Pulsed RF knock-out extraction: a potential enabler for FLASH hadrontherapy in the Bragg peak.

One challenge on the path to delivering FLASH-compatible beams with a synchrotron is facilitating an accurate dose control for the required ultra-high dose rates. We propose the use of pulsed RFKO extraction instead of continuous beam delivery as a way to control the dose delivered per Voxel. In a first feasibility test, dose rates in pulses of up to 600 Gy s-1were observed, while the granularity at which the dose was delivered is expected to be well below 0.5 Gy.

Technical Design Report for a Carbon-11 Treatment Facility.

Particle therapy relies on the advantageous dose deposition which permits to highly conform the dose to the target and better spare the surrounding healthy tissues and organs at risk with respect to conventional radiotherapy. In the case of treatments with heavier ions (like carbon ions already clinically used), another advantage is the enhanced radiobiological effectiveness due to high linear energy transfer radiation. These particle therapy advantages are unfortunately not thoroughly exploited due to particle range uncertainties. The possibility to monitor the compliance between the ongoing and prescribed dose distribution is a crucial step toward new optimizations in treatment planning and adaptive therapy. The Positron Emission Tomography (PET) is an established quantitative 3D imaging technique for particle treatment verification and, among the isotopes used for PET imaging, the 11C has gained more attention from the scientific and clinical communities for its application as new radioactive projectile for particle therapy. This is an interesting option clinically because of an enhanced imaging potential, without dosimetry drawbacks; technically, because the stable isotope 12C is successfully already in use in clinics. The MEDICIS-Promed network led an initiative to study the possible technical solutions for the implementation of 11C radioisotopes in an accelerator-based particle therapy center. We present here the result of this study, consisting in a Technical Design Report for a 11C Treatment Facility. The clinical usefulness is reviewed based on existing experimental data, complemented by Monte Carlo simulations using the FLUKA code. The technical analysis starts from reviewing the layout and results of the facilities which produced 11C beams in the past, for testing purposes. It then focuses on the elaboration of the feasible upgrades of an existing 12C particle therapy center, to accommodate the production of 11C beams for therapy. The analysis covers the options to produce the 11C atoms in sufficient amounts (as required for therapy), to ionize them as required by the existing accelerator layouts, to accelerate and transport them to the irradiation rooms. The results of the analysis and the identified challenges define the possible implementation scenario and timeline.

Optimization of synchrotron based ion beam therapy facilities for treatment time reduction, options and the MedAustron development roadmap.

A faster treatment reduces the risk of intra-fraction movement of organs, offers a more comfortable treatment to the patient, allows to treat lesion of larger volumes in a reasonable time and most of all expands the capacity of the facility. This work presents possible machine upgrades for synchrotron based ion beam therapy centers to shorten the irradiation time. The expected delivery times for each scenario are simulated for the study case of proton beams of MedAustron. The second part of the work focuses on the MedAustron development roadmap, where recently increase of ring fillings and delivered intensities were implemented for proton treatments achieving an average irradiation time of ~50% since start of operation.

The European Joint Research Project UHDpulse - Metrology for advanced radiotherapy using particle beams with ultra-high pulse dose rates.

UHDpulse - Metrology for advanced radiotherapy using particle beams with ultra-high pulse dose rates is a recently started European Joint Research Project with the aim to develop and improve dosimetry standards for FLASH radiotherapy, very high energy electron (VHEE) radiotherapy and laser-driven medical accelerators. This paper gives a short overview about the current state of developments of radiotherapy with FLASH electrons and protons, very high energy electrons as well as laser-driven particles and the related challenges in dosimetry due to the ultra-high dose rate during the short radiation pulses. We summarize the objectives and plans of the UHDpulse project and present the 16 participating partners.