The document discusses proton beam radiotherapy and its advantages over traditional x-ray radiotherapy. It describes the equipment used for proton beam therapy including cyclotrons, treatment rooms with rotating gantries, patient immobilization devices, and beam shaping tools. It also provides examples of treatment plans comparing proton and x-ray intensity modulated radiotherapy for tumors in brain and spine.

1. Radiotherapy with Protons by Dr. Ivan Rosenberg Radiotherapy Physics, UCLH

2. Why Proton Beam Radiotherapy ?

3. A Schematic Cyclotron Treatment Room 1 : isocentric gantry Treatment Room 2 horizontal beam Treatment Room 3: isocentric gantry Research beam; radiobiology, gantry design, engineering and fundamental physics Proton beam line

5. Patient Positioning for Charged Particles High precision in patient positioning is even more important for charged particle therapy, because of the sharp Bragg Peaks. Depending on the disease site, extensive immobilisation procedures need to be adopted

6. Head and Neck horizontal beam , LLMC

7. Extreme accuracy needed for eye melanoma treatments

8. Body mould immobilisation for pelvic sites

9. Patient Positioning for Charged Particles Patient in body mould in treatment position inside large proton beam gantry, LLMC. Auxiliary retractable X-ray tube inside machine head used to produce port films Deep false floor to allow gantry rotation

10. Compact gantry at the Paul Scherrer Institute, Switzerland

11. Practical Proton Radiotherapy Beams Range modulation of a proton beam

12. Practical Proton Radiotherapy Beams Range modulator (passive)

13. Practical Proton Radiotherapy Beams Collimators and beam shaping Irregular apertures are used to conform the beam to the shape of the tumour as projected along the direction of the incident beam they need to be thick enough to expend all the incident energy (thicker than the range)

14. Planning with Protons Treatments for Ocular Melanoma can be achieved most successfully with about 70 MeV protons. Because of its small volume, a single slightly modulated beam gives an ideal dose distribution

15. Practical Heavy Particle Radiotherapy Beams Beam Spreading by active scanning Tumor divided in iso-energy slices 2-D dose distribution on the actually scanned slice Bragg-peak Scanning magnets in x and y Z X Y proton beam Bragg peak On-line monitor system

16. Intensity Modulated Proton Treatment With active scanning, modulating the intensity and the energy depending on position, sophisticated plans can be achieved

17. 12 year old boy Delivered single field plan Some more Proton / IMXT comparisons Unpublished data 9 field IMRT plan 9 field IMRT – second try Factor 6 lower integral dose for protons

18. More IMPT vs. IMXT comparisons 64Gy to target volume, doses to brainstem and optic structures as low as possible IMXT ( 9 fields) IMPT ( 3 fields) Unpublished data z = 49 z = 49 z = 57 z = 57 z = 64 z = 64

19. Paraspinal tumour treated with IXRT vs. IPRT From Weber et al, Int. J. Radiation Oncology Biol. Phys., Vol. 58, No. 5, pp. 1596–1606, 2004

20. Paraspinal tumour treated with IXRT vs. IPRT From Weber et al, Int. J. Radiation Oncology Biol. Phys., Vol. 58, No. 5, pp. 1596–1606, 2004

21. Proton research at UCLH Non-clinical Proton treatment planning systems will be used to compare 3D-CRT with IMXT and with IMPT in selected patients with difficult paediatric and CNS tumours such as chordomas and chordosarcomas Analysis of dose distributions, DVH, TCP and NTCP, and possibility of dose escalation Identify patients who could benefit from referral to European or American Proton facility Develop understanding and expertise in proton planning among Clinicians and Physicists Prepare for the eventual availability of UK-based proton therapy facilities and strengthen the case for UCLH as one of those locations

22. The case for protons at UCLH UCLH practice is highly specialised and serves nearby National Hospital for Neurology and Neurosurgery, Great Ormond Street Children`s Hospital, ENT and Dental Hospital (Gray`s Inn Rd) and North London Cancer Network. Strong academic presence. Optimum Situation : University College Hospital near Euston Road/Station (excellent public transport access - train stations for Mid and North England/Scotland very close) . Surrounding medical support & expertise is most impressive: specialist medicine, imaging, surgery, medical oncology, research oncology. Several Large Radiation Oncology Centres nearby with large number of radiation oncology and medical physics experts. Use this expertise in patient selection, treatment planning and follow-up.