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Protontherapy at INFN-LNS

Learn about the benefits of proton beams in tumour radiation treatment, the Catana Proton Therapy Center, dosimetric commissioning, treatment procedures, and patient follow-up. Explore the current status of hadrontherapy at the Catana Spin-Off.

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Protontherapy at INFN-LNS

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  1. Protontherapy at INFN-LNS C.Agodi Laboratori Nazionali del Sud - Catania LEA-COLLIGA – IPN Orsay November 14-16 2011

  2. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Patient’s follow up 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  3. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Patient’s follow up 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  4. LNS Whyclinicalhadronbeam? Higher precision and greater biological effectiveness of the applied dose Depth dependence of the deposited dose for different radiation Because of the Bragg peak, protons dose distribution is “inverted” with respect to the almost exponential behaviour produced by a beam of high energy photons. The surface dose is low when compared to the dose absorbed in the region of the peak, at variance with what happens with photons and electrons.

  5. Why clinical proton beam? • penetration depth is well-defined and adjustable • most energy at end-of -range • protons travel instraight lines • dose tonormal tissueminimised • no dose beyond target PROTONS PERMIT TO DELIVER AN HIGH DOSE TO THE TUMOUR SPARING THE SOURRONDING TISSUES

  6. IntensityModulatetedRadiationTherapy vs PROTONS Between the eyes Abdomen Brain

  7. PT faces a fastgrowingdemand! PT center under operation LNS 1990 - The Loma Linda University Medical Centre in California heralded the age of “dedicated” medical accelerators with commissioned its proton therapy facility with a 250 MeV Synchroton • 1954 - C.Tobias and J.Lowrence: first therapeutic exposure of human patients to hadron beams at the Radiation Laboratory of California, Berkeley • 1957 – Protons treatments : University of Uppsala, Sweden • 1961 – Massachusetts General Hospital-Harvard Cyclotron Laboratory ,USA • 1967 – Dubna, 1969 Moscow, 1975 St Petersbourg in Russia • 1979 – Chiba, 1983 Tsukuba in Japa • 1984 – PSI-Villigen in Switzerland

  8. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Patient’s follow up 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  9. INFN & Hadrotherapy • In 90’ years INFN supported TERA in R&D project.• INFN, in collaboration with University of Catania, realized in its laboratory (Lab. Naz. Del Sud) the first Italian protontherapy facility.• INFN has UNIQUE capability in Italy in accelerators development.• Considering its particular features, INFN was involved in CNAO to guarantee the necessary expertise.• In 2005 INFN was encharged by Health Minister to produce a document about protontherapy in our country.

  10. In Catania we developed a facility (named CATANA) for the treatment of ocular tumours with 62 AMeV proton beams

  11. LNS Superconducting Cyclotron is the unique machine in in Italy and South Europe used for protontherapy Treatment of the choroidal and iris melanoma In Italy about 300 new cases for year

  12. LNS Accelerator Layout Ocular Protontherapy Unique Italian Facility CATANA

  13. CATANA proton therapy beam line (until June 2004)

  14. CATANA proton therapy beam line (new location)

  15. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Patient’s follow up 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  16. Modulator & Range shifter Ligth field Scattering system Monitor chambers Laser CATANA proton therapy beam line

  17. Lateral dose distribution in a clinical proton beam 95 % 50 % 20 %

  18. Depth dose distribution – Energy modulation Generation of the Spread Out Bragg Peak (SOBP)

  19. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Patient’s follow up 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  20. Dosimetric commissioning: absolute & relative dosimetry Absolute Dosimetry: Energy Released in Water (Gray)Relative Dosimetry: Three dimensional dose distribution measurements Considering the high gradient dose, conformation and small fields often used the detectors have to be kindly characterized in terms of spatial resolution, energy or fluence dependence to be used in protontherapy. Relative and Absolute Dosimetry are fundamental for: Customizing of TPS Monitor Unit Calculation Quality Control

  21. Dosimetric commissioning: absolute & relative dosimetry ICRU 59 AND TRS 398 IAEA RECOMMENDATION  “FOR MEASUREMENTS OF DEPTH-DOSE DISTRIBUTION IN PROTON BEAMS THE USE OF PLANE-PARALLEL CHAMBERS IS RECOMMENDED”  Parallel plate MARKUS PTWis the golden standard for depth dose measurements

  22. GEANT4 Simulation Monte Carlo Simulation of the entire beam line using GEANT4: Improvement of our beam line and dosimetry Give a general purpose tool for the design of new hadron-therapy beam line Validation of the treatment system software GEANT4 simulation

  23. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Patient’s follow up 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  24. A typical treatment • The Surgical Phase • The Treatment Planning Phase • The Verification Phase • The Treatment Phase

  25. Two orthogonal X-Rays tubes for the visualization of the clips

  26. NEW X-RAY SYSTEM FOR PATIENTS POSITIONING Lay-out of the axial X-Ray flat panel with its moving system Hamamatsu X-Ray axial flat panel name@mail.com

  27. Treatment Planning System Phase EYEPLAN Originally developed by Michael Goitein and Tom Miller (Massachussetts General Hospital), is now maintained by Martin Sheen (Clatterbridge Center for Oncology) and Charle Perrett (PSI)

  28. Fixation Point Choice This point is chosen in order to spare the organs at risk, and to maintain the best polar angle.

  29. Fixation Point Isocenter Fixation Light q f q Polar Angle fAzimuthal Angle

  30. Treatment Planning System Output Isodoses curves for different planes

  31. Treatment Phase At the end of patient positioning phase the radiotherapist draws the eye’s contour on a dedicated monitor in order to monitoring in any moment the eye’s position during the treatment. TREATMENT MODALITIES Dose: 15.0 CGE per day Treatment Time: 45-60 sec. Total Dose: 60 CGE Fractions: 4

  32. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Clinical results 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  33. Patient Distribution by Pathologies TOTAL PATIENTS 174

  34. Patient Distribution by Origin Region 10 1 2 Total number of patients : 230 Since feb 2002 3 2 18 29 3 7 1 10 18 70

  35. Patient Distribution by Sex The patients’age ranges between 14yrs and 81yrs (the mean age is 48 yrs)

  36. PATIENTS FOLLOW-UP (March 2002 – November 2008)

  37. OUTLINE 1. Why proton beams in tumour radiation treatment 2. INFN & HADRONTHERAPY: THE CATANA PROTON THERAPY CENTER • Beam line elements • The DOSIMETRIC COMMISIONING: Absolute and relative dosimetry • Treatment procedure • Patient’s follow up 3. ACTUAL STATUS OF HADRONTHERAPY: THE CATANA SPIN-OFF

  38. CATANA Spin-off: Some Important Milestones In 2002, the First Italian Protontherapy Facility Funded by INFN and Catania University started in Catania at INFN-Laboratori Nazionali del Sud Sicilian Region has approved to realize an HadronTherapy Center in Catania, for protons and heavy charge particles. It has to be realized as “Scientific collaboration between Region, INFN and University of Catania also open to private contributions”

  39. What is in progress? • Proton computed tomography (PCT) • Carbon beams for therapy… • Lithium beams for therapy? • …….

  40. Remarks • Knowledge gained from basic research influenced the choices of ion, energy, beam delivery system and treatment schedule. • Moreover radiotherapy shall be developed only on the basis of research conducted according to the highest standard of scientific inquiry and using the most advanced method available.

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