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Augen-Tumor-Therapie mit 68 MeV Protonen
am Hahn-Meitner-Institut BerlinC.Rethfeldt / SF4-ATT
Hahn-Meitner-Institut Berlin
1. Ionenstrahllabor ISL
2. Augen-Tumor-Therapie als Anwendung am ISL
3. DFG-Projekt: CT-basierte Therapie-Planung
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Hahn-Meitner-Institut GmbH Berlin
Forschungsreaktor: „BENSC“ Ionenstrahllabor: „ISL“
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M a g n eticS p ectrom eter
L o w E n erg y Target A rea a n dD u a l B ea m L in e
ex trem lys lo w Io n s
5 .5 M VVa n d e G ra aff - In jecto r
2 0 0 k V - In jector + 1 4 G H zE C R - S o u rce
R F QStructure In jector9 0 - 3 6 0 k e V /a m u
E ye - Tu m or - T h erap y
k = 1 3 0C y clo tro n
1 4 G H zE C R - S o u rce
Vertica l B ea m L in e
Hahn-Meitner-Institut Berlin
![Page 4: Augen-Tumor-Therapie mit 68 MeV Protonen am Hahn-Meitner-Institut Berlin C.Rethfeldt / SF4-ATT 1. Ionenstrahllabor ISL 2. Augen-Tumor-Therapie als Anwendung](https://reader034.vdocuments.net/reader034/viewer/2022051315/56649e2a5503460f94b183d0/html5/thumbnails/4.jpg)
M a g n eticS p ectrom eter
L o w E n erg y Target A rea a n dD u a l B ea m L in e
ex trem lys lo w Io n s
5 .5 M VVa n d e G ra aff - In jecto r
2 0 0 k V - In jector + 1 4 G H zE C R - S o u rce
R F QStructure In jector9 0 - 3 6 0 k e V /a m u
E ye - Tu m or - T h erap y
k = 1 3 0C y clo tro n
1 4 G H zE C R - S o u rce
Vertica l B ea m L in e
Hahn-Meitner-Institut Berlin
![Page 5: Augen-Tumor-Therapie mit 68 MeV Protonen am Hahn-Meitner-Institut Berlin C.Rethfeldt / SF4-ATT 1. Ionenstrahllabor ISL 2. Augen-Tumor-Therapie als Anwendung](https://reader034.vdocuments.net/reader034/viewer/2022051315/56649e2a5503460f94b183d0/html5/thumbnails/5.jpg)
M a g n eticS p ectrom eter
L o w E n erg y Target A rea a n dD u a l B ea m L in e
ex trem lys lo w Io n s
5 .5 M VVa n d e G ra aff - In jecto r
2 0 0 k V - In jector + 1 4 G H zE C R - S o u rce
R F QStructure In jector9 0 - 3 6 0 k e V /a m u
E ye - Tu m or - T h erap y
k = 1 3 0C y clo tro n
1 4 G H zE C R - S o u rce
Vertica l B ea m L in e
Hahn-Meitner-Institut Berlin
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M a g n eticS p ectrom eter
L o w E n erg y Target A rea a n dD u a l B ea m L in e
ex trem lys lo w Io n s
5 .5 M VVa n d e G ra aff - In jecto r
2 0 0 k V - In jector + 1 4 G H zE C R - S o u rce
R F QStructure In jector9 0 - 3 6 0 k e V /a m u
E ye - Tu m or - T h erap y
k = 1 3 0C y clo tro n
1 4 G H zE C R - S o u rce
Vertica l B ea m L in e
Hahn-Meitner-Institut Berlin
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Hahn-Meitner-Institut Berlin
Ion beam analysis at ISL
ERDA (Elastic Recoil Detection Analysis)
PIXE (Proton induced X-ray emission)
RBS (Rutherford Backscattering helium or
heavy ions)
ERDA-measuring principle
Example: SiNxH layer on Si
scattered to 230 MeV 129Xe-ions
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Hahn-Meitner-Institut Berlin
Ion beam analysis at ISL
ERDA (Elastic Recoil Detection Analysis)
PIXE (Proton induced X-ray emission)
RBS (Rutherford Backscattering helium or
heavy ions)
PIXE-measuring principle
![Page 9: Augen-Tumor-Therapie mit 68 MeV Protonen am Hahn-Meitner-Institut Berlin C.Rethfeldt / SF4-ATT 1. Ionenstrahllabor ISL 2. Augen-Tumor-Therapie als Anwendung](https://reader034.vdocuments.net/reader034/viewer/2022051315/56649e2a5503460f94b183d0/html5/thumbnails/9.jpg)
PIXE-measuring principle
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Hahn-Meitner-Institut Berlin
Ion beam analysis at ISL
ERDA (Elastic Recoil Detection Analysis)
PIXE (Proton induced X-ray emission)
RBS (Rutherford Backscattering helium or
heavy ions)
Hahn-Meitner-Institut Berlin
Ion beam analysis at ISL
ERDA (Elastic Recoil Detection Analysis)
PIXE (Proton induced X-ray emission)
RBS (Rutherford Backscattering helium or
heavy ions)
RBS-measuring principle
![Page 11: Augen-Tumor-Therapie mit 68 MeV Protonen am Hahn-Meitner-Institut Berlin C.Rethfeldt / SF4-ATT 1. Ionenstrahllabor ISL 2. Augen-Tumor-Therapie als Anwendung](https://reader034.vdocuments.net/reader034/viewer/2022051315/56649e2a5503460f94b183d0/html5/thumbnails/11.jpg)
M a g n eticS p ectrom eter
L o w E n erg y Target A rea a n dD u a l B ea m L in e
ex trem lys lo w Io n s
5 .5 M VVa n d e G ra aff - In jecto r
2 0 0 k V - In jector + 1 4 G H zE C R - S o u rce
R F QStructure In jector9 0 - 3 6 0 k e V /a m u
E ye - Tu m or - T h erap y
k = 1 3 0C y clo tro n
1 4 G H zE C R - S o u rce
Vertica l B ea m L in e
Hahn-Meitner-Institut Berlin
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Hahn-Meitner-Institut Berlin
Irradiation of Foils
Irradiation Study of Semiconductor Elements
Proton Therapy of Eye Tumors
ISL-Applications
Hahn-Meitner-Institut Berlin
Ion beam analysis at ISL
ERDA (Elastic Recoil Detection Analysis)
PIXE (Proton induced X-ray emission)
RBS (Rutherford Backscattering helium or
heavy ions)
Irradiation of Foils
![Page 13: Augen-Tumor-Therapie mit 68 MeV Protonen am Hahn-Meitner-Institut Berlin C.Rethfeldt / SF4-ATT 1. Ionenstrahllabor ISL 2. Augen-Tumor-Therapie als Anwendung](https://reader034.vdocuments.net/reader034/viewer/2022051315/56649e2a5503460f94b183d0/html5/thumbnails/13.jpg)
Hahn-Meitner-Institut Berlin
Irradiation of Foils
Irradiation Study of Semiconductor Elements
Proton Therapy of Eye Tumors
ISL-Applications
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Hahn-Meitner-Institut Berlin
Ion beam analysis at ISL
ERDA (Elastic Recoil Detection Analysis)
PIXE (Proton induced X-ray emission)
RBS (Rutherford Backscattering helium or
heavy ions)
Irradiation Study of Semiconductors
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Hahn-Meitner-Institut Berlin
Irradiation of Foils
Irradiation Study of Semiconductor Elements
Proton Therapy of Eye Tumors
ISL-Applications
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Eye Tumor Therapy with 68 MeV Protons
at Hahn-Meitner-Institut-Berlin
1995 Start of the ISL- Project
1998 First patient treated
2000 167 patients Residence of patients
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Why Protons ?
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Why Protons ?
Optic NerveMacula
Tumor
Tantalum Clips
Typical Fundus View
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Treatment Method
range shifter
X-ray screen
dose monitor
Treatment Method
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Treatment Method
Tantalum Clips: Positioning landmarks
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Tantal Clips: Positioning landmarks
Very precise Positioning SystemVery precise Positioning System
Axial Image
Lateral Image
Treatment Method
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Treatment Method
0
2
4
6
8
10
12
14
0,00 0,20 0,40 0,60 0,80 1,00
Standard Deviation [mm]
Numb
er of
Patie
nts
repeatability of patient positions
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Treatment Method
Treatment Planning: EYEPLAN OUTPUT
View Angles: polar/azimuthal
Proton range
Beam Modulation
Shape Collimator
3D Position of Clips
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Treatment Method
Treatment Planning: EYEPLAN OUTPUT
View Angles: polar/azimuthal
Proton range
Beam Modulation
Shape Collimator
3D Position of Clips
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Treatment Method
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Treatment Method
Proton Beam Physics
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treatments June 1998 – March 2000• 118 patients in 20 treatment weeks• patient age: 10 – 85 years• 85 choroidal melanomas• 17 choroidal hemangiomas • 12 iris melanomas• 4 conjunctival melanomas• dose/fractions:
- uveal melanomas: 60 CGE/ 4 fract./ 4 days- hemangiomas: 20 CGE/ 4 fract./ 4 days- iris melanomas: 50 CGE/ 4 fract./ 4 days
(CGE = Cobalt Gray Equivalent, RBE = 1,1)
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tumor stages
T123%
T259%
T318%
> 5 mm> 15 mmT3
3 – 5 mm
10 -15 mmT2
< 3 mm10 mmT1
tumor height
max.
diametertumor
category
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choroidal melanomas
CTV = 0.1 cm3
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follow-up of first patient
6 months after treatment 19 months after treatment
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collaborators• Hahn-Meitner Institut Berlin:
J. Heese, H. Kluge, H. Fuchs, H. Homeyer, H. Morgenstern, C. Rethfeldt, I. Reng, W. Hahn
• university hospital Benjamin Franklin, Berlin:• dept. of radiation oncology
M. Nausner, W. Hinkelbein, K. Kalk• dept. of ophthalmology:
M.H. Foerster, N. Bechrakis
• university eye clinic, Essen:
N. Bornfeld
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DFG-Project: CT-based Treatment PlanningDFG-Project: CT-based Treatment Planning
HMI-Berlin / DKFZ HeidelbergHMI-Berlin / DKFZ Heidelberg
Advantages:
- individual organ shape
- more precise dose calculation
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Introduction / Introduction / MotivationMotivation
Wide Angle Fundus View EYEPLAN Tumor Draw
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Introduction / Introduction / MotivationMotivation
Wide Angle Fundus View EYEPLAN Dose Distribution
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Problems: Problems:
> Human Eye is not a “Ideal Sphere”> Human Eye is not a “Ideal Sphere”
> Individual Anatomy > Individual Anatomy
Introduction / Introduction / MotivationMotivation
Wide Angle Fundus View EYEPLAN Dose Distribution
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Correction of Primary Field / Beamline GeometryCorrection of Primary Field / Beamline Geometry
Beamline Set-up at Hahn-Meitner Institute Berlin
Proton Beam
Quadrant Ion Chamber
Range Modulator
Range Shifter
Steel Tube
Collimator
Range Shift Variation: 0 -25 mm1,5 m Beamline
H2O PhantomGEANT Monte Carlo
Geometry
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Correction of Primary Field / Beamline GeometryCorrection of Primary Field / Beamline Geometry
GEANT Data-Set for Range Shifter = 0 mm
Approach:
Slope = 2.0 + 0.2 * SQRT( RS )
P1
( 1 + EXP ( ( x - P2 ) / P3 )
P1 = 1.
P3 = P3 * 4.39 ( 90 - 10%Dose Slope )
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Correction of Primary Field / Beamline GeometryCorrection of Primary Field / Beamline Geometry
Field (d (RS), x, y) = Coll(x, y) PSF(RS)Lateral Field on Air at “Eye Entry”
---> 65mm behind Collimator
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Correction of Primary Field / Wedge ApplicationCorrection of Primary Field / Wedge Application
45deg Wedge
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d Distance to “Eye Entry Point”
90-10 Dose slopeCol
Approach
d z’(p v)2
z LR
1 + 0.088 log10( )2(19.2MeV)2 LR
r 2(z ) = ( z - z’ )2z
0
Multiple Coulomb Scattering
Correction of Primary Field / Wedge ApplicationCorrection of Primary Field / Wedge Application
Collimator
Wedge
d Effective Thickness
d = F(curvecollimator)
Slope = F(curvecollimator )
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Correction of Primary Field / Wedge ApplicationCorrection of Primary Field / Wedge Application
Wedge + 10mm Range Shift
60 deg Wedge
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Correction of Primary Field / Wedge ApplicationCorrection of Primary Field / Wedge Application
5mm
Wedge Approach Conventional Version
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VerificationVerification
1.00
0
1.05
2
1.09
3
1.13
3
1.29
5
1.16
3
1.23
6
CT-Slice / Sugar Solutions 7 Chamber Phantom
Proton Beam
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VerificationVerification
1.00
0
1.05
2
1.09
3
1.13
3
1.29
5
1.16
3
1.23
6
CT-Slice / Sugar Solutions
Hounsfield based Density
Deviation: 0.99 +- 0.03
Comparison of Radiological Depths
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VerificationVerification
Depth: 24.5 mm Density: 1.133 g/cm3 Depth: 17.5 mm Density: 1.163 g/cm3 Depth: 10.5 mm Density: 1.236 g/cm3 Depth: 3.5 mm Density: 1.295 g/cm3
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Features of the Dose AlgorithmFeatures of the Dose Algorithm
Physical Model Input:
Beam Energy / Gaussian Width -> Modelling Bragg Curve
optional: measured Bragg Curve
Slope_90_10 = F(Range Shifter) -> GEANT Beamline Study
optional: measured Slopes
Density of Wedge Material
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Features of the Dose AlgorithmFeatures of the Dose Algorithm
Treatment Planning Output:
Dose Distribution Cube for Overlays in Planning Programs
Radiological Range and Modulation Width
of the Spread Out Bragg Peak
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How it looks in Practice ?How it looks in Practice ?
In Eye Tumor Treatment In Eye Tumor Treatment
Planning ?Planning ?
Segmented Eye with TumorCT-based Dose CalculationUse of artificial CT- CubeArtificial CT based Dose Calculation
Practical Usage of Dose AlgorithmPractical Usage of Dose Algorithm
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SummarySummary
Introduced Corrections of the Primary Radiation Field Influence of Range Shifter
Influence of Wedge Application
A Series of Verifications CT-based Calculations versus Measurement using “7-Chamber” -Phantom
First practical Usage in Treatment Planning Running in Problems with ‘Clip’ Artefacts