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From Physics to Medicine: Hadron Therapy CERN – Bulgarian Industry 28 - 29 November 2012 Manjit Dosanjh, KT-LS.

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Presentation on theme: "From Physics to Medicine: Hadron Therapy CERN – Bulgarian Industry 28 - 29 November 2012 Manjit Dosanjh, KT-LS."— Presentation transcript:

1 From Physics to Medicine: Hadron Therapy CERN – Bulgarian Industry 28 - 29 November 2012 Manjit Dosanjh, KT-LS

2 Knowledge Transfer | Accelerating Innovation Knowledge and Technology Transfer KT is an integral part of CERN’s mission PP technologies relevant to key societal issues e.g. Health CERN involved in the last 10-15 years in health applications few CERN resources attracted significant external funding (EC, MS…) raises impact and profile beyond the particle physics arena large number of collaborating institutes including medical institutes & hospitals Collaborators appreciate facilitation by CERN

3 Knowledge Transfer | Accelerating Innovation Detecting particles Accelerating particle beams Large-scale computing (Grid) First Bern Cyclotron Symposium - June 5-6, 20113Manjit Dosanjh CERN Technologies and innovation accelerators, detectors and IT to fight cancer CANCER

4 Knowledge Transfer | Accelerating Innovation Why Cancer ? Every year >3 millions new cases in Europe About one third of us will have cancer Number of patients needing treatment is increasing as people are living longer Main cause of death between the ages of 45 and 65 in Europe Second most common cause of death in Europe, Canada, USA after heart-disease 4 KT-LS 26 May 2011

5 Knowledge Transfer | Accelerating Innovation Cancer incidence increases with age

6 Knowledge Transfer | Accelerating Innovation Cancer is a large and growing challenge Need: Earlier diagnosis, better control, fewer side-effects How? new technologies Imaging, dosimetry, accelerator & detector technology Better understanding – genetics, radiobiology… Advanced healthcare informatics … international collaboration If progress is to be maintained Although cancer is a common condition, each tumour is individual  personalised approach  Large patients data to understand the key drivers of the disease Contribution from CERN is timely

7 Knowledge Transfer | Accelerating Innovation Catalysing collaboration in health field Challenges: Bring together physicists, biologists, medical physicists, doctors Cross-cultural at European and global level Why is CERN well placed to do this? It is widely acknowledged as a provider of technologies and as a catalyst for collaboration. It is international, non-commercial, not a health facility.

8 Knowledge Transfer | Accelerating Innovation 4 Pillars: 3 are the key technologies 4 th pillar: catalysing and facilitating collaboration Detecting particles Medical imaging Large scale computing (Grid)Grid computing for medical data management and analysis Particle Therapy Tumour Target Accelerating particle beams

9 Knowledge Transfer | Accelerating Innovation Accelerator technologies and health Looking forward: LEIR facility: requested by community (>20 countries, >200 people) Medicis (ISOLDE) exotic isotopes for future R&D Minicyclotron: commonly used isotopes Treatment centre in Pavia, Italy. First patient treated in Sept 2011 Treatment centre in Wiener Neustadt, Austria, foundation stone 16 March 2011, will be ready in 2015 PIMMS 2000 (coordinated by CERN) has led to :

10 Knowledge Transfer | Accelerating Innovation Detector Technologies Detector technology – improved photon detection and measurement: Crystal Clear, PET, PEM, Axial PET Electronics and DAQ – high performance readout: (Medipix) Multimodality imaging: PET-CT (proposed by Townsend, future with PET-MRI) CT PET PET-CT

11 Knowledge Transfer | Accelerating Innovation Photon detection used for calorimetry Idea of PET Positron Emission Tomography PET today CMS

12 Knowledge Transfer | Accelerating Innovation PET (Positron Emission Tomography) Detects pairs of photons emitted by an injected positron- emitting radionuclide LHC detector systems used in PET Systems Images tracer concentration within the body Reflects physiological activity Reconstructed by software

13 Knowledge Transfer | Accelerating Innovation PETCT PET/CT (David Townsend)

14 Knowledge Transfer | Accelerating Innovation In-beam-PET for Quality Assurance: real time In-beam-PET GSI- Darmstadt MC simulated measured Modelling of beta + emitters: Cross section Fragmentation cross section Prompt photon imaging Advance Monte Carlo codes On-line determination of the dose delivered

15 Knowledge Transfer | Accelerating Innovation Computing Technologies GRID – data storage, distributed, safe and secure computing MammoGrid: European-wide database of mammograms and support collaboration Health-e-Child: combining various types (clinical, imaging…) of data and share in distributed, clinical arena. HISP: Hadrontherapy Information Sharing Platform

16 Knowledge Transfer | Accelerating Innovation There is no substitute for RT in the near future The rate of patients treated with RT is increasing Present Limitation of RT: ~30% of patients treatment fails locally (Acta Oncol, Suppl:6-7, 1996) Conventional Radiotherapy in 21st Century 3 "Cs" of Radiation Cure (~ 45% cancer cases are cured) Conservative (non-invasive, few side effects) Cheap (~ 5% of total cost of cancer on radiation) (J.P.Gérard)

17 Knowledge Transfer | Accelerating Innovation Two opposite photon beams 80 30 50

18 Knowledge Transfer | Accelerating Innovation 110 100 Two opposite photon beams

19 Knowledge Transfer | Accelerating Innovation Physics technologies to improve treatment: higher dose Imaging: accuracy, multimodality, real-time, organ motion Data: storage, analysis and sharing (confidentiality, access) Biology: fractionation, radio-resistance, radio-sensitization Working together: multidisciplinary How to decrease failure rate? Raymond Miralbell, HUG

20 Knowledge Transfer | Accelerating Innovation Hadrontherapy: all started in 1946 In 1946 Robert Wilson: –Protons can be used clinically –Accelerators are available –Maximum radiation dose can be placed into the tumour –Proton therapy provides sparing of normal tissues Depth in the body (mm) Conventional: X-Rays Ion Radiation

21 Knowledge Transfer | Accelerating Innovation Proton & Ion Beam Therapy: a short history 1989 1990 1991 Proposed by R.R. Wilson 1st patient treated at Berkeley, CA HIT (carbon), Heidelberg (Germany) 1st patient in Europe at Uppsala 200920112014 CNAO, Pavia (Italy) MedAustron (Austria) Eye tumours, Clatterbridge, UK GSI carbon ion pilot, Germany 1992 1993 1994 CPO (Orsay), CAI (Nice), France Loma Linda (clinical setting) USA Boston (commercial centre) USA NIRS, Chiba (carbon ion) Japan 1946 19541957 PIMMS 1996-2000 ENLIGHT 2002 ENLIGHT 10 th year 1984 PSI, Switzerland

22 Knowledge Transfer | Accelerating Innovation ENLIGHT CERN collaboration philosophy into health field  Common multidisciplinary platform  Identify challenges  Share knowledge  Share best practices  Harmonise data  Provide training, education  Innovate to improve  Lobbying for funding Coordinated by CERN, 80% MS involved > 150 institutes > 400 people > 25 countries (>80% of MS involved)

23 Knowledge Transfer | Accelerating Innovation EU funded projects Wide range of hadron therapy projects: training, R&D, infrastructures A total funding of ~24 M Euros All coordinated by CERN,(except ULICE coordinated by CNAO Under the umbrella of ENLIGHT Marie Curie ITN 12 institutions Infrastructures for hadron therapy 20 institutions R&D on medical imaging for hadron therapy 16 institutions Marie Curie ITN 12 institutions

24 Knowledge Transfer | Accelerating Innovation Preparing for the Future…… review the progress in the domain of physics applications for health identify the most promising areas for further developments explore synergies between physics and physics spin-offs catalyse dialogue between doctors, physicists, medical physicists…… 24 KT-LS 26 May 2011

25 Knowledge Transfer | Accelerating Innovation International Conference on Translational Research in Radio-Oncology & Physics for Health in Europe February 27 – March 2, 2012 at CICG, Geneva  2 days devoted to physics, 2 days to medicine, 1 common day  Over 600 people registered, nearly 400 Abstracts  Chairs: Jacques Bernier (Genolier) and Manjit Dosanjh (CERN) Four physics subjects :  Radiobiology in therapy and space  Detectors and medical imaging  Radioisotopes in diagnostics and therapy  Novel technologies Sensitive structure (OAR) Target (PTV) Normal tissue

26 Knowledge Transfer | Accelerating Innovation 3 CERN Initiatives arising from PHE2010 Biomedical Facility creation of a facility at CERN that provides particle beams of different types and energies to external users Medical Accelerator Design coordinate an international collaboration to design a low-cost accelerator facility, which would use the most advanced technologies Radio Isotopes Establish a virtual European user facility to supply innovative radioisotopes (produced at ISOLDE-CERN, ILL, PSI, Arronax,..) for R&D in life sciences

27 Knowledge Transfer | Accelerating Innovation Future Biomedical Facility @ CERN Using LEIR (low energy ionising ring) 0)) for: European facility for radiobiology basic physics studies radiobiology fragmentation of ion beam dosimetry test of instrumentation Biomedical facility requested by ENLIGHT Community (> 20 countries, >200 people ) LEIR

28 Knowledge Transfer | Accelerating Innovation CERN contribution Provider of Know-how and Technologies Design studies for Hadron Therapy facilities Scintillating crystals for PET scanners Fast detector readout electronics for counting mode CT Grid middleware for Mammogrid, Health-e-Child Driving force for collaboration Coordinator of the European Network for Light Ion Hadron Therapy (ENLIGHT) Platform Training centre Coordinator of large EC-ITN funded programs, e.g. Particle Training Network for European Radiotherapy (PARTNER), ENTERVISION New ideas being proposed………. Life.Sciences@c 28

29 Knowledge Transfer | Accelerating Innovation Thank you for your attention

30 Knowledge Transfer | Accelerating Innovation

31 R&D isotopes for “Theranostics” 149 Tb-therapy 152 Tb-PET 155 Tb-SPECT 161 Tb-therapy & SPECT #177: C. Müller#177: C. Müller et al., Center for Radiopharmaceutical Sciences ETH-PSI-USZ

32 Knowledge Transfer | Accelerating Innovation Preparing Innovative Isotopes - 1.4GeV protons for spallation & fission reactions on diverse target materials - Providing a wide range of innovative isotopes such as 61,64,67 Cu & rare earth metals such as 47 Sc, 149 Tb - 1hr – 1 week t 1/2 - Will utilise CERN/EPFL patented nanostructured target material ISOLDE - MEDICIS Inventory of isotopes produced in a natural Zr target after proton beam irradiation.

33 Knowledge Transfer | Accelerating Innovation Cancer Treatment Options… SurgeryRadiotherapy X-ray, IMRT, Brachytherapy, Hadrontherapy Survival Quality of life Chemotherapy and others Hormones; Immunotherapy; Cell therapy; Genetic treatments; Novel specific targets (genetics..) Local controlLimited Local control Local control

34 Knowledge Transfer | Accelerating Innovation Status & Perspectives in Particle Therapy – A. Mazal Worldwide Patients Statistics 26.02.2012 M.Jermann A.Mazal PTCOG Protons are an (expensive) clinical tool at an institutional level, Ions are today an (even more expensive) tool for clinical research at a national or multinational level There is a need for interdisciplinary R&D and synergy with the photon world

35 Knowledge Transfer | Accelerating Innovation Radiobiology in therapy and space : a highlight Local effects of microbeams of hadrons seen by fluorescent proteins which repair DNA 10 µm 55 MeV carbon 5 × 5 µm² matrix 20 MeV protons randomly distributed 20 MeV protons 5 × 5 µm² matrix 117 protons per spot Günther Dollinger - Low LET radiation focused to sub-micrometer shows enhanced radiobiological effectiveness (RBE) Carbon ions have higher radiobiological effectiveness than protons

36 Knowledge Transfer | Accelerating Innovation Detectors and medical imaging: a highlight Detectors for Time-Of-Flight PET: the limit of time resolution With 20 picosecond Δx = 4 mm: no track reconstruction is needed D. Schaart: Prospects for achieving < 100 ps FWHM coincidence resolving time in Time-Of-Flight PET

37 Knowledge Transfer | Accelerating Innovation Novel technologies: a roadmap for particle accelerators What we need to be able to provide beams for therapy Marco Schippers

38 Knowledge Transfer | Accelerating Innovation Actions needed … Establish an appropriate framework @CERN Identify and secure resources (inside and outside) Develop the necessary structure Facilitate increased cooperation  between disciplines physics, engineering, chemistry … (physical sciences) medicine, biology, pharmacology… (life sciences)  within Europe  globally

39 Knowledge Transfer | Accelerating Innovation Needs for a radiation facility Increase radiobiological knowledge: Cell response to different dose fractionations Early and late effects on healthy tissue Irradiation of cell at different oxygenation levels Differing radio-sensitivity of different tumours/patients Simulations: Ballistics and optimization of particle therapy treatment planning Validation of Monte Carlo codes at the energies of treatment and for selected ion-target combinations Instrumentation tests: Providing a beam line to test dosimeters, monitors and other detectors used in hadron therapy

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