Post on 31-May-2020
transcript
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
1
Welcome to
our
symposium
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
2
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
3
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wThe Best in Proton Therapy Today and Tomorrow
Advanced PBS Quality AssuranceSimon Marcelis
Product Manager for Particle Therapy SolutionsIBA Dosimetry
4
Building the future of proton therapy
Sofie Gillis, Clinical Solutions Director
Damien Prieels, Research Director
IBA Proton Therapy
1
2
3
Treatment of Moving Targets with PBSVladimir Vondracek
Chief Medical Physicist, Proton Therapy Center Czech
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
PTCOG - Prague - 2016
Simon Marcelis
Product Manager Particle Therapy
IBA Dosimetry
Advanced PBS QA:Towards More Efficiency and Accuracy
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wDisclaimer
This presentation may contain forward-looking statementsconcerning industry outlook, including growth driver; thecompany’s future orders, revenues, backlog, or earnings growth;future financial results; market acceptance of or transition to newproducts or technology and any statements using the terms“could”, “believe”, “outlook”, or similar statements are forward-looking statements that involve risks and uncertainties that couldcause the company’s actual results to differ materially from thoseanticipated. The company assumes no obligation to update orrevise the forward-looking statements in this release because ofnew information, future events, or otherwise.
6
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wIntroduction
How can we improve your QA ?
Methodology
Acquire statistics on current practices
Analyze frequencies, devices, tolerances, etc.
Involve clinical partners in early stage of the project
Fast release process
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wCurrent Practices
Extensive analysis of QA common practices
PT Site DS US PBS Frequence Test Tolerance Device Comment
Site C ✔ ✔ Yearly Dose Rate ± 30 % PPC05 + WP One field per option
Site A ✔ Yearly Field Size > 30×40 Film Largest Field Size > 30×40
Site B ✔ Monthly Test Pattern γ 2%/2mm 98% Lynx160MeV 5cm solid water, 226.7MeV
5cm solid water
Site A ✔ Monthly Spot Sigma < 10% or 0.5 mm Lynx< 10% or 0.5 mm, whichever is
smaller
Site C ✔ ✔ Yearly Modulation ± 3mm or ± 3% PPC05 + WP
Site A ✔ Daily Spot Sigma ± 20% I'mRT MatriXX + Buildup CPASS ± 10 %
Site F ✔ Daily Spot Sigma ± 10% Daily QA 3 4 spots (220 MeV), Field size diodes
Site C ✔ ✔ Yearly Snout Motion ≤ 5 mm Ruler
Site C ✔ ✔ Monthly Modulation± 3.0 mm or ± 3
%PPC05 + WP 2 ref field + 1 other field (rotation)
Site C ✔ ✔ Weekly Modulation± 3.0 mm or ± 3
%Zebra 2 ref field + 1 other field (rotation)
Site A ✔ Daily Modulation ± 3 mm I'mRT MatriXX + Buildup CPASS ± 2 mm
Site A ✔ Daily Flatness ± 3 % I'mRT MatriXX + Buildup CPASS ± 2 %
Site A ✔ Daily Symmetry ± 3 % I'mRT MatriXX + Buildup CPASS ± 2 %
Site D ✔ Daily Symmertry ± 3 % Daily QA 3 2 electron energy chambers @ mid-
Site A ✔ Daily Range ± 3 mm I'mRT MatriXX + Buildup • Distal, Proximal, Middle
• CPASS ± 2 mm
Site C ✔ ✔ Daily Output ± 3% Daily QA 3 + Buildup
Site D ✔ Daily Output ± 3 % Daily QA 3 + Buildup SOBP Mid
Site B ✔ Daily Output ± 2% MatriXX
Site C ✔ ✔ Monthly Symmetry ± 2 % MatriXX 2 ref field, 1 GTR angle
Site C ✔ ✔ Yearly Symmetry ± 2% MatriXX + Buildup Mid SOBP, one field per option
Site A ✔ DailyPPS Absolute
Position± 2 mm I'mRT MatriXX + Buildup
Goto Setup ⇒ X-ray ⇒ CV ⇒ Goto
Correction
Site A ✔ Monthly Snout Position ± 2 mm 2 Snouts
Site F ✔ Daily Output ± 2 % Daily QA 3 + Buildup 3cmx3cm, 159MeV, 1g/cm² buildup
Site B ✔ Monthly Snout ± 2 mm Ruler
Site C ✔ ✔ Yearly Output ± 2 % PPC05 + WP One field per option
Site E ✔ Monthly Symmetry 0.02 MatriXX 1 angle, 8 energies, 3 sizes
Site C ✔ ✔ Weekly First Scatterer ± 2 mm Range Verifier Compare range ‘all in’ to ‘all out’
Site D ✔ Daily Lasers ± 2 mm .
Site A ✔ Monthly Test Pattern γ 1.5% 1.5mm Lynx G 1.5%/1.5mm for 95% of the points
Site C ✔ ✔ Monthly Range ± 1.5 mm PPC05 + WP 2 ref field + 1 other field (rotation)
Site C ✔ ✔ Monthly X-ray vs Proton ± 1.5 mm FilmDouble‐exposure x‐ray and proton
on film
Site A ✔ Daily Lasers ± 1.5 mm I'mRT MatriXX + Buildup
Site C ✔ ✔ Weekly X-ray vs LF ± 1.5 mm Crosshair + Aperture Different Snout sizes (rotation)
Site C ✔ ✔ Weekly X-ray vs Proton ± 1.5 mm Crosshair + Aperture Different Snout sizes (rotation)
Site C ✔ ✔ Monthly Alignment ± 1.5 mm Plastic box with bb’sSet up phantom at setup angle, go
to tx angle, verify
Site A ✔ Monthly PPS Isocentricity ± 1.5 mm
Site C ✔ ✔ Yearly Range ± 1.5 mm PPC05 + WP
Site F ✔ Daily Spot Position ± 1.5 mm Daily QA 3 • 4 spots (220 MeV)
• Field size diodes
Site A ✔ Monthly PPS Translation ± 1.5 mm
Site C ✔ ✔ Daily Range ± 1.5 mm Range Verifier
Site C ✔ ✔ Daily X-ray vs PPS ± 1.5 mm Daily QA 3 + index bar Drive PPS to predefined position
Site C ✔ ✔ Weekly PPS Isocentricity ± 1.5 mm Iso-AlignAlign target at rot 0, rotate to 90 and
check
Site C ✔ ✔ Weekly Range ± 1 mm Zebra 2 ref field + 1 other field (rotation)
Site G ✔ Daily X-ray vs Proton ± 1 mm . MatriXX align with X-rays
Site E ✔ Monthly PPS Translation 1 mm . Markings on PPS mount
Site E ✔ Monthly PPS Isocentricity 1 mm LF + Crosshair + Laser LF projection crosshair & pointer
Site E ✔ Monthly PPS Isocentricity 1 mm LF + Crosshair LF projection of crosshair
Site B ✔ Monthly PPS Translation ± 1 mm
Site E ✔ Monthly Snout Motion 1 mm LF + Crosshair LF projection of crosshair
Site C ✔ ✔ Daily Lasers ± 1 mm Markers on Daily QA 3
Site C ✔ ✔ Yearly Lasers ± 1 mm Iso-Align Iso-Align aligned with X-rays
Site B ✔ Daily Spot Position ± 1 mm MatriXX
Site C ✔ ✔ Yearly X-ray vs Proton ± 1 mm Film • All snouts (4)
• 3 gantry angles per snout
Site D ✔ Daily Range ± 1 mm Daily QA 3 + Buildup SOBP Distal
Site D ✔ Daily X-ray vs PPS ± 1 mm .“4 metal bb’s in Daily QA 3 holder +
index to couch”
Site F ✔ Daily Range ± 1 mm Daily QA 3
“electron energy chambers, 187
MeV and 201 MeV, Different
buildup (entrance&distal fall‐off)”
Site D ✔ Daily Couch Motion ± 1 mm .
Site C ✔ ✔ Yearly Output ± 1 % Farmer Chamber + WP IAEA TRS 398 protocol
Site C ✔ ✔ Yearly LF vs X-ray ± 1 mm Film
Site C ✔ ✔ Yearly Output vs Dose ± 1 % Farmer Chamber + WP 1 – 3 Gy/min
Site G ✔ Daily Range ± 1 mm MatriXX + Buildup SOBP Distal (cube)
Site A ✔ Monthly Spot Position ± 1 mm Lynx
Site C ✔ ✔ Yearly PPS Movement ± 0.5 mm Ruler
Site C ✔ ✔ Yearly PPS Isocentricity ≤0.5 mm Plastic Sphere • Plastic sphere and X‐ray system
• Rot center to iso: ≤0.5 mm
• Radius rot. center: ≤0.5 mm
Site C ✔ ✔ Yearly GTR Angle ± 0.5 ° Digital Level .
Site C ✔ ✔ YearlySymmetry
vs GTR Angle± 0.5 % MatriXX + Buildup Cardinal angles plus one inbetween
Site C ✔ ✔ YearlyFlatness
vs GTR Angle± 0.5 % MatriXX + Buildup Cardinal angles plus one inbetween
Site C ✔ ✔ Yearly Output ± 0.5 % PPC05 + WP
Site I ✔ Weekly Spot Sigma . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail
Site B ✔ Monthly X-ray vs Proton Lynx
Site I ✔ Weekly Spot Direction . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail
Site I ✔ Weekly Spot Shape . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail
Site I ✔ Weekly Spot Position . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail
Site C ✔ ✔ YearlySnout Motion
(perp. axis)≤0.5 mm X-ray
Site C ✔ ✔ Yearly Dose Linearity ±0.5 MU, ± 0.2 % Farmer Chamber + WP • Offset: ±0.5 MU
Site I ✔ Weekly Output . Custom (Pyramid) 2 PX-2 + BC-100 + Motion Rail
• Max diff from linear fit: ±0.2%, MU:
25, 50, 100,150, 200
Site C ✔ ✔ Yearly GTR Isocentricity 0.5 mm Plastic Sphere • Plastic sphere and x‐ray system
• Radius cross plane: ≤0.5 mm.
• Variation inline: ±0.5mm
Site C ✔ ✔ Yearly PPS Rotation ± 0.2 ° Level
Site B ✔ Monthly PPS Rotation ± 0.2° Level
Site H ✔ Daily Spot Sigma . Gafchromic Films
Site H ✔ Daily Spot Position . Gafchromic Films
Site F ✔ Daily X-ray vs PPS . Daily QA 3 + index bar
Site H ✔ Daily Range . Gafchromic Films Gafchromic set parallel to beam
Site A ✔ Yearly Test Pattern . Lynx 226 MeV, 146 MeV and 116 MeV
Site A ✔ Yearly Spots . Lynx 18 Energies, Iso ±10cm and ±20cm
Site A ✔ Yearly Spots Size . Lynx 18 Energies, Iso ±10cm and ±20cm
Site A ✔ Yearly SAD . Lynx Compared to TPS
Site A ✔ Yearly PDD Consistency . ZebraPDD curves compared with those
from TPS
Site A ✔ Yearly Range . Zebra 10×10 field, 18 energies
Site C ✔ ✔ Yearly SOBP Flatness . PPC05 + WP
Site C ✔ ✔ Yearly X-ray Quality . Leeds Phantom
Site C ✔ ✔ Yearly X-ray Dose . kVp&mAs meter
Site G ✔ Daily Field Size . MatriXX .
Site B ✔ Monthly Symmetry MatriXX
Site B ✔ Monthly Flatness MatriXX
Site A ✔ Yearly Dose Linearity . MatriXX
Five scanned mono-energy 20cm x
20cm field were measured with
MatriXX at 5 cm depth
Site A ✔ Daily Output ± 3 % I'mRT MatriXX + Buildup Mid SOBP. CPASS ± 2 %
Site C ✔ ✔ Monthly Profile Flatness ± 3 % MatriXX 2 ref field, 1 GTR angle
Site B ✔ Monthly Range ZebraR20M10, R31M10, R12M10, R12M10
(with Range Shifter)
Site A ✔ Monthly Uniformity ± 3 % Lynx
Site G ✔ Daily Output ± 3 % MatriXX + Buildup Average of four central chambers
Site C ✔ ✔ Yearly Profile Flatness ± 3% MatriXX + Buildup Mid SOBP, one field per option
Site A ✔ Daily Spot Position ± 3 mm MatriXX + Buildup CPASS ± 2 mm
Site C ✔ ✔ Weekly Output ± 2.5 % Zebra 2 ref field + 1 other field (rotation)
Site C ✔ ✔ Monthly Output ± 2.5 % PPC05 + WP 2 ref field + 1 other field (rotation)
Site B ✔ Monthly Output ± 2% MatriXX• R20M10, R31M10, R12M10, R12M10
(with Range Shifter)
Site B ✔ Daily Flatness ± 2% MatriXX
Site E ✔ Monthly Profile Flatness 0.02 MatriXX 1 angle, 8 energies, 3 sizes
Site B ✔ Daily Range ± 2 mm MatriXX
Site E ✔ MonthlyOutpus
vs GTR Angle0.02 Farmer Chamber • 4 angles, 8 energies, 3 sizes
Site A ✔ MonthlySpot Position
(max)± 2 mm Lynx
Site A ✔ Monthly Output ± 2 % PPC05
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w3h
16h
Duration and Frequencies Analysis (PBS)
3h
3h
3h
3h
3h
3h
3h
3h
3h
3h
3h
QA Test Min Max Average
Daily 20 min 60 min ≈ 30 min
Monthly 2 hours 6 hours ≈ 3 hours
Yearly 1 day 3 days ≈ 2 days
1 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250
Yearly Working Days
Yearly
Daily
Mo
nth
ly
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w3h
16h
Duration and Frequencies Analysis (PBS)
3h
3h
3h
3h
3h
3h
3h
3h
3h
3h
3h
QA Test Min Max Average
Daily 20 min 60 min ≈ 30 min
Monthly 2 hours 6 hours ≈ 3 hours
Yearly 1 day 3 days ≈ 2 days
1 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250
Yearly Working Days
Yearly
Daily
Mo
nth
ly
Total Daily QA • 125 h (≈ 16 days)
Total Monthly QA • 36 h
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
≈ 16 days
Duration and Frequencies Analysis (PBS)
QA Test Min Max Average
Daily 20 min 60 min ≈ 30 min
Monthly 2 hours 6 hours ≈ 3 hours
Yearly 1 day 3 days ≈ 2 days
Yearly Working Days
1 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250
16h
Total Monthly QA • 36 h
Total Daily QA • 125 h (≈ 16 days)
Yearly
Daily
Mo
nth
ly
≈ 5 days
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wDEVICES
SUMMARYEnergy
Spots
Positions
Spots
Sizes
Spots
SymmetryOutput
Imaging
System
Beam vs
X-ray
Zebraor equivalent
Lynxor films
MatriXXor equivalent
PPC05+ solid water
Stingray+ water phantom
…
TODAY’S CURRENT PRACTICES: OR+ +
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
MatriXX: 32x32 (1 020) pixels
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wDEVICES
SUMMARYEnergy
Spots
Position
Spots
Size
Spots
SymmetryOutput
Imaging
System
Beam vs
X-ray
Zebraor equivalent
Lynxor films
MatriXXor equivalent
PPC05+ solid water
Stingray+ water phantom
…
TODAY’S CURRENT PRACTICES: OR+ +
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wDEVICES
SUMMARYEnergy
Spots
Position
Spots
Size
Spots
SymmetryOutput
Imaging
System
Beam vs
X-ray
Zebraor equivalent
Lynxor films
MatriXXor equivalent
PPC05+ solid water
Stingray+ water phantom
…
YOU SHOULD NOT HAVE TO CHOOSE BETWEEN QUALITY AND TIME
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wDEVICES
SUMMARYEnergy
Spots
Position
Spots
Size
Spots
SymmetryOutput
Imaging
System
Beam vs
X-ray
Zebraor equivalent
Lynxor films
MatriXXor equivalent
PPC05+ solid water
Stingray+ water phantom
…
OBJECTIVE 2 ✔ ✔ ✔ ✔ ✔ ✔ ✔
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wSUMMARY
OBJECTIVE 1:
REDUCE PBS DAILY QA BY 20 MIN/DAY (TARGET=10MIN)
OBJECTIVE 3:
… KEEPING CLOSE COLLABORATIONS WITH CLINICAL INSTITUTIONS
OBJECTIVE 2:
… WHILE MAINTAINING IMPROVING QUALITY
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
IN COLLABORATION WITH:
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
IN COLLABORATION WITH:
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
COMPLETE DAILY QA IN ONE SHOT Energy
Spots Size
Spots Position
Spots Symmetry
Absolute dose
X-ray vs Proton
Lasers
Uniformity
Imaging system
Couch translation
…
+ AAPM TG Compliant
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wBenchmarking: Cloud*
* Not released yet
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wWhat’s next ?
Apply similar process for:
Monthly Machine QA
Yearly Machine QA
Patient QA
Automation
Integration
Efficiency
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
Simon Marcelis
Product Manager Particle Therapy
IBA Dosimetry
Thank you!
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
IN COLLABORATION WITH:
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wAAPM TG-224 in preparation
Source:AAPM 2015
Poster SU-E-T 649
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
One shot
Sw
Validated by partners
Come at booth
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wFig 4
Energy
Measurement
Gray
B&W
Color
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wLynx vs. MatriXX Resolution
600x600 (Lynx) 32x32 (MatriXX)
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wLynx vs. MatriXX Resolution – PBS Spots
MatriXXLynx
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wLynx vs. MatriXX Resolution – Gaussian Fit
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wLynx vs MatriXX for PBS QA
MatriXX Lynx
EnergyYES (2 per image, ≈1mm
resolution)YES (4 per image, ≈0.4mm
resolution)
Spot Position and Sigma will be smoothed
Spot symmerty will be smoothed
Penumbra will be smoothed
Xray / Proton coincidence NO YES
Homogeneity/Flatness will be smoothed YES
Output YES NO (Sphinx PPC05)
Measurement surface 24x24 cm² 30x30 cm²
Pixel Size 7.6mm x 7.6 mm 0.5mm x 0.5mm
Pixel # 32x32 = 1024 600x600 = 360,000
Price same
Compact YES NO
Weight same (≈11kg)
MatriXX
Lynx
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wHandle with Care
• 50+ Lynx
• Use extensively during IBA PT calibration
• Never one Lynx was dropped (or if dropped, it did
not get damaged)
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
Lynx: 600x600 (360 000) pixels
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wThe Best in Proton Therapy Today and Tomorrow
Advanced PBS Quality AssuranceSimon Marcelis
Product Manager for Particle Therapy SolutionsIBA Dosimetry
37
Building the future of proton therapy
Sofie Gillis, Clinical Solutions Director
Damien Prieels, Research Director
IBA Proton Therapy
1
2
3
Treatment of Moving Targets with PBSVladimir Vondracek
Chief Medical Physicist, Proton Therapy Center Czech
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
38
Vladimir Vondracek
Head of Medical Physics PTC Prague
vladimir.vondracek@ptc.cz
Treatment of Moving Targets with PBS – Experience of PTC Czech
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wProton Therapy Center Prague
Cyclotron IBA Proteus 235
Four treatment rooms in operation in Pencil Beam Scanning
Possibility of 4D CT scanning
Treatment planning system XiO 4.80 (Elekta)
Gating devices via UBTI Position verification by Vision RT system
SDX Dyn´R system39
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wInterplay effect
With PBS dose is delivered spot by spot
delivery has time structure
Intrafractional movements Periodic – time structure
Irregular
Delivery of one layer has approx. same duration as periodic physiological movements (breathing, heart beat)
Interplay effect may cause unwanted under- or overdosage
40
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wHow to avoid interplay effect
Repainting Prolongation of layer delivery leads to
smearing of dose distribution – physiological movements are faster than dose delivery
For movements that cannot be handled other way like heart beating
Gating Treatment only in situation when target is in
the right position
Handling of breathing Treatment during free breathing
Deep inspiration breath hold
41
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wDyn´R strategy
Check if patient is eligible for this approach Overall patient status
Position of target volume
Testing phase of patient compliance Patient is breathing through spirometer
Patient is equipped with video glasses with breathing pattern visualisation
Deep inspiration breath hold level is defined
CT scan is done with breath hold according to previous coaching
Irradiation is performed only when correct breathing phase is reached Beam triggering interface is switched on
When optimal position is left, beam is automatically switched off
42
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wExperience
Diagnoses treated with this approach Lymphomas in thoracic area (combined sometimes with repainting)
See posters PTC16-0047 and PTC16-0409
Approx. 50 patients treated
Lung tumors Approx. 20 patients treated
Breast cancer patients (combined with Align RT) Started this year
More complex
Approx. 10 patients treated
Treatment duration Usual time for one breath hold – 20 seconds
Number of breath holds for one field – approx. 3 (with TCS rel. 8)
43
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wWorkflow
44
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wProblems to face
Patient status getting worse in course of treatment – patient is no longer able to hold the breath
Location of the tumor in lower mediastinum Less reproducible position - interfractional changes
Breathing can change from thorasic to abdominal
Change of diaphragm position and thus change of target volume position
Deployment of 4D CT and creation of
More robust plan – more beams to smear interplay effect
ITV concept – larger target volume
Expected higher doses to OARs
Positioning of equipment – not to interfere with treatment beam direction
45
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
46
Vladimir Vondracek
Head of Medical Physics PTC Prague
vladimir.vondracek@ptc.cz
Thank you
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wThe Best in Proton Therapy Today and Tomorrow
Advanced PBS Quality AssuranceSimon Marcelis
Product Manager for Particle Therapy SolutionsIBA Dosimetry
47
Building the future of proton therapy
Sofie Gillis, Clinical Solutions Director
Damien Prieels, Research Director
IBA Proton Therapy
1
2
3
Treatment of Moving Targets with PBSVladimir Vondracek
Chief Medical Physicist, Proton Therapy Center Czech
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
Building the future of Proton Therapy
48
Sofie Gillis & Damien Prieels
Clinical Solution & Research
IBA
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wDisclaimer
This presentation may contain forward-looking statementsconcerning industry outlook, including growth driver; thecompany’s future orders, revenues, backlog, or earnings growth;future financial results; market acceptance of or transition to newproducts or technology and any statements using the terms“could”, “believe”, “outlook”, or similar statements are forward-looking statements that involve risks and uncertainties that couldcause the company’s actual results to differ materially from thoseanticipated. The company assumes no obligation to update orrevise the forward-looking statements in this release because ofnew information, future events, or otherwise.
49
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w0
10
20
30
40
50
60
70
80
90
100
Current standard (IMRT
photons)Protons
Probability (%)
Complications Local tumour control
Proton Therapy has the potential to
50
Improvement
of local tumor
control
Prevention of
complications
Photons
Improve Local
Control
Reduce Normal
Tissue
Complications
Decrease integral
dose (secondary
cancer)
Retreatment
Graph Courtesy of Johannes A. Langendijk
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
Clinically relevant innovation
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
52
Approach
Product evolution to maximize the Bragg peak advantages
IMPTImaging
solutions
Intra-
fraction
motion
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wIMPT for highly conformal dose distributions
53
54.0Gy(RBE)
0.0Gy(RBE)
14.4Gy(RBE)
2.0Gy(RBE)
Courtesy of
Pineal blastoma Rhabdosarcoma Boost
IBA rooms worldwide
treating with IMPT32
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wImaging without compromise
54
In-room CT
for
Adaptive treatment
CBCT
for
soft tissue visualisation
kV – imaging
for
Bony alignment
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wImaging without compromise - kV
55
Bony anatomy alignment as
base for any protocol
Straightforward
Fast
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wImaging without compromise - CBCT
56In collaboration with &
procedures in WKHS
since 2015+1000Alignment and follow-up of morphology
changes: among others H&N + Lung
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wImaging without compromise - In-room CT
57In collaboration with
Follow-up dose accumulation
and clinical monitoring since
2016
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wComplete toolset for motion management
58
Fast and complete
repainting capabilityGating interface
High speed irradiation
for breath-hold
techniques
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
59
Approach
IMPTImaging
solutions
Intra-
fraction
motion
Improving
targeting
TOMORROW
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
Intensity
correction
virtual CT
UPenn is using IBA’s CBCT for adaptive therapy
60
planning CTCBCT (180°)
deformed CT
DIR
repeated CT
Overranges
(beam-eye
view)
DoseP
AR
TN
ER
S
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
61
Decision to re-plan is based on multiple indicators
Patient-specific
indicators definition
PA
RT
NE
RS
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
62
Decision to re-plan is based on multiple indicators
Patient-specific
indicators definition
Indicators
computation
PA
RT
NE
RS
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
63
Decision to re-plan is based on multiple indicators
PA
RT
NE
RS
Patient-specific
indicators definition
Indicators
computation
Automatic reporting
for physicist review
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
64
Decision to re-plan is based on multiple indicators
* Veiga et al., “First clinical investigation of CBCT and deformable registration for adaptive proton therapy of lung cancer”,
International Journal of Radiation Oncology Biology Physics, 2016 + Poster #347 PTCOG 2016.
Patient-specific
indicators definition
Indicators
computation
Automatic reporting
for physicist reviewAutomatic reporting
for physician review
Evaluation completed on 20 lung patients*
CBCT & repeated CT provide equivalent triggers for re-planning*
PA
RT
NE
RS
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wCould Proton Radiography help reducing margins?
Each pixel =
Integral Depth Dose65
Range mixing effect
= information !
Error computation by comparison with simulations (TPS)
PA
RT
NE
RS
1 2
3
1
2
3
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wCT calibration improvement with Proton Radiography
66
Error map:
-2
0
2
mm
Anatomy modification Weight gain/loss
Tumor shrinkage
Cavity filling
Setup error during PR Alignment never perfect
CT calibration error Bad HU to RSP conversion
Implants
Confounding
factors
What we’re
Looking for
CT of the same day
PR-CT registration
0
1
2
3
4
5
-1000 1000 3000 5000
A B C
HU
mass d
en
sit
y
-8
-6
-4
-2
0
2
4
6
8
mm
A
B
C
Titanium implant
P. Farace et al 2016,
PMB 61, p 4078
Poster #192,
PTCOG 2016
PA
RT
NE
RS
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wPrompt Gamma Imaging allows real-time QA
67
PA
RT
NE
RS
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wPrompt Gamma Imaging allows real-time QA
68
PA
RT
NE
RS
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wPrompt Gamma Imaging allows real-time QA
69
PA
RT
NE
RS
110 MeV – 14.4 cm - 2e8 simulated protons (31cGy at peak)
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
wPrompt Gamma Camera prototype were delivered to two key partners: Oncoray & UPENN
70
PA
RT
NE
RS
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w1st Patient acquisition by Oncoray on August 17th, 2015
71
PA
RT
NE
RS
“Inter-fractional global range variations were in the range of ±2 mm for all evaluated fractions.” Richter et al. 2016.
Radiother. Oncol. 118(2):232
“In-vivo proton range verification is feasible using a 1D prompt gamma camera with a 2 mm range retrieval precision.” Xie
et al. 2016. ePoster AAPM 2016 (Washington)
M. Priegnitz, Poster #309
L. Nenoff, Poster #320
Next generation
Petzoldt et al., “Range verification under clinical conditions based on the Prompt Gamma timing method”, Oral presentation
72 PTCOG 2016.
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
72
Perfecting cancer care with our users
IMPTImaging
solutions
Intra-
fraction
motion
Improving
targeting
TOMORROW
The B
est in
Pro
ton T
hera
py T
oday a
nd T
om
orro
w
73
Sofie Gillis & Damien Prieels
Clinical Solution & Research
IBA
Thank you