Transcript Presentation_Manjit_Dosanjhx

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
• 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
Knowledge Transfer | Accelerating Innovation
CERN Technologies and innovation
accelerators, detectors and IT to fight cancer
Detecting
particles
Large-scale
computing (Grid)
Accelerating
particle beams
CANCER
Knowledge Transfer | Accelerating Innovation
Manjit Dosanjh
First Bern Cyclotron Symposium - June 5-6, 2011
3
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
Knowledge Transfer | Accelerating Innovation
[email protected]
4
KT-LS 26 May 2011
Cancer incidence increases with age
Knowledge Transfer | Accelerating Innovation
Cancer is a large and growing challenge
Need: Earlier diagnosis, better control, fewer side-effects
How?
• new technologies
•
•
•
•
Imaging, dosimetry, accelerator & detector technology
Better understanding – genetics, radiobiology…
Advanced healthcare informatics …
international collaboration
•
If progress is to be maintained
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
Knowledge Transfer | Accelerating Innovation
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.
Knowledge Transfer | Accelerating Innovation
4th pillar:
catalysing
collaboration
4 Pillars:
3 areand
thefacilitating
key technologies
Accelerating particle beams
Particle Therapy
Tumour Target
Detecting particles
Large scale computing (Grid)
Knowledge Transfer | Accelerating Innovation
Medical imaging
Grid computing for medical data
management
and analysis
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
Knowledge Transfer | Accelerating Innovation
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)
CT
Knowledge Transfer | Accelerating Innovation
PET
PET-CT
Positron Emission Tomography
Idea of PET
Photon detection used for calorimetry
PET
today
CMS
Knowledge Transfer | Accelerating Innovation
PET (Positron Emission Tomography)
• Detects pairs of photons emitted by an injected positronemitting radionuclide
• Images tracer concentration
within the body
• Reflects physiological activity
• Reconstructed by software
LHC detector systems used in
PET Systems
Knowledge Transfer | Accelerating Innovation
PET/CT (David
Townsend)
CT
Knowledge Transfer | Accelerating Innovation
PET
In-beam-PET for Quality Assurance: real time
MC simulated
measured
On-line determination of the dose delivered
Modelling of beta+ emitters:
Cross section
Fragmentation cross section
Prompt photon imaging
Advance Monte Carlo codes
Knowledge Transfer | Accelerating Innovation
In-beam-PET
GSI- Darmstadt
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
Knowledge Transfer | Accelerating Innovation
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)
Knowledge Transfer | Accelerating Innovation
Two opposite photon beams
80
50
Knowledge Transfer | Accelerating Innovation
30
Two opposite photon beams
110
100
Knowledge Transfer | Accelerating Innovation
110
How to 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
Knowledge Transfer | Accelerating Innovation
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
Depth in the body (mm)
Knowledge Transfer | Accelerating Innovation
Ion Radiation
Proton & Ion Beam Therapy: a short history
Proposed by R.R. Wilson
MedAustron (Austria)
1st patient treated at Berkeley, CA
1st patient in Europe at
Uppsala
CNAO, Pavia (Italy)
HIT (carbon), Heidelberg (Germany)
1984 1989 1990 1991 1992 1993 1994 1996-2000 2002
1946
2009
1954 1957
2011 2014
PIMMS
PSI, Switzerland
Eye tumours, Clatterbridge, UK
GSI carbon ion pilot, Germany
CPO (Orsay), CAI (Nice), France
Loma Linda (clinical setting) USA
Boston (commercial centre) USA
NIRS, Chiba (carbon ion) Japan
Knowledge Transfer | Accelerating Innovation
ENLIGHT
ENLIGHT
10th year
ENLIGHT
CERN 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
> 150 institutes
> 400 people
Coordinated by CERN, 80% MS involved
> 25 countries
(>80% of MS involved)
Knowledge Transfer | Accelerating Innovation
EU funded projects
•
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
•
•
•
•
Marie Curie ITN
12 institutions
•
•
R&D on medical
imaging for hadron
therapy
16 institutions
Knowledge Transfer | Accelerating Innovation
•
Infrastructures for
hadron therapy
20 institutions
•
•
•
Marie Curie ITN
12 institutions
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
Knowledge Transfer | Accelerating Innovation
KT-LS 26 May 2011
24
International Conference on
Translational Research in
Radio-Oncology &
Physics for Health in Europe
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 Manjit Dosanjh (CERN)
Four physics subjects :
 Radiobiology in therapy and space
 Detectors and medical imaging
 Radioisotopes in diagnostics and therapy
 Novel technologies
Knowledge Transfer | Accelerating Innovation
Normal tissue
Sensitive
structure
(OAR)
Target (PTV)
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
Knowledge Transfer | Accelerating Innovation
Future Biomedical Facility @ CERN
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 by ENLIGHT
Community (> 20 countries, >200 people )
Knowledge Transfer | Accelerating Innovation
LEIR
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……….
Knowledge Transfer | Accelerating Innovation
Life.Sciences@c
28
Thank you for your attention
[email protected]
Knowledge Transfer | Accelerating Innovation
Knowledge Transfer | Accelerating Innovation
R&D isotopes for “Theranostics”
149Tb-therapy
161Tb-therapy
& SPECT
Knowledge Transfer | Accelerating Innovation
152Tb-PET
155Tb-SPECT
#177: C. Müller et al., Center for Radiopharmaceutical
#177: C. Müller
Sciences ETH-PSI-USZ
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
Knowledge Transfer | Accelerating Innovation
Inventory of isotopes produced in a natural
Zr target after proton beam irradiation.
Cancer Treatment Options…
Surgery
Local control
Radiotherapy
Chemotherapy and others
X-ray, IMRT, Brachytherapy,
Hadrontherapy
Hormones; Immunotherapy;
Cell therapy; Genetic treatments;
Novel specific targets (genetics..)
Local control
Survival
Quality of life
Knowledge Transfer | Accelerating Innovation
Limited Local
control
Status & Perspectives in Particle Therapy – A. Mazal
Worldwide 100,000
Patients
80,000
Statistics
26.02.2012 60,000
M.Jermann
A.Mazal
PTCOG
Total
40,000
Protons
20,000
0
2006
2007
2008
2009
2010
2011
2012
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
Knowledge Transfer | Accelerating Innovation
Radiobiology in therapy and space : a highlight
Local effects of microbeams of hadrons seen by fluorescent proteins
which repair DNA
55 MeV carbon
5 × 5 µm² matrix
20 MeV protons
randomly distributed
10 µm
10 µm
20 MeV protons
5 × 5 µm² matrix
117 protons per spot
10 µm
Günther Dollinger - Low LET radiation focused to sub-micrometer shows
enhanced radiobiological effectiveness (RBE)
Carbon ions have higher radiobiological effectiveness than protons
Knowledge Transfer | Accelerating Innovation
Detectors and medical imaging: a highlight
Detectors for Time-Of-Flight PET: the limit of time resolution
With 20 picosecond
Δx = 4 mm:
no track
reconstruction
is needed
D. Schaart: Prospects for achieving < 100 ps FWHM coincidence
resolving
time in Time-Of-Flight PET
Knowledge Transfer | Accelerating Innovation
Novel technologies: a roadmap for particle accelerators
Marco Schippers
WhatKnowledge
we need
to| Accelerating
be ableInnovation
to provide beams for therapy
Transfer
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
Knowledge Transfer | Accelerating Innovation
Needs for a radiation facility
•
Increase radiobiological knowledge:
•
•
•
•
•
Simulations:
•
•
•
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
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
Knowledge Transfer | Accelerating Innovation