732
M. Dohlus et al.
Not linked to NIRS developments is the synchrotron-based facility of HIBMC
in Hyogo, which was developed by Mitsubishi and is in operation since 2001. This
was the first clinical centre featuring dual modality, protons with energy between
70 MeV and 230 MeV and carbon ions between 70 MeV/u and 320 MeV/u.
Today the five carbon-ion therapy centres in operation in Japan treat, combined,
more than 2000 patients each year, with a total at the end of 2016 of 18,000
treatments [92].
Built by Siemens Medical, the centre of HIT in Heidelberg applies the competences developed by GSI for its pilot project including the active scanning
capabilities. This is the first dual centre featuring a gantry. Its construction has been
a real challenge since it weighs 600 tons and consumes, at maximum energy, about
400 kW. The dual centre of Magburg was initiated as the second centre of Siemens
Medical, and, when the company withdrew from hadron therapy it was bought by
Marburger Ionenstrahl-Therapiezentrum which recommissioned and started treating
patients in 2015.
In 1996 the Proton Ion Medical Machine Study (PIMMS) [93] was initiated at
CERN with the participation of TERA Foundation (Italy), MedAustron (Austria),
and Oncology 2000 (Czech Republic) to study a proton and carbon-ion accelerator
for the therapy. The project of the high-tech part of the Centro Nazionale di
Adroterapia Oncologica (CNAO)—shown in Fig. 11.29—is due to the TERA
Foundation [94] which in 2002 obtained the financing of the centre by the Italian
Health Minister. The synchrotron, features a unique ‘betatron core’ to obtain a
very uniform extracted beam. The centre, built in Pavia, treated the first patient
with protons in 2011, a year later, treated the first patient with carbon ions. The
MedAustron centre built in Wiener Neustadt, uses the synchrotron design of CNAO
and treated the first patient with proton beams in December 2016.
A new carbon-ion therapy facility is under construction in China (HITFil,
Lanzhou). A dual center will be operational starting in 2018 in South Korea
(KIRAMS, Busan). By the year 2020 two more carbon-ion centres will be operational in Japan, in the cities of Osaka and Yamagata. All these centers are based on
synchrotrons.
Dose Distribution Systems
In order to maximize the outcomes of the therapy, the optimal hadron accelerators
systems should deliver a biological equivalent dose defined with an uncertainty
lower than 5% to tumour volumes that varies from few cubic milliliters up to 2 L
preserving as much as possible the healthy surrounding tissue. The desirable dose
rate is 2 grays/min/L, where 1 Gy = 1 J/kg.
Till the end of the last century, in all facilities, except PSI, the conformation
of the dose to the tumour was realized with ‘passive’ dose delivery systems,
using individually machined collimators, boluses, and passive absorbers to spread
longitudinally the Bragg peak. With this technique, which is still widely used, the
same spread out Bragg peak applies to the whole transversal section of the tumour,
so that large volumes of healthy tissue, that surrounds the tumour, are exposed to
the same dose as the tumour tissues.
M. Dohlus et al.
Not linked to NIRS developments is the synchrotron-based facility of HIBMC
in Hyogo, which was developed by Mitsubishi and is in operation since 2001. This
was the first clinical centre featuring dual modality, protons with energy between
70 MeV and 230 MeV and carbon ions between 70 MeV/u and 320 MeV/u.
Today the five carbon-ion therapy centres in operation in Japan treat, combined,
more than 2000 patients each year, with a total at the end of 2016 of 18,000
treatments [92].
Built by Siemens Medical, the centre of HIT in Heidelberg applies the competences developed by GSI for its pilot project including the active scanning
capabilities. This is the first dual centre featuring a gantry. Its construction has been
a real challenge since it weighs 600 tons and consumes, at maximum energy, about
400 kW. The dual centre of Magburg was initiated as the second centre of Siemens
Medical, and, when the company withdrew from hadron therapy it was bought by
Marburger Ionenstrahl-Therapiezentrum which recommissioned and started treating
patients in 2015.
In 1996 the Proton Ion Medical Machine Study (PIMMS) [93] was initiated at
CERN with the participation of TERA Foundation (Italy), MedAustron (Austria),
and Oncology 2000 (Czech Republic) to study a proton and carbon-ion accelerator
for the therapy. The project of the high-tech part of the Centro Nazionale di
Adroterapia Oncologica (CNAO)—shown in Fig. 11.29—is due to the TERA
Foundation [94] which in 2002 obtained the financing of the centre by the Italian
Health Minister. The synchrotron, features a unique ‘betatron core’ to obtain a
very uniform extracted beam. The centre, built in Pavia, treated the first patient
with protons in 2011, a year later, treated the first patient with carbon ions. The
MedAustron centre built in Wiener Neustadt, uses the synchrotron design of CNAO
and treated the first patient with proton beams in December 2016.
A new carbon-ion therapy facility is under construction in China (HITFil,
Lanzhou). A dual center will be operational starting in 2018 in South Korea
(KIRAMS, Busan). By the year 2020 two more carbon-ion centres will be operational in Japan, in the cities of Osaka and Yamagata. All these centers are based on
synchrotrons.
Dose Distribution Systems
In order to maximize the outcomes of the therapy, the optimal hadron accelerators
systems should deliver a biological equivalent dose defined with an uncertainty
lower than 5% to tumour volumes that varies from few cubic milliliters up to 2 L
preserving as much as possible the healthy surrounding tissue. The desirable dose
rate is 2 grays/min/L, where 1 Gy = 1 J/kg.
Till the end of the last century, in all facilities, except PSI, the conformation
of the dose to the tumour was realized with ‘passive’ dose delivery systems,
using individually machined collimators, boluses, and passive absorbers to spread
longitudinally the Bragg peak. With this technique, which is still widely used, the
same spread out Bragg peak applies to the whole transversal section of the tumour,
so that large volumes of healthy tissue, that surrounds the tumour, are exposed to
the same dose as the tumour tissues.