Present & Future of Accelerators for Hadrontherapy

1. Present & Future of Accelerators forHadrontherapy A. Faus-Golfe IFIC-IFIMED IFIMED'09 Symposium

2. electron “e” “hadrons” are made of quarks atom carbon ion = 6 protons + 6 neutrons Proton or neutron quark “u” or “d” “Hadrontherapy” is a collective word It covers therapy with beams of particles made of quarks: neutrons protons pions helium, lithium, boron, carbon, oxygen … ions antiprotons IFIMED'09 Symposium

3. Outline • The Early years • The Present of Hadrontherapy • Proton Facilities • Ion Facilities • The Future and the Dreams IFIMED'09 Symposium

4. Outline • TheEarlyyears • ThePresent of Hadrontherapy • ProtonFacilities • Ion Facilities • TheFuture and theDreams IFIMED'09 Symposium

5. The Early years At the beginning most of the patients have been treated in research facilities, where parasitic beams were devoted for relatively short periods to the treatments. Only in the nineties dedicated based facilities have entered in use. IFIMED'09 Symposium

6. R. Stone at the 60- inch cyclotron 1935: Ernest and John Lawrence at the control of the 27-inch cyclotron Neutrontherapy at Berkeley Single deeis 5-inch diameter IFIMED'09 Symposium

7. 1943 - Harvard Founder and first director of Fermilab - 1990 Hymer Friendell Bob Wilson Percy Bridgeman Protontherapy 1946 R.R. Wilson proposes the use of protons for teletherapy 1954 First irradiations in Berkeley 1961 New Harvard cyclotron irradiates patients IFIMED'09 Symposium

8. Bőrje Larsson at Uppsala “On the Application of a 185 MeV Proton Beam to Experimental Cancer Therapy and Neurosurgery” Doctoral dissertation - 1962  The modified synchrocyclotron (1931-1998) Protontherapy in Europe IFIMED'09 Symposium

9. SuperHILAC UNILAC Bevatron Ion therapy – 1974-92 Cornelius Tobias 1918 - 2000 IFIMED'09 Symposium

10. 30 years of pioneering protontherapy in physics labs Lawrence Berkeley Laboratory USA 1954 Uppsala Sweden 1957 Harvard Cyclotron Laboratory (*) USA 1961 Dubna Russia 1964 Moscow Russia 1969 St. Petersburg Russia 1975 Chiba Japan 1979 Tsukuba Japan 1983 Paul Scherrer Institute Switzerland 1984 (*) 9,116 patients were treated with protons before the laboratory closes in 2002 IFIMED'09 Symposium

11. 1992-1994: the turning years 1993 Como, Italy First International Symposium on Hadrontherapy • 1992: Loma Linda treats first patient with protons • 1993: MGH selects IBA for first commercial centre • 1993: At GSI the ‘pilot project’ is approuved • 1994: HIMAC treats the first patient with C ions IFIMED'09 Symposium

12. Outline • TheEarlyyears • ThePresent of Hadrontherapy • ProtonFacilities • Ion Facilities • TheFuture and theDreams IFIMED'09 Symposium

13. The Present of Hadrontherapy Nowadays proton therapy is a mature field, many firms are competing to offer more and more reliable proton facilities and also the production of accelerators for light-ion therapy is rapidly increasing IFIMED'09 Symposium

14. Hadrontherapy in the world Hadrontherapy in the world IFIMED'09 Symposium

15. The Present Accelerator Technology • Proton Therapy • Cyclotron based • Synchrotron based • Ion Therapy • Synchroton based IFIMED'09 Symposium

16. Outline • TheEarlyyears • ThePresent of Hadrontherapy • ProtonFacilities • Ion Facilities • TheFuture and theDreams IFIMED'09 Symposium

17.  5 companies offer turn-key centres PT center in operation PT is booming IFIMED'09 Symposium

18. The Accelerator is a very small part of a PT center • A Proton therapy system is much more than an accelerator • It is most often a complex, multi-room treatment system • The treatments rooms are larger than the cyclotron/synchrotron vault • Half of the total investment is for the equipment IFIMED'09 Symposium

19. A typical Cyclotron PT center Beam Transport Cyclotron 4 m Irradation systems: Fixed Irradation systems: Rotating Gantries IFIMED'09 Symposium

20. Cyclotons marked the PT Cyclotron Proton Therapy Centers IFIMED'09 Symposium

21. Cyclotrons for PT • In the 90’s the consensus was that the best accelerator for PT was a synchrotron • However today the majority of the PT centers use the cyclotron technology (IBA, Varian, Still Rivers…) • Over these 15 years, users appreciated the advantages of cyclotrons: • Simplicity • Reliability • Lower cost and size • Most importantly the ability to modulate rapidly and accurately the proton beam current • But fixed energy… IFIMED'09 Symposium

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25. Synchrotrons for PT • Slow Cycle Synchrotron • Variable energy operation • Modified Flat-Top operation • Easy dose management • Relatively low intensity • Some PT centers use the synchrotron technology (Hitachi, Mitsubishi…), but all the IT centers use synchrotron • Possibility of PT/IT with the same accelerator IFIMED'09 Symposium

26. PT/IT centers in Japan based on synchroton H: HITACHI M: MITSUBISHI IFIMED'09 Symposium

27. A typical Synchroton PT center Courtesy of HITACHI 7 m (Slow Cycle) IFIMED'09 Symposium

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31. PT Centers in Europe PSI Villigen CPO Orsay PNPI St. Petersburg NCRH Krakow TSL Uppsala INFN-LNS Catania RPTC Munich WPE Essen Worth mentioning: IFIMED Valencia, ATREP Trento… IFIMED'09 Symposium

32. Outline • TheEarlyyears • ThePresent of Hadrontherapy • ProtonFacilities • Ion Facilities • TheFuture and theDreams IFIMED'09 Symposium

33. Synchrotrons for IT • Slow Cycle Synchrotron • Variable energy operation • Modified Flat-Top operation • Easy dose management • Relatively low intensity • All IT centers use the synchrotron technology • Possibility of PT/IT with the same accelerator IFIMED'09 Symposium

34. A typical Synchrotron IT center Courtesy of SIEMENS 22 m IFIMED'09 Symposium

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38. IT Centers in Europe HIT Heilderberg CNAO Pavia Med-AUSTRON Viena ETOILE Lyon PTC Marburg NRoCK Kiel Worth mentioning: RPTC-2 Koeln, MAASTRO The Netherlands, BHTC Belgium, Nordic Light Ion Project Sweden… IFIMED'09 Symposium

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41. Outline • TheEarlyyears • ThePresent of Hadrontherapy • ProtonFacilities • Ion Facilities • TheFuture and theDreams IFIMED'09 Symposium

42. Cyclotron Alternatives IFIMED'09 Symposium

43. Cyclotron Alternatives Theenergy can bevaried 1-2 ms in the full rangebychangingthepower pulses senttothe 16-22 accelerating modules IFIMED'09 Symposium

44. Cyclotron Alternatives Cyclinac for Carbon ions IFIMED'09 Symposium Carbon Booster for Therapy in Oncology

45. Cyclotron Alternatives IFIMED'09 Symposium

46. Synchrotron Alternatives IFIMED'09 Symposium

47. Alternative Accelerators • RF Linacs: • energy control in the accelerator itself: • S-Band: • ACLIP Side Couple LINAC (3GHz, 20 MeV/m, 30 MeV injection Energy, 62 MeV final energy) INFN Catania • IDRA project (3 GHz, 30 MeV injection Energy) TERA Foundation/ADAM • X-Band: • US High-gradient collaboration (injection energy 70 MeV , 250 MeV final energy) SLAC IFIMED'09 Symposium

48. Alternative Accelerators IFIMED'09 Symposium

49. Alternative Accelerators Dielectric Wall Accelerators IFIMED'09 Symposium

50. Alternative Accelerators IFIMED'09 Symposium