ORIGINI E SVILUPPI DELL ’ADROTERAPIA (*) IN ITALIA · Fisica Medica in Lombardia - 23.5.07 - U....

Fisica Medica in Lombardia - 23.5.07 - U. Amaldi 1

ORIGINI E SVILUPPI DELLORIGINI E SVILUPPI DELL’’ADROTERAPIA (*) IN ITALIAADROTERAPIA (*) IN ITALIA

UgoUgo AmaldiAmaldi

(*) Termine collettivo che copre tutte le terapie basate su particelle fatte di quark:

neutroni veloci, BNCT, pioni, protoni, ioni leggeri (C), alfa per alfa-immunotherapy, antiprotoni, …


PrehistoryPrehistoryG. Tosi:

1964 in "Energia Nucleare" , CISE

"Gli acceleratori di particelle in radioterapia“

betatrons for electrons and synchrotrons for protons.

E. Fiorini:

1974 in “Giornale di Fis. San. e Prot. delle Radiazioni”

“Nuovi mezzi strumentali per le applicazioni mediche delle particellead altissima energia”


My view of the Italian developments My view of the Italian developments

Discussions in the years 1988-1990 between G. Tosi and U.A. while meeting at Via Celoria when giving the courses to the students of

Scuola di Specializzazione in Fisica Sanitaria e Ospedaliera

September 1991 INFN finances ATER at INFN-Milano to design the ion accelerator

October 1992 Creation of TERA foundation (U.A., E. Borgonovi, G. Tosi, G. Vanolo)

1992- 2000 INFN finances extensions of ATER up to 12 groups in 12 Sections


The The ““BluBlu BookBook”” and the and the ““Green BookGreen Book””

1995 1996


The The ““Red BookRed Book”” and the and the ““White BookWhite Book””

1997

THE PATH TO THE ITALIAN

NATIONAL CENTRE FOR ION

THERAPY

FONDAZIONE TERA

UGO AMALDI and GIULIO MAGRIN editors

2005


Basic facts: protons and ions spare healthy tissues Basic facts: protons and ions spare healthy tissues

charged hadron beam

that loses energy in matter

27 cm

tumour

target200 200 MeVMeV -- 1 1 nAnA

protonsprotons

4800 4800 MeVMeV –– 0.1 0.1 nAnAcarbon ionscarbon ions

which can also control which can also control

radioresistantradioresistant

tumourstumours

Photons ProtonsPhotons ProtonsX raysprotons or

carbon ions

tail

cobalt 60

linac

httt://global.mitsubishielectric.com/bu/particlebeam/index_b.htmhttt://global.mitsubishielectric.com/bu/particlebeam/index_b.htmll

light ion

(carbon)

proton


Protons are Protons are quantitativelyquantitatively different from Xdifferent from X--raysrays

9 X-ray fields 4 proton fields

PSI


Carbon ions are Carbon ions are qualitativelyqualitatively different from Xdifferent from X--raysrays

9 X-ray fields 4 proton fields

PSI

Carbon ions deposit in a cell 24 times more energy than a proton

producing not reparable multiple close-by double strand breaks

Carbon ions can control radio-resistant tumours


The siteThe site

treatedtreated

with hadronswith hadrons

Today in the worldToday in the world

protontherapyprotontherapy::

5050''000 patients000 patients

carbon ioncarbon ion

therapytherapy

3500 patients3500 patients

BUTBUT

In 1991 about In 1991 about

15'000 patients had 15'000 patients had

been treated with p been treated with p

and none with C and none with C

ionsions


NumbersNumbers of of potentialpotential patientspatients (2004)(2004)XX--rayray therapytherapy ( ( >>>>>>>> 40 40 linacslinacs))

everyevery 10 10 millionmillion inhabitantsinhabitants:: 2020''000 000 ptspts//yearyear

ProtontherapyProtontherapy

12% of 12% of XX--rayray patientspatients 2'400 2'400 ptspts//yearyear

TherapyTherapy withwith CarbonCarbon ionsions forfor radioradio--resistantresistant tumourtumour

3% of 3% of XX--rayray patientspatients 600 600 ptspts//yearyear

TOTAL TOTAL everyevery 10 M10 M aboutabout 3'000 3'000 ptspts//yearyear (*) (*)

(*) In (*) In ItalyItaly : : 1717'000'000 patients

5 5 protonproton centrescentres and 1 and 1 carboncarbon centrecentre (AIRO(AIRO--2004)2004)


Italian activitiesItalian activities


CCààtanatana at at ““LaboratoriLaboratori NazionaliNazionali del del SudSud”” of INFNof INFN

is described by. G. is described by. G. BattistoniBattistoni

CATANA

LNS Accelerator Layout

Ocular Protontherapy

Unique Italian Facility


15 years of TERA: 199215 years of TERA: 1992--20072007

TERA has proposed and produced 3 designs for the National CentrTERA has proposed and produced 3 designs for the National Centre for carbon ions e for carbon ions

(and p) to be built on 3 sites: Novara (1993(and p) to be built on 3 sites: Novara (1993--1995), Milano (19961995), Milano (1996--2000) and Pavia 2000) and Pavia

TERA has developed (1993TERA has developed (1993--2006) a novel type of accelerator:2006) a novel type of accelerator:

the the ““cyclinaccyclinac”” for protons and carbon ionsfor protons and carbon ions

2. IDRA (2001)2. IDRA (2001)

3. CABOTO (2005) 3. CABOTO (2005)

1. CNAO is being completed in Pavia by 1. CNAO is being completed in Pavia by

the CNAO Foundation together with INFN the CNAO Foundation together with INFN


Basic PIMMS design: CERNBasic PIMMS design: CERN--TERATERA-- MedAustronMedAustron 19961996--20002000

Project leader: P. Bryant


CNAO = Centro CNAO = Centro NazionaleNazionale di di AdroterapiaAdroterapia

CNAO Foundation created by the Italian Government in 2001: CNAO Foundation created by the Italian Government in 2001: ““to construct and manageto construct and manage

the the ‘‘Centro Centro NazionaleNazionale di di AdroterapiaAdroterapia AncologicaAncologica’’ designed by TERAdesigned by TERA””

Founders: Founders: OspOsp. Maggiore, San . Maggiore, San MatteoMatteo, INT, IEO, , INT, IEO, BestaBesta and TERAand TERA

SinceSince 2004 INFN 2004 INFN isis InstitutionalInstitutional ParticipantParticipant withwith constructionconstructionresponsabilitiesresponsabilities asas describeddescribed byby G.G. BattistoniBattistoni

25 m25 m

PIMMS/TERA

1122

331

2

3

Modifications to PIMMS: multi-turn injection, linac inside the ring, short beam lines


The surface buildingsThe surface buildings

In October 2003 TERA In October 2003 TERA

passed to CNAO passed to CNAO

specifications + specifications +

drawings (3000 pages) drawings (3000 pages)

and 25 peopleand 25 people

Main source of 90 MMain source of 90 M€€::

Italian Health MinistryItalian Health Ministry

First beam:First beam:

spring 2008spring 2008

Project: Calvi Project: Calvi ––TEKNETEKNE

CNAO CNAO FoundationFoundation PresidentPresident: : E. E. BorloniBorloni

MedicalMedical Director: Director: R. OrecchiaR. Orecchia

TechnicalTechnical Director: Director: S. RossiS. Rossi


LinacsLinacs in in hadrontherapyhadrontherapy


The first proposal of the The first proposal of the ““cyclinaccyclinac”” accelerator: 1993accelerator: 1993

UA in :Hadrontherapy in Oncology”, UA and B. Larsson eds., Elsevier, 1994

TERA 94/13 GEN 11: “Il progetto adroterapia tre anni dopo” 25.5.1994


2 routes to light ion therapy2 routes to light ion therapyLIBO prototype

CERN-INFN-TERA 1998-2002 TERA “cyclinacs” for p and C

Green

Book

1996

p-62 MeV

LIBOLIBO

p: 62-74 MeV230 MeV

p-30 MeV

LIBOLIBO LIBOLIBOp-C 300

MeV/u

435 MeV/u


2 routes to light ion therapy2 routes to light ion therapyLIBO prototype

CERN-INFN-TERA 1998-2002 TERA “cyclinacs” for p and C

Green

Book

1996

p-62 MeV

LIBOLIBO

62-74 MeV230 MeV

p-24 MeV

LIBOLIBO LIBOLIBOp-C 300

MeV/u

435 MeV/u

TOP = ‘Terapia Oncologica con Protoni’

ENEA and Istituto Superiore di Sanità

Linac: 7 MeV LIBOLIBO

SCDTLSCDTL

SCDTL prototype G. Picardi et al

2000-2005

7-11 MeV

62 MeV


WHY? The challenge of WHY? The challenge of hadrontherapyhadrontherapy: treat moving organs: treat moving organs

BETTER SOLUTION:

energy variation by electronics

and not mechanics

p+1 or C+6

PSI and GSI approach : depth adjusted by moving absorbers


The proton The proton ‘‘cyclinaccyclinac’’ concept faces the challenge : IDRAconcept faces the challenge : IDRA

Cyclone 30

IBA IBA

19 m

IDRA

Institute for Diagnostics

and RAdiotherapy


The The linaclinac is made by 20 separately powered modulesis made by 20 separately powered modules

The first two modules:

3 = locations of the permanent quadrupoles

2

3

1

3 3 3

30 MeV 35 MeV 40 MeV

3

50 cm


The cyclotron has 4 highThe cyclotron has 4 high--current beam lines (30 current beam lines (30 MeVMeV, , ≤≤ 750 750 µµA) A)

to produce radioisotopes for diagnostics and to produce radioisotopes for diagnostics and endotherapyendotherapy

FDG

targets for

Ga-67 Tl-201

I-123 Bi-212

Bi-214 …

ACS

Neutron fields for BNCS andAdiabatic Resonance Crossing

by AAA:Re-186, Ho-166 (liver)

C-11 O-15

systemic hadrontherapy


Time and amplitude structure of the IDRA beamTime and amplitude structure of the IDRA beam

2 107


Depth as a function of the number of active klystronsDepth as a function of the number of active klystrons


Use of the Use of the cyclinaccyclinac approach with the PSI techniqueapproach with the PSI technique

Fast variation by ± 15 mm

if the magnetic channel has ± 2% momentum acceptance

Depth scanning with

upstream absorbers

1 2

43

Single ‘spot’

Depth scanning: vary the power to the 20 accelerating modules

Lateral scanning with

magnet: 2 ms/step

Third scanning bya bending magnetand movable bed

PSI


CyclinacCyclinac for carbon ionsfor carbon ions


For C ions the TERA solution is based on the 300 For C ions the TERA solution is based on the 300 MeV/uMeV/u SC SC

cyclotron designed by LNScyclotron designed by LNS

IBA (Belgium) offers today the INFN 300 MeV/u SC cyclotron

The superconducting cyclotron

accelerates particles with Q/A = ½

12C6+ 6p+ + 6n

H2+ 2p+ + 1e-

Output energies:

protons 300 MeV

carbon ions 3600 MeV

pp

CC

pp // CC

foil

4.9 m4.9 mdeflector

SCENT = Superconducting Cyclotronfor Exotic Nuclei and Therapy

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HIMAC statistics of the maximum range used per patientHIMAC statistics of the maximum range used per patient

% treated with 300 MeV/u

65 %

75 %

55 %

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A A modulemodule of CABOTO of CABOTO

Bridge coupler for the housingof a PMQ

End cell for the housingof a PMQ

Power input

Biperiodic chain of

accelerating and coupling cells

120 cm


Ion Bragg curves by adjusting the 16 powers: 300Ion Bragg curves by adjusting the 16 powers: 300--435 435 MeV/uMeV/u

16 modules

13 modules

10 modules

7 modules

4 modules

0 modules


The The protonherapyprotonherapy Centre in TrentoCentre in Trento


Characteristics of the Characteristics of the ATrePATreP CentreCentre

Centro ospedaliero finanziato dall’Assessorato e alla Ricerca ed Innovazione.

Capacità di trattamento di 600 pazienti/anno a regime.

Una testata isocentrica e una linea fissa, con la predisposizione per una seconda.

Spazzolamento attivo.

Preparazione del paziente fuori della sala di trattamento.


Foreseen solutionForeseen solution

Un solo fornitore responsabiledell’intero complesso

Contratto di manutenzione e probabilmente di operazione a lungo termine.


Treated tumours in the first 4 yearsTreated tumours in the first 4 years

Tumori da trattare

0

20

40

60

80

100

120

140

1 2 3 4

Anno

n°

pa

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nti

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pediatria

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mobili

Altro

P

66

173

372

552


THE ENDTHE END

ORIGINI E SVILUPPI DELL ’ADROTERAPIA (*) IN ITALIA · Fisica Medica in Lombardia - 23.5.07 - U....

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Transcript of ORIGINI E SVILUPPI DELL ’ADROTERAPIA (*) IN ITALIA · Fisica Medica in Lombardia - 23.5.07 - U....