Evaluation of STPA in the Safety Analysis of the Gantry 2 Proton Radiation Therapy System Martin Rejzek, Paul Scherrer Institute, Switzerland
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1 Evaluation of STPA in the Safety Analysis of the Gantry 2 Proton Radiation Therapy System Martin Rejzek, Paul Scherrer Institute, Switzerland STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 1
2 Agenda Proton Therapy at the Paul Scherrer Institute, Switzerland Evaluation of STPA for the Advanced Scanning Technique Scope of the Project Examples Conclusions STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 2
3 Proton Therapy at the Paul Scherrer Institute, Switzerland STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 3
4 PSI Center for Proton Therapy 250 MeV Proton accelerator (superconducting cyclotron) Beamlines to 4 user areas OPTIS Gantry 1 Gantry 2 Experimental area STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 4
5 Gantry 1 Sweeper magnet (1 dimension) Beam enters rotating Gantry Dose monitoring Range shifter STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 5
6 Gantry 1 Spot Scanning Technique Elements of spot scanning: Beam on/off 50 µs Sweeper magnet 5 ms/step Range shifter 30 ms Patient table 1 cm/s spots to treat 1 liter volume STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 6
7 Gantry 2 Beam enters rotating Gantry Sweeper magnets (2 dimensions) Dose monitoring STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 7
8 Gantry 2 Advanced Scanning Technique Advanced scanning: Increased speed Increased flexibility New treatment modalities STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 8
9 Evaluation of STPA for the Advanced Scanning Technique STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 9
10 Scope of this Project Safety analysis done with classical methods Evaluation of STPA as supplementary method for advanced scanning explored different approaches considered different parts of whole facility Few examples: 1) STPA during workshops 2) How to model controllers that can insert veto 3) What is the reference for inadequate timing and the Thomas process Treatment Facility Irradiation Patient Treatment Operator Nurse STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 10
11 Evaluation of STPA for the Advanced Scanning Technique 1) Performing STPA during workshops STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 11
12 Recipe for a STPA Workshop Step 1 Performing STPA analysis during workshop with engineers Preparation: Hierarchical control structure / high-level hazards Table with guidewords STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 12
13 Recipe for a STPA Workshop Step 2 Performing STPA analysis during workshop with engineers Preparation: Hierarchical control structure / high-level hazards Table with guidewords Reduced process loop Influence1 Influence2... Controller (1) Control Algorithm (relevant part) Var1 Var2... Param1 Param2... (3) Sensor 1 (2) Controller / Actuator Param1 Param2... Var1 Var2... Var1 Var2... Param1 Param2... (3) Sensor STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 13
14 Recipe for a STPA Workshop Classification Work in progress! UCA = Unsafe Control Action PV = Process Variable STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 14
15 Evaluation of STPA for the Advanced Scanning Technique 2) How to model controllers which can insert veto STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 15
16 Controllers that can insert Veto Typical Situation: One Treatment Delivery System (TDS) Treatment Delivery System In Proton Therapy: One source of beam for all treatment areas Intensity Controller Dose Controller various actuators and sensors Patient Treatment STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 16
17 Controllers that can insert Veto First approach: Second approach: Beam Allocator Other Areas Treatment Delivery System Req. Master Set Intensity Set Intensity Other Areas Treatment Delivery System Beam Allocator Dose Controller Intensity Controller Intensity Controller Dose Controller various actuators and sensors various actuators and sensors Patient Treatment Patient Treatment STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 17
18 Evaluation of STPA for the Advanced Scanning Technique 3) What is the reference for inadequate timing STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 18
19 Reference for Inadequate Timing Dose Beam Patient Personnel Start null off Personnel brings patient and installs him null off Personnel leaves room null off Turn beam on Pres. dose reached? accumulating on yes Turn beam off prescribed dose reached prescribed off Personnel enters room prescribed off Personnel takes patient out prescribed off End STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 19
20 Reference for Inadequate Timing too early Dose Beam Patient Personnel Start null off Personnel brings patient and installs him Personnel leaves room Turn beam on null off accumulating on X accumulating on Turn beam on Pres. dose reached? accumulating on yes Turn beam off prescribed dose reached prescribed off Personnel enters room prescribed off Personnel takes patient out prescribed off End too late STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 20
21 Conclusions STPA is a very useful method Results achievable in straitforward way and rather short time Feasible to perform with non safety experts Discussion points raised for components not yet developed Next steps Finish this project Compare Results with those of existing safety analysis hopefully continue with STPA method STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 21
22 Acknowledgments Prof. Dr. Nancy Leveson Blandine Antoine Massachusetts Institute of Technology, US Prof. Dr. Christian Hilbes Zurich University of Applied Sciences, CH Dr. Martin Grossmann Dr. David Meer Center for Proton Therapy Paul Scherrer Institute, CH Contacts: Dipl. el. Ing. FH Martin Rejzek Prof. Dr. Nancy Leveson Blandine Antoine Dr. Christian Hilbes Dr. Martin Grossmann Dr. David Meer STAMP/STPA Workshop - Massachusetts Institute of Technology - April 17-19, (c) copyright by PSI, 2012 Page 22
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