A Visit to CNAO:A Visit to CNAO:

The Italian Carbon Therapy FacilityThe Italian Carbon Therapy Facility

HistoryHistory

May 1991 – Amaldi & Tosi, “For a center May 1991 – Amaldi & Tosi, “For a center of teletherapy with hadrons”of teletherapy with hadrons”

1992 – financing for a study by INFN1992 – financing for a study by INFN 1992 – TERA Foundation formed1992 – TERA Foundation formed 1992 – 2002 – three different designs 1992 – 2002 – three different designs

completedcompleted 1995 – 2000 – Proton Ion Medical 1995 – 2000 – Proton Ion Medical

Machine Study (PIMMS) by CERNMachine Study (PIMMS) by CERN

History continuedHistory continued

May 2000 – decision to construct CNAOMay 2000 – decision to construct CNAO 2001 – CNAO Foundation formed2001 – CNAO Foundation formed 2005 construction starts2005 construction starts Feb. 15, 2010 – construction completeFeb. 15, 2010 – construction complete Sep. 22, 2011 – first proton patientSep. 22, 2011 – first proton patient Nov. 13, 2012 – first carbon patientNov. 13, 2012 – first carbon patient Note: Italy, Austria, and France all Note: Italy, Austria, and France all

planned to use the CNAO designplanned to use the CNAO design

Source & LinacSource & Linac

Same as HITSame as HIT 2 permanent magnet ECR sources2 permanent magnet ECR sources 400 keV/u 4-rod type RFQ400 keV/u 4-rod type RFQ 20 MV IH-type drift tube linac (IH-DTL)20 MV IH-type drift tube linac (IH-DTL)

CNAO vs HITCNAO vs HIT

~21 m

~ 25 m

Synchrotron circumference78 m

Synchrotron circumference65 m

Extraction, etc.Extraction, etc.

Use amplitude momentum extraction, 5/3 Use amplitude momentum extraction, 5/3 resonanceresonance

Event driven, i.e resp. gatingEvent driven, i.e resp. gating Right now only one event - completion of a planeRight now only one event - completion of a plane

Indefinite flattop, spill 200 msec – 10 secIndefinite flattop, spill 200 msec – 10 sec Presently, 1 sec spillPresently, 1 sec spill

Rep rate design 3 secRep rate design 3 sec Presently 5 secPresently 5 sec

Daily scheduleDaily schedule

Treat 4 days/week with carbonTreat 4 days/week with carbon (5 days/week with protons)(5 days/week with protons) Up to 12 hours per dayUp to 12 hours per day Mid – 8 AM, QAMid – 8 AM, QA Make adjustments ~ 1/monthMake adjustments ~ 1/month QA & TP on some weekends alsoQA & TP on some weekends also

Patient positioningPatient positioning

Couch platform rides on air cushionCouch platform rides on air cushion IR optical tracking and lasersIR optical tracking and lasers

Later may use x-rays or CTLater may use x-rays or CT

Some pre-positioning outside of roomSome pre-positioning outside of room Therapists don’t like to make patients Therapists don’t like to make patients

waitwait Alignment and Prep takes a long timeAlignment and Prep takes a long time

Cont.Cont.

Use the Japanese protocolsUse the Japanese protocols Use couch tilt like JapanUse couch tilt like Japan

ScanningScanning

Active scanningActive scanning Beam monitors drive the scanning systemBeam monitors drive the scanning system

5 msec to treat each voxel5 msec to treat each voxel 10 10 μμsec to move between voxelssec to move between voxels

Beam does not stopBeam does not stop

3 mm voxel pitch3 mm voxel pitch Beam size 4 - 10 mmBeam size 4 - 10 mm Beam abort in 200 Beam abort in 200 μμsecsec

What would you do What would you do differently?differently?

Would not outsource the control systemWould not outsource the control system Lost too much control and ability to adjust Lost too much control and ability to adjust

to evolution of the designto evolution of the design

Other concernOther concern

Need a second acceleratorNeed a second accelerator Once in treatment, time is scarce for Once in treatment, time is scarce for

studiesstudies Reluctance to make changes once Reluctance to make changes once

treatment is stabletreatment is stable

What can the US What can the US (Fermilab) do?(Fermilab) do?

Varian has not entered even the proton Varian has not entered even the proton marketmarket

Siemens has withdrawn from ions and Siemens has withdrawn from ions and even has abandoned two proton centers even has abandoned two proton centers under constructionunder construction

Ions are too expensive right nowIons are too expensive right now

In my viewIn my view

Ion market will be smallIon market will be small An opening for a national lab to develop a An opening for a national lab to develop a

national resource:national resource: Choose a technologyChoose a technology

Something that will provide a significant cost savingsSomething that will provide a significant cost savings Develop itDevelop it Provide a prototype for initial developmentProvide a prototype for initial development Allow for continued development to allow for Allow for continued development to allow for

upgrades to be proven before deployment to upgrades to be proven before deployment to operational facilitiesoperational facilities

Thank youThank you