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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.

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Presentation on theme: "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."— Presentation transcript:

1 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 am ISL 3. DFG-Projekt: CT-basierte Therapie-Planung

2 Hahn-Meitner-Institut GmbH Berlin Forschungsreaktor: „BENSC“ Ionenstrahllabor: „ISL“

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7 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: SiN x H layer on Si scattered to 230 MeV 129 Xe-ions

8 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

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10 Ion beam analysis at ISL ERDA (Elastic Recoil Detection Analysis) PIXE (Proton induced X-ray emission) RBS (Rutherford Backscattering helium or heavy ions) 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

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12 Irradiation of Foils Irradiation Study of Semiconductor Elements Proton Therapy of Eye Tumors ISL-Applications 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

13 Irradiation Study of Semiconductor Elements Proton Therapy of Eye Tumors ISL-Applications

14 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

15 Irradiation of Foils Irradiation Study of Semiconductor Elements Proton Therapy of Eye Tumors ISL-Applications

16 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

17 Why Protons ?

18 Optic NerveMacula Tumor Tantalum Clips Typical Fundus View

19 Treatment Method range shifter X-ray screen dose monitor Treatment Method

20 Tantalum Clips: Positioning landmarks

21 Tantal Clips: Positioning landmarks Very precise Positioning System Axial Image Lateral Image Treatment Method

22 repeatability of patient positions

23 Treatment Method Treatment Planning: EYEPLAN OUTPUT View Angles: polar/azimuthal Proton range Beam Modulation Shape Collimator 3D Position of Clips

24 Treatment Method Treatment Planning: EYEPLAN OUTPUT View Angles: polar/azimuthal Proton range Beam Modulation Shape Collimator 3D Position of Clips

25 Treatment Method

26 Proton Beam Physics

27 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)

28 tumor stages > 5 mm> 15 mmT3 3 – 5 mm 10 -15 mmT2 < 3 mm10 mmT1 tumor height max. diameter tumor category

29 choroidal melanomas CTV = 0.1 cm 3

30 follow-up of first patient 6 months after treatment 19 months after treatment

31 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

32 DFG-Project: CT-based Treatment Planning HMI-Berlin / DKFZ Heidelberg Advantages: - individual organ shape - more precise dose calculation

33 Introduction / Motivation Wide Angle Fundus View EYEPLAN Tumor Draw

34 Introduction / Motivation Wide Angle Fundus View EYEPLAN Dose Distribution

35 Problems: > Human Eye is not a “Ideal Sphere” > Individual Anatomy Introduction / Motivation Wide Angle Fundus View EYEPLAN Dose Distribution

36 Correction of Primary Field / Beamline Geometry Correction 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 mm 1,5 m Beamline H 2 O Phantom GEANT Monte Carlo Geometry

37 Correction of Primary Field / Beamline Geometry Correction of Primary Field / Beamline Geometry GEANT Data-Set for Range Shifter = 0 mm Approach: Slope = 2.0 + 0.2 * SQRT( RS ) P 1 ( 1 + EXP ( ( x - P 2 ) / P 3 ) P 1 = 1. P 3 = P 3 * 4.39 ( 90 - 10%Dose Slope )

38 Correction of Primary Field / Beamline Geometry Correction 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

39 Correction of Primary Field / Wedge Application Correction of Primary Field / Wedge Application 45deg Wedge

40 d Distance to “Eye Entry Point” 90-10 Dose slope Col Approach d z’ (p v) 2 z LRLR 1 + 0.088 log 10 ()2)2 (19.2MeV) 2 LRLR r 2 (z ) =( z - z’ ) 2 Multiple Coulomb Scattering Correction of Primary Field / Wedge Application Collimator Wedge d Effective Thickness d = F(curve collimator ) Slope = F(curve collimator )

41 Correction of Primary Field / Wedge Application Wedge + 10mm Range Shift 60 deg Wedge

42 Correction of Primary Field / Wedge Application 5mm Wedge ApproachConventional Version

43 Verification 1.000 1.052 1.093 1.1331.295 1.1631.236 CT-Slice / Sugar Solutions 7 Chamber Phantom Proton Beam

44 Verification 1.0001.052 1.093 1.1331.2951.1631.236 CT-Slice / Sugar Solutions Hounsfield based Density Deviation: 0.99 + - 0.03 Comparison of Radiological Depths

45 Verification Depth: 24.5 mm Density: 1.133 g/cm 3 Depth: 17.5 mm Density: 1.163 g/cm 3 Depth: 10.5 mm Density: 1.236 g/cm 3 Depth: 3.5 mm Density: 1.295 g/cm 3

46 Features 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

47 Features 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

48 How it looks in Practice ? In Eye Tumor Treatment Planning ? Segmented Eye with Tumor CT-based Dose Calculation Use of artificial CT- Cube Artificial CT based Dose Calculation Practical Usage of Dose Algorithm

49 Summary 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

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