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European Network for Light Ion Therapy ENLIGHT. Manjit Dosanjh ENLIGHT Coordinator & CERN. Hadron therapy history …. …in 1997. 22,000 patients since the beginning (18,300 protons). First patient. Today. 1954 Berkeley. 51,000 patients (44,000 protons, 2900 carbon ions). .

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european network for light ion therapy enlight

European Network for Light Ion Therapy ENLIGHT

Manjit Dosanjh

ENLIGHT Coordinator

& CERN

ENLIGHT, ESF Workshop-Oxford

hadron therapy history
Hadron therapy history …

…in 1997

22,000 patients since the beginning (18,300 protons)

First patient

Today

1954

Berkeley

51,000 patients(44,000 protons, 2900 carbon ions).

ENLIGHT, ESF Workshop-Oxford

numbers of potential patients
Numbers of potential patients

From studies in Austria, France, Germany and Italy

X-ray therapy

every 10 million inhabitants 20,000 pts/year

Proton therapy

12% of X-ray patients 2,400 pts/year

Therapy with Carbon ions for radio-resistant tumour

3% of X-ray patients 600 pts/year

TOTAL for hadron therapy for 10 M 3,000 pts/year

ENLIGHT, ESF Workshop-Oxford

pimms at cern in 1996 2000

linacs for

carbon ions

and protons

p

p

p

C

C

PIMMS at CERN in 1996 - 2000

CERN–TERA–MedAustron Collaboration for optimized medical synchrotron

400 MeV/u synchrotron

Resonance sextupole

RF cavity

Sextupole horiz. chromaticity

Sextupole vert. chromaticity

Circumference C = 76.84 m

Tune horizontal Qx = 1.67

Tune vertical Qz = 1.72

Betatron

core

Sextupolevert.

chromaticity

16 Bending Magnets

3 extraction systems:

betatron core

1/3 resonance

RF knock-out

Sextupole horiz. chromaticity

Electrostatic septum

Extraction septum

Injection septum

ENLIGHT, ESF Workshop-Oxford

why collaborate
Why collaborate?
  • Hadrontherapy to improve cancer treatment & outcome
  • Very complex in all aspects of undertaking, therefore
    • Create common multidisciplinary platform
    • Share knowledge
    • Share best practices
    • Harmonise data
    • Provide training, education
    • Identify challenges
    •  innovate

ENLIGHT, ESF Workshop-Oxford

enlight challenges
ENLIGHT challenges
  • A heterogeneous group - different disciplines plus networking
  • How to balance between basic research and the clinical needs?
  • Many partners. How to give space to each and make progress with the main objectives?
  • How to strike a balance between agenda of the single centres and the common ENLIGHT goals?
  • Can we show ion therapy is more effective? Will practice validate the theory?

ENLIGHT, ESF Workshop-Oxford

enlight ingredients
ENLIGHT++ ingredients
  • Clinical Studies
  • Radiobiology
  • Treatment planning for Intensity Modulated Particle Therapy
  • Adaptive ion therapy and treating of moving organs
  • Novel in-beam PET systems
  • Feasibility study for innovative gantry designs
  • Information and Communication Technologies for Hadron therapy
    • ………..Future acclerator designs??

+ networking

ENLIGHT, ESF Workshop-Oxford

what happened
What happened?

ENLIGHT was established in 2002

ENLIGHT was composed of:

Centres in Heidelberg, Lyon, and Pavia, CERN, EORTC, ESTRO, GSI, Karolinska, MedAustron, TERA, Czech Rep, Spain

  • Main achievements:
  • Creation of a European Hadrontherapy Community
  • Common multidisciplinary platform with a shared vision
  • Catalysed the transition from research to the clinical environment, 5 centres approved in Europe
  • Served as a vehicle for education and dissemination

ENLIGHT, ESF Workshop-Oxford

european situation in 2008
European situation in 2008
  • The first two dual Carbon/proton centres in Heidelberg and Pavia are foreseen to start operation in 2008/9…..
  • Approved: Marburg (Germany), Etoile (France), MedAustron (Austria) and ARCHADE (France)
  • Sweden, Belgium, Netherlands, Spain, UK ………

Clear desire for continuing the network

focusing on new and on un- completed research

topics and helping new initiatives….

ENLIGHT, ESF Workshop-Oxford

from enlight to enlight
From ENLIGHT… to ENLIGHT++

In 2006 ENLIGHT++:

+ one “plus” for more hadrons (specifically protons),

++ the second “plus” refers to more Countries (17 countries, with >60 Institutions)

ENLIGHT++ goes beyond being a network:

Main Objective: Being more INCLUSIVE and becoming a RESEARCH network

ENLIGHT, ESF Workshop-Oxford

enlight 2008
ENLIGHT 2008

European Commission funding project (Framework programme 7)

Training 25 young researchers - 5.6 million euro project

Research in optimizing 8.5 million euro project

ENLIGHT, ESF Workshop-Oxford

partner
PARTNER
  • 25 researcher positions
  • 21 PhDs and 4 Post-doc
  • Positions posted: www.cern.ch/PARTNER
  • Will start 1st October 2008
ulice
ULICE

Infrastructure project (8.5M Euros)

3 Pillars:Transnational access, Research and Networking

Start at the beginning of 2009

slide14

HEALTH- 2009-1.2-4: Novel imaging systems for in vivo

monitoring and quality control during tumour ion beam therapy.

Single stage application.

Collaborative project (small or medium-scale focused research project)

The focus should be to develop novel imaging instruments, methods and

tools for monitoring, in vivo and preferably in real time, the 3-dimensional

distribution of the radiation dose effectively delivered within the patient during ion beam therapy of cancer. The ions should be protons or heavier ions. The system should typically be able to quantify the radiation dose delivered, to determine the agreement between the planned target volume and the actually irradiated volume, and for decreasing localisation uncertainties between planned and effective positions (e.g. of tissues or organs), and between planned and effective dose distribution during irradiation. It should aim at improving quality assurance, increasing target site (tumour) to normal tissue dose ratio and better sparing normal tissue.

2.9.2008

Manjit Dosanjh

ENLIGHT, ESF Workshop-Oxford

slide15

1. What do we have? In-beam PET

Advantages

  • In-beam PET allows fora control of tumour irradiations by means of ion beams
  • an in-vivomeasurement of the ion range
  • the validation of the physical model of the treatment planning
  • the evaluation of the whole physical process of the treatment from planning to the dose application deviationsbetween planned and actually applied dose distributions

ENLIGHT, ESF Workshop-Oxford

slide16

2. What do we have? In-beam PET

Disadvantages and open problems

PET is not applicable to

- real time monitoring:

▪ too slow

▪T1/2(15O) = 2 min, T1/2(11C) = 20 min

▪ dose specific activity: ~ 1000 - 7000 Bqcm-3 Gy-1

- quantitative imaging, precise dose quantification, feedback to treatment

planning and to IGRT

▪ limited angle artefacts

▪ degradation of activity distributions by the metabolism

▪ degradation of activity distributions bymoving organs

▪ inaccurate prediction of activity distributions from treatment

planning due to unknown nuclear reaction cross sections

ENLIGHT, ESF Workshop-Oxford

slide17

3. What do we need?

Aim of this FP7-project

- Development and proof of principle new solutions for

▪non-invasive, real-time, in-vivo monitoring

▪quantitative imaging

▪precise dose quantification

▪feedback to treatment planning

▪ real-time feedback to IGRT for moving organs

- Preserve the leading European position in the field

ENLIGHT, ESF Workshop-Oxford

enlight meeting novel imaging systems

ENLIGHT MeetingNovel Imaging Systems

WP1: Time-of-flight in-beam PET

(F. Sauli, M. Rafecas)

WP2: In-beam single particle tomography

(W. Enghardt, D. Dauvergne)

WP3: PT in-vivo dosimetry and moving target volumes(K. Parodi, G. Baroni)

WP4: The combination of in-vivo dosimetry, treatment planning, and clinical relevance

(D. Georg, B. Jones)

WP5: Monte Carlo Simulation of in-vivo dosimetry

(I. Buvat? , G. Battistoni)

ENLIGHT, ESF Workshop-Oxford

enlight meeting novel imaging systems19

ENLIGHT MeetingNovel Imaging Systems

WP1: Time-of-flight in-beam PET

(TERA, INFN, IFIC/CSIC, IN2P3, OncoRay, CERN, PoliAnnecy, Oxford)

WP2: In-beam single particle tomography

(TERA, IBA, ICX, IFIC/CSIC, In2P3,Etoile,OncoRay)

WP3: PT in-vivo dosimetry and moving target volumes(GSI, HIT , Oncoray, PoliMilano, Oxford, IBA, Etoile, IFIC/CSIC, INFN,TERA, Siemens?, Marburg?)

WP4: The combination of in-vivo dosimetry, treatment planning, and clinical relevance

(BHTC, MUVienna, Oxford, INFN, Siemens, Etoile, Marburg)

WP5: Monte Carlo Simulation of in-vivo dosimetry

(CERN, INFN, Ciemat, IFIC, PoliAnnecy, HIT, OncoRay, IN2P3, Etoile, IBA)

ENLIGHT, ESF Workshop-Oxford

slide20

FIRST LIST

SECOND LIST

TERA

INFN

IFIC/CSIC

IN2P3

OncoRay

CERN

PoliAnnecy

Oxford

IBA

ICX

Etoile

GSI

HIT

PoliMilano

Siemens

Marburg

BHTC

MUVienna

Ciemat

--------------

TERA/CNAO/PoliMilano/UBern

INFN

IFIC-CSIC/Ciemat

IN2P3/CEA?

OncoRay

CERN

Oxford

IBA

ICX

Etoile/PoliAnnecy/Archade?

GSI

HIT/Marburg

Siemens

BHTC

MUVienna

------------------

Manjit Dosanjh

ENLIGHT, ESF Workshop-Oxford

2.9.2008

conclusions
Conclusions

ENLIGHT++ continues to catalyse

  • Common interdisciplinary environment
  • Creation of maximum possible uniformity
  • Inter-facilities uniformity and comparison
  • Ease of exchange of information.
  • Harmonization of data…………..

ENLIGHT, ESF Workshop-Oxford

outlook
Outlook
  • Particle therapy will cover the full spectrum of radiotherapeutical indications
  • One particle therapy facility for 10 million inhabitants
  • Treatments will be fully accepted by the health insurance systems

ENLIGHT, ESF Workshop-Oxford