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Technology Trends of Carbon-Ion Radiotherapy
andNIRS’s Role for its promotion
HIMAC
NIRS
Contents: 1. Feature of heavy ion radiotherapy2. Irradiation methods and necessary equipments3. Facilities worldwide4. Government's strategy and the role of NIRS
A. KitagawaLeader, Promotion of Carbon Therapy Team
(Senior Researcher, Dept. of Accelerator and Medical Physics)Research Center for Charged Particle Therapy
National Institute of Radiological Sciences
HIMAC
NIRS
Low dose distribution at high energy region
Particles’ movement in a straight line
Particles’ energy is slowly decreasing through the interaction
High dose distribution near the stopping position
Photons’ amount and energy are steadily decreasing
Charged particle
photon
Secondary electrons or radicals affect DNA in cells
High dose distribution due to amount of photons
• Physical effectiveness depends on amount of dose
• Biological effectiveness depends on micro distribution of dose
Low dose distribution, and a few photons penetrate deep
Interaction of radiations in materials
1. Feature of heavy ion radiotherapy
HIMAC
NIRS
Physical advantage of heavy ion
1. Feature of heavy ion radiotherapy
0
20
40
60
80
100
0 5 10 15
Depth in water (cm)
Rel
ative
dos
e (%
)
C ion
n
gamma-ray
proton
Lateral biological dose distribution
0
1
2
3
4
5
-8 -6 -4 -2 0 2 4 6 8
lateral position (cm)
Dos
e (G
yE)
Cproton
Good longitudinal dose localization due to the Bragg peak.
Good transverse dose localization due to the low scattering.
HIMAC
NIRS
Linear Energy Transfer (LET)Energy deposition / path length
Relative Biological EffectivenessRBE = Dose of X-ray / Equivalent dose
of the particleLET-RBE
• low LET(X, γ); RBE = 1• high LET(heavy ion); RBE > 1• too high LET; RBE < 1
low LET radiation
too high LET
high LET
1μm Ionization
L ET (k eV / µm )
lowLETtoo high
LET(ov er kill)
high LET
RBE
1
Biological effectiveness
1. Feature of heavy ion radiotherapy
HIMAC
NIRS
Comparison between heavy ion and other radiotherapy
Advantage of heavy ion
- Good concentrate physical dose distribution due to Bragg curve
- Lower multiple scattering in the lateral direction
- Large relative biological effectiveness (RBE) at the stopping point
1. Feature of heavy ion radiotherapy
Tumor
RBE are equal at any place
Tumor
X-ray
proton
RBE is higher at tumor
Tumor
RBE is low as p or X-ray
Heavy Ion
HIMAC
NIRS
Why carbon beam was chosen?
Thickness: ~ Single Bragg peak
Depth: ~ 26 cm
(A. Brahme, private communication)
~ 6 cm
~ 16 cm
Biological Depth-Dose Distribution of 6cm SOBP
0
1
2
3
4
5
0 5 10 15 20Depth in Water
Bio
logi
cal D
ose
(GyE
)
He
C
Ne
Proton
TumorNormal tissue
1. Feature of heavy ion radiotherapy
HIMAC
NIRS
Spread Out of Bragg Peak (SOBP)
In order to realize the advantage of heavy ion RT, It’s important the irradiation technique to obtain a large uniform irradiation volume from the pencil shaped and mono-energetic heavy ion beam.
2. Irradiation methods and necessary equipments
Calculating SOBP bio-clinical depth dose
C290MeV/u beam SOBP 6.0 cm
Mono-energy peak(Bio-clinical)
(Relative)
Sum
Spread Out of Bragg Peak (SOBP)
HIMAC
NIRS
Categories of irradiation methods
The irradiation methods are roughly divided into two categories at present facilities.
1. Passive ‘Wobbler’ method
2. Active ‘Pencil beam scanning’ methodslike ‘spot scanning’ or ‘raster scanning’.
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Wabbler method for making irradiation field
Scatterer
X- and Y- scanning magnets
Scatterer
X- and Y- scanning magnets
Scatterer
− The beam profile is originally sharp.
Multi-leaf Collimator
− In order to enlarge the size of beam, a scatterer is inserted.
− A pair of orthogonal magnets is used to form a uniform dose in the lateral distribution.
− A multileaf collimator tailors the beam according to the perpendicular cross section of the tumor.
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Ridge filter for making SOBP
RidgeFilter
RangeShifter
BolusCollimator
− The beam energy is originally monochromatic.
− In order to expand the beam energy, a ridge filter is inserted.
− A range shifter is used for energy absorbers for the fine tuning of the range.
− In order to adjust the end-point to the curvature of tumor, a bolus collimator is set.
Tumor
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Scatterer
Wobbler Magnets
FieldTarget
Ridge Filter
IonizationChamber
Patient Collimator
Multi-Leaf Collimator
Range Shifter
Patient Compensator
Equipments of Wobbler method
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Layer-stacking wobbler methodBroad-beam scanning
Dose monitor
Wobbler Magnetsand Scatterers
Range shifter
Multi-leaf Collimator
Painting the target volume with thin SOBP layers. Each layer changes in the depth, area and shape.
Ridge Filter
Compensator
T. Kanai, et al., Med. Phys. 33, 2989 (2006).
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Respiratory gated irradiation
Irradiation room
Positioning area
Accelerator Treatment control
Gate signal generator
Watch & record system
Beam monitor
Planning simulation
Reference Image
Positioning systemusing x-ray TV images
Compare
X-ray TV
Positioning Image
PSD
Respirationwaveform
Gated beam extraction system(RF knockout method)
Interlock system
Ion beam
- Irradiation system of coincident with a patient‘s respiratory motion -
S. Minohara et al., Int. J. Rad. Oncol. Bio. Phys. 2000;47:1097
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Pencil beam scanning method
Beam scanned x- and y- direction by magnets
Beam energy changed slice by slice
Beamon/off
x (mm)
y (m
m)
0
0
50
-50
50-50
2. Irradiation methods and necessary equipments
Uniform dose distribution is obtained according to accumulation of the weighted beam path / spot
HIMAC
NIRS
History of Pencil beam scanning
1979 Spot scanning system for proton RT at NIRS1980’s 1-D raster scanning for pion and proton RT at PSI1997 3-D raster scanning for heavy ion RT at GSI
Advantage: Good dose distributionDrawback:This method is extremely sensitive to organ motion during treatment.
The development on the respiratory gated scanning method is now a hot topic in this field, even for p-RT.
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Summary of irradiation methods
II. a) Pencil-beamScanningI. a) Wobbler
I. b) Layer-stacking wobbler II. b) Scanning without respiratory gate
Head, Prostate, Lung, Liver…
Target volume
Head, Prostate, Lung, Liver…
Unexpected dose
2. Irradiation methods and necessary equipments
HIMAC
NIRS
Structure of acceleratorRange: 25cm Max. beam energy
[Wobbler]400MeV/u for C
[Scanning]350MeV/u for C
Dose rate: 5GyE/min.at 15x15cm Max. beam intensity(22cm dia.)
[Wobbler]1x109pps for C
[Scanning]4x108pps for C
~ 3.3s
1 ~ 2 sSynchrotron
Linac
Ion Source
2. Irradiation methods and necessary equipments
HIMAC
NIRS
History of heavy ion radiotherapy
* include research room, + exclude other rooms for proton only, pps: particle per second, ppp: particle per pulse (spill)
3. Facilities worldwide
Max.Energy
H V Other MeV/uLawrenceBerkeley
LaboratoryBevalac
Berkeley(USA)
1975 -1992
433 1 1 0 0wholebody
Scatterer /Wobbler
670for Ne
1E10 ppp(0.25Hz)
Elec.Stat.+ Alvarez
PIG 3
National Instituteof Radiological
Sciences (NIRS)HIMAC
Chiba(Japan)
1994 -6512
(Feb.'12)3 2 2 0
wholebody
Wobbler / Layerstacking / Raster
scanning400
1.8E9 pps(typ. 0.3Hz)
RFQ+ Alvarez
ECRIS,PIG
324 hours /6 days / 10
month
2times /year
Gesellschaft furSchwerionenfors
chung (GSI)
UNILAC +
SIS
Darmstadt(Germany)
1997 -2009
440 1 1 0 0head &
neckRaster
scanning430
1E6- 4E10 ppp
RFQ+ IH
+ AlvarezECRIS 1
7 days /4weeks at5 per year
5times /year
Hyogo Ion BeamMedical Center
(HIBMC)HIBMC
Hyogo(Japan)
2002 -1393
(Mar.'12)3+ 2 1
1(fix45)
wholebody
Wobbler 320 2E9 ppsRFQ
+ AlvarezECRIS 2
5days /1week
1times(4days) /1month
Institute ofModern Physics
(IMP)
HIRFL-CSR
Lanzhou(China)
2009 -shallow 103
deep 56 (Oct.'11)
1 1 0 0 sarcomaWobbler /
Layerstacking
235 5E8 ppp Cyclotron ECRIS 17days /1week
2times /year
UniversityHospital
Heidelberg
Hidelberg IonTherapyFacility(HIT)
Heidelberg(Germany)
2009 -~900
(May '12)3 2 0
1Gantor
y
wholebody
Rasterscanning
430 1E9 ppp RFQ + IH ECR 2
GunmaUniversity
Gunma-UniversityHeavy -Ion Medical
Center (GHMC)
Maebashi(Japan)
2010 -424
(Dec.'11)4* 2 3* 0
wholebody
Wobbler /Layer
stacking400 1.2E9pps
RFQ +APFIH
ECR 1
Fondazione CentroNazionale
AdroterapiaOncologica
Centro NazionaleAdroterapiaOncologica
(CNAO)
Pavia(Italy)
2012 --
(Oct.'12)3 3 1 0
wholebody
(start:hea
Rasterscanning
400 4.5E8ppp RFQ + IH ECR 2
Irradiationmethod
Targetdeseases
Name offacility
Institute /Hospital
Treat-mentrooms
Totalpatients
Startyear
Location(Country)
Irradiatin port Maintenance interval
Operationschedule
No. ofion
souce
Type ofion souce
Type ofinjector
Typical beamintensity fromaccelerator
HIMAC
NIRS
Pioneer’s work at LBL1940‘s R. Willson proposed the medical application of heavy ion.
1975 LBL start the clinical trials (mainly Ne ions).
Biological and Medical Research with Accelerated Heavy Ions at the Bevalac, LBL-11220, UC-48 (1980).E.A. Blakely et al., Adv. Radiat. Biol. 11, 295 (1984).
W.T. Chu et al., Rev. Sci. Instrum. 64, 2055 (1993).
1992 Research was aborted due to the shutdown of physics program.
3. Facilities worldwide
HIMAC
NIRS
HIMAC project
Size: 60 x 120 mConstruction cost: 32.6GJPY
(Building 14.6GJPY)(machine 18.0GJPY)
Heavy Ion Medical Accelerator in Chiba
‘84 ‘85 ‘86 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94Feasibility studyDesign of machine
Manufacturing & installation of machine
Design of Buildings
Installation of UtilitiesConstruction of Buildings
Research
commissioning
SurveyMachine
InjectorSynchrotron
Irradiation system,…
BuildingsBuildings
Electricity, cooling system, …
Developments of devices
Clinical trialsPhysics & Biology
‘84 ‘85 ‘86 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94Feasibility studyDesign of machine
Manufacturing & installation of machine
Design of Buildings
Installation of UtilitiesConstruction of Buildings
Research
commissioning
SurveyMachine
InjectorSynchrotronIrradiation system,…
BuildingsBuildings
Electricity, cooling system, …
Research & developments for devices technology (incl. biology)
Clinical trials
Physics & Biology
“Summary at the 10th anniversary of the heavy ion radiotherapy”, edited by MEXT, Monbu-Kagaku Jihou No.1541, August 2004, pp. 10-49.
3. Facilities worldwide
HIMAC
NIRS
Major features:
- intensity modulated raster-scanning beam-delivery system
- R&D for the rotating gantry system
The first 3D scanning in the world
T. Haberer, in PAC09
GSI, Darmstadt
3. Facilities worldwide
HIMAC
NIRS
- Funded by Japanese local government
- 1st dual use facility for proton and carbon beams in the world.
- maximum beam energy of carbon is 320 MeV/n
HIBMC, Hyogo
3. Facilities worldwide
HIMAC
NIRS
superficially-placedtumor therapy
deep-seated tumor therapy
- A new treatment room and beam delivery system for deep-seated tumors has been installed in the Cooling Storage Ring (HIRFL-CSR).
- A clinical trial for treatment of deep-seated tumors has begun in March 2009.
IMP, Lanzhou
3. Facilities worldwide
Q. Li et al., Med. Bio. Eng. Comput. 45, 1037 (2007).
HIMAC
NIRS
T. Haberer, in PAC09
- 1st medical dedicated facility in Europe.
- proton & carbon are available
- 3D raster scanning for head & neck
- 2 treatment rooms and 1st heavy ion rotating gantry is installed
- Start Nov. 2009
Hidelberg University, Germany
3. Facilities worldwide
HIMAC
NIRS
Gunma University, JapanTreatment room
Ion source
Synchrotron
3. Facilities worldwide
Demonstration facility of the downsized carbon-RT facility in Japan.- Dedicated carbon only- Wobbler & layer-stacking- construction cost12 GJPY- size 60x50 m- start since Mar. 2010 S. Yamada et al., NIRS-M-218, p.170 (2009).
RFQ+APF-IH Linac
HIMAC
NIRS
Facilities under construction
* include research room, + exclude other rooms for proton only, pps: particle per second, ppp: particle per pulse (spill)
3. Facilities worldwide
Max.Energy
H V Other MeV/uKyushu InternationalHeavy-Ion TreatmentCenter
Saga Heavy IonMedical Accelerator inTosu (SAGA HIMAT)
Tosu(Japan) C 2013 2012
(plan) 3 2 1 145deg. whole body
Wobbler /Layer stacking /Raster scanning
400 1.2E9pps
Syn +RFQ +
IHECR 1
Fudan UniversityShanghai CancerHospital
Shanghai Protonand Heavy IonTherapy Hospital
Shanghai(China) C, p 2013 2012
(plan) 3 1 2 1Lung, Liver,head&neck,etc
Rasterscanning 430 3E8pps
Syn +RFQ +
IHECR 3
EBG MedAustronLtd. MedAustron
WienerNeustadt(Austria)
C, p, O 2014 2013(plan) 3* 2* 1 0
whole body(no eyetumor)
Rasterscanning 400 1E9pps
Syn +RFQ +
IH
ECR/EBIS/
Volume4
Kanagawa CancerCenter
Ion-Beam RadiationOncology Center (I-ROCK)
Yokohama(Japan) C 2014 2014
(plan) 4 4 2 0 whole bodyWobbler /Layer stacking /Raster scanning
430 1.2E9pps
Syn +RFQ +
IHECR 1
No. ofion
source
Location(Country)Name of facility
1st beamfromaccel-erator
Beamintensity
Targetdeseases
Typeof ionsouce
Institute / Hospital
Typeof
accelerator
Number ofirradiatin port Irradiation
method
Treatment
rooms
Ionspecies
Sche-duledstartyear
HIMAC
NIRS
Facilities under construction
3. Facilities worldwide
W. Pirkl et al., IPAC11
SAGA HIMAT
Clinical trial of proton has been started.
CNAO
MedAustron
HIMAC
NIRS
Facilities under construction or planning
* include research room, + exclude other rooms for proton only, pps: particle per second, ppp: particle per pulse (spill)
3. Facilities worldwide
Max.Energy
H V Other MeV/u
ETOILE foundation ETOILE Lyon(France) C, p 2011
Gansu Tumor HospitalHeavy Ion TherapyFacility inLanzhou (HITFiL)
Lanzhou(China) C 2014 2013
(paln) 4 2 2 145deg. whole body
passive /spotscanning
400 4E8pps Syn +Cyc ECR 1
Wuwei Tumor HospitalHeavy Ion TherapyFacility in Wuwei(HITFiW)
Wuwei(China) C 2014 2013
(plan) 4 2 2 145deg. whole body
passive /spotscanning
400 4E8pps Syn +Cyc ECR 1
Korean Institute ofRadiological and MedicalSciences (KIRAMS)
Korean Heavy IonMedical Accelerator(KHIMA)
Busan(Korea) C 2015 S.Cyc ECR 1
Chang Yung-FaFoundation
Taipei(Taiwan)
C
Universiti SainsMalaysia (USM)
Penang(Malaysia)
C
King Abdulaziz City forScience and Technology(KACST)
Riyadh(Saudi Arabia)
Mayo Clinic Mayo Clinic HeavyCharged Particle facility
Rochester(USA)
C, p,(others tofollow)
To bedetermined 3+ 2 0
2+45-45
Radioresistantand inoperabletumors of allsites
Spotscanning 400 Dependent on vendor to satisfy the dose rate
of 2 Gy/min to a liter of water at patient
Irradiationmethod
Beamintensity
Typeof
accelerator
Typeof ionsouce
Targetdeseases
No. ofion
sourceInstitute / Hospital Name of facility Location
(Country)Ion
species
Sche-duledstartyear
1st beamfromaccel-erator
Treatment
rooms
Number ofirradiatin port
HIMAC
NIRS
Heavy ion radiotherapy worldwide
Chiba
Gunma
Hyogo
Lanzhou
Busan
(Darmstadt)
Lyon
Wiener Neustadt
Pavia
Heidelberg
RochesterYokohamaTosu
Shanghai
Heavy ion Heavy ion (under construction)
ProtonProton (under construction)
Heavy ion (planning)
Penang
Taipei
Riyadh
Wuwei
3. Facilities worldwide
(Berkeley)
HIMAC
NIRS
2004 R&D for a hospital-based facility 2006 Start of clinical2007 Start of Program for the Human trials at IMP2009 Resources Development Open of 1st facility,2010 Open of 3rd facility, Gunma Heidelberg
1997 Start of clinical trials at GSI
2001 Open of 2nd facility, Hyogo 2003 Approval as medical by Japanese government
1984 Cancel of new project Start of HIMAC project1992 Shut down of Bevalac Cancel of Eurima project1994 Start of clinical trials with C
Historical trend of heavy ion radiotherapyUSA Japan Europe Other Asia
1940‘s Proposed by Dr. Robert Wilson
1975 The first clinical trial in the worldwith Ne at LBL
1980‘s ========== New research projects were proposed in many countries ==========
2010‘ new project Start of constructions of New facilities’ KIRAMS &of 4th & 5th projects other new facility
WobblerWobbler [Irradiation methods] Pencil-beam Scanning Pencil-beam Scanning
3. Facilities worldwide
HIMAC
NIRS
Strategy by Japanese government[Comprehensive 10-Year Strategy for Cancer Control, 1984-1993]
1984 HIMAC project at NIRS as the 1st medical dedicated heavy-ion accelerator in the world has been funded by Ministry of Education, Culture, Sports, Science and Technology (MEXT).
[2nd Comprehensive 10-Year Strategy for Cancer Control, 1994-2003]1994 Start of clinical trials with carbon ions at NIRS under prescribed clinical protocols.2001 The 2nd facility (Hyogo Ion Beam Medical Center) has been opened. 2003 Carbon ion therapy has approved as “advanced medicine” by Ministry of Health, Labour, and Welfare
(MHLW).[3rd Comprehensive 10-Year Strategy for Cancer Control, 2004-2013]
2004 “Workshop for popularization of the charged-particle radiotherapy” was held by MEXT and the summary report has been distributed.
2005 “The guideline for charged particle radiotherapy in Japan” has been authorized by the Japanese Society of medical Physics (JSMP).
2004-5 Design of a hospital-specified facility and development on prototypes of various components at NIRS was funded by MEXT.
2005-7 “Research on radiation protection for proton and heavy ion radiotherapy” was funded by MHLW.2006-10 Construction of the 3rd facility at Gunma University as a demonstration model was funded by MEXT.2007- “Program for the Human Resources Development Relating to Charged Particle Radiotherapy” has
been funded by MEXT.2007- Approved the construction of “the next-generation irradiation systems” at NIRS.2010 First treatment at Gunma University.2011 Start of clinical trials with the respiratory gated 3D scanning at NIRS.
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Gunma Univ.
Promotion section for carbon therapy
Working group for construction
Committee for medical
application
Committee for facility
construction
NIRSPresident
Promotion of carbon therapy section
Research Center for charged particle
therapy
Committee on promotion of carbon
therapy
Sub-committee for Gunma
Univ.
General strategy
Specific action plan
Example of framework for cooperation
Negotiation forSeparate agreements
•Cooperative research•Dispatch of Committee Members•Training of Staff•Technology transfer•Treatment of sending patients •Sharing of clinical data etc…
Sub-committeesfor each cooperation
President
MemorandumOf
Understanding
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Operation
Technology transfer
Technical guidance
Planning for Operation & Maintenance (O&M)
• Plan development• Unified work
through Basic Desing to O&M planning
• Establishment of hospital network
Example of construction procedure
Drafting of basic concept of whole facility and vision for operation
• Committee for formulation of basic concept
Basic Design• Selection of optimal companies for
basic design• Estimation of cost and conditions
Engineering, Procurement andConstruction (EPC) • Selection of
contractors
Organizer NIRS
Dispatch of Committee Members
Suggestion of model plan
Cooperative research
Training of Staff
Dispatch of Committee Members
Sharing of clinical data
Several months ~ a few year
4. Government's strategy and the role of NIRS
Half ~ one year
2 ~ 4 years
HIMAC
NIRS
Q/A, Q/C, safety studies[Comprehensive 10-Year Strategy for Cancer Control, 1984-1993]
1984 HIMAC project at NIRS as the 1st medical dedicated heavy-ion accelerator in the world has been funded by Ministry of Education, Culture, Sports, Science and Technology (MEXT).
[2nd Comprehensive 10-Year Strategy for Cancer Control, 1994-2003]1994 Start of clinical trials with carbon ions at NIRS under prescribed clinical protocols.2001 The 2nd facility (Hyogo Ion Beam Medical Center) has been opened. 2003 Carbon ion therapy has approved as “advanced medicine” by Ministry of Health, Labour, and Welfare
(MHLW).[3rd Comprehensive 10-Year Strategy for Cancer Control, 2004-2013]
2004 “Workshop for popularization of the charged-particle radiotherapy” was held by MEXT and the summary report has been distributed.
2005 “The guideline for charged particle radiotherapy in Japan” has been authorized by the Japanese Society of medical Physics (JSMP).
2004-5 Design of a hospital-specified facility and development on prototypes of various components at NIRS was funded by MEXT.
2005-7 “Research on radiation protection for proton and heavy ion radiotherapy” was funded by MHLW.2006-10 Construction of the 3rd facility at Gunma University as a demonstration model was funded by MEXT.2007- “Program for the Human Resources Development Relating to Charged Particle Radiotherapy” has
been funded by MEXT.2007- Approved the construction of “the next-generation irradiation systems” at NIRS.2010 First treatment at Gunma University. 2011 Start of clinical trials with the respiratory gated 3D scanning at NIRS.
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Exposure of medical staffs
Study report on radiation protection related to particle therapy (2005-2007)
Chief researcherTujii, H. National Institute of Radiological Sciences (NIRS)
Commitments Ì the National Institute of Radiological Sciences (HIMAC) Ì the Hyogo Ion Beam Medical Center (HIBMC) Ì the National Center Center Hospital East (NCCHE) Ì the Sizuoka Cancer Center (SCC) Ì the Proton Medical Research Center, Tsukuba University (PMRC)
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Behavior of a radiological technologist
ConclusionThe results of the experiment showed that the exposures of medical staffs and patient’s-family members, and the radioactivity concentration of the drain water from the lavatory which the patient used are far below the Japanese legal limits which are same as the recommendations of ICRP. We can conclude that the present legal control for the ordinary accelerator facilities is sufficient to the charged-particle radiotherapy facilities.
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Human resources development[Comprehensive 10-Year Strategy for Cancer Control, 1984-1993]
1984 HIMAC project at NIRS as the 1st medical dedicated heavy-ion accelerator in the world has been funded by Ministry of Education, Culture, Sports, Science and Technology (MEXT).
[2nd Comprehensive 10-Year Strategy for Cancer Control, 1994-2003]1994 Start of clinical trials with carbon ions at NIRS under prescribed clinical protocols.2001 The 2nd facility (Hyogo Ion Beam Medical Center) has been opened. 2003 Carbon ion therapy has approved as “advanced medicine” by Ministry of Health, Labour, and Welfare
(MHLW).[3rd Comprehensive 10-Year Strategy for Cancer Control, 2004-2013]
2004 “Workshop for popularization of the charged-particle radiotherapy” was held by MEXT and the summary report has been distributed.
2005 “The guideline for charged particle radiotherapy in Japan” has been authorized by the Japanese Society of medical Physics (JSMP).
2004-5 Design of a hospital-specified facility and development on prototypes of various components at NIRS was funded by MEXT.
2005-7 “Research on radiation protection for proton and heavy ion radiotherapy” was funded by MHLW.2006-10 Construction of the 3rd facility at Gunma University as a demonstration model was funded by MEXT.2007- “Program for the Human Resources Development Relating to Charged Particle Radiotherapy” has
been funded by MEXT.2007- Approved the construction of “the next-generation irradiation systems” at NIRS.2010 First treatment at Gunma University. 2011 Start of clinical trials with the respiratory gated 3D scanning at NIRS.
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Required human resourcesThe development of the human resources who operate the facilities is
one of the greatest problems.
•Diagnosis•Informed consent•Determination of the therapeutic policy•Assessment of therapeutic effect•Follow-up
Radiological technologist
Engineer, Technologist forequipments
Medical physicist
Radiological Oncologist
Heavy ion therapy•Treatment planning•Dosimetry•Quality control of equipments•Research and development of new equipments
•Preparation of equipments•CT scanning for treatment planning•Patient positioning•Irradiation
•Operation of equipments•Radiation protection•Support for research and development•Maintenance of equipments
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Joint 6 existing therapy facilities
Instruction
Association for Nuclear Technology in Medicine
University
Human resource
Program committee
MEXTfunding
Report
Government program for human resources
Road mapFY2006 2007 2008 2009 2010 2011
committee
Therapy facilities
Design of curriculam Instruction / Support / Evaluation
On the Job training
5yeas project “Program for the Human Resources Development Relating to Charged Particle Radiotherapy” by the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Necessary network for patient selection
Nationalhospital
Medical college
Regionalcancer center
Treatment facility
Communication before the treatment- diagnosis data
(from hospital side)- clinical results
(from facility side)
Patients
Introduction
Information
Com
munity hospitals
Special Examination for heavy-ion therapy
Communication after the treatment- follow-up data(both side)
Regional core hospitals
4. Government's strategy and the role of NIRS
NIRS
HIMAC
NIRS
Researches for advanced technology[Comprehensive 10-Year Strategy for Cancer Control, 1984-1993]
1984 HIMAC project at NIRS as the 1st medical dedicated heavy-ion accelerator in the world has been funded by Ministry of Education, Culture, Sports, Science and Technology (MEXT).
[2nd Comprehensive 10-Year Strategy for Cancer Control, 1994-2003]1994 Start of clinical trials with carbon ions at NIRS under prescribed clinical protocols.2001 The 2nd facility (Hyogo Ion Beam Medical Center) has been opened. 2003 Carbon ion therapy has approved as “advanced medicine” by Ministry of Health, Labour, and Welfare
(MHLW).[3rd Comprehensive 10-Year Strategy for Cancer Control, 2004-2013]
2004 “Workshop for popularization of the charged-particle radiotherapy” was held by MEXT and the summary report has been distributed.
2005 “The guideline for charged particle radiotherapy in Japan” has been authorized by the Japanese Society of medical Physics (JSMP).
2004-5 Design of a hospital-specified facility and development on prototypes of various components at NIRS was funded by MEXT.
2005-7 “Research on radiation protection for proton and heavy ion radiotherapy” was funded by MHLW.2006-10 Construction of the 3rd facility at Gunma University as a demonstration model was funded by MEXT.2007- “Program for the Human Resources Development Relating to Charged Particle Radiotherapy” has
been funded by MEXT.2007- Approved the construction of “the next-generation irradiation systems” at NIRS.2010 First treatment at Gunma University. 2011 Start of clinical trials with the respiratory gated 3D scanning at NIRS.
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Research topic of irradiation methods
II. a) ScanningI. a) Wobbler
I. b) Layer-stacking wobbler II. b) Scanning without respiratory gateHead, Prostate, Lung, Liver…
Target volume
Head, Prostate, Lung, Liver…
Unexpected dose
III. Scanning with respiratory gate
Head, Prostate, Lung, Liver…
4. Government's strategy and the role of NIRS
HIMAC
NIRS
Clinical trial of new irradiation systemA fast 3D-scanning irradiation system as the next-generation irradiation technology of the heavy-ion beam is completed. The clinical trial of new treatment room has started since May 2011.
HIMAC
Hospital
New facility
2011 Gold Award
4. Government's strategy and the role of NIRS
HIMAC
NIRS
S. Korea<Soul>
Korea Institute of Radiological and Medical Sciences
USA<Fort Collins>
Colorado State University
Taiwan<Taipei>
Chang Yung-Fa Foundation
China<Lanzhou>
Institute of Modern Physics
USA<Rochester>Mayo Clinic
International cooperation related heavy ion radiotherapy
China<Shanghai>
Shanghai Institute of Nuclear and Applied Physics
China<Beijing>
Tsinghua Univ.Yuquan Hospital
China<Beijing>
Institute of High Energy Physics
China<Daliang>
Daliang Univ.
Germany <Heidelberg>
University of Heidelberg
Germany <Darmstadt>
GSI
Austria <Vienna>
Vienna Univ. of Technology-atomic institute of the Austrian
Universities
Austria <Innsbruck>
Medical University of Innsbruck
Italy<Milan>
CNAO Foundation
Maleysia< Penang >
UNIVERSITI SAINS MALAYSIA
Russia<Dubna>
Joint Institute for Nuclear Research
… in process or negotiationHungary
<Debrecen>ATOMKIFrance
<Lyon>Etoile
Romania <Cluj-Napoca>Sapientia University
Saudi Arabia <Riyadh>
King Abdulaziz City for Science and Technology
China <Shanghai>
Fudan Univ.
4. Government's strategy and the role of NIRS
HIMAC
NIRS
NIRS’s roadmap (2011-15)I..Short term subject ( ~2015)i. Enlightenmentii.Personnel training for
operation staff at future facilities
iii.Research for more downsizing and optimizing
II. Long term subjectsi. More downsizingii.Increase acceptable patientsiii.Human resources development for related
fieldsiv.Support developments for revolutionary
technology
4. Research cooperation
3. Improvement of cooperation framework
2. Human resources development
1. Transfer of knowledge and technology
20152014201320122011ActionRealize the popularization of heavy-ion radiotherapy with• more excellent performance• enough safety• more cost effective
Goal
① Propose the specification of a future optimized facility② Improve the organization of human resources development
and continue personnel training③ Support for standarization and establish the rule for
technology transfer④ Continue the collaborations between related organizations
Propose the specification of a future optimized facility
Improve the knowledge transfer
Improve the organization of human resources development
Continues personnel training
Support for standarization
Establish the rule for technology transfer
Continues collaborations
MEXT ordered to make a roadmap for the next step of promotion,
Cooperation of related organizations in wide fields <Public organizations> <Private organizations>• Hospitals, medical universities and institutes, • Machine vendor, Building constructors, medical instruments suppliers• Private insurance companies, finance and investment companies• Local governments
4. Government's strategy and the role of NIRS
Summary1. Feature of heavy ion radiotherapy
Heavy ion has physical and biological advantage; Ì Good concentrate dose distribution due to Bragg curve and lower multiple scattering.Ì Large relative biological effectiveness (RBE) at tumor.
2. Irradiation methods and necessary equipmentsThere are two historical trends in the world; Ì Passive ‘wobbler’ irradiation method Ì Pencil-beam scanning irradiation method.
3. Facilities worldwide Ì Presently, there are five facilities in operation.Ì Clinical results awaken a worldwide interest. More new facilities are under
construction in Europe and Asia.4. Government's strategy and the role of NIRS
The approaches for the promotion are based on 10-year Strategy by the government. Ì Technology transfer has been arranged. Ì Studies for the regulations were carried out.Ì Human resource development has been established.The international framework is in progress.