The creation of CNAO was based on collaboration and a series of partnerships with Companies and Institutions which allowed for the aggregation of specialists in different sectors around the project and, at the same time, the availability of a group of experts to support the management of CNAO. The following table lists the entities that have contributed to the creation of the centre in Pavia, now involved in its operational activities and research.
Agencies in collaboration with CNAO
- TERA Foundation: Final Project, specific High Technology aspects, research
- INFN: With Co-direction responsibilities, more than 15 technical tasks, training and research
- Milan University: Medical coordination and training
- Pavia University: Technical tasks, radiobiology and training
- Catania University: Medical Physics
- East Piedmont University: Medical Activities
- Polytechnic of Milan: Patient’s positioning and radioprotection
- European Institute of Oncology: Medical activities, authorization
- Hospital San Matteo Foundation (Pavia): Management of the CNAO Imaging Department, Medical activities, Logistics
- ABO Foundation and Alma Mater (UniBo): Research
- Municipality of Pavia: Land and authorizations
- Province of Pavia: Transport logistics/roads
- CERN (Geneva): Technical tasks, PIMMS Project
- GSI (Darmstadt): Linac and special components
- LPSC (Grenoble): Accelerator optics, Betatron, low-level RF and control system
- Med-Austron (Vienna): Technical collaboration for the Med-Austron Centre
- Roffo Institute (Buenos Aires): Medical activities and Research
- NIRS (Chiba): Medical activities, radiobiology and training
- HIT (Heidelberg): Research activities
The European Projects and Research
The Particle Training Network for European Radiotherapy (PARTNER) project was launched in 2008. The project aimed to train medical and technical personnel and medical physicists at European Hadrontherapy Centers and in Hadrontherapy Projects. The goal of the project was to promote the exchange of researchers between countries. Under the project two radiation oncologist from India and Singapore and a physicist from Colombia worked at the CNAO in Pavia.
The activities of the PARTNER radiation oncologists at CNAO included training on the clinical aspects of the Hadrontherapy, the definition of new clinical studies and the identification of new potential indications for Hadrontherapy on the basis of epidemiological data.
The physicist was involved in the design of a new gantry for carbon ions in collaboration with the group that operated within the framework of a project on the Union of Light Ion Centres in Europe (ULICE). The ULICE Project was funded by the European Community under the 7th Program (FP7-2008-1-Infrastructure), for a total duration of 48 months and was launched in 2009. The project was coordinated by Professor Roberto Orecchia, Scientific Director of the CNAO Foundation and included the participation of 19 other European Institutes (Table below).
|1||Centro Nazionale di Adroterapia Oncologica||Italy|
|2||Medical University of Vienna||Austria|
|3||University Hospital of Heidelberg||Germany|
|4||European Organization for Nuclear Research||Switzerland|
|7||Gesellschaft für Schwerionenforschung||Germany|
|10||Technical University of Dresden||Germany|
|11||Siemens AG - MED PT PLM P||Germany|
|12||European Society for Therapeutic Radiology and Oncology||Belgium|
|13||Université Catholique de Louvain||Belgium|
|14||Medical University Aarhus||Denmark|
|15||Stichting Katholieke Universiteit||Netherlands|
|16||Ion Beam Applications SA||Belgium|
|17||Istituto Nazionale di Fisica Nucleare||Italy|
|18||Henryk Niewodniczanski Institute of Nuclear Physics Polish Academy of Sciences||Poland|
|20||Université Claude Bernard Lyon 1||France|
The objective of the ULICE Project was to “open” European Centers that practice Hadrontherapy to the scientific community, by providing resources and facilities to disseminate this innovative technique in the treatment of cancer. The involvement of the medical and scientific community was carried out through subprojects organized into three main areas of activity: Joint-Research Activities, Networking Activities and Trans-National Access activities, as indicated in the figure below.
In addition to overall coordination, the CNAO has been responsible for the coordination of research and development on a new gantry for ions (Work Package 6 – Marco Pullia ), awareness-building and information for local and European authorities on Hadrontherapy (WP 9 – Roberto Orecchia), the definition of procedures for the standardization of protocols which facilitate access to Hadrontherapy facilities and the comparison of research results (WP10 – Piero Fossati) Professor Marco Krengli had finally the responsibility for the activities related to the provision of the beam at CNAO for treatment and research activities in the context of ULICE.
Hadrontherapy - collaborating for the future
Three researchers have been working on the WP6-CNAO Gantry. The 2010 activities included the definition of basic functional specifications of a gantry for carbon ions, based on a questionnaire given to the community of doctors and physicists. Two possible types of gantry have been outlined from the specifications: with fixed or mobile isocenter; in addition the position of scanning magnet upstream or downstream of the last bending dipole is under investigation. Work has continued in 2011 on the two configurations to determine the best choice in terms of performance and cost.
The discussion within the WP9 involved institutions interested in developing a hadrontherapy project and those already active with Proton therapy. A questionnaire has been distributed among stakeholders to survey current and future hadrontherapy needs.
The WP10 activities have focused on the census of existing and under-construction centers in the world. From Japanese centers in Chiba, Hyogo and Gunma, the possibility of sharing clinical protocols for hadrontherapy applied in these facilities with the informed consent for patients and a series of technical information concerning devices used in immobilization and treatment has been obtained.
On 27 January 2010, the Lombardy Regional Government approved and funded a project for the Planning and Control in hadrontherapy, as part of its wider support for clinical and scientific activities within the context of the Lombardy Cancer Network (ROL). The project involves the creation of instruments for collaboration and biomedical research between CNAO and the Foundations IRCCS San Matteo di Pavia, Besta, Istituto Nazionale dei Tumori di Milano and Ospedale Maggiore Policlinico di Milano, to create synergies and useful links for effective administration, planning and security of hadrontherapy treatment.
In July 2010 the CNAO-MED Project was approved and financed by the Cariplo Foundation, as part of a wider call for symbolic donations. The project aims to equip CNAO with the most modern tools for the identification of tumor volume so it can ensure the extreme precision and effectiveness characteristic of treatment with hadron beams. The project provided the purchase of a CT scan and a CT-PET equipment and a high-resolution magnetic resonance imaging (3T MR), together with the necessary tools for the Oncological Information System (OIS ) and the control and management systems for accelerating machines producing hadrons beams. The equipments are now operative at CNAO.
In 2011 the Beam-patient Interface Project, financed by the Lombardy Region in cooperation with the Ministry of Productive Activities and aimed at optimizing the techniques for precision radiotherapy, was completed. The project focused on identifying the necessary systems for diagnosis, elaboration of treatment plans, patient positioning and the irradiation with beams of hadrons (protons and carbon ions) in a controlled and safe manner.
Also in 2010 the prototype of the Proton Range Radiography Detector, developed by the TERA Foundation as part of the AQUA Program (Quality Assurance in Hadrontherapy) was finalized. The detector is a kind of electronic telescope that allows for the simultaneous measurement of the position and distance which a beam of protons must travel. The detector was tested at PSI in Villigen and it has been used since the beginning of 2011 on the CNAO beams of protons. The Italian Association for Cancer Research has funded the Plasma Focus Project in which CNAO is involved with ABO and Alma Mater.
The project aimed to characterize from the radiobiological point of view, a new accelerator of photons that in the future might prove to be a compact generator of radioisotopes for imaging.With regard to other research projects, 2010 has seen the conclusion of the final design of the MISHA (Multicharged Ion Source for Hadrontherapy) collaboration between INFN and CNAO. This project proposes the creation of a reliable ion source more powerful than those currently used for hadrontherapy beams.
The goal of 2012 was to obtain the financing necessary for completion of a prototype that will allow adding a third source to those already in use at CNAO and thus open interesting market opportunities for the companies involved. At the end of 2010, the CARIPLO Foundation approved the post-graduate training project “Masters in Hadrontherapy”, promoted by the University of Pavia, which includes the CNAO Foundation among its technical sponsors. This represents a major step towards integration of CNAO’s work into the network of the University of Pavia, with a prospect of ensuring a continuous source of research and high-level development skills.