01-2-Frederick_Bordry.pptx

Hadron therapy (present and future)
CERN roadmap: from PIMMS to NIMMS
Frédérick Bordry
Director for Accelerators and Technologies
Chair of CERN Medical Applications Steering Committee (CMASC)
A tribute to Gaspar Barreira
"Particle physics: from fundamental science to society“
11th September 2019

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A tribute to Gaspar Barreira "Particle physics: from fundamental science to society“
Lisbon, 11th September 2019
2017: 60 Proton Centres
10 Carbon Ion Centres
More than
120 Centres
expected for 2022
Durante M, Orecchia R, Loeffler JS, 2017
Hadron-therapy Centres

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2017
Protons 149345 (+80%)
C-ions 21580 (+120%)
Other ions 3587
Total 174512
Protons ~ 80000
C-ions ~ 9800
Number of treated patients with Protons and Carbon-ions

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Particle therapy centres in Europe
2002
2015

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Brief reminder : PIMMS
The Proton Ion Medical Machine Study (PIMMS) was hosted at CERN at the end of
the 1990s and supported by MedAustron, Onkologie-2000 and the TERA Foundation
Outcome: synchrotron design optimised for treating cancer with protons and
carbon ions (a toolkit !)
Design further adapted by TERA and finally evolved into CNAO (Italy), with seminal
contributions from INFN
MedAustron (Austria) was built starting from the CNAO design.

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Proton therapy is rapidly progressing, thanks to the commercial availability of turn-key facilities.
Research is oriented towards delivery systems and optimizing treatment; nobody questions the accelerator
→ Should not interfere with commercial companies.
Instead, there is clear indication that ion therapy has a strong potential (higher RBE (Radio Biological Effectiveness),
effective with radio-resistant tumours) but to make it accessible to a larger fraction of the population some action is
needed along three axis:
- Collect more data from biomedical research with different types of ions
(the BioLEIR line, extended to tests on animals and possibly clinical trials).
- Try to reduce size and cost of the facility, using some new accelerator design (for carbon or lighter ions).
- Further optimise the delivery system, including the gantry.
Courtesy Maurizio Vretenar
Hadron therapy: where and how to contribute ?

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~20 years later (and after the LHC construction!): it’s time for a
next generation of ion therapy accelerators.
A new collaborative study to develop the design and the key
components for a new generation of medical accelerators:
- more compact
- cost-effective
- light-ion (carbon, helium,…)
From PIMMS to NIMMS NIMMS = Next Ion Medical Machine Study

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Knowledge transfer for the benefit of medical applications
CERN’s core mission is basic research in particle physics.
Transferring CERN’s know-how and technology to other fields, and
thus maximising the societal impact of the Laboratory’s research, is an
integral part of CERN’s mission
CERN’s involvement in medical applications-related activities and
the resulting expectations placed on the Organization by all the
relevant stakeholders have been growing over recent years to the
point where knowledge transfer for the benefit of medical applications
has become an established part of CERN’s programme of activities.

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Every year, at least one KT Forum meeting is entirely devoted to the
discussion of medical applications-related activities.
The KT Forum on MA is co-chaired by the Chair of the CMASC and
the CERN KT Group Leader.
Council Delegates have been invited to appoint
one additional delegate to attend these meetings.
The ideal Delegate for the KT Forum on MA has
- knowledge of the applications of HEP technologies to healthcare
- a broad understanding of the ongoing activities in this field in the
Member or Associate Member State
KT Forum on Medical Applications

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Main topics (Annex of the June 2017 Council document):
MEDICIS
Accelerator design for future hadron therapy facilities
Applications of high-field superconducting magnets
Computing and simulation for health applications
Medical imaging
Dosimetry
Other project: Medical linacs for challenging environments
On-going medical applications-related activities

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CERN-MEDICIS:
innovative radioisotopes for medical research
Passively uses proton
beams from ISOLDE
December 2017:
first batch of
isotopes produced
(155Tb)

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Main topics (Annex of the June 2017 Council document):
MEDICIS
Accelerator design for future hadron therapy facilities
Applications of high-field superconducting magnets
Computing and simulation for health applications
Medical imaging
Dosimetry
Other project: Medical linacs for challenging environments
On-going medical applications-related activities
June 2017, CERN Council:
“A collaborative design study coordinated by CERN would contribute to the
development of a new generation of compact and cost-effective light-ion medical
accelerators. A new initiative of this type would leverage existing and upcoming
CERN technologies and the Laboratory’s expertise in the fields of
radiofrequency systems, advanced magnet design, superconducting materials,
and beam optics. The possible launch of such a study is currently being
explored by CERN experts and a proposal will be put forward and evaluated by
CERN’s medical applications decision-making structure.”

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Workshop 19-21 June 2018: jointly organised by CERN, the
European Scientific Institute (ESI) and GSI
https://indico.cern.ch/event/682210/overview
~60 experts from all over the world
Requirements from the particle therapy community and initial
set of medical specifications
Accelerator
Lower cost, compared to present (~120 M€);
Higher beam intensities than present (1010 ppp);
Reduced footprint, to about 1’000 m2;
Lower running costs.
Delivery
Fast dose delivery (possibly with 3D feedback);
Equipped with a rotating gantry;
Using multiple ions;
With range calibration and diagnostics online.

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Jul 2020 – June 2022
Technical design study and
prototyping of the selected
accelerator configuration
Jan 2019- Jun 2020
Compare and analyse
different options
Intermediate
report
Design
report
3. Folded linac
2.
Superconducting
synchrotron
4. Beam
delivery and
gantry
1. Injector linac (10
MeV)
10 MeV
Two possible designs for the future facility:
- Superconducting Synchrotron
- Linear Accelerator

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Superconducting
synchrotron
CCT-type magnets,
Bmax 3.5T,
Ring 27m
Linear accelerator
Folded, 53m length,
high rep. frequency and intensity,
low emittance
Superconducting gantry
Two options being analysed:
- Rotational CCT magnets (TERA)
- Toroidal (L. Bottura, CERN)
Size comparison:
Superconducting (top left)
vs. CNAO (bottom left)
and Medaustron (right)
Options for next generation ion therapy
Courtesy Maurizio Vretenar

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GaToroid: A Novel Superconducting Compact and Lightweight
Gantry for Hadron Therapy
Protons
Torus dimensions: ~1.5 m x 3 m
Estimated mass: 12 tons
Carbon ions
Torus dimensions: ~3 m x 5 m
Estimated mass: 50 tons
(patent
pending)

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 CERN is collaborating with the SEEIIST (South East Europe International Institute for
Sustainable Technologies), a new international partnership aiming at the construction of a
particle therapy facility in South East Europe.
 SEEIIST has received a preliminary funding of 1 M€ from the EC, part of which will be used to
finance 2 FTEs working on ion therapy accelerator design for the next 18 months under the
supervision of CERN (18pm for beam optics, 6pm for diagnostics and extraction + 6pm for
magnet design).
 Next step: EU Design Study proposal to the last call of H2020 Research Infrastructures,
deadline November 2019, mobilising some 15-20 partners. 3 years duration 2020/23, 3 MEUR,
co-funded.
 The Design Study is in preparation, expected partners are: CERN, GSI, CEA, U. Liverpool,
INFN, CNAO, Medaustron, HIT, IAP, Cosylab, U. Melbourne + SEEIIST and other partners in
the region.
 Other partners interested in collaborating with CERN are from India, Latvia, Iran, Sweden, etc.
 A dedicated collaboration for the design of a superconducting gantry, possibly of the toroidal
type, has been started with CNAO, INFN and MedAustron.
Collaborations

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Develop a medical linear accelerator that provides state-of-the-art conventional
radiation therapy in regions where power supply is unreliable, the climate harsh
and/or communications poor.
Medical linacs for challenging environments
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November 2016, Geneva; ICEC Sponsored and CERN hosted Workshop:
“Design Characteristics of a Novel Linear Accelerator for Challenging Environments – Improving global access to
radiation therapy”
October 2017, Geneva; ICEC, CERN, STFC:
“Innovative, robust and affordable medical linear accelerators for challenging environments”
Outcome: 5 seedcorn projects
March 2018, Manchester; CERN, ICEC, STFC:
“Burying the Complexity: Re-Engineering for the Next Generation of Medical Linear Accelerators for Use in
Challenging Environments”
Progress on the 5 projects, refine specifications
March 2019, Workshop in Gaborone, Botswana with over 60 participants.
Attended by oncologists, medical physicists and accelerator experts
from 7 African countries, Nepal, ICEC, CERN and UK institutes
1. Local LMIC perspective on healthcare, cancer care, and technology challenges
2. Current radiation therapy systems and challenges
3. Project reports on the STFC funded work packages
4. Education, training and technical support needs
5. Discussion on priorities and next steps
Medical linacs for challenging environments
Radiotherapy at Life Botswana Hospital, Gaborone

01-2-Frederick_Bordry.pptx

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