IONTRIS Particle Therapy Systems Status of the Siemens IONTRIS Particle Therapy Systems: Marburg, Kiel and Shanghai Peter Urschütz SIEMENS Healthcare Particle Therapy Siemens AG 2011. All rights reserved.
IONTRIS Particle Therapy Systems Outline The Siemens IONTRIS Particle Therapy System Projects HIT Heidelberg PTZ Marburg NRoCK Kiel ShaPHIH Shanghai Summary Page 2
IONTRIS Particle Therapy Systems Siemens History in Particle Therapy 2003 Siemens decided to provide combined proton & heavier ion systems Siemens entered technology transfer contract with GSI: Access to accelerator design for Heidelberg HIT Project; synchrotron based solution (design of IONTRIS accelerator system derived from GSI design for HIT, modifications were applied) Build on experience from GSI carbon therapy pilot project 2004 Joint development of Siemens with Danfysik/DK (industrial partner with strong accelerator background) 2005 Order: Patient environment for HIT, Heidelberg 2006 Order: Complete PT equipment for RKA, Marburg 2007 Order: Treatment planning system for CNAO, Pavia 2008 Order: Complete facility (PT and conventional therapy) for NRoCK, Kiel Acquisition of PT branch of Danfysik 2009 Order: Complete PT equipment for ShaPHIH, Shanghai Page 3
IONTRIS Particle Therapy Systems Accelerator & Raster Scanning Active energy selection Panoramic beam scanning Courtesy of GSI Scanner Magnets MWPCs ICs Page 4
IONTRIS Particle Therapy Systems Treatment Planning System for Protons and Carbon Ions TPS Features Protons and carbon ions Workflow oriented DICOM RT and syngo based (CE certified) Implementation of LEM / TRiP for carbon ions (Cooperation GSI) 2D pencil beam algorithm for protons (Cooperation DKFZ) Patient (Clivus Chordoma) - 12 C Plan Courtesy HIT SAG Session Jan 2009 Page 5
IONTRIS Particle Therapy Systems Patient Handling: Robotic Systems Robotic patient positioning system Identical in treatment and CT rooms Position correction in 6 degrees of freedom (including roll & pitch) High position accuracy independent from patient weight (carbon fiber boards) Workflow optimization positioning according to treatment plan Robotic imaging system Orthogonal x-ray and Cone beam CT Position verification in every treatment position High position accuracy in imaging position Page 6
IONTRIS Particle Therapy Systems Example: NRoCK, Kiel Footprint: 6000 m² (soccer field) Conventional Therapy Treatment Rooms: Patient Setup and Treatment Concrete: 36.000 tons (>5.000 trucks) Steel: 5.500 tons CT and Immobilization Areas Cables: more than 40 km Power: ~ 5MVA Isotope Production IT Integration: Complete workflow from diagnostic to treatment planning, position verification and treatment Page 7
IONTRIS Particle Therapy Systems Key Parameters Parameter Protons Carbon Ions # Energy Range (2-30 cm) ~50-250 MeV 1 mm steps ~85-430 MeV/u 1 mm steps ~300 Max Intensity 2-4 10 10 / Spill 1 10 9 / Spill Intensity Variation 0.001 1 15 steps 0.001 1 15 steps 15 Beam Width 5 steps 5 steps 5 Extraction time 1-10 s 1-10 s 5 Ramping time < 0.3 s < 1 s Field size 200 x 200 mm 2 200 x 200 mm 2 Dose homogeneity ±5% ±5% Lateral position accuracy ±0.5 mm* ±0.5 mm* *with position feedback applied Long. position accuracy ±0.3 mm ±0.3 mm Page 8
IONTRIS Particle Therapy Systems Project Specific Adaptations IONTRIS is a product Marburg but with project specific variations! (e.g. number of on sources, treatment room configuration beam outlets) Page 9 Kiel & ~Shanghai
IONTRIS Particle Therapy Systems Outline The Siemens IONTRIS Particle Therapy System Projects HIT Heidelberg PTZ Marburg NRoCK Kiel ShaPHIH Shanghai Summary Page 10
Projects Past and Present 1 HIT Heidelberg University, Germany Provide medical devices, workflow, treatment planning, and patient environment 2 PTZ Marburg University, Rhön Clinic, Germany Provide turn-key solution for carbon and proton ion therapy 3 CNAO, Pavia, Italy Provide treatment planning 4 NRoCK Kiel, University of Schleswig-Holstein, Germany Comprehensive cancer center comprising Particle Therapy, conventional radiotherapy, brachytherapy and isotope production, building and financing (Public-Private Partnership contract). 5 Shanghai Proton and Heavy Ion Hospital, China Provide turn-key solution for carbon and proton ion therapy Page 11
IONTRIS Particle Therapy Systems Outline The Siemens IONTRIS Particle Therapy System Projects HIT Heidelberg PTZ Marburg NRoCK Kiel ShaPHIH Shanghai Summary Page 12
University of Heidelberg HIT Patient Environment Siemens supplied all components related to patient environment: Scanning and monitoring system Robotic patient positioning system Imaging system (2D x-ray and CB CT) Therapy control system (TCS) Collaboration on TPS syngo PT planning Courtesy of the University of Heidelberg, Germany Accelerator system designed and delivered by GSI Gesellschaft für Schwerionenforschung mbh, Darmstadt Patient treatment started Nov 2009 To date ~ 300 patients have been treated Page 13
IONTRIS Particle Therapy Systems Outline The Siemens IONTRIS Particle Therapy System Projects HIT Heidelberg PTZ Marburg NRoCK Kiel ShaPHIH Shanghai Summary Page 14
University of Marburg /Giessen Rhön Klinikum AG Building Page 15
University of Marburg /Giessen Rhön Klinikum AG Layout All particle therapy equipment is provided by Siemens 3 rooms with horizontal beams 1 room with semi vertical beam Start of construction: August 2007 Start of installation: August 2008 Start of commissioning: January 2009 Handover to customer: End of 2011 66m / 216.5ft 110m / 361ft Courtesy of Rhön-Klinikum AG, Germany Page 16
University of Marburg /Giessen Rhön Klinikum AG Accelerator - Injector RFQ IH mode DTL Debuncher ECR Ion source 7 MeV/u Beam chopper 0.008 MeV/u 0.4 MeV/u Stripper foil (H 3+ to p, C 4+ to C 6+ ) Beam chopper Courtesy: Pantechnic Quadrupole triplett for intensity variation (factor 100 in 15 steps at RKA) Page 17
University of Marburg /Giessen Rhön Klinikum AG Accelerator - Synchrotron Synchrotron key parameters (at Marburg): Active energy selection, ~ 300 energy steps/ion species Energy: 85-430 MeV/u (C6+), 48 221 MeV (p) Ramp speed: 6.6 Tm/s (1s to highest carbon extraction energy) Extraction time: 8 s Electrostatic extraction septum To Patient RF Cavity ~22m RF frequency from1-7 MHz From Injector (7 MeV/u) Page 18
University of Marburg /Giessen Rhön Klinikum AG Accelerator High Energy Beam Transport Line HEBT: 3 horizontal places, 1 semi-vertical Optics: Dispersion free optics in the isocenters Fast spill abort system (magnetic chicane): shutoff < 200 µs Extraction Septum Magnetic chicane Dipole magnets slit Beam parameters in isocenter (at Marburg): Maximum intensities: 2 x 10 10 protons, 1 x 10 9 carbon ions Beam Foci (FWHM in air at isocenter): 8 33 mm (p), 3 14 mm (carbon ions) RF Cavity 1-7 MHz Page 19
University of Marburg /Giessen Rhön Klinikum AG Photos Sources and LEBT Linac Synchrotron HEBT Page 20
University of Marburg /Giessen Rhön Klinikum AG Commissioning status - Injection, acceleration and extraction control Multi-turn injection scheme (30 turns injected - pulse length defined by micro chopper) Slow 3rd order resonance extraction scheme using an RF KO exciter for spill shape control. Fast pausing and resuming extraction Beam Gating (Breathing Motion) Carbon 300 MeV/u Time resolved intensity variation of a spill (1 ms integration time) Beam Intensity [ions/s] 2.50E+08 2.00E+08 1.50E+08 1.00E+08 5.00E+07 0.00E+00 0 1 2 3 4 5 6 7 8 9 10 Time [s] Injection Pulse MEBT 50µs Time resolved intensity variation of multiple spill pauses 2.50E+08 multi-turn injection 50µs Beam Intensity [ions/s] 2.00E+08 1.50E+08 1.00E+08 5.00E+07 stored current 1s 0.00E+00 0 2 4 6 8 10 12 14 16 Time [s] Example of extracted beam, 300 MeV/u carbon ions Page 21
University of Marburg / Giessen Rhön Klinikum AG Commissioning Status Beam Library Commissioning of a beam library Parameter Protons Carbon Ions # Energy 48-221 MeV 86-430 MeV/u ~300 Range (2-30 cm) 1 mm steps 1 mm steps Max Intensity 2 10 10 / Spill 1 10 9 / Spill Intensity 0.02 1 0.01 1 12, 15 Variation 12 steps 15 steps Beam Width 4 steps 5 steps 4, 5 Extraction time 8 s 8 s 1 Beam Lines 2 2 2 Combinations/Beam Line: ~36000 Beam library as presently commissioned at Marburg Page 22
University of Marburg /Giessen Rhön Klinikum AG Commissioning Strategy Define commissioning strategy (Synchrotron extraction, HEBT) Example: horizontal tune shift prior to extraction E.g. parameters kept constant (chromaticity, size and angle of extraction separatrix, average orbit corrected to zero, ) What knobs to touch? Fine-tuning of some beams Interpolation over parameter space Request and test beams in between Goal: Similar starting condition (beams) for HEBT over entire parameter space Choose HEBT optics (e.g. dispersion in isocenter, large beam size in final focusing quadrupoles) support points Interpolation Q hor. Page 23
University of Marburg /Giessen Rhön Klinikum AG Commissioning Status Example: Beam width at the isocenter Scan of all foci over all E from available treatment beam library Excellent reproducibility All foci (5), energies (~300), intensities (15) commissioned Horizontal and Vertical Projections of a High-E Proton Beam at Isocenter horizontal beam width FWHM (mm) 16 14 12 10 8 6 4 2 multiple scattering in window + detectors Carbon Ions 90 430 Energy (MeV/u) Page 24
University of Marburg /Giessen Rhön Klinikum AG Commissioning Status Beam properties (position and width) over intensity (without position feedback) horizontal position vertical position horizontal position (mm) vertical position (mm) horizontal width vertical width horizontal width (mm) vertical width (mm) intensity 1x10 7 1x10 9 particles/spill Page 25
University of Marburg /Giessen Rhön Klinikum AG Beam Intensity Control Beam intensity control: Pre set value for the KO Exciter Monitoring system measures current Comparison to reference and feedback on KO Exciter Carbon 300 MeV/u Reference Controller Set value Exciter meas. current beam Monitoring system Spill noise: max/avg = 1.6 (1ms integration time) Spill shape with and w/o feedback Page 26
University of Marburg /Giessen Rhön Klinikum AG Beam width measurements with Isocenter MWPC Measured focus vs. energy (Protons, Focus setting 1) Beam width (FWHM) measured for all energy and focus settings using an Isocenter MWPC (plots show focus setting 1). Agreement with requested beam size (beam library) is within tolerances. For final adjustments, measurements with films are used Focus [mm] 35 30 25 20 15 10 5 0 40 60 80 100 120 140 160 180 200 220 240 Energy [MeV/u] Focus X (IsoMWPC) Focus Y (IsoMWPC) Measured focus vs. energy (Carbon, Focus setting 1) 12 10 Focus [mm] 8 6 4 2 0 70 120 170 220 270 320 370 420 Energy [MeV/u] Focus X (IsoMWPC) Focus Y (IsoMWPC) Page 27
University of Marburg /Giessen Rhön Klinikum AG Beam width measurements with films Film response correction Beam profiles measured in x and y Film response corrected (with grey scale method Dr. U. Weber, private communication) beam profile measurements All foci at low/mid/high energy measured Measured beam width results are within tolerances Page 28
University of Marburg /Giessen Rhön Klinikum AG Depth distribution of dose Position of the Bragg-Peak was measured for both ion species for low, medium and high energies Position of the peaks agree well with the expected penetration depth Dose Depth Distribution Protons in Water Dose Depth Distribution Carbon Ions in Water rel. Dose 7 6 5 4 3 2 1 59.8MeV 150.1MeV 221.1MeV 31mm 159mm 310mm rel. Dose 8 7 6 5 4 3 2 1 285.6MeV 430.1Mev 110.6MeV 31mm 159mm 310mm 0 0 100 200 300 400 0 0 50 100 150 200 250 300 350 Depth(mm) Depth(mm) Page 29
University of Marburg /Giessen Rhön Klinikum AG Treatment Rooms Not only the beams are in good shape, but also the treatment rooms (robotic patient positioning and imaging systems) Page 30
University of Marburg /Giessen Rhön Klinikum AG Summary for Marburg Example: Intensity modulated 2D raster-scan of arbitrary shapes Mr. Edwin McMillan Summary for Marburg: Accelerator commissioning practically complete (rooms 1 and 2) - ~ 70.000 beams available. Formal testing ongoing, e.g. System Integration Final parameterization of the treatment delivery system ongoing 430 MeV/u carbon beam Page 31
IONTRIS Particle Therapy Systems Outline The Siemens IONTRIS Particle Therapy System Projects HIT Heidelberg PTZ Marburg NRoCK Kiel ShaPHIH Shanghai Summary Page 32
North European Radiooncological Center Kiel NRoCK Integrated Cancer Treatment Hospital Cancer treatment center with PT integrated as a department Patient care facilities Standard Treatment Options Conventional Radiotherapy Brachytherapie PET Isotope production Page 33
North European Radiooncological Center Kiel NRoCK Accelerator Installation 3 ECR sources Upper HEBT Vertical beam line Page 34
North European Radiooncological Center Kiel NRoCK Actual Commissioning Status Accelerator commissioning: Beams in the first two treatment rooms Setting up complete parameter space for carbon ions/protons ongoing Doubled Linac transmission, twice the amount of extracted particles System integration: System integration work has started Beams request from Therapy control system Conventional Radiotherapy: Ready to start in autumn 2011 Linacs, PET cyclotron installed on site Carbon spill (not final) 2.3E9 particles Page 35
North European Radiooncological Center Kiel NRoCK Project Duration Comparison - Marburg vs. Kiel Duration [Calendar days] 0 100 200 300 400 500 600 700 800 900 Marburg Sum Marburg: 553 calendar days Kiel Sum Kiel: 337 calendar days Sources/LEBT RFQ IH-Linac MEBT 1st turn 1st beam in TR All beam combinations available Durations for installation and commissioning activities of the accelerator Time reduction: ~1/3 Tasks related to patient environment and complete system integration run in parallel Page 36
IONTRIS Particle Therapy Systems Outline The Siemens IONTRIS Particle Therapy System Projects HIT Heidelberg PTZ Marburg NRoCK Kiel ShaPHIH Shanghai Summary Page 37
Shanghai Proton & Heavy Ion Hospital (ShaPHIH) 上海质子和重离子医院项目 1 st shipment Autumn This Year Installation starting early 2012 Page 38
Shanghai Proton & Heavy Ion Hospital (ShaPHIH) Components for Shipment 1 st shipment - autumn 2011 Most of the components are manufactured, tested and ready for shipment. Start of installation - early 2012 Sync dipoles waiting for shipment at production site in Jyllinge/Denmark Page 39
Shanghai Proton & Heavy Ion Hospital (ShaPHIH) 上海质子和重离子医院项目 Date: 14 Jan. 2011 Level 4 in construction. Synchrotron area completed. JanuaryJune February March April May June July Page 40
IONTRIS Particle Therapy Systems Outline The Siemens IONTRIS Particle Therapy System Projects HIT Heidelberg PTZ Marburg NRoCK Kiel ShaPHIH Shanghai Summary Page 41
Summary IONTRIS: fully-integrated solution for particle therapy PTZ Marburg: Full treatment beam library available for treatment delivery. Beam tests ongoing. Customer handover in November this year. NRoCK KIEL: First beam in treatment rooms. Work progressing to commission beams. Start of system integration. Conventional radiotherapy handover in autumn this year. ShaPhiP Shanghai: Component production and shipments on schedule, building nearing completion. Start of installation early 2012. Page 42
IONTRIS with an integrated careflow Thank you for your attention! just another intensity modulated 2D raster-scan Page 43
IONTRIS with an integrated careflow Thank you for your attention Page 44 Siemens AG Healthcare Sector Particle Therapy Siemens AG 2010. All rights reserved.