Status of the Hadron Therapy Centers at Heidelberg (HIT ... · Th. Haberer and S. Rossi provide the irradiation technology to optimally use the advantageous properties of heavy charged

Status of the Hadron Therapy Centers atHeidelberg (HIT) and Pavia (CNAO)

Sandro Rossi, Fondazione CNAOThomas Haberer, Heidelberg Ion Therapy Center

Th. Haberer and S. Rossi

provide the irradiation technology to optimally use the advantageous properties of heavycharged particles in external radiotherapy

treat > 1000 patients per year and perform clinical trials using low-LET (p, He) and high-LET (C, O) beams

optimum dose to tumour conformity by beamscanning dose application

conduct technical, physical and clinical R+D

Goal

tumour-conformaldose distribution

organs atrisk

tumour


Beam Scanningscanning offocussedion beamsin fastdipole magnets

active variationof the energy,focus andintensity in theaccelerator andbeam lines

utmost precisionvia activeposition and intensity feedback loops

intensity-controlled raster scan technique @ GSI


Advanced / Beam Scanning

• Protons (Pedroni et al., PSI): spot scanning gantry(1D magnetic pencil beamscanning) plus passive range stacking(digital range shifter)

• Ions (Haberer et al.): raster scanning(2D magnetic pencil beamscanning) plus active range stacking(spot size, intensity) in the accelerator

Extreme dose conformationby beam scanning


Advanced / Slice

Fluence distribution of a single slice through thetarget volume


Plan ComparisonIMRT vs. scanned Carbon ions

IMRT 9 fields Carbon 2 fields


Therapy@GSI


Pilot Project @ GSI: Clinical Trials

• Chordoma and chondrosarcoma at the skull base and adenoidcysticcarcinomas:recognition as standard treatment, approved treatment by the German public health system, reimbursal

• Prostate, spinal and sacrococcigeal chordoma, chondrosarcoma in the head/neck- and pelvis region:phase-I/II clinical studies open: 1st patient envisaged

• 286 patients treated • minimal treatment related toxicity• overall survival approx. 95%• local tumor control (4 years):

Chondrosarcomas 100%Chordomas >80%Others (Accs, ...) >60%

The Heidelberg Ion Therapy Center-Realisation and Status -

Thomas HabererScientific-technical Director

Heidelberg Ion Therapy Center


HIT Facility• compact design• full clinical integration• rasterscanning only• low-LET modality:

Protons (later He)• high-LET modality:

Carbon (Oxygen)• ion selection within

minutes• world-wide first scanning

ion gantry• state of the art medtech• > 1000 patients/year

> 15.000 fractions/year


• ions : p 3He2+ 12C6 16O8+

• energies (MeV/u) : 48 72 88 102 (255 steps) -220 -330 -430 -430

• beam spot size : 4 - 10 mm (2d-gaussian)

( 4 steps)

• treatment caves : 3 (2 horizontal, 1 iso-centric gantry)

• QA and research : 1 (1 horizontal)

HIT / General Requirements


HIT / Building


Construction Site Recently


HIT / Linac

RFQ

Ion source

• compactdesign

• proven technology• fast change of the ion species

• fast intensityvariation(1000-times)

• constantbeam parameter

Cooperation: GSI + IAP Frankfurt/M.


HLI-Linac @ GSI

• IH-DTL-structure

• combined accelerationand focussing

• 12 years usage as „therapy injector“ in thepilot project @ GSI


HIT / Synchrotron

Multiturn injection

Multiple extraction

0,5 bis 10 sec

• compact design

• proven technology

• multiturn-injection => high intensities

• rasterscanningoptimized, extremelyflexible beamextraction

• fast variationof the energy(range)


Scanning Ion Gantry

MT Aerospace

• optimum dose application

• world-wide firstion gantry

• world-wide first integration of 2d beam scanning

• 13 m diameter25 m length600 to overall weight420 to rotational0.5 mm max. deformation

• prototype segment testedat GSI


HIT / Scanning Ion Gantry

test of scanning gantrysegment at GSI


HIT / Scanning Ion Gantrytest of scanning gantry segment at GSI

testpattern

scan recorded in multi-wire proportional chambers


Medtech Equipmentdepartment-wide workflow concept (photons and particles)

fixed lines:• robotic patient positioner• robotic digital x-ray imagers

o C-armo 30 Hzo Cone-beam CT capability

• in-beam PET

gantry:integration of • robotic patient positioner• digital X-ray systems• stereotactic equipment

(PET-upgrade available)

Siemens Medical Solutions

Siemens Medical Solutions


HIT/ Organisation and Structure• Project of the Heidelberg University Hospital

existing contracts with: University Civil Engineering Department (building) Ges. f. Schwerionenforschung (design and accelerator)Heidelberg Ion Therapy Limited (irradiation tech, R+D, operation)

• GSI and HIT Limited: design, feasibility study, technical design report, responsibility for the accelerator-installations, tendering documents, supervision of industrial partners, integration, commissioning, staff training

• Heidelberg Ion Therapy Limited: runs and maintains the facility, "sells quality-assured dose distributions", performs R+D, consulting

• Cooperations: German Cancer Research Center in Heidelberg FZ-Rossendorf near Dresden (PET)

• Approval authorities: Notified body (FDA-related aspects): Eurocat (Darmstadt), Regulatory authority: Regierungspräsidium (Mannheim)


HIT / Milestones

• Building ready for hi-tech installations 10 / 2005• Horizontal caves installed 09 / 2006• Horizontal caves patient-ready 11 / 2007• Horizontal caves handing-over 01 / 2008• Gantry cave installed 06 / 2007• Gantry cave patient-ready 09 / 2008• Gantry cave handing-over 12 / 2008• QA cave operational 04 / 2008


Accelerator Systems• Building: partially usable, mapped• Magnets: first lots @ GSI, field mapping under way • Power supplies: first lot commissioned and installed• Vacuum: linac RFQ under test, IH-structure in process• Beam diagnostics: last lot will be handed over in March.• Controls: hardware available, software partially under test• RF-linac: operational and under test• RF-ring: hitachi part in plan• Sources: mounted and operational• Gantry: structure in process, medtech-interface challenging• Beamlines: LEBT mounted


Technical Status and

Project Development of

CNAO Sandro Rossi

Enlight++

CERN, 24th March 2006


To treat patients using hadrontherapy

To perform clinical and radiobiological reasearch

Created by the Italian Ministry of Health at the beginning of 2001

21st November 2001, the Board has been established

to build a Centre with two main goals:


CNAO OrganisationCouncil Council BoardBoard::

E. E. BorloniBorloni F F –– ““Fondazione PoliclinicoFondazione Policlinico”” PresidentPresident

G. G. AzzarettiAzzaretti F F -- PoliclinicoPoliclinico San San MatteoMatteo ViceVice--presidentpresident

G. G. ArbostiArbosti F F -- IstitutoIstituto NeurologicoNeurologico C. C. BestaBesta

C. C. CianiCiani F F -- IstitutoIstituto EuropeoEuropeo didi OncologiaOncologia

U. U. AmaldiAmaldi F F -- Fondazione TERAFondazione TERA

L. L. MaspesMaspes F F -- IstitutoIstituto NazionaleNazionale deidei TumoriTumori

R. R. PetronzioPetronzio PI PI -- IstitutoIstituto NazionaleNazionale didi FisicaFisica NucleareNucleare

G. G. CoggiCoggi PI PI -- UniversitUniversitàà di Milanodi Milano

A. A. PedottiPedotti PI PI -- Politecnico di MilanoPolitecnico di Milano

G. G. GoggiGoggi PI PI -- UniversitUniversitàà di Paviadi Pavia

P. CapitelliP. Capitelli PI PI -- Comune di PaviaComune di Pavia


Technical Group of CNAO Foundation

40 persons (physicists, engineers and technicians) to follow the construction

Ufficio TecnicoI. Ferrari, M. Nodari

(INFN/LNF)

SegretariatoM. Di Rosa, V. Mutti, L. Zucca

Coordinamento TecnicoF. Gerardi

Ottica e ParametriM. Pullia e A. Pisati

Impianto Elettrico(L. Frosini)(INFN/LNF,UniPv)

Impianti MeccaniciL. Bianchi e S. Gallo(INFN/LNF)

InterlockS. Gallo(INFN/LNF)

Radioprotezione e SicurezzeA. Ferrari, (M. Ferrarini), (A. Porta)(INFN/LNF,PoliMi,UniPv)

CablaggioF. Gerardi

Logistica sul sitoG. Baccaglioni(UniPv)

Progetto Definitivo e Direzione LavoriCalvi-Tekne (Inarcheck)

Edifici e Impianti

Magneti Convenzionali e misure magneticheG. Bazzano, C. Priano, L. Vuffray

(INFN/LNF-Ge, CERN-LPSC)

Alimentatori e Cablaggio di potenzaI. De Cesaris(INFN/LNF)

Magneti Speciali(G. Venchi)

(CERN, UniPv)

Sistema da VuotoS. Bini, V. Chimenti e L. Lanzavecchia

(INFN/LNF)

Betatrone(G. Venchi)

(UniPv,LPSC)

Diagnostica dei fasciJ.Bosser,M.Caldara,A.Parravicini,G.Balbinot

(CERN)

LinacS. Vitulli

(GSI,INFN/LNL)

Sistema di ControlloL.Casalegno,S. Hunt,M.Pezzetta,S.Toncelli

(A. El Mahrad) (LPSC)

Sistema di MonitoraggioM. Donetti(INFN/To)

Cavità RFG. Primadei, F. Schiappelli

(INFN/Mi,LPSC)

Posizionamento del Paziente(PoliMi)

Installazione e AllineamentoD. Bianculli(INFN/LNF)

SorgentiR. Monferrato

(INFN/LNS)

Area di Ricerca - Radiobiologia(INFN)

90°, scanning and PS(INFN/Ge)

Alta Tecnologia

DIREZIONE TECNICAS. Rossi

(G. Brianti)(INFN)


COLLABORATIONSNATIONAL

INFN: co-direction, involvment/responsibility in many technical issues (15), formation

Town of Pavia: land and authorisations

University of Milan: medical coordination and formation

Polytechnic of Milan: patient positioning, radioprotection and authorisations

University of Pavia: electrical plants, special power supplies and betatron, formation

Province of Pavia: logistics and authorisation

INTERNATIONAL

CERN: special magnets, dipole measurements and diagnostics (+ PIMMS heritage)

GSI: linac and special components

LPSC: optics, betatron, low-level RF, control system


A closer look to CNAO...In Pavia

ProjectProject areaarea

HistoricalHistorical centercenter

RiversRivers

Medical centersMedical centers and and hospitalshospitals

MainMain streetstreet

Strade principali Strade principali distrdistr..

HighHigh--wayway

RailwayRailway


High Technology Bld.

Delivery – June 2006Hospital Building

Completion May 2007


CNAO layoutCNAO layout

Approved by Approved by CNAO BoardCNAO Board

Three treatment rooms (3H+1V)

One experimental room


CNAO SITE

March 22nd, 2006


The heart of CNAO

HE lines

GSI Linac

Treatment rooms

OPTIMIZEDfor an hospital based facility (all Ion-therapy centres existing in the World adopt it):- Safety- Efficiency- Reliability - Maintainability

MODULAR and UPGRADABLE system:Up-to-date for 20-30 years

SYNCHROTRON


More than 50 companies working for CNAO …DITTA OGGETTO

DITTE ITALIANE1 Ansaldo Superconduttori (Genova) 1. Magneti convenzionali sincrotrone / 2. Magneti HEBT e MEBT2 Alintel (Pieve di Cento -- Bologna) Alimentatori RF3 Bonetti Aircraft Supports (Genova) Filo in tungsteno per prototipo wire scanner4 BrainLab (Milano) Lettino5 Pierino Bonifazi (Roma) 1. Flange / 2. Supporti per quadrupolo6 Busato & Satta (Fiumicino) Camera da vuoto LEBT7 Camib (Torino) Box rivelatore8 CASTELLI S.a.s (Moppale di Caselle - Torino) Piastra e telai per nozzle9 Calvi-Tekne - Inarcheck (Pavia - Milano) Progetto definitivo e direzione lavori

10 C&D elettronica (Bergamo) Componenti elettronici per il sistema di controllo11 CECASA (Castelverde di Lunghezza - Roma) Calibri per allineamento quadrupoli e sestupoli12 CECOM (Guidonia - Roma) 1. Camere da vuoto del sincrotrone / 2. Guarnizioni da vuoto13 CINEL srl (Vigonza - PD) Apparecchiatura per misure magnetiche dei dipoli14 CMN (La Loggia - TO) Particolari per il nozzle15 CO.ME.B srl (Casalpalocco - Roma) 1. Flange / 2. Sistema di raffreddamento prototipo FC / 3. Camere da vuoto MEBT / 4. Movimentazioni MEBT16 Comelec (Ferriera di Buttigliera Alta - Torino) Connettori17 Craftec (Arcore - Milano) Alimentatori18 DEC (BARI) Edificio del CNAO19 DIM (Milano) Molle20 DISTRELEC Italia (Milano) Componenti elettronici per prototipo PS betatrone21 EEI (Vicenza) Alimentatori dei multipoli del sincrotrone22 INNOVACTION (Pianopoli - Catanzaro) Driver amplifier23 Mollificio Ciullo (Cecchina di Albano Laziale - Roma) Molle24 Morgan - Wesgo (Casalpusterlengo - Lodi) Controlled resistivity alumina e metallizzazione aggiuntiva25 NUOVA OLPA (Torino) Particolari per il nozzle26 OCEM (San Giorgio di Piano - Bologna) 1. Alimentatore dipoli / 2. Ripristino, collaudo e upgrade alimentatore per RF / 3. Alimentatori HEBT e MEBT27 Passoni (Pavia) Alimentatore prototipo betatrone28 PEGASO SISTEMI (Trivero - BI) Posizionatori llineari29 Prodotti Gianni (Milano) Componenti Prototipo Faraday Cup30 Robot Italy (Frascati - Roma) Componenti elettronici per il sistema di controllo31 RMP (Roma) Passanti elettrici32 RS Components (Cinisello Balsamo - Milano) Componenti elettronici per diagnostica e laboratorio CERN33 Sidea-Blu Sof (Milano -Torino) Sistema di Controllo 34 Sysma srl (Orbassano) Relè35 Stiavelli Irio SpA (Capalle - Campi Bisenzio - Firenze) Elettroventilatori per RF36 Teoresi (Milano) Fornitura hardware sistema di controllo37 VARIAN (Leinì - Torino) Pompe da vuoto per il sincrotrone38 VLT (Colleferro - Roma) 1. Isolatori ceramici / 2. Prove di applicazione di isolante su flange DN 100

DITTE STRANIERE39 COMVAT (Haag - Svizzera) Soffietti40 DANFYSIK (Jyllinge - Danimarca) 1. Quadrupoli linac / 2. Magneti speciali41 Dynalloy (Costa Mesa - California) Componenti elettronici per il sistema di controllo42 Eckelmann (Wiesbaden - Germania) Sistema di controllo Linac43 EVAC ( Buchs - Svizzera) Catene44 JAEGER (Eppstein - Germania) Alimentatori Linac45 Leybold Vacuum GmbH (Colonia - Germania) Pompe linac46 NTG (Gelnhausen - Germania) Struttura RFQ47 Pantechnik (Caen - Francia) Sorgenti 48 PINK (Wertheim -. Germania) Struttura IH49 SigmaPhi (Vannes - Francia) 1. Correttore / 2. Magneti LEBT1 / 3. Solenoidi50 Stesalit AG (Zuillwil - Svizzera) Vetronite per strumentazione di misura dei dipoli51 Vacuumschmelze (Hanau - Gemania) Vitrovac52 VAT Vakuumventile AG (Haag - Svizzera) Valvole linac53 THALES (Velizy - Francia) 1. Electron Tubes / 2. RF del linac


Timeplan

2004/2005: N. 13 European tenders

N. 7 Private European Bids

> N. 40 Direct orders

Presently: N. 53 firms (38 Italian) working for CNAO

2005/2006: Completion of orders, mainly construction activities

June 2006/ Early 2007: Installation

Late 2007: Operation commissioning and start treatments


Running PhaseDay-hospital

80% treatments with ions and 20% with protons – time for R&D

Session duration: 20-30 minutes

Running Year 1 2 3 Shifts 1 2 2

regimeTreatment hours per day 7 13 13 Treatment rooms 3 3 3 Working days per week 5 5 5 Working weeks per year 44 44 44 Working days per year 220 220 220 Total number of sessions per year 4835 12160 18738


Ongoing activities to be ready for the CNAO start-up

Formation of personnel(Doctors, medical and accelerator physicists)

Authorisation proceduresPermissions to use beams for patient treatments

Medical ServiceTo support and inform doctors and patients

Medical Physics ActivitiesAccelerator technology to the Medical To link the field

Creation of a multimedial network and the CNAO siteTo connect the CNAO to the hospitals and to the reasearch institutes


Outlook

• Particle therapy will cover the full spectrum of radiotherapeutical indications

• Per 10 million inhabitants one particle therapy facilitymay be required

• Treatments will be fully accepted by the health insurancesystems

Documents

Status of the Hadron Therapy Centers at Heidelberg (HIT ... · Th. Haberer and S. Rossi provide the irradiation technology to optimally use the advantageous properties of heavy charged