IL CENTRO NAZIONALE DI ADROTERAPIA ONCOLOGICA C N A O STATO DELLA COSTRUZIONE

IL CENTRO NAZIONALE DI ADROTERAPIA ONCOLOGICA C N A O STATO DELLA COSTRUZIONE by C. Sanelli 27 Maggio 2005 1

The CNAO (National Centre for Oncological Hadrontherapy) will be an hospital based facility, sited in Pavia, devoted to: treatments of tumours with hadron beams advanced research in clinical and radiobiological fields Mandate from the Ministry of Health: CNAO has to be a centre of excellence in radiation therapy 2

A brief history of CNAO: Advisory Committees and Commissions The CNAO project (initiated by TERA in 1992) has been (and is) submitted to the following reviews: Year 1995: First National Oncological Commission by Ministry of Health Years 1996-1999: Project Advisory Committee (PIMMS/CERN) - Technical Year 2001: Second National Oncological Commission by Ministry of Health Year 2003 - ongoing: CNAO Foundation Scientific Committee Year 2003 - ongoing: International Advisory Committee CNAO Foundation has been created at the beginning of 2001 21st November 2001, the Board has been established 3

Council Board: E. Borloni - Ospedale Maggiore (Milan) G. Arbosti - Istituto Neurologico C. Besta (Milan) G. Azzaretti - Policlinico San Matteo (Pavia) C. Ciani - Istituto Europeo di Oncologia (Milan) U. Amaldi - Fondazione TERA (Novara) A. Mattiussi - Istituto Nazionale dei Tumori (Milan) E. Iarocci - Istituto Nazionale di Fisica Nucleare (Rome) G. Coggi - Università di Milano (Milan) A. Pedotti - Politecnico di Milano (Milan) G. Goggi - Università di Pavia CNAO Foundation President Vice-president L. Lamberti Scientific Committee : E. Solcia - Policlinico San Matteo F. Bonino - Ospedale Maggiore G. Cascinelli - Istituto Nazionale dei Tumori F. Cognetti - Istituto Regina Elena F. Cornelio - Istituto Neurologico C. Besta L. Magno - Dip. Oncologia Prov. Brescia R. Orecchia - Università di Milano e Fondazione TERA D. Schiffer - Ospedale Molinette U. Veronesi - Istituto Europeo di Oncologia D. Scannicchio - Università di Pavia General Secretary Scientific Director R. Orecchia (Università di Milano) L. Zambianchi (Policlinico S. Matteo di Pavia) M. Campiotti (President), G. Minniti e A. Petrucci Medical Director Health Director Financial Reviewers 4

CNAO ORGANISATION COUNCIL PRESIDENT SCIENTIFIC COMMITTEE ADVISORY BOARD PRESIDENT OFFICE GENERAL SECRETARY MEDICAL DIRECTOR OFFICE MANAGER TECHNICAL COORDINATION Prof. R. Orecchia Medical Director (Università di Milano) Dott. L. Zambianchi - Health Director (San Matteo di Pavia) Dott. G. Fortuna (INFN) and Dott. S. Rossi Co-Directors of the Technical part 5

Technical group of CNAO Foundation: 25 persons (physicists, engineers and technicians) TECHNICAL ORGANISATION TECHNICAL DIRECTION S. Rossi+G. Fortuna (G. Brianti) Technical coordination F. Gerardi e S. Gallo Optics and parameters M. Pullia e M.Tiberti (LPSC) Technical office A. Franchellucci, P. Greco, M. Nodari Secretariat V. Mutti, L. Zucca Buildings and plants High Technology Electrical plants (INFN/LNF,UniPv) Conventional Magnets C. Priano, L. Vuffray (INFN/LNF) Power Supplies and Cabling I. De Cesaris (INFN/LNF) Technical Committee: (N. 15 - Tasksresponsibles+ Co-directors) Restricted Steering Committee: S. Rossi + G. Fortuna + C. Sanelli Fluids (INFN/LNF) Mechanical plants (INFN/LNF) Radioprotection and safety A. Ferrari e M. Ferrarini (INFN/LNF,PoliMi) Final Design and Work Direction Calvi-Tekne (Inarcheck) Special Magnets (CERN, UniPv) Betatron core (UniPv,LPSC) Sources, Linac (INFN/LNL,INFN/LNS) Nozzle assembly M. Donetti (INFN/To) Vacuum System V. Chimenti e L. Lanzavecchia (INFN/LNF) Beam Diagnostics J.Bosser,M.Caldara,A.Parravicini (CERN) Control System L.Casalegno,M.Pezzetta,S.Toncelli (INFN/Mi,LPSC) RF G. Primadei (INFN/Mi,LPSC) Patient positioning (PoliMi) Installation and Alignment (INFN/LNF) 6

The base of success: COLLABORATIONS THE SUCCESS OF CNAO IS BASED ON THE COLLABORATION WITH MANY ISTITUTIONS NATIONAL INFN: co-direction of the technical realisation and involvment/responsibility in many technical issues (15) Town of Pavia: land and authorisations University of Milan: medical coordination Polytechnic of Milan: patient positioning, radioprotection and authorisations University of Pavia: electrical plants, special power supplies and betatron INTERNATIONAL CERN: special magnets and diagnostics (+ PIMMS heritage) GSI: linac and special components LPSC (Etoile): optics, betatron, low-level RF, control system European Project that required CNAO collaboration: MED-AUSTRON signed collaboration agreement last 19th March Asclepios CAEN (agreement in progress) Etoile Lyon (site selected by France Governement) 7

Partecipanti Istituzionali: Istituto Nazionale di Fisica Nucleare In data 12 Novembre 2003 Accordi di collaborazione Stipulata convenzione quadro e definiti gli accordi attuativi Co-responsabilità del Progetto (G. Fortuna) 8

Obiettivi di INFN-LNF Magneti Convenzionali (C. Sanelli) Alimentatori Magneti Convenzionali e Cablaggi (M. Incurvati) Sistema da Vuoto (A. Clozza) Installazione e Allineamento (F. Sgamma) Impianti Elettrici Speciali (R. Ricci) Impianti a Fluido (L. Pellegrino) Radioprotezione e Autorizzazioni (A. Esposito) 9

Altri Obiettivi con INFN Cavità RF INFN - Mi (C. De Martinis) Monitoraggio dei Fasci INFN - To (R. Cirio) Magneti Verticali INFN - Ge (P. Fabbricatore) Radiobiologia INFN - LNL (R. Cherubini) LINAC INFN LNL (C. Roncolato) Dosimetria INFN LNS (Da definire) Sorgenti INFN LNS (G. Ciavola) 10

Time and Industrial Plan High Tech: tenders, contracts and construction Building and plants: construction under way 11

A clooser look to CNAO... SITEPLAN TERRITORIAL CONTEXT Project area Historical center Rivers Medical centers and hospitals Main street Strade principali distr. High-way Railway 12

Area of 37 000 mq Policlinico S. MATTEO 13

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One experimental room Three treatment rooms (3H+1V) CNAO Phase 1 Approved by CNAO Board 16

CNAO Phase 2 + 2 gantries for ions (?) future upgrade with minimum impact on routine operation 17

Phase 1- Sections Section A-A B Section B-B A A B 18

Site ground investigation 19

Alta Tecnologia... a tutta velocità 2004: 11 Bandi gara europei completati 2 Trattative private 16 Ordini all industria = 30 Ditte (18 Italiane) lavorano attualmente per il CNAO 2005: Completamento degli ordini e anno soprattutto di costruzione 2006: Installazione dei componenti (attività già in preparazione) 2007: Prove di funzionamento 20

Elenco ditte che lavorano per il CNAO DITTA OGGETTO DITTE ITALIANE 1 Ansaldo Superconduttori (Genova) Magneti convenzionali sincrotrone 2 Alintel (Pieve di Cento -- Bologna) Alimentatori RF 3 C&D elettronica (Bergamo) Componenti elettronici per il sistema di controllo 4 Calvi-Tekne-Inarcheck (Pavia - Milano) Progettazione Definitiva Edifici e Impianti e Direzione Lavori 5 CECOM (Guidonia - Roma) Camere da vuoto del sincrotrone 6 CINEL srl (Vigonza - PD) Apparecchiatura per misure magnetiche dei dipoli 7 CMB (Casalpalocco - Roma) 1. Flange / 2. Sistema di raffreddamento prototipo FC 8 DEC SpA (Bari) Costruzione Edifici e Impianti 9 EEI (Vicenza) Alimentatori dei multipoli del sincrotrone 10 INNOVACTION (Pianopoli - Catanzaro) Driver amplifier 11 Morgan - Wesgo (Casalpusterlengo - Lodi) Controlled resistivity alumina e metallizzazione aggiuntiva 12 OCEM (San Giorgio di Piano - Bologna) 1. Alimentatore dipoli, sext.res, corr. / 2. Ripristino, collaudo e upgrade alimentatore per RF 13 Robot Italy (Frascati - Roma) Componenti elettronici per il sistema di controllo 14 RS Components (Cinisello Balsamo - Milano) Componenti elettronici per diagnostica e laboratorio CERN 15 Sidea Srl-BlueSof (Milano-Torino) Sistema di supervisione e controllo 16 Stiavelli Irio SpA (Capalle - Campi Bisenzio - Firenze) Elettroventilatori per RF 17 VARIAN (Leinì - Torino) Pompe da vuoto per il sincrotrone 18 VLT (Colleferro - Roma) 1. Isolatori ceramici / 2. Prove di applicazione di isolante su flange DN 100 DITTE STRANIERE 19 COMVAT (Haag - Svizzera) Soffietti 20 DANFYSIK (Jyllinge - Danimarca) 1. Quadrupoli linac / 2. Magneti speciali 21 Dynalloy (Costa Mesa - California) Componenti elettronici per il sistema di controllo 22 Eckelmann (Wiesbaden - Germania) Sistema di controllo Linac 23 EVAC ( Buchs - Svizzera) Catene 24 JAEGER (Eppstein - Germania) Alimentatori Linac 25 NTG (Gelnhausen - Germania) Struttura RFQ 26 PINK (Wertheim -. Germania) Struttura IH 27 SigmaPhi (Vannes - Francia) Correttore 28 Stesalit AG (Zuillwil - Svizzera) Vetronite per strumentazione di misura dei dipoli 29 Vacuumschmelze (Hanau - Gemania) Vitrovac 30 THALES (Velizy - Francia) 1. Electron Tubes / 2. RF del linac 21

The synchrotron The heart of CNAO Linac HE lines Treatment rooms 22

Table 1 Clinical performance specifications for the CNA. 1 Beam particle species p, He 2+, Li 3+, Be 4+, B 5+, C 6+, O 8+ 2 Beam particle switching time 10 min 3 Beam range 1.0 g/cm 2 to 27 g/cm 2 in one treatment room 3.1 g/cm 2 to 27 g/cm 2 in two treatment rooms Up to 20 g/cm 2 for O 8+ ions 4 Bragg peak modulation steps 0.1 g/cm 2 5 Range adjustment 0.1 g/cm 2 6 Adjustment/modulation accuracy ± 0.025 g/cm 2 7 Average dose rate 2 Gy/min (for treatment volumes of 1000 cm 3 ) 8 Delivery dose precision ± 2.5% 9 Beam axis height (above floor) 150 cm (head and neck beam line) 120 cm (elsewhere) 10 Beam size 1 4 to 10 mm FWHM for each direction independently 11 Beam size step 1 1 mm 12 Beam size accuracy 1 ± 0.25 mm 13 Beam position step 1 0.8 mm 14 Beam position accuracy 1 ± 0.2 mm 15 Field size 1 5 mm to 34 mm (diameter for ocular treatments) 2 2 cm 2 to 20 20 cm 2 (for H and V fixed beams) 16 Field position accuracy 1 ± 0.5 mm 17 Field dimensions step 1 1 mm 18 Field size accuracy 1 ± 0.5 mm 19 Field homogeneity 2 (orthogonal) R t 105% 20 Field homogeneity 3 (longitudinal) R l 111% 21 Field symmetry 2 105% 22 Lateral penumbra 2 < 2 mm for each side (80%-20%) (at the phantom entrance surface) 23 Distal dose fall-off 3 (80%-20%) < 2 mm (in addition to intrinsic distal fall-off) 24 Source to surface distance (SSD) > 3 m 25 Coincidence of H and V beam axis ± 0.2 mm 1 At isocentre or, for fixed beam, at normal treatment distance. At patient surface. 3 Measured in water phantom. Starting point... THE PATIENT Deep hadrontherapy Optimised dose distribution Beam quality (active scanning) 23

In collaboration with: Conventional magnets Prototype of a quarter of a synchrotron Quadrupole (N. 25) 24

Synchrotron Dipole Contract signed on 9 June 2004 with: ANSALDO SUPERCONDUTTORI In collaboration with: 25

Synchrotron Dipole In collaboration with: 26

Synchrotron Dipole In collaboration with: 27

Synchrotron Dipole In collaboration with: 28

Synchrotron Quadrupole and Sextupole In collaboration with: 29

Synchrotron Vertical Steering In collaboration with: 30

In collaboration with: Synchrotron Horizontal Steering 31

In collaboration with: Synchrotron Vertical Steering B (G) Z 200 180 160 X s 140 120 100-60,30 0,0 80-60,-30 60 40 20 0-200000 0 200000 400000 600000 800000 s (µm) 32

In collaboration with: Synchrotron Horizontal Steering Z X s 450 400 350 300 250 200-60,30 0,0-60,-30 150 100 50 0-200000 0 200000 400000 600000 800000 33

Synchrotron Magnets Under Construction by ANSALDO Superconduttori N. 21 Dipole Magnets (Synchrotron+HEBT) N. 2 Dipole Magnets with Hole (HEBT) N. 2 Half Dipole Magnets(HEBT) N. 25 Quadrupoles N. 5 Sextupole (1.5 mm) N. 2 Resonance Sextupole N. 11 Horizontal Correctors N. 9 Vertical Correctors 34

HEBT and MEBT Magnets Under Construction by: ANSALDO Superconduttori N.1 Switching Dipole (HEBT) N. 38 Quadrupoles (HEBT) N. 19 Corrector Magnets (HEBT) N. 2 Dipole Magnets (MEBT) N. 10 Quadrupoles (MEBT) N. 8 Corrector Magnets (MEBT) 35

Linear Accelerator Example of a similar structure realised at GSI Contract signed 15th July 2004 Sub-contracts with firms: Thales Pink Danfysik Sigmaphy Jaeger NTG Eckelmann 36

In collaboration with: Vacuum System 6 cm 14 cm Contract signed 16th September 2004 With CECOM (Roma) Object: 70 m of vacuum chamber Thin dipole chamber 37

CNA/PS In collaboration with: Contract signed 19th October 2004 with: OCEM S. Gorgio di Piano (Bo) In collaboration with Bologna University 38

Synchrotron Dipole Power Supply Dipole Magnetic Field Cycles Vout = ± 1600 V Iout = 3000 A 39

Synchrotron Power Supplies Under Construction by OCEM (S. Giorgio di Piano Bo) DIPOLES: ±1600V 3000A 10ppm Number 1 QUADRUPOLES: ± 150V 600A 10ppm Number 3+1 STANDARD SEXTUPOLES: ± 45V 600A 200ppm Number 2+1 RESONANCE SEXTUPOLE: ± 40(400)V 600A 6000ppm Number 1+1 HORIZ. CORRECTORS: ± 15V 30A 500ppm Number 10+1 VERT. CORRECTORS: ± 15V 30A 500ppm Number 8 4 TENDERS AND 29 POWER SUPPLIES Under Construction by EEI (Vi) 40

HEBT and MEBT Power Supplies European Tender under way HEBT DIPOLES: ±110 V 3000A 100 ppm Number 10+1 MEBT DIPOLE: ±35 V 300A 100 ppm Number 2+1 HEBT QUADRUPOLES: ± 65V 350A 100 ppm Number 37+1 MEBT QUADRUPOLES: ± 20V 150A 100 ppm Number 9+1 HEBT COMB. STEERERS: ± 30V ± 150A 1000 ppm Number 36+2 MEBT COMB. STEERERS: ± 15V ± 60A 1000 ppm Number 14+2 1 TENDER (3 issues) and 116 POWER SUPPLIES 41

RF Cavity Acquired at the end of 2003 Completion plan in 2 years LPSC+CERN for low-level Milan Task in the agreement INFN-CNAO (23 July 2004) 42

In collaboration with: Special Magnets Università di Pavia Chopper dipole Under construction by DANFYSIK (DK) Electrostatic Extraction Septum 43

In collaboration with: Università di Pavia Special Magnets Under construction by DANFYSIK (DK) Injection and Extraction Section Models 44

Prototype of a pixel chamber Beam Monitoring Realised by: Torino Task approved in INFN-CNAO agreement (23 July 2004) 45

Realised by: Task approved in INFN- CNAO agreement (23 July 2004) Last magnets of the HEBT lines 46

Beam diagnostics Started realisation: PU + Schottky By CECOM (Roma) Pick Up 47

Computed Aided Positioning in Hadrontherapy PoliMi Respiration gating TVC Gantry Couch 48

Controls Domain Level 1 Supervisory Processes Presentation Layer Several WS Virtual Instruments (LabView like) for maintenance The Challange is to guarantee: To scopes, TV monitors or digital viewers Signals Acquisition and Distribution System Signals Analyser Equipment Component Level 2 CSRS Protocols on Ethernet or the crate bus Level 3 Equipment Component Equipment Component Equipment Component Equipment Component Equipment Component Once per cycle per station 1 SERVER or embedded in VME/PXI Data Management Layer Once per cycle or off line Equipment Server Layer Many VME/PXI RT processes run once per cycle TCP/IP on Giga Ethernet CPU Equipment Component asap Once per cycle or off line Cycle Decoder Equipment Component Equipment Component Timing Triggers Cycle Code Repository Master Timing RF Train B Train - Safety - Efficiency - Reliability - Maintainability Adequate for an hospital based facility Digital or Analogue Signals Digital Signals Digitiser Level 4 Equipment Controller CSDRS Protocols on Ethernet or FieldBus Equipment Controller Manufacturer Protocols on FieldBus or point to point Once per cycle (max 1000 scalar data) or off line Many VME/PXI/ PLC Equipment Electronics Layer RT processes can run many times per cycle Many times per cycle Equipment Controller CPU Front End Electronics (signal conditioning) Once per cycle (max 1000 scalar data) or off line Cycle Decoder Timing Many times per cycle Off Off Line means e.g. end of of treatment or or before starting treatment sessions Cycle Code Triggers Equipment Electronics Domain Under realization by: SIDEA s.r.l. (Mi) SubSystems Domain (e.g. Beam Diagnostics) Detectors and Actuators 49

Tappe nella realizzazione degli edifici 30 Aprile 2003 Completamento del progetto preliminare 5 Dicembre 2003 Chiusura del bando per progetto definitivo e direzione 30 Marzo 2004 Completamento progetto definitivo 22 Luglio 2004 Approvazione del progetto definitivo da parte della Conferenza dei Servizi Permesso a costruire 9 Febbraio 2005 Ordine della stazione elettrica di trasformazione (ENEL) 16 Febbraio 2005 Chiusura del bando di costruzione e firma del contratto. Durata della costruzione dell edificio: 18 mesi - fine 2006 21 Febbraio 2005 Presa di possesso dell area per l edificazione 18 Maggio 2005 Consegna progetto esecutivo 15 Giugno 2005 Inizio attività edilizie 28 Febbraio 2006 Consegna area Alta tecnologia 50

Attività AMBULATORIALE Funzionamento 80% trattamenti con ioni e 20% con protoni tempi liberi per ricerca e sviluppo Durata seduta: ca. 20-30 minuti di cui 2-3 minuti per l irraggiamento Anno di funzionamento 1 2 3 Turni di lavoro per i trattamenti 1 2 2 regime Ore giornaliere di funzionamento 7 13 13 Giorni di funzionamento / settimana 5 5 5 Settimane equivalenti / anno 44 44 44 Giorni equivalenti / anno 220 220 220 Pazienti che si trattano / anno 850 2200 3400 Numero sedute effettuate all anno 4835 12160 18738 51