Status of the Hadron Therapy Centers at Heidelberg (HIT) and Pavia (CNAO) Sandro Rossi, Fondazione CNAO Thomas Haberer, Heidelberg Ion Therapy Center

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1 Status of the Hadron Therapy Centers at Heidelberg (HIT) and Pavia (CNAO) Sandro Rossi, Fondazione CNAO Thomas Haberer, Heidelberg Ion Therapy Center

2 Goal provide the irradiation technology to optimally use the advantageous properties of heavy charged particles in external radiotherapy organs at risk treat > 1000 patients per year and perform clinical trials using low-let (p, He) and high- LET (C, O) beams tumour optimum dose to tumour conformity by beam scanning dose application conduct technical, physical and clinical R+D tumour-conformal dose distribution

3 Beam Scanning scanning of focussed ion beams in fast dipole magnets active variation of the energy, focus and intensity in the accelerator and beam lines utmost precision via active position and intensity feed back loops intensity-controlled raster scan GSI

4 Advanced / Beam Scanning Protons (Pedroni et al., PSI): spot scanning gantry (1D magnetic pencil beam scanning) plus passive range stacking (digital range shifter) Ions (Haberer et al.): raster scanning (2D magnetic pencil beam scanning) plus active range stacking (spot size, intensity) in the accelerator Extreme dose conformation by beam scanning

5 Advanced / Slice Fluence distribution of a single slice through the target volume

6 Plan Comparison IMRT vs. scanned Carbon ions IMRT 9 fields Carbon 2 fields

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8 Pilot GSI: Clinical Trials Chordoma and chondrosarcoma at the skull base and adenoidcystic carcinomas: 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%

9 The Heidelberg Ion Therapy Center -Realisation and Status - Thomas Haberer Scientific-technical Director Heidelberg Ion Therapy Center

10 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 > fractions/year

11 HIT / General Requirements ions : p 3 He C 6 16 O 8+ energies (MeV/u) : (255 steps) 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)

12 HIT / Building

13 Construction Site Recently

14 HIT / Linac compact design proven technology fast change of the ion species fast intensity variation (1000-times) constant beam parameter Cooperation: GSI + IAP Frankfurt/M. RFQ Ion source

15 GSI IH-DTL-structure combined acceleration and focussing 12 years usage as therapy injector in the pilot GSI

16 HIT / Synchrotron compact design proven technology multiturninjection => high intensities rasterscanning optimized, extremely flexible beam extraction Multiple extraction 0,5 bis 10 sec fast variation of the energy (range) Multiturn injection

17 Scanning Ion Gantry optimum dose application world-wide first ion gantry world-wide first integration of 2d beam scanning 13 m diameter 25 m length 600 to overall weight 420 to rotational 0.5 mm max. deformation prototype segment tested at GSI MT Aerospace

18 HIT / Scanning Ion Gantry test of scanning gantry segment at GSI

19 HIT / Scanning Ion Gantry test of scanning gantry segment at GSI testpattern scan recorded in multi-wire proportional chambers

20 Medtech Equipment department-wide workflow concept (photons and particles) fixed lines: robotic patient positioner robotic digital x-ray imagers o C-arm o 30 Hz o Cone-beam CT capability in-beam PET Siemens Medical Solutions gantry: integration of robotic patient positioner digital X-ray systems stereotactic equipment (PET-upgrade available) Siemens Medical Solutions

21 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)

22 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

23 Accelerator Systems Building: partially usable, mapped Magnets: first 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

24 Technical Status and Project Development of CNAO Sandro Rossi Enlight++ CERN, 24 th March 2006

25 Created by the Italian Ministry of Health at the beginning of st November 2001, the Board has been established to build a Centre with two main goals: To treat patients using hadrontherapy To perform clinical and radiobiological reasearch

26 Council Board: CNAO Organisation E. Borloni G. Azzaretti G. Arbosti C. Ciani U. Amaldi L. Maspes F Fondazione Policlinico F - Policlinico San Matteo F - Istituto Neurologico C. Besta F - Istituto Europeo di Oncologia F - Fondazione TERA F - Istituto Nazionale dei Tumori President Vice-president R. Petronzio G. Coggi A. Pedotti G. Goggi PI - Istituto Nazionale di Fisica Nucleare PI - Università di Milano PI - Politecnico di Milano PI - Università di Pavia P. Capitelli PI - Comune di Pavia

27 Technical Group of CNAO Foundation 40 persons (physicists, engineers and technicians) to follow the construction DIREZIONE TECNICA S. Rossi (G. Brianti) (INFN) Coordinamento Tecnico F. Gerardi Ottica e Parametri M. Pullia e A. Pisati Ufficio Tecnico I. Ferrari, M. Nodari (INFN/LNF) Segretariato M. Di Rosa, V. Mutti, L. Zucca Edifici e Impianti Alta Tecnologia Impianto Elettrico (L. Frosini) (INFN/LNF,UniPv) Impianti Meccanici L. Bianchi e S. Gallo (INFN/LNF) Magneti Convenzionali e misure magnetiche G. Bazzano, C. Priano, L. Vuffray (INFN/LNF-Ge, CERN-LPSC) Alimentatori e Cablaggio di potenza I. De Cesaris (INFN/LNF) Interlock S. Gallo (INFN/LNF) Radioprotezione e Sicurezze A. Ferrari, (M. Ferrarini), (A. Porta) (INFN/LNF,PoliMi,UniPv) Magneti Speciali (G. Venchi) (CERN, UniPv) Sistema da Vuoto S. Bini, V. Chimenti e L. Lanzavecchia (INFN/LNF) Cablaggio F. Gerardi Progetto Definitivo e Direzione Lavori Calvi-Tekne (Inarcheck) Logistica sul sito G. Baccaglioni (UniPv) Betatrone (G. Venchi) (UniPv,LPSC) Linac S. Vitulli (GSI,INFN/LNL) Diagnostica dei fasci J.Bosser,M.Caldara,A.Parravicini,G.Balbinot (CERN) Sistema di Controllo L.Casalegno,S. Hunt,M.Pezzetta,S.Toncelli (A. El Mahrad) (LPSC) Sistema di Monitoraggio M. Donetti (INFN/To) Cavità RF G. Primadei, F. Schiappelli (INFN/Mi,LPSC) Posizionamento del Paziente (PoliMi) Installazione e Allineamento D. Bianculli (INFN/LNF) Sorgenti R. Monferrato (INFN/LNS) Area di Ricerca - Radiobiologia (INFN) 90, scanning and PS (INFN/Ge)

28 COLLABORATIONS NATIONAL 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

29 A closer look to CNAO... In Pavia Project area Historical center Rivers Medical centers and hospitals Main street Strade principali distr. High-way Railway

30 Hospital Building Completion May 2007 High Technology Bld. Delivery June 2006

31 One experimental room Three treatment rooms (3H+1V) CNAO layout Approved by CNAO Board

32 CNAO SITE March 22nd, 2006

33 The heart of CNAO SYNCHROTRON GSI Linac OPTIMIZED for an hospital based facility (all Ion-therapy centres existing in the World adopt it): - Safety - Efficiency - Reliability - Maintainability HE lines MODULAR and UPGRADABLE system: Up-to-date for years Treatment rooms

34 More than 50 companies working for CNAO DITTA OGGETTO DITTE ITALIANE 1 Ansaldo Superconduttori (Genova) 1. Magneti convenzionali sincrotrone / 2. Magneti HEBT e MEBT 2 Alintel (Pieve di Cento -- Bologna) Alimentatori RF 3 Bonetti Aircraft Supports (Genova) Filo in tungsteno per prototipo wire scanner 4 BrainLab (Milano) Lettino 5 Pierino Bonifazi (Roma) 1. Flange / 2. Supporti per quadrupolo 6 Busato & Satta (Fiumicino) Camera da vuoto LEBT 7 Camib (Torino) Box rivelatore 8 CASTELLI S.a.s (Moppale di Caselle - Torino) Piastra e telai per nozzle 9 Calvi-Tekne - Inarcheck (Pavia - Milano) Progetto definitivo e direzione lavori 10 C&D elettronica (Bergamo) Componenti elettronici per il sistema di controllo 11 CECASA (Castelverde di Lunghezza - Roma) Calibri per allineamento quadrupoli e sestupoli 12 CECOM (Guidonia - Roma) 1. Camere da vuoto del sincrotrone / 2. Guarnizioni da vuoto 13 CINEL srl (Vigonza - PD) Apparecchiatura per misure magnetiche dei dipoli 14 CMN (La Loggia - TO) Particolari per il nozzle 15 CO.ME.B srl (Casalpalocco - Roma) 1. Flange / 2. Sistema di raffreddamento prototipo FC / 3. Camere da vuoto MEBT / 4. Movimentazioni MEBT 16 Comelec (Ferriera di Buttigliera Alta - Torino) Connettori 17 Craftec (Arcore - Milano) Alimentatori 18 DEC (BARI) Edificio del CNAO 19 DIM (Milano) Molle 20 DISTRELEC Italia (Milano) Componenti elettronici per prototipo PS betatrone 21 EEI (Vicenza) Alimentatori dei multipoli del sincrotrone 22 INNOVACTION (Pianopoli - Catanzaro) Driver amplifier 23 Mollificio Ciullo (Cecchina di Albano Laziale - Roma) Molle 24 Morgan - Wesgo (Casalpusterlengo - Lodi) Controlled resistivity alumina e metallizzazione aggiuntiva 25 NUOVA OLPA (Torino) Particolari per il nozzle 26 OCEM (San Giorgio di Piano - Bologna) 1. Alimentatore dipoli / 2. Ripristino, collaudo e upgrade alimentatore per RF / 3. Alimentatori HEBT e MEBT 27 Passoni (Pavia) Alimentatore prototipo betatrone 28 PEGASO SISTEMI (Trivero - BI) Posizionatori llineari 29 Prodotti Gianni (Milano) Componenti Prototipo Faraday Cup 30 Robot Italy (Frascati - Roma) Componenti elettronici per il sistema di controllo 31 RMP (Roma) Passanti elettrici 32 RS Components (Cinisello Balsamo - Milano) Componenti elettronici per diagnostica e laboratorio CERN 33 Sidea-Blu Sof (Milano -Torino) Sistema di Controllo 34 Sysma srl (Orbassano) Relè 35 Stiavelli Irio SpA (Capalle - Campi Bisenzio - Firenze) Elettroventilatori per RF 36 Teoresi (Milano) Fornitura hardware sistema di controllo 37 VARIAN (Leinì - Torino) Pompe da vuoto per il sincrotrone 38 VLT (Colleferro - Roma) 1. Isolatori ceramici / 2. Prove di applicazione di isolante su flange DN 100 DITTE STRANIERE 39 COMVAT (Haag - Svizzera) Soffietti 40 DANFYSIK (Jyllinge - Danimarca) 1. Quadrupoli linac / 2. Magneti speciali 41 Dynalloy (Costa Mesa - California) Componenti elettronici per il sistema di controllo 42 Eckelmann (Wiesbaden - Germania) Sistema di controllo Linac 43 EVAC ( Buchs - Svizzera) Catene 44 JAEGER (Eppstein - Germania) Alimentatori Linac 45 Leybold Vacuum GmbH (Colonia - Germania) Pompe linac 46 NTG (Gelnhausen - Germania) Struttura RFQ 47 Pantechnik (Caen - Francia) Sorgenti 48 PINK (Wertheim -. Germania) Struttura IH 49 SigmaPhi (Vannes - Francia) 1. Correttore / 2. Magneti LEBT1 / 3. Solenoidi 50 Stesalit AG (Zuillwil - Svizzera) Vetronite per strumentazione di misura dei dipoli 51 Vacuumschmelze (Hanau - Gemania) Vitrovac 52 VAT Vakuumventile AG (Haag - Svizzera) Valvole linac 53 THALES (Velizy - Francia) 1. Electron Tubes / 2. RF del linac

35 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

36 Running Phase Day-hospital 80% treatments with ions and 20% with protons time for R&D Session duration: minutes Running Year Shifts regime Treatment hours per day Treatment rooms Working days per week Working weeks per year Working days per year Total number of sessions per year

37 Ongoing activities to be ready for the CNAO start-up Formation of personnel (Doctors, medical and accelerator physicists) Authorisation procedures Permissions to use beams for patient treatments Medical Service To support and inform doctors and patients Medical Physics Activities Accelerator technology to the Medical To link the field Creation of a multimedial network and the CNAO site To connect the CNAO to the hospitals and to the reasearch institutes

38 Outlook Particle therapy will cover the full spectrum of radiotherapeutical indications Per 10 million inhabitants one particle therapy facility may be required Treatments will be fully accepted by the health insurance systems