A Visit to CNAO:

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A Visit to CNAO

• The Italian Carbon Therapy Facility

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History

• May 1991 Amaldi Tosi, For a center of
  teletherapy with hadrons
• 1992 financing for a study by INFN
• 1992 TERA Foundation formed
• 1992 2002 three different designs completed
• 1995 2000 Proton Ion Medical Machine Study
  (PIMMS) by CERN

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History continued

• May 2000 decision to construct CNAO
• 2001 CNAO Foundation formed
• 2005 construction starts
• Feb. 15, 2010 construction complete
• Sep. 22, 2011 first proton patient
• Nov. 13, 2012 first carbon patient
• Note Italy, Austria, and France all planned to
  use the CNAO design

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Source Linac

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

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CNAO vs HIT
25 m
21 m
Synchrotron circumference 65 m
Synchrotron circumference 78 m
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Extraction, etc.

• Use amplitude momentum extraction, 5/3 resonance
• Event driven, i.e resp. gating
• Right now only one event - completion of a plane
• Indefinite flattop, spill 200 msec 10 sec
• Presently, 1 sec spill
• Rep rate design 3 sec
• Presently 5 sec

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Daily schedule

• Treat 4 days/week with carbon
• (5 days/week with protons)
• Up to 12 hours per day
• Mid 8 AM, QA
• Make adjustments 1/month
• QA TP on some weekends also

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Patient positioning

• Couch platform rides on air cushion
• IR optical tracking and lasers
• Later may use x-rays or CT
• Some pre-positioning outside of room
• Therapists dont like to make patients wait
• Alignment and Prep takes a long time

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Cont.

• Use the Japanese protocols
• Use couch tilt like Japan

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Scanning

• Active scanning
• Beam monitors drive the scanning system
• 5 msec to treat each voxel
• 10 µsec to move between voxels
• Beam does not stop
• 3 mm voxel pitch
• Beam size 4 - 10 mm
• Beam abort in 200 µsec

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What would you do differently?

• Would not outsource the control system
• Lost too much control and ability to adjust to
  evolution of the design

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Other concern

• Need a second accelerator
• Once in treatment, time is scarce for studies
• Reluctance to make changes once treatment is
  stable

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What can the US (Fermilab) do?

• Varian has not entered even the proton market
• Siemens has withdrawn from ions and even has
  abandoned two proton centers under construction
• Ions are too expensive right now

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In my view

• Ion market will be small
• An opening for a national lab to develop a
  national resource
• Choose a technology
• Something that will provide a significant cost
  savings
• Develop it
• Provide a prototype for initial development
• Allow for continued development to allow for
  upgrades to be proven before deployment to
  operational facilities

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Thank you