ESR8 H anen Ziri 12 13 march 2018 Oma Topical workshop psi Optimization of medical accelerators project The integration of the adaptive particle therapy in clinical practice consists of two major approaches ID: 1043595
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1. Tumor Tracking in particle therapyESR8: Hanen Ziri12-13 march 2018Oma Topical workshop - psi Optimization of medical accelerators project
2. The integration of the adaptive particle therapy in clinical practice consists of two major approaches:Treatment preparation by measuring the target displacement which includes acquisition of breathing motion, target delineation and treatment simulations(2) Treatment delivery where irradiation is delivered to the patient under free breathing conditions using real-time respiratory motion tracking system2Moving tumors in particle therapy
3. 3*A. Rossi, 2011Dose profile in water of carbon ion and X and gamma-rays at different energiesMoving tumors in particle therapy
4. *McGowan et al., 20134Treatment delivery and verificationMotion mitigationMoving tumors in particle therapy
5. 5Moving tumors in particle therapyInter-fractionIntra-fractionIntra-fractionIntra- and inter-fractional motionBaseline shiftBaseline shift observed on two overlaid CBCT scans
6. Water equivalent path length variationInterplay effect*Furukawa et al., 2010(a) Dose distribution delivered with a scanned beam to a static target. (b) Dose distribution delivered to a moving target: the interplay effect is clearly visible. Coronal ΔWEL maps at end-inhale (a) and end-exhale (b) phase. Tumor region is identified by a dotted circle, while ROI in the lungs are identified by solid circles. 6Moving tumors in particle therapy
7. “…Tracking attempt to make the particle beam follow the target motion, which entails the real-time modulation of the beam direction and energy, to accurately conform the delivered dose to the target motion without increasing the treatment time…”7Tracking as a motion mitigation technique*Vedam et al., 2013
8. 8Motion monitoring systems
9. 9Optical tracking @CNAO
10. 10Optical tracking framework
11. 11Gating & rescanningTracking Compensates well for motion-induced interplay effect within the target volumeLong treatment time due to breathing irregularitiesBetter compensation for motion-induced interplay effect within the target volume and its bordersSignificant treatment time reduction expectedMaking better use of the extracted particle beamMotion monitoring systemPatient couchDose delivery systemStatic irradiationTrackingGating*Fattori et al., 2016Experimental results
12. - The choice of a specific motion monitoring solution for PBS proton therapy is strongly influenced by the working environment and treatment unit design.- Remaining challenge of ensuring that delivered plans are robust to range uncertainties in proton therapy.- Global motion models for adaptive strategies- Need for beam energy modulation strategy for longitudinal motion compensation - Real-time feedback on delivered dose variation as well as anatomical changes for respiratory correlated treatment - Need to perform clinical studies to investigate which approach is the best in a given clinical situation.12Conclusion
13. Optimization of Medical Accelerators (OMA)Horizon2020 Marie Skłodowska-Curie Grant Agreement No 675265 Thank you !
14. 14Conclusion