Transcript Enlight++ proton therapy

ENLIGHT ++
Proton and Ion Therapy
“e”-infrastructure for health; “e” for “enhanced,
enabled, excellent”
example of choice: Hadrontherapy
Hans F. Hoffmann-PH/CMO
08 November 2006
ENLIGHT++ for KnowARC project
1
What is Health
Definition
Health is a state of complete physical, mental and social
well being and not only the absence of disease or infirmity
WHO Constitution: The enjoyment of the highest
attainable standard of health is one of the fundamental
human rights of every human being without distinction for
race, religion, political belief, economic or social condition
WHO Mission
The attainment by all peoples of the highest possible level
of health
08 November 2006
ENLIGHT++ for KnowARC project
2
Prospective for cancer therapy…
Metastasis
Primary tumour
Surgery
Radiotherapy
Conformal RT
Medical treatments
Hormones; Chemotherapy;
Immunotherapy; Cell therapy;
Genetic treatments…
Novel specific targets
(genetics..)
High LET
particles
(?)
Survival
Quality of life
Local control
08 November 2006
ENLIGHT++ for KnowARC project
3
Hadrontherapy vs. Conventional radiotherapy
proton
carbon ion
Bragg Peak
Photons and Electrons
Physical dose high near surface
Effect not localised
Biological effect constant
Effective in well oxygenated cells
08 November 2006
vs.
Hadrons
(protons or light-ions)
Dose highest at Bragg Peak
Effect is localised
DNA damage less repairable
Biological effect highest at
maximum depth
Effective in poorly oxygenated cells
(carbon)
ENLIGHT++ for KnowARC project
4
Hadron therapy
28 cm
tumour
200 MeV
Protons
target
/
480 MeV
carbon ions
charged hadron beam
GSI
that loses energy in matter
Protons: ocular melanomas, base skull
tumours, cancers close to the spinal
cord
cyclotrons ~ 3-4 m diameter
synchrotrons ~ 6-8 m diameter
XPhotons
rays
Photons
Carbon ions: subset of patients with
radio-resistant tumors
synchrotrons ~ 20-25 m diameter
08 November 2006
ENLIGHT++ for KnowARC project
protons or
Protons
Protons
carbon
ions
GSI
5
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 of hadron therapy every 10 M
about 3'000 pts/year
08 November 2006
ENLIGHT++ for KnowARC project
6
Hadron therapy status
1954 the first patient treated with protons at the
University of California, Berkeley, USA
By 2005 about 50000 patients treated.
Europe is moving coherently towards the realisation
of a network of Hadron therapy Centres with 12C beams:
The two first ones in Heidelberg and Pavia are foreseen to start
operation in 2007
France and Austria (approved), Marburg
Sweden, Belgium, Netherlands, Spain, UK ………..
Japan has 2 carbon facilities and 4 proton facilities
USA has 2 running proton facilities and various others
being planned
08 November 2006
ENLIGHT++ for KnowARC project
7
Hadrontherapy goals
Provide the irradiation technology and the detection
systems to optimally use the advantageous properties
of heavy charged particles in external radiotherapy
Optimize dose to tumour conformity by beam scanning
and adaptation of the delivery to the organ motion
organs at
risk
tumour
Treat > 1000 patients per year and perform clinical
trials using low-LET
(p, He) and high-LET (C, O) beams
Conduct technical, physical and clinical R+D
tumour-conformal
dose distribution
08 November 2006
ENLIGHT++ for KnowARC project
8
What is ENLIGHT
2002-2005 ENLIGHT
(European Network for Light Ion Therapy)
ENLIGHT was composed of: Centres in Heidelberg, Lyon, and Pavia,
CERN, EORTC, ESTRO, GSI, Karolinska, MedAustron, TERA
Main achievements:
•Creation of a European Hadron therapy Community
•Common multidisciplinary platform with a shared vision
•ENLIGHT catalysed the transition from research to the
clinical environment
•Served as a vehicle for education and dissemination
08 November 2006
ENLIGHT++ for KnowARC project
9
What is 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: challenge for quality and success by
being more inclusive and becoming a research
network
and an FP7 project
08 November 2006
ENLIGHT++ for KnowARC project
10
Present European projects on the same scale
MedAustron
ETOILE
CNAO /
TERA
HICAT
08 November 2006
ENLIGHT++ for KnowARC project
11
ENLIGHT++ strengths
Success of original ENLIGHT and other pre-existing cooperation
Top research institutes
Scientists working at the cutting edge of knowledge and
technologies
Expectations of cancer patients
08 November 2006
ENLIGHT++ for KnowARC project
12
ENLIGHT++ ingredients
Networking light ion research:
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 (this presentation!)
08 November 2006
ENLIGHT++ for KnowARC project
13
Outlook
Particle therapy will cover the full spectrum of radiotherapeutical
indications
Per 10 million inhabitants one particle therapy facility may be
required
Treatments will be fully accepted by the health insurance systems
Pilot “European application of e-Health”?
08 November 2006
ENLIGHT++ for KnowARC project
14
ENLIGHT++ challenge
A heterogeneous group - 7 different disciplines-
How to a balance between basic research and the clinical
needs?
Many partners. How to collaborate effectively and make
progress with the main objectives
Is ion therapy more effective? Will practice validate the
theory?
Here: Is Hadrontherapy particularly appropriate
for a pilot ICT e-health infrastructure??
08 November 2006
ENLIGHT++ for KnowARC project
15
e-Health: Health Care enhanced by ICT
“e-Health”, Healthcare “enhanced” by ICT, deals with the use
of ICT to develop intelligently connected infrastructures
(very likely “ grids”) that provide:
"the right information, at the right time, in the right place"
For ubiquitous management of citizens’ health
To assist health professionals
To integrate advances in health knowledge into clinical practice
To streamline the citizens' healthcare system and
To empower the patients to take informed decisions for their wellbeing
e-Health is an obvious necessity
e-Health is also excellent business
08 November 2006
ENLIGHT++ for KnowARC project
16
There are many issues
“in the German Health care system every institution in
itself is an isolated solution, partially in line with the
latest scientific research, but singular. As a rule, the
limits of ICT are reached where the resources of one’s
own institution are exhausted” (BM Gesundheit)
Making data available in electronic patient records
Security, authentication, access control,
anonymity...
Using the same vocabularies, ontologies...
Provision of sufficient computers and networking
infrastructure to Doctor’s practices and hospitals
Clinical data restrictions, FDA, (21 CFR part 11...),
Also
, national practices, . . .
Adopting ideas of Collaboration in the Health
community and many other issues...
But the promise is great... ...and the time is right
08 November 2006
ENLIGHT++ for KnowARC project
17
Ingredients of e-health infrastructure
e-health infrastructure items
Patient card
Specialist card
Patient file
Prescription
Mobile diagnostics attached to patients (RFID, Bluetooth, GSM, . . .)
Referral system between hospitals
Security, privacy, . . .
Distributed data storage
Standardised data curation
Standard interfaces
Computers
Networks
Patient empowerment
Networked solutions
08 November 2006
ENLIGHT++ for KnowARC project
18
HealthGrid: Research Vision
Computing Grid
For data crunching applications

An environment, created through the sharing of resources,
in which heterogeneous and dispersed health data :
 molecular data (ex. genomics, proteomics)
 cellular data (ex. pathways)
 tissue data (ex. cancer types, wound healing)
 personal data (ex. EHR)
 population ( ex. epidemiology)

as well as applications, can be accessed by all users as an tailored information
providing system according to their authorisation and without loss of information.
Data Grid
Knowledge Grid
Distributed and optimized storage of
large amounts of accessible data
Intelligent use of Data Grid for
knowledge creation and tools
provisions to all users
HealthGrid:
State-of-the art and next steps
Current applications
Next application fields
Computing Grid
Image analysis
Ex.: MammoGrid
Real time operational assistance
Modeling, simulation, algorithms
Ex.: Gemss, Data Grid, CrossGrid
Radiotherapy
Disease related Grids
Drug discovery
Epidemiology
Image storage and accessibility
Ex.: MammoGrid
Data Grid
Bio-informatics
Ex. BioGrid
Knowledge Grid
HealthGrid: Research Challenges

Highly Distributed sources of health data, with strong privacy rules
 Semantic integration - building on the results related to

interoperability of Electronic Health Records and research data
 Algorithms for search, data mining and knowledge retrieval based on

advances in language understanding

Privacy and Security
 Adopting existing solutions to the Grid
 High reliability of system must be proven

User friendliness and acceptance
 Need to provide fast and easy to use tool at the point of need
 Very heterogeneous user community - health professionals,
researchers, authorities, patients
 Organizational and cultural issues related to new ways of working and

virtual collaborations

From technology to a solution in Healthcare
 Political awareness and understanding
 Business models
 Legal and ethical issues
HealthGrid: Implementation questions
What could be the role of HealthGrid in meeting the challenges in managing the
the rising costs, growing demands from consumers (patients; citizens) and
demographic changes, aging population?
2) Can HealthGrid play a role as an enabling tool for reorganisation of the
healthcare systems and can the needed training be provided ?
3) How can we assure a maximal user acceptance and user friendly technologies
and standards ?
1)
What is needed in order to be able to promise respect of legal, security
and privacy ? Do we have convincing proofs today or is there still homework
to be done ?
5) Can we convince industry to invest in HealthGrid and which part of it ?
6) Can HealthGrid find its place in the general strategy of health information
networks ? Can it become a leader ?
7) Can HealthGrid find its place in the general strategy of online health services ?
4)
ENLIGHT++ - Meeting, CERN, March 24th, 2006
Reflections on requirements of ehadrontherapy
(T. Auberger‘s (radio-onkologist‘s) slides)
WP 7 – ICT
Network for Particle Therapy
Requirements are the domain of the users of a project:
What to achieve
Specialists:
How to do it
Execution: in continuous collaboration
08 November 2006
ENLIGHT++ for KnowARC project
23
Two Versions of Network for Particle Therapy
 network of European ion therapy centres
 national network between user groups and
a central ion therapy centre
08 November 2006
ENLIGHT++ for KnowARC project
24
Questions
Why do we need a network?
What is necessary for an European network and for a
national network ?
What do we have to do?
Proposals ?
What do we need for our work ?
08 November 2006
ENLIGHT++ for KnowARC project
25
Why do we need a network?
I) European Network of Ion Therapy Centres
Communication between European ion therapy centres
Video conferences replace meetings
Exchange of know how
Mutual treatment strategies and protocols
Exchange of technical parameters
Unique definition of treatment parameters
Standardized technical parameters
08 November 2006
ENLIGHT++ for KnowARC project
26
Why do we need a network?
I) European Network of Ion Therapy Centres
Preparation of clinical multi-centre trials
Input of patient and treatment data,
diagnostic imaging, image fusion,
comparisons of treatment planning
online planning
Mutual data library
rare tumour entities
unique statistics
08 November 2006
ENLIGHT++ for KnowARC project
27
Why do we need a network?
I) European Network of Ion Therapy Centres
Coordination of non clinical research
Mutual scientific proposals
Distribution of beam time and programmes
(i.e. for radiobiological research of countries which don’t have
facilities)
08 November 2006
ENLIGHT++ for KnowARC project
28
Why do we need a network?
II) National network between user groups and a
central ion centres (1)
Information and training of users (peripheral hospitals)
Definition of standards on diagnostic and clinical
preparation of patients
Nationwide and bilateral video tumour boards
Rapid exchange of patient and treatment data (mutual
electronic patient files?)
08 November 2006
ENLIGHT++ for KnowARC project
29
Why do we need a network?
II) National network between user groups and a
central ion centres (2)
Adjustment of treatment modalities in combined
therapy regimes
(summarizing doses from different treatment plans,
online treatment planning )
Patient preparation and follow-up under observation
of ion centres
National tumour libraries
08 November 2006
ENLIGHT++ for KnowARC project
30
What is necessary for an European network
and for a national network ?
Common structure in medical and scientific strategy
Unique acquisition of patient and treatment data
Unique definition of beam and planning data
European clinical study protocols
Necessary technical support
Telecommunication systems
Unique electronic patient files ?
unique treatment planning systems ?
image data and planning data transfer
one mutual definition on software for international trials
08 November 2006
ENLIGHT++ for KnowARC project
31
What do we have to do?
Medical and scientific structure
Evaluation of the national medical infrastructure
in various European countries
Technical solution, which regards this existing
infrastructure or alternative ways
08 November 2006
ENLIGHT++ for KnowARC project
32
What do we have to do?
Medical and scientific Structure
mutual treatment strategies and guidelines for
preparation of patients, diagnostics, follow-up
preparation of unique clinical trials regarding
system not contents (protocols) ?
tumour libraries (indications? –what has to be
stored and how?)
organisation of non-clinical research
(if appreciated?)
08 November 2006
ENLIGHT++ for KnowARC project
33
What do we have to do?
Evaluation of national medical infrastructure in various
European countries
video tumour boards
organisation of patient preparation and follow-up
documentation of treatment results
data formats
patient files and imaging data (storage, transfer)
electronic communication systems
Compatibility of treatment planning systems
electronic epidemiologic registries
Software for support of clinical studies (ARCS ?, other
commercial and non-commercial systems?)
08 November 2006
ENLIGHT++ for KnowARC project
34
What do we have to do?
Technical solution
commercial and non commercial systems (advantages
and disadvantages)
costs and requirements of installation
compatibility with existing infrastructure and
running or planned technical equipment
08 November 2006
ENLIGHT++ for KnowARC project
35
Proposals
Learn from - integrate existing projects:
Mammogrid
Health-e-child
...
08 November 2006
ENLIGHT++ for KnowARC project
36
What do we need ?
Experts/scientific assistants on
radio oncology
medical physics
ICT
Reimbursement of
Travelling costs
Communication costs
Software/hardware ?
(hfh): Connect “stand alone” solutions, solve, satisfy:
Private interests of firms providing case solutions
Limited/local perspective of the users
IP
08 November 2006
ENLIGHT++ for KnowARC project
37
Conclusion for Enlight++ e-infrastructure
There are various reasons to build up an international network and
national networks as well
Step 1 - (medical point)
development of a common medical and scientific strategy
Step 2 – (medical, technical)
evaluation of current national infrastructure
Step 3 – (technical)
evaluation of a technical solution for an international network which
goes ahead with national development
Step 4 – (medical, technical)
pilot projects which will prove the efficiency of proposed solutions
08 November 2006
ENLIGHT++ for KnowARC project
38