1. Hadron Therapy and Grids: Issues and Requirements Ken Peach (Particle Therapy Cancer Research Institute, Oxford) EGI Technical Forum Amsterdam, September 16 th 2010 on behalf of The ENLIGHT Network of EU projects http://enlight.web.cern.ch

2. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 2 Outline Cancer– statistics and challenges ENLIGHT – research and development Cancer informatics – what is needed? – (how) can Grids help? – issues? Summary

3. Cancer Statistics and challenges

4. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 4 Cancer Statistics About one third of us will have cancer About two thirds of cancers are in people over 65 Source CRUK

5. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 5 Cancer - Information Cancer is a terrible condition but there have been great advances in therapy “ Radiotherapy remains a mainstay in the treatment of cancer. Comparison of the contribution towards cure by the major cancer treatment modalities shows that of those cured, 49% are cured by surgery, 40% by radiotherapy and 11% by chemotherapy”. RCR document BFCO(03)3, (2003). Radiotherapy is a very important weapon in the battle against cancer Thanks to Roger Dale

6. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 6 Photons, Protons and Carbon

7. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 7 X-rays compared with protons IMRT Intensity Modulated RadioTherapy IMPT Intensity Modulated Proton Therapy X-rays IMRTIMPT

8. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 8 Thanks to Raj Jena CPT is very effective 1.503 proton matched with 1591 X-ray patients. 6.4% of proton patients had a second malignancy 12.8% of X-ray patients had a second malignancy [Median follow-up 7.7 years (proton) and 6.1 years (X-ray) Median age at treatment 56 (proton) and 59 (X-ray) ] (C.S. Chung et al, International Journal of Radiation Oncology*Biology*Physics, 72/1, Supplement 1 doi:10.1016/j.ijrobp.2008.06.785 )International Journal of Radiation Oncology*Biology*Physics72/1, Supplement 1 doi:10.1016/j.ijrobp.2008.06.785 2.Chordoma Dose Response Spinal cord tolerance 65Gy in 39 fractions Only protons/light ions can deliver the required 90Gy for good local control (D. Schulz-Ertner et al. Int J Radiat Oncol Biol Phys. 2007 Jun 1;68(2):449-57)

9. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 9 CPT worldwide Courtesy Janet Sisterson, MGH In Physics Laboratories In hospitals

10. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 10 ENLIGHT Coordinated by CERN

11. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 11 ENLIGHT FP7 Projects

12. Cancer Informatics – what is needed? – (how) can Grids help? – issues?

13. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 13 Cancer Informatics what is needed? Cancer is very common –lung, breast, skin … … but … many rare tumours “rare” tumours make up 20% of all cancers tens or fewer each year in each country naturally distributed and multidisciplinary Cancer treatment is sophisticated –many options, many variables Maximise tumour control Minimise normal tissue toxicity and long-term complications Secondary tumours, organ function impairment

14. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 14 PARTNER GRID Test Bed Classes of use: –Clinical Patient referral (few centres, cross-border…) Treatment options (search for similar cases with treatment outcomes) –Research Access to statistical data –Treatment and outcomes –Training Treatment planning, research methodologies Example: Rare Tumour DataBase

15. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 15 Cancer Informatics (how) can Grids help? In order to allow rapid accumulation of evidence in trials, standard informatics systems are required so that data from different centres can be readily combined. This same system would underpin patient services, such as transnational referral. H adron therapy i I nformation S haring P latform Daniel Abler Faustin Laurentiu Roman Vassiliki Kanellopoulos [PARTNER]

16. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 16 Cancer Informatics – issues? 1. Authentication –Patient data –Confidentiality –Legal considerations –Ethical considerations Username/password & certificate not enough 2.Authorisation –Anonymity (research) –Full record (clinical) –Need to account for “Role” [Actor] Different authorisation according access –As doctor –As researcher

17. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 17 Cancer Informatics – issues (cont) 3.Data Ownership, Access, Integrity & Use –These data have a specific “owner” The patient If part of a clinical trial, the research team –Undesirable to make common real DB –Undesirable to make local copy Once copied, owner risks losing control –Note: does not apply to (a)Backup (b)Archiving (c)Cloning for security/integrity/availability −Data volumes can be large 10’s GB per patient with images (CT, MRI, PET, TP…) }

18. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 18 CT PET high-resolution structural information lower-resolution functional information PET-CT fuses two co-registered images (same coordinate system) Fusion helps identify position and extent of tumour Examples: multi-modal imaging Topkan et. al., J Exp Clin Cancer Res. 2008; 27(1): 41. Thanks to Dan Warren Imaging in different places/at different times complicated

19. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 19 Further comments Confidentiality, Anonymity & Trust –Clinical [Confidentiality] Confidentiality must be guaranteed –Note: the doctor, radiologist, medical physicist… can only access a patient record for a patient in their care –Research [Anonymity] Anonymity must be guaranteed –Where is anonymisation performed? »Can only be at source –Hospital policies [Trust] Many hospital IT policies are very restrictive –With good reason … the internet is a security risk

20. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 20 Common issues with other VOs Platform/infrastructure independence Middleware independence –Together “interoperability” Security and sustainability (Virtual) database definition & management Metadata, ontology & semantics Workflow Curation

21. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 21 Data Data Data Treatment Planning & Verification is computationally intenseBUT Cancer informatics is about Data! –Agreed data formats –Open data standards –Ergonomic GUIs –Service reliability –Data integrity –Data completeness

22. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 22 What do IBM think? http://www.youtube.com/watch?v=AEh6LStxY-I Thanks to Faust Roman

23. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 23 ENLIGHT ENLIGHT: a multidisciplinary collaboration platform ENLIGHT: –300 persons, 20 countries The aim is to: – communicate – share data – collaborate and network – train and educate – improve and optimise – refer and treat patients – research and improve –real time imaging & quality assurance 4 funded projects: 3 ongoing ULICE ENVISION ULICE ENVISION PARTNER Thanks to Manjit Dosanjh

24. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 24 ENLIGHT addresses these issues

25. Ken Peach, EGI Technical Meeting, Amsterdam,16/9/2010 25 Summary Hadron Therapy and Grids Common requirements with other applications Specific issues concerned with patient data Confidentiality Security Authentication Authorisation Anonymisation Health system IT managers –Cautious Clinicians –Prefer the tried and trusted – what I know works