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Hello and welcome to a

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new interview in medical physics

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here at the German Cancer Research Center

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in Heidelberg. In this interview, I will meet

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two PhD students here from the

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Division of Medical Physics in

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Radiation Oncology and I'm

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here in the Building Imaging and

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Radiation Oncology. Let's go

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and meet the two PhD

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students, they are waiting for us

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there.

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[Music]

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Hello! Hi Marcel! Hello! Good to see you!

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Yes, good to see you. Thanks for

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your time. Maybe you could

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introduce yourselves briefly: which of you

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is who? So I'm Rebekka, I'm doing

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my doctoral thesis here and started

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half a year ago.

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Yes, I'm Margareta. I'm also doing

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my doctoral thesis here as well and I started

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one and a half years. I have a

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physics background and I am now also

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doing my PhD in physics. Okay! We

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are here in the kitchen area and I think

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it's better if we go straight up to

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your office to continue our interview.

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[Music]

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Now we are here at

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your office. What

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working group do you actually work in

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here at the DKFZ?

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We work with special

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detectors that can make radiation visible

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and we use those in

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different ways to make

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cancer radiation more precise. Okay,

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that sounds very exciting. Then we'll start with Rebekka.

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You will show us your

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research project as well. We'll see you

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again in a moment.

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Exactly! What are you working on or what

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is your

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research project about?

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I work in carbon ion therapy.

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This is a special type of

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radiotherapy for cancer patients, and

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I want to briefly introduce what is

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special about this therapy.

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Here, we see a CT image of a

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patient, this is in the head, and the

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black circle here is the tumor.

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That's where we want to destroy the tumor

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and there is a lot of

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healthy tissue around it, which we don't want to

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want to damage. Now, there is

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a color scale, and that tells us

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in principle, how much damage

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is being done, and we can now see here,

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that with carbon ion therapy, this

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red area, the area with a lot of

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damage, is located quite well in the tumor

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and we do relatively little damage

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outside.

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And that's a huge advantage,

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but it also entails a risk, because

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if something changes in the

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patient, which you can't see from the outside,

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what you don't expect, then

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the whole setting shifts, so this whole

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color distribution shifts and then

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the red area can also end up outside the

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tumor in healthy tissue and

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we want to be able to warn.

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I am now working on a method that can warn of

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such errors, so that it

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does not happen. And how we do that

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exactly, I'll show you now

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briefly with a little animation that

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my colleague Patrice made.

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There is a patient lying on a couch here

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and he is being irradiated. This is a typical

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situation in radiotherapy. And there is

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our detector, which is behind it, and

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there are now so many small

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yellow dots in the patient. These represent

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the carbon ions, and they

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don't come out again, but they break up

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in smaller fragments and fly out again

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and then fly into our

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detector, where we measure them. If

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something changes in the patient, then

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these fragments also change

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and so we can in principle warn. And

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thus make the therapy more precise.

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Exactly, this is how we make the therapy

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more precise. That is our method.

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Thank you for the insight into your

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research. In the meantime,

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Margareta has already built something here around

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the corner. We'll go there now

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and see what she wants to show us.

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Hello, Margareta! Hi, Marcel!

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We just heard from Rebekka what

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she is working on. What are you working on in

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your doctorate? I'm working on a

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slightly different project from Rebekka,

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but I use the same detectors.

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That's why we are in the same group

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and unlike them, I don't use

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the therapy beam and then see what

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comes out of the patient again,

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but I use the beam directly

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for imaging.

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Of course, we attenuate

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the beam so that it

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does not cause so much damage to the patient

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and the radiation exposure is

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then about as high as that of a

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conventional X-ray image, so it's pretty

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low. And I brought my

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experimental setup with me today.

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The ions would now fly in from the side,

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from the side here

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fly in and then hit our

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detector, which is located here in front of the patient

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Then they would pass through the

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patient or, in our case, now this

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plastic dummy patient, because

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we use very high energies, and

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then they hit the

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rear detector,

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and depending on what the ion has seen on its

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path, whether that was bone

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or maybe a sinus,

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which just doesn't have such dense tissue,

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the ion leaves a different signal

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on our detector, and from that

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we can then create a medical image and

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this image tells us just a bit

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about how the ions interacted with the material

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and that is important

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for the therapy at the end, because we

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can learn a lot from it. In order to

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then make the therapy more precise.

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Exactly, yes. If I've understood that correctly

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you are working on

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a new

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imaging modality. Why is it

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so important that you are now developing a

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new imaging modality

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when we already have CT and MRI?

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Yes, that's a good question, because CT and

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MRI naturally provide excellent image quality

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and they are also used in

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in the clinic. We don't want to replace them at all

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so they're great

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but we think there is a small

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niche in ion beam therapy.

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What is currently being done there is that

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images are taken with

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X-rays, because you want an accurate

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picture of the anatomy of the

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patient, the tumor and so on, and

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then, we plan for each patient,

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how the therapy should proceed,

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and this image actually shows how

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the patient interacts with X-rays.

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But what we need to know

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is how ions interact with the patient

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and currently the only way to do that

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is that this is simply translated,

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but the processes that take place are

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so complex that it actually

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cannot be translated into a simple translation.

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And so uncertainties

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become quite large and that the

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radiation is less precise than it

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could be, and therefore it is

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actually much smarter to use ions for

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imaging as well

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if you also use it for radiation.

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We have the process here

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of a radiation treatment shwon very schematically.

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Can you prescribe

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and explain where you would position your research here

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even if it is very

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far away from clinical reality

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or whether it is actually very close to

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clinical reality.

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So I can say that we are currently working very

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experimentally. So we are

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not yet at the point where we can go to the

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clinic, but I can

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nevertheless say where we might be

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in a few years. Exactly.

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So first of all, I can say: okay,

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Imaging is, of course,

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exactly what we do, but here in

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this chain

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I think

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CT imaging is meant, which is done just before

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the radiation.

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We would actually like to intervene at the point

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where the patient is positioned

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because we also want to use our image

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to re-position the patient

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but at the same time

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we also want to offer

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quality assurance measurements with our

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image, so at the last point

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of this chain,

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but early in this process,

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just at this point. This helps

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to understand where your research

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can then be categorized.

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And here is also

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Rebekka again. Maybe you can

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also briefly

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explain where you would prescribe your research here

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on the radiotherapy process?

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Yes, well, we are still in the process of

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investigating our method,

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so it is not in the

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clinical routine, but we are already doing

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a clinical study with patients, which

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means we are perhaps already a

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bit closer to this chain and

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I would say now, at this

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overlap between treatment and

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verification.

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So the idea of our method is

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of course a verification of the

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treatment, whether something has unexpectedly changed

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in the patient,

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but we measure during

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the treatment and can give very direct

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feedback every day, and can

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verify every day how the

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treatment has expired.

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You just mentioned that you do regular

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checks every day, why not

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just do a CT image every day?

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Why do you need your new

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detectors? Yes, first of all,

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here at HIT, where this carbon ion therapy

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is performed,

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this method is not used yet.

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So a CT scan is not done every day

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of the patient. You can now

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of course ask if we introduce a daily

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verification, we can

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of course either introduce a daily CT

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or our method.

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Our method already has many advantages because

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our method means no

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additional radiation exposure for the

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patient. This is probably the

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most important point, because we simply

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measure radiation during therapy

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that is there anyway, that flies

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anyway during the therapy in the room,

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and we get it basically for free,

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and besides, a CT of course means

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once again, the patient has to go

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somewhere else, he has to lie down again,

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lies down again and has to be repositioned.

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That also takes time. Okay, it

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is then easier to

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use your detector because it

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already measures something that

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is already there anyway. Exactly, they

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can be very well integrated into the

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treatment process.

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Thank you both for giving us a

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look at your research.

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If you think back over the last few months

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when you were studying here at the DKFZ,

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what was your highlight?

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Well, for me, it's actually over a

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larger time period, a real

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highlight for me is

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that we are now

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doing a clinical study, and there

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years of research by this

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working group, that we are now

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can do this, and this is a totally

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exciting phase in research because

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we can now see what it would really look like in

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everyday clinical practice, and

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I am now allowed to get involved and

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do research here, I think that's

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totally great. What fascinates you about

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medical physics field? Well, first of all,

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I find it a totally fulfilling job,

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because at the end of the day you always

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know what you're doing it for. You want to

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do research somehow to improve the treatment of

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cancer patients. And then

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I also think it's really nice that it's

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is so interdisciplinary.

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I work together with computer scientists,

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biologists, with people from the clinic,

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engineers and so on,

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and that often forces you

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to somehow take a different

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perspective,

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and I just think that is

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always profitable. And especially

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for my project, I think it's really

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nice to have such a colorful everyday life.

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So I do everything myself, from the design

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of the experiment to the construction.

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I also talk to

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the engineers here, who then do

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3D printing or something. I do my

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experiments at the Heidelberg

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ion beam therapy center and then I evaluate

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them too. I also have to

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program, for example. So it's just very

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varied, I like that.

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Do you perhaps have some tips

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for young people

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who have now graduated from high school

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or maybe they have just started

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studying physics and

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maybe they are a bit unhappy.

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Why should they

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maybe consider entering the field of

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medical physics?

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I have to say that my

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fascination with medical physics

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actually comes from very similar aspects that

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Margareta just described.

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And I originally studied

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pure physics, even until

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before my master's thesis.

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So, I only switched to medical physics for my master's thesis

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and for me it was also very good

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because I was able to learn more about

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physics and different areas

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and to find out

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what suits me best, and now

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I've just found medical physics and

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I think it's great and I think physics

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is a good degree for this, to still

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have flexibility, but I think

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it's great when young people also know

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early on that they want to go into

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medical physics, then I think it's a

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really great thing that there are now

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these specialized courses,

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where you can start directly with medical physics.

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Okay, thank you very much

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both of you for your time and for the

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insights into your research.

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[Music]