National Institute of Radiological Sciences. Naoya Saotome

National Institute of Radiological Sciences Naoya Saotome 1

Contents Introduction History and collaboration KCC i-rock Commissioning of commercial scanning system NIRS Gantry Commissioning of NIRS s Gantry with superconducting magnet 2017/2/23 Naoya Saotome(NIRS) 2

OUR EVOLUTION 2008 Experimental port for scanning 2011 New treatment rooms with scanning 2015 Commercial machine with scanning 2017 Superconducting Gantry for carbon ion Iso-center RSF Main monitor SCN02 PRN SCN01 5.20m SM-Y SM-X PH1 By courtesy of Toshiba 2017/2/23 Naoya Saotome(NIRS) 4

OUR RECENT PROGRESS 2013 2014 2015 2016 2017 2018 2019 2020 Building construction start(12/12) Installation start (14/5) Accelerate 430MeV/u (15/1) Multiple-energy operation and scanning irradiation(15/2) Treatment start (15/12) Beam commissioning start(10/13) Treatment start(15/2) Installation start(15/1) Gantry Energy scanning Beam commissioning start (16/1) Treatment start (17/4,plan) KCC: Kanagawa Cancer Center NIRS: National Institute of Radiological Sciences 5

drawn by RF63_IDD_forGComi_20160812_Overflow NIRS OUR COLLABORATION RGF RSF SCMY SCMX SCN USING (TREATMENT) DESIGN IC DSN_M DSN_S NST FST DSN_P COLLABORATION National Institute of Radiological Sciences 2017/2/23 COMMISSIONING Amount of ionization [C] 0e+00 1e 07 2e 07 3e 07 4e 07 20160809052036LGRC_IDD_000_PM1m 20160809054241LGRC_IDD_008_PM1m 20160809055742LGRC_IDD_016_PM1m 20160809061159LGRC_IDD_024_PM1m 20160809062717LGRC_IDD_032_PM1m 20160809064231LGRC_IDD_040_PM1m 0 50 100 150 200 250 300 350 Moter value [mm] 0e+00 1e 07 2e 07 3e 07 4e 07 DEVELOPENT Naoya Saotome(NIRS) 6

Specification of KCC Combination of a compact dissemination treatment system and pencil beam 3D scanning technique designed by NIRS Moving target treatment is available with respiratory-gated and rescanning technique item specification Ion C 6+ Energy 140-430MeV/u Max. field 220 x 220 mm 2 Max. dose rate 2 Gy/L/min Beam intensity Irradiation type 1.2x10 9 pps 3D Scanning 2017/2/23 Treatment rooms Horizontal: 2 rooms Horizontal and Vertical: 2 rooms Vender Toshiba Naoya Saotome(NIRS) 8

Building Construction 2017/2/23 Naoya Saotome(NIRS) 9

OUR RECENT PROGRESS 2013 2014 2015 2016 2017 2018 2019 2020 Building construction start(12/12) Installation start (14/5) Accelerate 430MeV/u (15/1) Multiple-energy operation and scanning irradiation(15/2) Treatment start (15/12) KCC: Kanagawa Cancer Center NIRS: National Institute of Radiological Sciences 10

DARUMA CEREMONY 2017/2/23 Naoya Saotome(NIRS) 11

Commissioning of the irradiation system NON-scanned beam test Beam intensity Beam position Beam size Beam on/off response Scanned beam test Scanned beam position Field uniformity Complex field Dose monitor performance Position monitor performance Beam data collection for TPS Beam size Beam divergent Integral depth-dose Dose monitor unit Overall verification Interlock check Information transfer check Coordinate check End-to-End test Training for staff Beam matching 2017/2/23 Naoya Saotome(NIRS) 12

Beam intensity Extended FT + Multiple Energy Operation Extended FT + Intensity Modulation Operation 2017/2/23 Naoya Saotome(NIRS) 13

Screen monitor for spot Beam size and position Beam shape was adjusted as round shape Beam size was adjusted within 10 percent from designed Beam size for each treatment port were matched Beam Size [mm] 1.0 1.5 2.0 2.5 3.0 3.5 4.0 150 250 350 450 Energy [MeV/n] 2017/2/23 Naoya Saotome(NIRS) 14 140MeV 430MeV 1HC 2HC 2VC

Beam size and position Beam position stability was within +/-0.5mm Beam size stability was within +/-0.5mm from design Beam position (2VC) Beam size (2VC). +0+.- +1. +0+.- +1 2017/2/23 Naoya Saotome(NIRS) 15

Integral depth dose Concentric Ionization chamber IDD for 11 energy beams Beam energy/range was adjusted Residual range for each treatment port were matched Lateral distribution was used for TPS 3D Water phantom Integral depth dose [A.U.] 0 20 40 60 80 100 120 0 50 100 150 200 250 300 350 Depth in water[mm] 0 20 40 60 80 100 120 beam modelling Dose of integral electrode [C] 0.0 0.2 0.4 0.6 0.8 1.0 Depth [mm] BeamData_KCC20151130_inaniwa2 RID06_PMMA 20160407_rangecheck 1HC_RID06 offset= 9.1,scallcor= 1 20160407_rangecheck 2HC_RID06 offset= 9.1,scallcor= 1 20160407_rangecheck 2VC_RID06 offset= 6.3,scallcor= 1 150 155 160 0.0 0.2 0.4 0.6 0.8 1.0 2017/2/23 Naoya Saotome(NIRS) 16

Screen monitor for field Scanned beam position Scanned beam position for every beam energy was checked Beam shape was adjusted as round shape at any position The precision of the scanned beam position was verified within 0.5 mm. 430MeV/u +/-0.5mm ü 240x240mm 2 field ü 20 mm pitch +/-0.5mm 380MeV/u +/-0.5mm ü 240x240mm 2 field ü 20 mm pitch +/-0.5mm 2017/2/23 Naoya Saotome(NIRS) 17

Screen monitor for field Field uniformity Field uniformity for every beam energy was checked The flatness of the uniform field was verified within +-1.5 % 290MeV/u ± 1.5% ü 150x150mm 2 field ü 2mm pitch 2017/2/23 Naoya Saotome(NIRS) ± 1.5% 18

Position monitor system Complex field Beam intensity, dose, and beam position were modulated Complex field for every beam energy was checked The dose distribution was compared with plan and confirmed 2017/2/23 Naoya Saotome(NIRS) 19 Flanz et al., PTCOG2009

Treatment planning 3D dose distribution Rectangle shape irradiation fields were planned Dose distribution on the depth and lateral direction were compared with planned dose distribution Depth dose distribution Lateral dose distribution 3D Water phantom 2017/2/23 Naoya Saotome(NIRS) 20

Beam matching Beam size matching Beam Size [mm] 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Dose of integral electrode [C] 0.0 0.2 0.4 0.6 0.8 1.0 140MeV Dose [Gy] Dose [Gy] 0.0 0.5 1.0 1.5 2.0 0.0 0.5 1.0 1.5 2.0 plan meas plan meas../data/1hc_20160222/la_pr003_111a.csv../data/2hc_20160217/la_pr003_111a.csv Lateral position [mm] 2017/2/23 Naoya Saotome(NIRS) 21 Depth [mm] BeamData_KCC20151130_inaniwa2 RID06_PMMA 20160407_rangecheck 1HC_RID06 offset= 9.1,scallcor= 1 20160407_rangecheck 2HC_RID06 offset= 9.1,scallcor= 1 20160407_rangecheck 2VC_RID06 offset= 6.3,scallcor= 1 430MeV 150 250 350 450 Energy [MeV/n] Range matching 150 155 160 1HC 2HC 2VC 0.0 0.2 0.4 0.6 0.8 1.0 Room 1 Room 2 Sample patient field for Prostate and H&N were planned The plan were deliver and measured at each treatment rooms Beam size and range matching brought dose distribution matching Prostate 100 50 0 50 100 100 50 0 50 100 Dose [Gy] Dose [Gy] 0.0 0.4 0.8 0.0 0.4 0.8 H&N plan meas../data/1hc_20160222/la_hn005bh.csv 100 50 0 50 100 plan meas../data/2hc_20160217/la_hn005bh.csv 100 50 0 50 100

Treatment planning 2Gy/L/min 2Gy of physical dose to 10x10x10cm 3 cubic target was planned The dose homogeneity was better than 2.5% 57 sec Lateral dose distribution Relative Dose [A.U.] 0 20 40 60 80 100 10mm 10mm 10mm +/-2.5% 102.5% 97.5% 100 50 0 50 100 Lateral Position [mm] 2017/2/23 Naoya Saotome(NIRS) 22

DARUMA CELEMONY 2017/2/23 23

ADVANTAGES OF GANTRY 2017/2/23 Naoya Saotome(NIRS) 25

Specification of NIRS s Gantry Function combined superconducting magnets were employed Moving target treatment is available with respiratory-gated and rescanning technique item specification Ion C 6+ Energy 48-430MeV/u Max. field 200 x 200 mm 2 Irradiation type Rotating angle Magnet type Beam orbit radius Length 3D Scanning +/- 180 degree Superconducting magnet 5.45 m 13 m 2017/2/23 Weight 300 ton Naoya Saotome(NIRS) Vender Toshiba 27

Construction and installation 2017/2/23 Naoya Saotome(NIRS) 28

installation Gantry room Treatment room 2017/2/23 Naoya Saotome(NIRS) 29

Commissioning of the Gantry NON-scanned beam test Beam data collection for TPS Beam intensity Beam size Beam position Beam divergent Beam sizegantry angle dependence Integral check depth-dose Beam on/off response Beam position Dose monitor unit Scanned beam test Beam size Dose output Scanned beam position Scanned beam position Field uniformity Complex field Dose monitor performance Position monitor performance Overall verification Interlock check Information transfer check Coordinate check End-to-End test Training for staff Beam matching 2017/2/23 Naoya Saotome(NIRS) 30

Angle dependence of the beam size Angular dependence of a beam size and shape at the isocenter (E=430 MeV/u) 180 deg 135 deg 90 deg 67.5 deg 45 deg 22.5 deg 0 deg -45deg -90deg -135deg 2017/2/23 Naoya Saotome(NIRS) 31

Angle dependence of the beam size Screen monitor for spot The accuracy of the beam size and beam position for every gantry angle were checked The measurement was performed with sequence (15min for 200Energy) Angle dependent of the beam size is less than 10% 4 Measurement sequence Lateral Beam Spread (1 ) [mm] 3 2 1 0 50 100 150 200 250 300 350 400 450 Degree 0 45 90 135 180 225 270 315 Energy [MeV/u] Naoya Saotome(NIRS) 32

Beam size Beam tuning was made for various beam energies E=430~55.6 MeV/u 3 430 MeV/u 387 MeV/u 292 MeV/u 2.5 σx σy 238 MeV/u 174 MeV/u 55.6 MeV/u 1σ beam size at Iso [mm] 2 1.5 1 0.5 0 0 50 100 150 200 250 300 350 400 450 E [MeV/u] 2017/2/23 Naoya Saotome(NIRS) 33

Angle dependence of the beam position Digital starshout device The accuracy of the isocenter position and gantry angles are checked using digital starshout device Beam position accuracy for each gantry angle was confirmed within +/- 0.5mm. 3D Water phantom Naoya Saotome(NIRS) 34

Concentric Ionization chamber Integral Dose Distribution Beam energy/range was adjusted Lateral distribution was used for TPS beam modelling Low energy 20160808_GRC_20160810030226LGRC_IDD_144_AL1cm Rad symbol means 'Over Flow' (integral) High energy 3D Water phantom Amount of ionization [C] 0e+00 2e 07 4e 07 6e 07 20160810030226LGRC_IDD_144_AL1cm 20160810033213LGRC_IDD_152_AL1cm 20160810034759LGRC_IDD_160_AL1cm 20160810040802LGRC_IDD_168_AL1cm 20160810042155LGRC_IDD_176_AL1cm 20160810043523LGRC_IDD_184_AL1cm 0 50 100 150 200 250 300 350 Moter value [mm] 0e+00 2e 07 4e 07 6e 07 drawn by RF63_IDD_forGComi_20160812_Overflow Amount of ionization [C] 0e+00 1e 07 2e 07 3e 07 4e 07 20160809052036LGRC_IDD_000_PM1m 20160809054241LGRC_IDD_008_PM1m 20160809055742LGRC_IDD_016_PM1m 20160809061159LGRC_IDD_024_PM1m 20160809062717LGRC_IDD_032_PM1m 20160809064231LGRC_IDD_040_PM1m 0 50 100 150 200 250 300 350 Moter value [mm] 0e+00 1e 07 2e 07 3e 07 4e 07 drawn by RF63_IDD_forGComi_20160812_Overflow 2017/2/23 Naoya Saotome(NIRS) 35

Dose output Dose output for every gantry angle was checked using famer type ionization chamber Angle dependence of the dose output was less than 0.5% 1.00 0.75 0.50 430 MeV/u 290 MeV/u 89 MeV/u Dose [%] 0.25 0.00-0.25-0.50-0.75-1.00 0 60 120 180 240 300 Ganrty Angle [degree] 2017/2/23 Naoya Saotome(NIRS) 36

Screen monitor for field Scanned Beam Position (-)Distortion correction Scanned beam position for every beam energy and gantry angle was checked Beam shape was adjusted as round shape at any position and any gantry angle The precision of the scanned beam position after the distortion correction was verified within 0.5 mm. (+)Distortion correction 1.5 1 0.5 FB-ON FB-OFF 0-1.5-1.0-0.5 0.0 0.5 1.0 1.5-0.5-1 -1.5 2017/2/23 Naoya Saotome(NIRS) 37

3D Water phantom 3D dose distribution Rectangle shape irradiation fields were planned Dose distribution on the depth and lateral direction were compared with planned dose distribution Depth dose distribution../result/nirsg_20170216/dd_al1c_d1rec90todd_al1c_d5rec90_g02.pdf Lateral dose distribution../result/nirsg_20170216/la_al1c_d2rec30tola_al1c_d2rec90_g02.pdf Pin-point chamber array Dose [Gy] 0.0 0.4 0.8 plan s1_plan s2_plan s3_plan s4_plan s5_plan 0 50 100 150 200 250 300 Range in water [mm] Dose [Gy] 0.0 0.4 0.8 plan s1 s2 s3 s4 s5 Lateral position [mm] 100 50 0 50 100../result/NIRSG_20170216/dd_AL1c_d1rec30todd_AL1c_d5rec30_g02.pdf../result/NIRSG_20170216/la_AL1c_d1rec30tola_AL1c_d1rec90_g02.pdf Dose [Gy] 0.0 0.4 0.8 plan s1_plan s2_plan s3_plan s4_plan s5_plan 0 50 100 150 200 250 300 Range in water [mm] plan s1 s2 s3 s4 s5 Lateral position [mm] 2017/2/23 Naoya Saotome(NIRS) 38 Dose [Gy] 0.0 0.4 0.8 100 50 0 50 100

3D Water phantom 3D dose distribution Rectangle shape irradiation fields were planned Dose distribution on the depth and lateral direction were compared with planned dose distribution Lateral dose distribution../data/nirsg_20170216/la_al1c_920070_2_pro_d3mm_0.csv../data/nirsg_20170216/la_al1c_924016_1_pro_d29mm_0.csv../data/nirsg_20170216/la_al1c_926108_1_hn_ 11175mm.csv Pin-point chamber array Dose [Gy] Dose [Gy] 0.0 0.4 0.8 0.2 0.3 0.4 0.5 0.6 plan meas Lateral position [mm] 100 50 0 50 100 plan meas 100 50 0 50 100 Lateral position [mm] Dose [Gy] Dose [Gy] 0.0 0.4 0.8 0.90 1.00 1.10 plan meas 100 50 0 50 100 plan meas Lateral position [mm] 100 50 0 50 100 Lateral position [mm] Dose [Gy] Dose [Gy] 0.0 0.4 0.8 0.6 0.7 0.8 0.9 1.0 plan meas Lateral position [mm] 100 50 0 50 100 plan meas 100 50 0 50 100 Lateral position [mm] 2017/2/23 Naoya Saotome(NIRS) 39

SUMMARY Fast scanning system dedicated for moving target was succeeded at NIRS Commercial system which is combination of a compact dissemination treatment system and pencil beam 3D scanning technique was constructed at KCC Treatment using superconducting rotating-gantry will be started in near future 2017/2/23 Naoya Saotome(NIRS) 40