ENLIGHT ++

08 November 2006 ENLIGHT++ for KnowARC project 1

ENLIGHT ++

Proton and Ion Therapy“e”-infrastructure for health; “e” for “enhanced,

enabled, excellent”example of choice: Hadrontherapy

Hans F. Hoffmann-PH/CMO


What is Health

DefinitionHealth is a state of complete physical, mental and social well being and not only the absence of disease or infirmity

WHO Constitution: The enjoyment of the highest attainable standard of health is one of the fundamental human rights of every human being without distinction for race, religion, political belief, economic or social condition

WHO MissionThe attainment by all peoples of the highest possible level of health


Prospective for cancer therapy…

Primary tumour Metastasis

Surgery

Medical treatments Hormones; Chemotherapy;

Immunotherapy; Cell therapy; Genetic treatments…

Radiotherapy

Novel specific targets (genetics..)

Conformal RT

High LET particles

Local controlSurvival

Quality of life

(?)


Hadrontherapy vs. Conventional radiotherapy

Physical dose high near surfaceEffect not localisedBiological effect constantEffective in well oxygenated cells

Dose highest at Bragg PeakEffect is localisedDNA damage less repairable Biological effect highest at maximum depth Effective in poorly oxygenated cells (carbon)

Photons and Electrons vs. Hadrons (protons or light-ions)

Bragg Peak

proton

carbon ion


Hadron therapy

charged hadron beam

that loses energy in matter

28 cmtumour

target

200 MeV200 MeVProtonsProtons

//

480 MeV480 MeVcarbon ionscarbon ions

Photons ProtonsX raysprotons or

carbon ions

GSI

Protons: ocular melanomas, base skull tumours, cancers close to the spinal cordcyclotrons ~ 3-4 m diameter synchrotrons ~ 6-8 m diameter

Carbon ions: subset of patients with radio-resistant tumors synchrotrons ~ 20-25 m diameter

GSI


Numbers of potential patients

From studies in Austria, France, Germany and Italy

X-ray therapy

every 10 million inhabitants 20'000 pts/year

Proton therapy

12% of X-ray patients 2'400 pts/year

Therapy with Carbon ions for radio-resistant tumour

3% of X-ray patients 600 pts/year

TOTAL of hadron therapy every 10 M

about 3'000 pts/year


Hadron therapy status

1954 the first patient treated with protons at the 1954 the first patient treated with protons at the University of California, Berkeley, USA University of California, Berkeley, USA

By 2005 about 50000 patients treated. By 2005 about 50000 patients treated.

Europe is moving coherently towards the realisationEurope is moving coherently towards the realisationof a network of Hadron therapy Centres with of a network of Hadron therapy Centres with 1212C C beams:beams:

The two first ones in Heidelberg and Pavia are foreseen to The two first ones in Heidelberg and Pavia are foreseen to start operation in 2007start operation in 2007France and Austria (approved), MarburgFrance and Austria (approved), MarburgSweden, Belgium, Netherlands, Spain, UK ………..Sweden, Belgium, Netherlands, Spain, UK ………..

Japan has 2 carbon facilities and 4 proton facilitiesJapan has 2 carbon facilities and 4 proton facilities

USA has 2 running proton facilities and various others USA has 2 running proton facilities and various others being plannedbeing planned


Provide the irradiation technology and the detection systems to optimally use the advantageous properties of heavy charged particles in external radiotherapy

Optimize dose to tumour conformity by beam scanning and adaptation of the delivery to the organ motion

Treat > 1000 patients per year and perform clinical trials using low-LET (p, He) and high-LET (C, O) beams

Conduct technical, physical and clinical R+D

Hadrontherapy goals

tumour-conformaldose distribution

organs at risk

tumour


What is ENLIGHT

2002-2005 ENLIGHT (European Network for Light Ion Therapy)

ENLIGHT was composed of: Centres in Heidelberg, Lyon, and Pavia, CERN, EORTC, ESTRO, GSI, Karolinska, MedAustron, TERA

Main achievements:•Creation of a European Hadron therapy Community

•Common multidisciplinary platform with a shared vision

•ENLIGHT catalysed the transition from research to the clinical environment

•Served as a vehicle for education and dissemination


What is ENLIGHT++

In 2006 ENLIGHT++:

+ one “plus” for more hadrons (specifically protons),

++ the second “plus” refers to more Countries (17 countries,

with 60 Institutions

ENLIGHT++ goes beyond being a network:

Main Objective: challenge for quality and success by being more inclusive and

becoming a research network and an FP7 project


Present European projects on the same scale

ETOILE

HICAT

CNAO / TERA

MedAustron


ENLIGHT++ strengths

Success of original ENLIGHT and other pre-existing co-operation

Top research institutes

Scientists working at the cutting edge of knowledge and technologies

Expectations of cancer patients


ENLIGHT++ ingredients

Networking light ion research:

Clinical StudiesRadiobiology Treatment planning for Intensity Modulated Particle Therapy Adaptive ion therapy and treating of moving organs Novel in-beam PET systemsFeasibility study for innovative gantry designs Information and Communication Technologies for Hadron therapy (this presentation!)


Outlook

Particle therapy will cover the full spectrum of radiotherapeutical indications

Per 10 million inhabitants one particle therapy facility may be required

Treatments will be fully accepted by the health insurance systems

Pilot “European application of e-Health”?


ENLIGHT++ challenge

A heterogeneous group - 7 different disciplines-

How to a balance between basic research and the clinical needs?

Many partners. How to collaborate effectively and make progress with the main objectives

Is ion therapy more effective? Will practice validate the theory?

Here: Is Hadrontherapy particularly appropriate for a pilot ICT e-health infrastructure??


e-Health: Health Care enhanced by ICT

“e-Health”, Healthcare “enhanced” by ICT, deals with the use of ICT to develop intelligently connected infrastructures (very likely “ grids”) that provide:"the right information, at the right time, in the right place"

For ubiquitous management of citizens’ healthTo assist health professionalsTo integrate advances in health knowledge into clinical practiceTo streamline the citizens' healthcare system and To empower the patients to take informed decisions for their well-being

e-Health is an obvious necessitye-Health is also excellent business


There are many issues

“in the German Health care system every institution in itself is an isolated solution, partially in line with the latest scientific research, but singular. As a rule, the limits of ICT are reached where the resources of one’s own institution are exhausted” (BM Gesundheit)

Making data available in electronic patient recordsSecurity, authentication, access control, anonymity...Using the same vocabularies, ontologies...Provision of sufficient computers and networking infrastructure to Doctor’s practices and hospitalsClinical data restrictions, FDA, (21 CFR part 11...), Also , national practices, . . .Adopting ideas of Collaboration in the Health community and many other issues...But the promise is great... ...and the time is right


Ingredients of e-health infrastructure

e-health infrastructure itemsPatient cardSpecialist cardPatient file PrescriptionMobile diagnostics attached to patients (RFID, Bluetooth, GSM, . . .)Referral system between hospitalsSecurity, privacy, . . .Distributed data storageStandardised data curationStandard interfacesComputersNetworksPatient empowermentNetworked solutions

HealthGrid: Research Vision

An environment, created through the sharing of resources, in which heterogeneous and dispersed health data :

molecular data (ex. genomics, proteomics)cellular data (ex. pathways)tissue data (ex. cancer types, wound healing) personal data (ex. EHR)population ( ex. epidemiology)

as well as applications, can be accessed by all users as an tailored information providing system according to their authorisation and without loss of information.

Knowledge GridIntelligent use of Data Grid for knowledge creation and tools

provisions to all users

Data GridDistributed and optimized storage of

large amounts of accessible data

Computing GridFor data crunching applications

HealthGrid: State-of-the art and next steps

Computing Grid

Data Grid Knowledge Grid

Image storage and accessibilityEx.: MammoGrid

Modeling, simulation, algorithmsEx.: Gemss, Data Grid, CrossGrid

Image analysisEx.: MammoGrid

Bio-informaticsEx. BioGrid

Drug discovery

Disease related Grids

Radiotherapy

Real time operational assistance

Epidemiology

Current applicationsNext application fields

HealthGrid: Research Challenges

Highly Distributed sources of health data, with strong privacy rules Semantic integration - building on the results related to interoperability of Electronic Health Records and research data Algorithms for search, data mining and knowledge retrieval based on advances in language understanding

Privacy and Security Adopting existing solutions to the Grid High reliability of system must be proven

User friendliness and acceptance Need to provide fast and easy to use tool at the point of need Very heterogeneous user community - health professionals,

researchers, authorities, patients Organizational and cultural issues related to new ways of working and virtual collaborations

From technology to a solution in Healthcare Political awareness and understanding Business models Legal and ethical issues

HealthGrid: Implementation questions

1) What could be the role of HealthGrid in meeting the challenges in managing the the rising costs, growing demands from consumers (patients; citizens) and demographic changes, aging population?

2) Can HealthGrid play a role as an enabling tool for reorganisation of the healthcare systems and can the needed training be provided ?

3) How can we assure a maximal user acceptance and user friendly technologiesand standards ?

4) What is needed in order to be able to promise respect of legal, security and privacy ? Do we have convincing proofs today or is there still homework to be done ?

5) Can we convince industry to invest in HealthGrid and which part of it ?

6) Can HealthGrid find its place in the general strategy of health informationnetworks ? Can it become a leader ?

7) Can HealthGrid find its place in the general strategy of online health services ?


WP 7 – ICT Network for Particle Therapy

ENLIGHT++ - Meeting, CERN, March 24th, 2006

Reflections on requirements of e-hadrontherapy

(T. Auberger‘s (radio-onkologist‘s) slides)

Requirements are the domain of the users of a project:What to achieve

Specialists: How to do it

Execution: in continuous collaboration


network of European ion therapy centres

national network between user groups and a central ion therapy centre

Two Versions of Network for Particle Therapy


Questions

Why do we need a network?What is necessary for an European network and for a national network ?What do we have to do?Proposals ?What do we need for our work ?


Why do we need a network?

I) European Network of Ion Therapy Centres

Communication between European ion therapy centresVideo conferences replace meetingsExchange of know howMutual treatment strategies and protocols

Exchange of technical parameters Unique definition of treatment parametersStandardized technical parameters




Preparation of clinical multi-centre trialsInput of patient and treatment data, diagnostic imaging, image fusion, comparisons of treatment planningonline planning

Mutual data libraryrare tumour entitiesunique statistics




Coordination of non clinical researchMutual scientific proposalsDistribution of beam time and programmes

(i.e. for radiobiological research of countries which don’t have facilities)



II) National network between user groups and a central ion centres (1)

Information and training of users (peripheral hospitals)Definition of standards on diagnostic and clinical preparation of patientsNationwide and bilateral video tumour boardsRapid exchange of patient and treatment data (mutual electronic patient files?)



II) National network between user groups and a central ion centres (2)

Adjustment of treatment modalities in combined therapy regimes

(summarizing doses from different treatment plans, online treatment planning )

Patient preparation and follow-up under observation of ion centres

National tumour libraries


What is necessary for an European network and for a national network ?

Common structure in medical and scientific strategyUnique acquisition of patient and treatment dataUnique definition of beam and planning dataEuropean clinical study protocols

Necessary technical supportTelecommunication systemsUnique electronic patient files ?unique treatment planning systems ?image data and planning data transferone mutual definition on software for international trials


What do we have to do?

Medical and scientific structure

Evaluation of the national medical infrastructure in various European countries

Technical solution, which regards this existing infrastructure or alternative ways



Medical and scientific Structuremutual treatment strategies and guidelines for preparation of patients, diagnostics, follow-uppreparation of unique clinical trials regarding system not contents (protocols) ?tumour libraries (indications? –what has to be stored and how?)organisation of non-clinical research

(if appreciated?)



Evaluation of national medical infrastructure in various European countries

video tumour boardsorganisation of patient preparation and follow-updocumentation of treatment resultsdata formatspatient files and imaging data (storage, transfer)electronic communication systemsCompatibility of treatment planning systems electronic epidemiologic registriesSoftware for support of clinical studies (ARCS ?, other

commercial and non-commercial systems?)



Technical solution

commercial and non commercial systems (advantages and disadvantages)

costs and requirements of installationcompatibility with existing infrastructure and

running or planned technical equipment


Proposals

Learn from - integrate existing projects:MammogridHealth-e-child . . .


What do we need ?

Experts/scientific assistants onradio oncologymedical physicsICT

Reimbursement ofTravelling costsCommunication costsSoftware/hardware ?

(hfh): Connect “stand alone” solutions, solve, satisfy:Private interests of firms providing case solutionsLimited/local perspective of the usersIP


Conclusion for Enlight++ e-infrastructure

There are various reasons to build up an international network and national networks as well

Step 1 - (medical point)development of a common medical and scientific strategy

Step 2 – (medical, technical)evaluation of current national infrastructure

Step 3 – (technical)evaluation of a technical solution for an international network which goes ahead with national development

Step 4 – (medical, technical)pilot projects which will prove the efficiency of proposed solutions

Documents

ENLIGHT ++