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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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

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

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

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

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

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

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 Study of Semiconductors

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

Eye Tumor Therapy with 68 MeV Protons at Hahn-Meitner-Institut-Berlin 1995 Start of the ISL- Project 1998 First patient treated patients Residence of patients

Why Protons ?

Optic NerveMacula Tumor Tantalum Clips Typical Fundus View

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

Tantalum Clips: Positioning landmarks

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

repeatability of patient positions

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

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

Treatment Method

Proton Beam Physics

treatments June 1998 – March 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)

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

choroidal melanomas CTV = 0.1 cm 3

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

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

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

Introduction / Motivation Wide Angle Fundus View EYEPLAN Tumor Draw

Introduction / Motivation Wide Angle Fundus View EYEPLAN Dose Distribution

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

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: mm 1,5 m Beamline H 2 O Phantom GEANT Monte Carlo Geometry

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

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

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

d Distance to “Eye Entry Point” Dose slope Col Approach d z’ (p v) 2 z LRLR 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 )

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

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

Verification CT-Slice / Sugar Solutions 7 Chamber Phantom Proton Beam

Verification CT-Slice / Sugar Solutions Hounsfield based Density Deviation: Comparison of Radiological Depths

Verification Depth: 24.5 mm Density: g/cm 3 Depth: 17.5 mm Density: g/cm 3 Depth: 10.5 mm Density: g/cm 3 Depth: 3.5 mm Density: g/cm 3

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

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

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

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