisotopes in diagnostics and therapy • Novel technologies Normal tissue Sensitive structure (OAR) Target (PTV) International Conference on Translational Research in Radio-Oncology & Physics for Health in Europe

  26. 3 CERN Initiatives arising from PHE2010 • Biomedical Facility creation of a facility at CERN that provides particle beams of different types and energies to external users • Medical Accelerator Design coordinate an international collaboration to design a low-cost accelerator facility, which would use the most advanced technologies • Radio Isotopes Establish a virtual European user facility to supply innovative radioisotopes (produced at ISOLDE-CERN, ILL, PSI, Arronax,..) for R&D in life sciences

  27. Future Biomedical Facility @ CERN LEIR Using LEIR (low energy ionising ring) 0)) for: European facility for radiobiology • basic physics studies • radiobiology • fragmentation of ion beam • dosimetry • test of instrumentation Biomedical facility requested byENLIGHT Community (> 20 countries, >200 people )

  28. Life.Sciences@cern.ch CERN contribution • Provider of Know-how and Technologies • Design studies for Hadron Therapy facilities • Scintillating crystals for PET scanners • Fast detector readout electronics for counting mode CT • Grid middleware for Mammogrid, Health-e-Child • Driving force for collaboration • Coordinator of the European Network for Light Ion Hadron Therapy (ENLIGHT) Platform • Training centre • Coordinator of large EC-ITN funded programs, e.g. Particle Training Network for European Radiotherapy (PARTNER), ENTERVISION New ideas being proposed……….

  29. Thank you for your attentionmanjit.dosanjh@cern.ch

  30. R&D isotopes for “Theranostics” 149Tb-therapy 152Tb-PET 161Tb-therapy & SPECT 155Tb-SPECT #177: C. Müller et al., Center for Radiopharmaceutical Sciences ETH-PSI-USZ #177: C. Müller

  31. ISOLDE - MEDICIS Preparing Innovative Isotopes • 1.4GeV protons for spallation & fission reactions on diverse target materials • Providing a wide range of innovative isotopes such as 61,64,67Cu & rare earth metals such as 47Sc, 149Tb • 1hr – 1 week t1/2 • Will utilise CERN/EPFL patented nanostructured target material Inventory of isotopes produced in a natural Zr target after proton beam irradiation.

  32. Cancer Treatment Options… Surgery Radiotherapy Chemotherapy and others • Hormones; Immunotherapy; Cell therapy; Genetic treatments; Novel specific targets (genetics..) X-ray, IMRT, Brachytherapy, Hadrontherapy Local control Local control Limited Local control SurvivalQuality of life

  33. Status & Perspectives in Particle Therapy – A. Mazal M.Jermann A.Mazal PTCOG Protons are an (expensive) clinical tool at an institutional level, Ions are today an (even more expensive) tool for clinical research at a national or multinational level There is a need for interdisciplinary R&D and synergy with the photon world Worldwide Patients Statistics 26.02.2012

  34. 20 MeV protons 5 × 5 µm² matrix 117 protons per spot 55 MeV carbon 5 × 5 µm² matrix 20 MeV protons randomly distributed 10 µm 10 µm 10 µm Radiobiology in therapy and space : a highlight Günther Dollinger - Low LET radiation focused to sub-micrometer shows enhanced radiobiological effectiveness (RBE) Carbon ions have higher radiobiological effectiveness than protons Local effects of microbeams of hadrons seen by fluorescent proteins which repair DNA

  35. Detectors and medical imaging: a highlight With 20 picosecond Δx = 4 mm: no track reconstruction is needed D. Schaart: Prospectsforachieving < 100 ps FWHM coincidence resolving time in Time-Of-Flight PET Detectors for Time-Of-Flight PET: the limit of time resolution

  36. Novel technologies: a roadmap for particle accelerators Marco Schippers What we need to be able to provide beams for therapy

  37. Actions needed … • Establish an appropriate framework @CERN • Identify and secure resources (inside and outside) • Develop the necessary structure • Facilitate increased cooperation • between disciplines • physics, engineering, chemistry … (physical sciences) • medicine, biology, pharmacology… (life sciences) • within Europe • globally

  38. Needs for a radiation facility • Increase radiobiological knowledge: • Cell response to different dose fractionations • Early and late effects on healthy tissue • Irradiation of cell at different oxygenation levels • Differing radio-sensitivity of different tumours/patients • Simulations: • Ballistics and optimization of particle therapy treatment planning • Validation of Monte Carlo codes at the energies of treatment and for selected ion-target combinations • Instrumentation tests: • Providing a beam line to test dosimeters, monitors and other detectors used in hadron therapy

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