1. Particle Physics Software aids Medicine Accurate geometry and material modeling in the fight against cancer Precise physics models for radiation interactions with matter Friendly interface through the World Wide Web Powerful data analysis tools The GRID for fast and cheap processing on distributed computing resources Open source code providing advanced technologies to developing countries at no cost

2. cell Interaction of radiation with biological structures Radiation can be electrons, photons, protons, ions, neutrons electric interactions Radiation interacting with molecules loses energy thanks to electric interactions If the energy deposited in a cell is sufficiently high, the cell dies fight cancer This property of radiation is used to fight cancer: beams of radiation, or radioactive sources, are used to destroy tumour cells, while preserving the surrounding healthy tissue

3. Before the radiotherapy treatment experts study the configuration of the treatment with the help of software, to determine the optimal dose (energy deposited per unit of mass) to be delivered in the patient’s body Radiotherapy with external beams Direction of the beam Energy of the beam Time of exposure of the patient... Brachytherapy with radioactive sources Number of radioactive sources needed Position of the sources in the body Time of exposure of the patient...

4. to develop a general purpose precise dosimetric system with the capability of realistic geometry and material modeling interface to CT images with a user-friendly interface at low cost adequate speed for clinical usage performing at challenge How particle physics software responds to the

5. Ocular melanoma can be treated with a proton beam software tools geometry CERN L arge H adron C ollider Powerful software tools, originally developed to model complex geometry for the detectors at the CERN L arge H adron C ollider, allow to simulate the proton beam line realistically The CATANA proton beam line in Catania, Italy The set-up of the proton beam line is optimized for cancer treatment by means of a software simulation ATLAS CMS Monte Carlo simulation of the CATANA beam line Software to model geometry

6. The geometry and material model of a patient’s anatomy can be reconstructed with great accuracy from Computerized Tomography images realistic anatomy, effect of radiationdifferent tissuesprecision Thanks to a realistic anatomy, it is possible to study the effect of radiation on different tissues with great precision Commercial treatment planning software systems approximate all human tissues to water special module load CT images into a simulation application A special module interfaced to the Geant4 Toolkit allows to load CT images into a simulation application

7. Sophisticated software tools have been developed in the Geant4 Simulation Toolkit to track particles in magnetic fields Geant4 simulation of protons trapped in the earth magnetic field purging magnet electrons photons photons A pure beam of photons is left for therapeutic usage electrons The design of the magnetic field is optimized to deflect electrons away from the patient purging magnet radiotherapy The same software tools are used to design the purging magnet of a new accelerator for radiotherapy

8. A sample of physics models for hadron and ion interactions with matter Bragg peak antiprotons protons ions Fe lines GaAs lines Atomic relaxation Fluorescence Auger effect A sample of physics models for electron and photon interactions with matter physics models Software developed for particle physics experiments provides an ample variety of precise physics models to describe radiation interactions with matter physics models Software developed for particle physics experiments provides an ample variety of precise physics models to describe radiation interactions with matter

9. validation Particle physics software is subject to a rigorous validation independentdiverseworldwide by many independent users in diverse domains worldwide validation Particle physics software is subject to a rigorous validation independentdiverseworldwide by many independent users in diverse domains worldwide Validation is performed through comparison to experimental data: manufacturer data, protocol data, data from direct experiments Distance along Z (mm) Simulation Nucletron Data F. Foppiano et al., IST Genova superficial brachytherapy experimental mesurements G. Ghiso, S. Guatelli S. Paolo Hospital Savona interstitial brachytherapy Validation is especially important in sensitive applications, such as in medicine!

10. Commercial treatment planning systems are based on analytical methods, because of speed constraints crude approximationsgeometrymaterialsphysics Often crude approximations in geometry, materials and physics are made to simplify the analytical calculations more precise Particle physics software is intrinsically more precise, because of its capabilities to model geometry materials materials (e.g. body tissue) physics interactions realistically realistically, then using these models Monte Carlo methods with Monte Carlo methods Precision is important! In some tumours sites (ex: larynx T2/T3-stage) a 5% underdosage will decrease local tumour control probability from ~75% to ~50% Central-Axis depth dose particle physics commercial  2 /ndf (Plato) = 6.71  2 /ndf (TMS) = 0.81  2 /ndf (Geant4) = 0.52

11. The Particle tracks Particle tracks in a section of the ATLAS ATLAS detector at the CERN Large Hadron Collider graphic tools detectors tracks Particle physics experiments need powerful graphic tools to visualize complex detectors and tracks resulting from physics interactions A brachytherapy source in a Leipzig applicator used skin cancer to cure skin cancer These tools allow to visualize the effects of a radioactive source skin cancer radioactive source, enclosed in a special applicator, used for the therapy of skin cancer Visualisation tools in the Simulation Toolkit

12. 0.16 mGy =100% Isodose curves Data Analysis Tools allow to calculate quantities of clinical interest originally developed for experiments at the Large Hadron Collider allow to calculate quantities of clinical interest Dose at various radiation penetration depths AIDA AIDA ( A bstract I nterfaces for D ata A nalysis) Anaphe and Anaphe Analysis Tool

13. Geant4 application Web interface Type of brachytherapic source Phantom configuration Number of events World Wide Web user interface configurecontrol run The World Wide Web, originally developed at CERN for particle physics experiments, offers a friendly user interface to configure, control and run software applications In usual clinical practice the software for radiotherapic treatment planning should be easily usable even by non-specialists Configuration of a simulation for brachytherapy (therapy with radioactive sources

14. physicsgeometry versatile applications of the same code The powerful physics and geometry modeling techniques enable versatile applications of the same code to many diverse medical problems Same simulation and analysis application software for: endocavitary brachytherapy (uterus, vagina, lung cancer) interstitial brachytherapy (prostate cancer) superficial brachytherapy (skin cancer)...while commercial software is specialised for one specific application only same software = lower cost to hospitals

15. The versatility of particle physics software is such, that it is used to study not only effect of radiation on human body the effect of radiation on human body in conventional applications like radiotherapy, but also in extreme conditions, such as on astronauts in interplanetary missions astronauts in interplanetary missions, where they are subject to solar and cosmic radiation from hospitals......to Mars The same software tools can be applied to study the effect of radiation to airline staff in intercontinental flights

16. speed The speed of software execution is fundamental when the medical staff has to take quick decisions about the treatment planning of the patients Even if recognized as more precise, slower Monte Carlo methods have not been used so far in clinical practice, because they are much slower than analytical methods Master-Worker model Parallel execution of independent tasks Very typical in many scientific applications Usually applied in local clusters Adequate speed parallel inexpensive PCs Adequate speed for clinical usage can be achieved by running the Monte Carlo-based software in parallel on a farm of inexpensive PCs

17. Grid The emerging Grid technology, Large Hadron Collider adopted by the experiments at the CERN Large Hadron Collider, allows seamless access to geographically distributed computing resources In the near future hospitals will be able to access PCs scattered all over the world for parallel processing, without even needing to own their own farm of PCs Any hospital even small ones, or in developing countries, that cannot afford expensive commercial software systems – may have access to advanced software technologies and tools for radiotherapy at very low or even no cost

18. Thanks to G. Cosmo, J. Moscicki, A. Pfeiffer, CERN G.A.P. Cirrone and G. Cuttone, INFN-LNS, Italy F. Foppiano, IST-National Institute for Cancer Research, Italy S. Larsson, Karolinska Institute, Sweden L. Peralta, P. Rodrigues, A. Trindade, LIP, Portugal G. Ghiso, S. Paolo Hospital of Savona, Italy R. Taschereau, UCSF, USA L. Archambault, L. Beaulieu, J.F. Carrier, V.H. Tremblay, Univ. Laval, Canada Geant4 Collaboration AIDA Collaboration