对122名原发肝细胞癌患者进行质子治疗课件.ppt

1、Energy Modulation Ion TherapyEnergy Modulation Ion Therapy Pre-conceptual design of Energy Modulation Ion Therapy (EMIT)YK HengRepresents EMIT group Institute of High Energy Physics April 30, 2008 USTC, HefeiPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Y

2、uekun Heng2主要人员主要人员总体设计总体设计 韦杰韦杰/方守贤方守贤快循环同步加速器物理设计快循环同步加速器物理设计 焦毅焦毅/王生王生基于直线加速器的注入器基于直线加速器的注入器 傅世年傅世年回旋加速注入器回旋加速注入器 唐靖宇唐靖宇环注入、引出、传输线及束流配送环注入、引出、传输线及束流配送 唐靖宇唐靖宇机械系统预制研究机械系统预制研究 屈化民屈化民电气系统预研电气系统预研 张旌张旌旋转机架设计旋转机架设计 屈化民屈化民/唐靖宇唐靖宇治疗头设计治疗头设计 衡月昆衡月昆/刘力刘力成像与定位系统成像与定位系统 舒航舒航控制及安全联锁系统控制及安全联锁系统 上海光源上海光源 刘德康刘德

3、康PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng3Outline General introduction with proton/ion therapy Clinical Requirements and EMIT advantages Main pre-conceptual design: Accelerator (Injector, Synchrotron, Delivery ) Therapy (Gantry, Nozzle, p

4、ositioning ) Control and software (TCS, TPS, dose verification ) SummaryPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng4 Part I General introduction with proton/ion therapyPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei

5、, April 30, 2008, Yuekun Heng5Comparison of irradiation therapy 放射源放射源(放射性同位素放射性同位素)产生产生射线射线: 刀刀. 电子直线加速器：电子打靶产生电子直线加速器：电子打靶产生 X 射线射线 新型放射治疗新型放射治疗: 质子及重离子速器质子及重离子速器: 质子及重离子质子及重离子PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng6Dose and effects co

6、mparison 例如：例如：PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng7Demands and status 20%人死于肿瘤，我国每年至少有240万发病的肿瘤病人，其中适应放疗的病人约为100万人 治疗费用：1020万RMB 装置费用：3亿10亿RMB世界上,正式运行的约30台，正在建造中或计划建造的粒子治疗装置共有14台。 其中美国9台、日本8台、德国6台、法国4台、俄罗斯3台、意大利3台、瑞士3台、南非2台、英国1台、瑞典1台

7、、加拿大1台、奥地利1台、韩国1台。 中国13台PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng8 Part II Clinical Requirements and EMIT advantagesPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng9Clinical Requirement

8、sRange in patient：3.535g/cm2 (beam 60250MeV)Range Adjustment precision：0.1g/cm2 60MeV: 1Mev variation is relative to 1mm depth; 220MeV: 1Mev variation is relative to 2.5mm depthAverage Dose rate：2Gy/min (Scattering) 20Gy/min (Scanning)Field size：20cmX20cmDose uniformity：4%Beam Positioning resolution

9、 at isocenter: 0.5mmP Energy Range in water (MeV) (cm) 100 3.50 126 10.00 155 13.35 186 20.00 200 21.15 225 29.00 250 33.90PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng10Comparison of Accelerator technique 逥旋加速器逥旋加速器慢同步加速器慢同步加速器快同步加速器快同步加速器供应商

10、供应商比利时比利时IBA ;日本住友日本住友美囯费米美囯费米;日本日立日本日立无无质子流强质子流强5x 10.13 1x10.105x10. 13输出能量值输出能量值固定固定250 MeV 70-250MeV 可变可变70-250 MeV可变可变能量降能器能量降能器必需必需不用不用不用不用能量稳定度能量稳定度+-0.5%+- 0.1%+- 0.1%引出效率引出效率差差90%99%入射能量入射能量(MeV)0.01-0.17MeV RFQ+Linac7MeV RFQ+Linac束流发散度束流发散度5-10 -mm- mrad1-3 -mm- mrad0.2-mm- mrad加速器重量及功率加速器

11、重量及功率220吨吨,460Kw60吨吨,250Kw尺寸尺寸直径约直径约4米米直径约直径约10米米直径约直径约10米米扫描强度均匀性扫描强度均匀性好好差差优异优异Refer to RCMS (BNL)PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng11EMIT main parameters PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei,

12、April 30, 2008, Yuekun Heng12Energy Modulation AC advantagesAC can adjust precise energy: 1MeV, spread 0.2%Beam intensity modulation: factor of 100 7 by chopping the beam to different length (50 - 350 ns). Another factor of 15 by source current adjustment & collimationTypical Treatment of 50 mm x 50

13、 mm x 50 mm volume: 1 4 minutesVoxels of 5 mm x 5 mm x 5 mm 100 pulses per layer with 5 mm steps ( 4 s per layer) Energy adjustment (transport & gantry magnets) in 2 s 10 layers of 1,000 scanning voxels in 1 min. Respiration synchronization: 3 4 times longer treatment time PageEnergy Modulation Ion

14、TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng13EMIT layout PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng14 Part IIIMain pre-conceptual design: Accelerator (Injector, Synchrotron, Delivery ) Therapy (Gantry, Nozzl

15、e, positioning ) Control and software (TCS, TPS, dose verification )PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng15EMIT-p injector: IS + RFQ + DTL S.N. FuOutput Energy10MeVPulse Current1mAPulse repetition rate25HzPulse length50-350nsEmittance（

16、Norm. RMS）0.15mm-mradEnergy Spread0.2%PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng16EMIT-p rapid cycling synchrotron ParametersUnitInjection energy MeV 10Max. extraction energy MeV 250Min. extraction energy MeV 60Repetition rate, frep Hz25Tre

17、atment protons per bunch2.0 x107Treatment protons per bunch2.0 x109Proton fluxprotons/min 3.0 x1012Circumference Cm 32.48Norm. rms emittance, e e m mm 0.15PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng17Transport and dispatch J.Y. Tang, J. Qiu,

18、 et alBeam energy (MeV)25060Beam rigidity (T.m)2.43211.137Beam emittance (un., full, .m mm)1.743.72Momentum spread (%)0.190.27Particles per pulse(0.012.0) 109(0.012.0) 109Average current (nA)0.046.800.046.80Repetition rate (Hz)2525Pulse length (ns)60160PageEnergy Modulation Ion TherapyEnergy Modulat

19、ion Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng18Gantry (BNL 2003 design)H.M. QuNameUnit weightQuantityTotal weightDipole320 Kg72.24 tQuadrupole25 Kg120.3 tshielding block behind beam inlet1000 Kg11 tSum weight3.54 tEMIT GantryRiesenrad GantryHeidelberg GantryPSI GantryTotal weight of all ma

20、gnets2.54 t70 t140 t25 t (for a 90 bend magnet)Weight of beam absorber1 t120 tWeight of gantry20 t127t570 t110 tPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng19Schematic of Scattering NozzleTargets: To make a large field, 1cm beam spot 20cm the

21、rapy field Energy modulation and spreading Uniform dose distribution Efficiently beam usingDM 1: SEM Sca.1 Sca.2: Double ring, 6 candidates Energyadjustment. DM2: TICC2C3:MLDM3: 2D BolusC4C1beam 2 scattering plates and 1 adjusting plates 3 dosimeters 5 collimators PageEnergy Modulation Ion TherapyEn

22、ergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng20Spreading Beam, Sca. Angle Principle: The bigger density and the smaller radiation length, The bigger. Sca. Angle:1st Scatter: Pb2nd Scatter: double rings, inner: Pb; outer: AlEnergy modulation :Energy lose in material:3rd, Energy

23、modulation: Jagged plate The most possibility energy lose is proportional to thicknessKey results:A: field radius, 10cmBeam efficiency: 40% Dose Uniform: 3%Total length: 3m Scattering Nozzle: Dual-Ring Double Scattering (1) Spreading field uniform dose Spreading energy adjusting energyRange adjustin

24、gPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng21Schematic of scanning Nozzle45fixed beam, therapy bed can be rotated to make different fields.X-Y section: spot scanning is realized by magnetic system Step: 5mmX5mm, by scanning magnet, angle st

25、ep:2.5 mradSpot size: 10mm, controlled by focusing magnet, overlap between spots to unify the field dose distribution Positioning precision isocenter: 0.5mm, Angle precision: 0.25 mradRange modulation (depth) :Tumor in depth is divided layer by layerLayer Step: 1mm10mm, energy varied by AC controlWC

26、Scanning guideMagnetExit WindowSEMCollimatorCompensatorSICWCPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng223 dosimeters for Scanning NozzleWire Chamber (WC) :Just out of beam deliveryMeasure the beam profile,resolution: 0.5mmMeasure the total

27、dose Secondary Emission Monitor (SEM) :Out of magnet,used for large proton flux: 2X109 proton within 50ns /pulse Segmented IC just out of the scanning guide.used to measure the field dose distributionRefer to Lawrence Berkeley LaboratoryScanning guideMagnetExit WindowSEMCollimatorCompensatorSICWCPag

28、eEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng23Controls and softwareD.K. LiuHospital Information SystemsPic. Arch. Comm. SystemCT, PET CT，MRIControls & DiagnosticsFacility controlsBeam diagnosticsTreatment controlNozzle Positioning Verification /

29、 quality assuranceTreatment planningRf, vacuum, power supplyPosition, loss, intensityDose monitoringFabrication centerSafety interlockMedical center Dose safety monitoring networkPageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng24SummaryProton/Ion

30、 therapy is a big opportunity and challengeRapid cycling synchrotron is the technology of choice for EMIT-p due to: Relevance to flexible energy modulation and 3D point scanning for stereo-tactic therapy Similarity with CSNS technology R&DRoadmap: a continuous upgrade path From fixed port to gantry

31、From scattering to spot scanning (position & energy scan) From proton to carbon/proton dual facility From 25 Hz to 50 Hz repetition rate; shorter treatment time From demo to marketable productionPre-conceptual design are finished.PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC He

32、fei, April 30, 2008, Yuekun Heng25PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng26质子与碳离子作比较(1)在剂量分布和物理特性上碳重离子优于质子。碳离子和质子都具有Bragg峰物理特性，但凡原子系数越大，其Bragg峰宽度越狭，后沿下降越快，剂量分布越能集中在肿瘤部位上。在生物特性上，碳离子能直接切断DNA双键功能，能直接杀死肿瘤细胞，质子只能切断DNA單键功能，质子难于有效治疗抗阻型和乏氧型癌细胞 在

33、照射剂量的提升上，碳离子比质子有利 .PageEnergy Modulation Ion TherapyEnergy Modulation Ion Therapy USTC Hefei, April 30, 2008, Yuekun Heng27质子与碳离子作比较(2)碳离子12C在行程中会发生核分裂现象，将变成11C 或10C。在Bragg峰后形成一个小尾巴，往往对峰后的正常(或敏感)组织带来伤害，也会稍微增加横向散射和陰影 .由于碳离子重量过大，从而使被照射的肿瘤区，从微观上看始终存在某些癌细胞没有照射到的冷点。在今后有复发的可能。质子共治疗了近5万名肿瘤患者，积累了大量丰富的临床经验，一

34、般治疗有效率达到95% 以上，五年存活率高达80%。碳离子有治疗病例4千名左右。质子治疗设备约需2-3亿元的投资，建造周期需2-3年之久。 但碳离子治疗所需的加速器及其相应的设备规模则更大，技术更为复杂，投资约为质子治疗的三倍之多。It is unclear if carbon is better than protons, but the Japanese are sold on it. (The RBE is perhaps the most important aspect.) The Americans are going only for protons. by Andrew M. Sessler