Very High Energy Electron for Radiotherapy Studies Awad Almarhaby Christmas Talk 2016. Supervised by Prof. Roger Jones Sponsored by The Ministry of Health, Saudi.

Outline My Background PhD Project Overview VHEE for Radiotherapy Application. Scattered Gammas for Real-Time Verification Future Plans

My Background BSc in Medical Physics from Umm- Alqura University, Saudi, 2005. Teaching Assistant at Medical Collage KAU, Jeddah, Saudi 2006. Medical Physicist at Radiotherapy Department-Oncology Center, Jeddah, Saudi (2007-2011). QA for linacs (photon and electron). Dosimetry using TPS (Xio and Eclips). Radiation Protection (RSO) for Brachytherapy and NM radioactive sources.

4- Neutrons react with boron 5- Cancer cells are destroyed My Background MSc in Radiation and Environmental Protection. The University of Surrey, UK (2013). MSc dissertation title “Boron Neutron Capture Therapy for Cancer Treatment”. 2- Thermal neutron irradiation (energy about 0.025 eV) 1- Administration of boron-containing drug 3- Neutron capture 4- Neutrons react with boron 5- Cancer cells are destroyed Pictures from OIST 4/10

CT image quality phantom My Background Medical Physicist at Radiology Department-KFGH, Jeddah, Saudi (2014). QA for medical imaging devices Occupational exposure monitoring Radiation protection program (RSO) Fluoroscopy CT X-ray Machine Mammography CT image quality phantom CT dosimetry phantom Ionization chamber CT ionization chamber

PhD Project Overview To investigate VHEE properties in comparison to current external radiotherapy methods. Exploring the feasibility of using secondary radiation for dose verification during VHEE irradiation.

Conventional Accelerators Laser-Plasma Wakefield Accelerator VHEE (100-250 MeV) for Radiotherapy Esophagus case dose distributions for 6MV photon VMAT and 120 MeV VHEE. Palma et. al 2016 Effective range exceed 40 cm Very good dose conformation Better dose sparing of OARs Scattering in air and tissues is sufficiently constrained Electromagnetic steering Conventional Accelerators Laser-Plasma Wakefield Accelerator

Real-Time Verification Typical Radiotherapy Process 1- Imaging for anatomical and functional information usually using CT. 3- Set-up on the Linac using kV or MV images followed by dose delivery (4-6 weeks). 2- Acquired image is used for treatment planning

Real-Time Verification There are several sources of uncertainty that may affect dose delivery for example: Dose at the calibrated point in water Beam monitor stability Patient data Patient setup Organ motions Tissue swilling Internal cavity fillings Tumour shrinkage EPID MV or kV beam use bony structures for setup verification by producing 2D images before the treatment (extra dose).

Scintillator Detector Secondary Radiation for Real-Time Verification Is it possible to make an image from treatment beams to overcome exposing patients to extra doses? User Level Application Layer Core Layer Geant4 Beam Direction 10 6 particle Geant4 Application for Emission Tomography (GATE) Scintillator Detector Water Phantom 150 MeV Electron 15 cm 40 cm

Lead fluorescence peaks Secondary Radiation for Real-Time Verification 2D Image Lead fluorescence peaks Annihilation peak Backscatter peak ? ?

Future Work Further simulations using different geometries. Different target materials will be added such as bone and cartilage. Exploring other scintillator detectors such as NaI(TI), LYSO and GSO crystals. Adding more number of detectors around the phantom to produce 3D image.

Questions