Digital Tomosynthesis (DT) is a 3D mode of x-ray imaging. Adaptix Ltd have developed a novel mobile DT device enabled by implementing an array of R-ray emission points and a flat-panel detector. This device gives access to human and animal 3D imaging, as well as to non-destructive material evaluation. DT is not as clinically popular as Computed Tomography (CT) or radiography, and flat-panel source DT even less so, thus creating scope to investigate the optimal flat-panel detector technology for this modality. Geant4, a Monte Carlo Particle Transport code, has been used to simulate the Adaptix Ltd system to do this. Parameters such as the material composition of the detectors, the exact detection method and the inclusion vs exclusion of a scintillation layer are tested in this simulation environment. This work aims to find the optimal flat-panel detector design by comparing different scintillator compositions and structures for this DT method. Therefore, the ideal detector that preserves the advantages of this low-cost, low-dose scanning approach is determined.

As one of the state-of-the-art radiotherapy approaches, proton therapy possesses conformal dose profiles yet expensive cost. Designing a facility with a small footprint and a high treatment efficiency is the main goal for researchers to fulfill the potential of proton therapy and make it more affordable both for vendors and patients. In this contribution, the design of a light-weight proton therapy gantry based on the alternating-gradient canted-cosine-theta (AG-CCT) super-conducting (SC) magnet is presented. The AG-CCT magnets adopt large bores and combined function design. With fine field harmonic control and fringe field shape optimization of the magnets, the multi-particle tracking results prove that the gantry achieves a momentum acceptance of ±8%. So that the full energy range from 70 to 230 MeV can be covered with merely 3 field switch points. Combined with a fast degrader component, whose switch time is below 50 ms, the energy modulation speed can be greatly fastened. To fully utilize the advantages of the large momentum acceptance gantry, the energy spread of the proton beam is expanded and a reduced treatment plan is proposed. Compared with the standard treatment plan, the energy layers number of a prostate case is reduced by 61.3% with comparable plan quality. In summary, the proposed gantry has significant superiority both in manufacture and clinical aspects.

In order to miniaturize ion injectors for particle therapy, a design of ion injectors based on a 325 MHz operating frequency was completed. The LINAC was consist of a 2.0 m length RFQ and a 3.8 m length IH-DTL, which was designed to accelerate 12C4+, 3H+, 3He+ and 18O6+ beams to 7 MeV/u. The RFQ cavity and the first DTL tank was been manufactured using aluminum. This paper gives an overview of the fabrication and tuning procedure of the prototype. The quadrupole electric field of the RFQ is adjusted flat by the tuner while reducing the dipole field components in both directions. The measured DTL electric field distribution after tuning is in good agreement with the simulation results.

By using a high-energy electron beam (beam energy of several hundred MeV) strongly focused on the tumor lesion area, radiotherapy can be performed with a relatively simple beam generation and handling system while resulting in a suitable shape of the deposition energy curve in a tissue-like material. Quadrupole magnets are typically used for beam focusing, which makes the beam delivery system complex and challenging from an engineering point of view. In the Geant4 simulation toolkit, we performed a feasibility study of an alternative solution, in which focusing is achieved by using a bent silicon crystal with an appropriately shaped exit surface. However, the focusing strength is still not high enough. Research to find the optimal crystal shape to achieve the ideal focusing strength is ongoing. Such a crystal lens can be a very light object (mass in the order of grams), allowing for a much simpler beam delivery system for radiotherapy facilities.

Various initiatives in Europe have been launched to study superconducting magnets for a rotatable gantry suitable to deliver up to 430 MeV/u carbon ions for hadron therapy. Different technologies and layouts are being considered: the baseline solution is developed within the EuroSIG collaboration and consists of a strongly curved cos-$\theta$ dipole based on the classical NbTi superconductor. The HITRIplus and I.FAST projects are dedicated to the study of the novel Canted Cosine Theta (CCT) dipoles based on NbTi and also HTS. Common design targets were set to allow a direct comparison of the different solutions: 4 T central field in an 80 mm bore, a curvature radius of 1.65 m, and a ramp rate of 0.15 – 0.4 T/s. The progress in the construction of four different demonstrator magnets is discussed and a preliminary comparison is proposed.

In the context of research on simultaneous heavy ion radiotherapy and radiography, a mixed carbon/helium ion beam has been successfully established and investigated at GSI for the first time to serve fundamental experiments on this new mode of image guidance. A beam with an adjustable ratio of 12C3+/4He+ was provided by the 14.5 GHz Caprice ECR ion source for subsequent acceleration in the linear accelerator UNILAC and the synchrotron SIS18. Despite the mass difference between the 4He+ and 12C3+ ions, both could be slowly extracted simultaneously at 225 MeV/u using the transverse knock-out extraction scheme. The ion beam has been finally characterized in the biophysics cave in terms of beam composition (particularly inter- and intra-spill He fraction), depth-dose-profiles, beam size, position and other parameters, all related to combined ion beam treatment and online monitoring. Utilizing high-speed particle radiography techniques, a fast extracted mixed ion beam has also been characterized in the plasma physics cave under conditions favorable to FLASH therapy.

The temporal characteristics of ultra-high dose rate beams delivered for FLASH research are often dictated by machine constraints, making it challenging to compare the outcomes across studies performed at different facilities. To broaden the opportunities for systematic, non-clinical FLASH research, this study explores methods to deliver beams with customizable time structures from a medical synchrotron. The studies are being performed at the center for ion beam therapy and research MedAustron and aim at extracting ultra-high dose rate proton beams in a series of pulses with adjustable dose per pulse, pulse length and pulse separation down to sub-ms levels. This contribution describes the implementation of the extraction methods explored for this application, phase displacement and radio frequency knockout extraction, and presents first measurement results. The measurement setup employs a silicon carbide detector in conjunction with a 20 MHz bandwidth amplifier, enabling intensity measurements with a resolution exceeding the synchrotron revolution period.

With a very low relative charge-to-mass ratio offset of approximately 0.065%, helium (⁴He²⁺) and carbon ions (¹²C⁶⁺) are interesting candidates for being simultaneously accelerated in hadron therapy accelerators. At the same energy per nucleon, helium ions exhibit a stopping range approximately three times greater than that of carbon ions. They can therefore be exploited for online range verification in a detector downstream of the patient during carbon ion therapy. The synchrotron-based MedAustron Ion Therapy Center provides the opportunity to study the feasibility of such a mixed beam-based in-vivo range verification system due to the availability of 120-402.8 MeV/u carbon beams and the ongoing commissioning of 39.8-402.8 MeV/u helium beams. One possibility for creating this mixed beam is accelerating ⁴He²⁺ and ¹²C⁶⁺ sequentially through the LINAC and subsequently “mixing” the ion species at injection energy in the synchrotron with a double injection scheme. This contribution introduces this newly proposed injection scheme, outlines challenges and presents first feasibility estimates obtained through measurements and particle tracking simulations.

Ultra-high energy electrons (UHEE) are used to investigate their effect on tumor cells and healthy tissue in short pulses of microseconds at the electron accelerator facility ELSA. This may enable highly efficient treatment of deep-seated tumors due to the FLASH effect. In a preliminary setting electrons with an energy of 1.2 GeV are used to irradiate cell samples which are located inside a water volume, representing the human body. Irradiation occurs with dose rates of up to 10 MGy/s due to the short pulse lengths of 250 ns. The relative biological effectiveness (RBE) can be determined by assessing the cell survival of tissues under FLASH and conventional conditions. For a precise dose determination, dose measurements via radiochromic films are utilized and compared to simulations with Geant4, that reproduce the electromagnetic shower process.

We present a design of the proton FLASH radiation therapy facility using the Brag peak to be built at Stony Brook University Hospital at the Radiation Oncology Department. It includes an injector using a commercially available injector cyclotron (10-30 MeV), fixed field alternating (FFA) gradient beam lines, permanent magnet Fixed Field Alternating Gradient non-scaling variable transverse field fast-cycling synchrotron accelerator with unprecedented kinetic energy range between 10-250 MeV, and a permanent magnet delivery system the FFA gantry. This facility removes limitations of the present proton cancer therapy facilities allowing FLASH radiation to be performed with 40 Gy/s in 100 ms. This allows treatment with the FLASH therapy without magnet adjustments for any proton kinetic energy between 70-250 MeV. The proposal is based on already experimentally proven FFA concept at the Energy Recovery linac 'CBETA' built and commissioned at Cornell University.

Digital Tomosynthesis (DT) is a 3D mode of x-ray imaging. Adaptix Ltd have developed a novel mobile DT device enabled by implementing an array of R-ray emission points and a flat-panel detector. This device gives access to human and animal 3D imaging, as well as to non-destructive material evaluation. DT is not as clinically popular as Computed Tomography (CT) or radiography, and flat-panel source DT even less so, thus creating scope to investigate the optimal flat-panel detector technology for this modality. Geant4, a Monte Carlo Particle Transport code, has been used to simulate the Adaptix Ltd system to do this. Parameters such as the material composition of the detectors, the exact detection method and the inclusion vs exclusion of a scintillation layer are tested in this simulation environment. This work aims to find the optimal flat-panel detector design by comparing different scintillator compositions and structures for this DT method. Therefore, the ideal detector that preserves the advantages of this low-cost, low-dose scanning approach is determined.

At the Photo Injector Test facility at DESY in Zeuthen (PITZ), an R&D platform for electron FLASH cancer radiation therapy and radiation biology is being prepared: FLASHlab@PITZ. The design of the full beamline with optimized beam properties was finished; the setup is currently being finalized and the mechanical design and manufacturing is underway. The beamline runs in parallel to the SASE THz beamline at PITZ and is connected to it with a dogleg. Beam dynamics simulations were conducted to assure excellent beam quality at the experimental area. A fast kicker system will be installed which is capable of distributing electron bunches from a single bunch train freely over an area of 25mm x 25mm within one microsecond. When the full FLASHlab@PITZ beamline is ready in 2024, the accelerator will deliver 22 MeV electrons to generate dose rates from 0.01 Gy/s up to 10e+14 Gy/s to an experimental area, which can accommodate a variety of setups for irradiation studies. The flexible arrangement of the experimental area will make it possible for external users to collaborate with PITZ and conduct experiments with existing or newly designed irradiation setups.

The replacement of radionuclides used for cancer therapy with accelerators offers several advantages for both patients and medical staff. These include the elimination of: unwanted dose, specialized storage and transportation, and isotope production/replacement. Several electronic brachytherapy devices exist, and typically utilize an x-ray tube around 50 keV. These have primarily been used for skin cancer, though intraoperative applications are becoming possible. For several types of cancer, Iridium-192 has been the only brachytherapy treatment option, due to its high dose rate and 380 keV average energy. An accelerator-based alternative to Ir-192 has been developed, comprised of a 9.4 GHz, 1 MeV compact brazeless accelerator, narrow drift tube, and target. The accelerator is supported and positioned through the use of a robotic arm, allowing for remote delivery of radiation for internal cancer treatment. Preliminary results including dose rate and profile and plans for complete system demonstration will be presented.

An increasing number of accelerators are pursuing FLASH radiotherapy, which promises to mitigate unwanted damage to healthy tissues by applying ultra-high dose rates. To reach this extreme intensity regime, it is necessary to maximize the transmission through the exit nozzle, apart from increasing the accelerator’s output beam current. Simultaneously, the delivered beam properties must satisfy certain quality criteria that clinical applications require, such as transverse homogeneity. For this reason, a Python-based software has been developed to optimize the design of double-scattering beam nozzles. For a user-defined set of incoming beam parameters, output field requirements and available materials, the tool searches for the most efficient scattering conditions utilizing a graphical interface. These conditions are then translated into distances and shaping of the scatterers, involving a combination of high and low-density elements in a multiple-ring arrangement. A solution for the treatment of eye tumors has been successfully calculated, implemented, and tested with beam, in order to demonstrate the capabilities of this approach.

As one of the state-of-the-art radiotherapy approaches, proton therapy possesses conformal dose profiles yet expensive cost. Designing a facility with a small footprint and a high treatment efficiency is the main goal for researchers to fulfill the potential of proton therapy and make it more affordable both for vendors and patients. In this contribution, the design of a light-weight proton therapy gantry based on the alternating-gradient canted-cosine-theta (AG-CCT) super-conducting (SC) magnet is presented. The AG-CCT magnets adopt large bores and combined function design. With fine field harmonic control and fringe field shape optimization of the magnets, the multi-particle tracking results prove that the gantry achieves a momentum acceptance of ±8%. So that the full energy range from 70 to 230 MeV can be covered with merely 3 field switch points. Combined with a fast degrader component, whose switch time is below 50 ms, the energy modulation speed can be greatly fastened. To fully utilize the advantages of the large momentum acceptance gantry, the energy spread of the proton beam is expanded and a reduced treatment plan is proposed. Compared with the standard treatment plan, the energy layers number of a prostate case is reduced by 61.3% with comparable plan quality. In summary, the proposed gantry has significant superiority both in manufacture and clinical aspects.

Radiation therapy is an important oncological treatment method in which the tumor is irradiated with ionizing radiation. In recent years, the study of the beneficial effects of short intense radiation pulses (FLASH effect) or spatially fractionated radiation (MicroBeam/MiniBeam) have become an important research field. Systematic studies of this type often require research accelerators that are capable of generating the desired short intense pulses and, in general, possess a large and flexible parameter space for investigating a wide variety of irradiation methods. The KIT accelerators give access to complementary high-energy and time-resolved radiation sources. While the linac-based electron accelerator FLUTE (Ferninfrarot Linac- und Testexperiment) can generate ultrashort electron bunches, the electron storage ring KARA (Karlsruhe Research Accelerator) provides a source of pulsed X-rays. In this contribution, first dose measurements at FLUTE and KARA, as well as simulations using the Monte Carlo simulation program FLUKA are presented.

LhARA, the Laser-hybrid Accelerator for Radiobiological Applications, is a proposed facility designed to advance radiobiological research by delivering high-intensity beams of protons and ions in unprecedented ways. Designed to serve the Ion Therapy Research Facility (ITRF), LhARA will be a two-stage facility that will employ laser-target acceleration in the first stage, generating proton bunches with energies around 15 MeV via the TNSA mechanism. A series of Gabor plasma lenses will efficiently capture the beam, directing it to an in-vitro end station. In the second stage, protons will be accelerated in a fixed-field alternating gradient ring, reaching up to 127 MeV, while ions can achieve up to 33.4 MeV/u. The resulting beams will be directed to either an in-vivo end station or a second in-vitro end station. The demonstrated technologies have the potential to shape the future of hadron therapy accelerators, offering versatility in time structures and spatial configurations, with instantaneous dose rates surpassing the ultra-high dose rates required for studies into the FLASH effect. Here, we present a status update of the LhARA accelerator as we approach a full conceptual design.

FLASH Therapy, an innovative cancer treatment, minimizes radiation damage to healthy tissue while maintaining the same efficacy in tumor cure as conventional radiotherapy. Successful integration of FLASH therapy into clinical practice, specifically for treating deep-seated tumors with electrons, relies on achieving Very High Electron Energy (VHEE) within the 50-150 MeV range. In collaboration with INFN, Sapienza University actively develops a compact C-band high-gradient VHEE FLASH linac called SAFEST. This paper presents the general layout and the main characteristics of the machine and the first prototype set for deployment at Sapienza University of Rome. This endeavor is a significant step towards the clinical implementation of FLASH Therapy.

A new proton injector based on the 425-MHz radio frequency quadrupole (RFQ) and interdigital H-mode drift tube linac (IH-DTL) has been designed. The injector is ~7 m long and comprises an electron-cyclotron-resonance (ECR) ion source, a low-energy beam transport, an RFQ, an IH-DTL, two triplets, a medium-energy beam transport, and a debuncher. The IH-DTL is specially designed with two tanks with different bunching phases, which can contribute to excellent transverse and longitudinal beam quality. The ion source produces an 18-mA proton beam with the energy of 30 keV. The output energy of the injector is 7 MeV with the transmission efficiency of 86.2%. A three-dimensional electromagnetic simulation was conducted, and the results agreed with the design. A systematic and mechanical design of the entire proton injector was also performed for the following research and development. The injector has great performance and is planned to be utilized in Shanghai APACTRON Proton Therapy facility (SAPT). In the future, it can also promote advanced proton accelerators for medical applications.

In order to miniaturize ion injectors for particle therapy, a design of ion injectors based on a 325 MHz operating frequency was completed. The LINAC was consist of a 2.0 m length RFQ and a 3.8 m length IH-DTL, which was designed to accelerate 12C4+, 3H+, 3He+ and 18O6+ beams to 7 MeV/u. The RFQ cavity and the first DTL tank was been manufactured using aluminum. This paper gives an overview of the fabrication and tuning procedure of the prototype. The quadrupole electric field of the RFQ is adjusted flat by the tuner while reducing the dipole field components in both directions. The measured DTL electric field distribution after tuning is in good agreement with the simulation results.

In contemporary radiotherapy, most accelerators employ the scatter technique to achieve a relatively uniform dose distribution of electron beams. However, this method often results in the loss of a substantial number of particles, leading to suboptimal efficiency. This paper proposes a method utilizing permanent magnet components to homogenize the beam, achieving both beam spreading and uniformity within a short distance without particle loss. The proposed homogenization beamline comprises two quadrupole magnets and two octupole magnets, ultimately yielding a square field with a side length of approximately 20 cm. The manuscript includes theoretical derivations and simulation validations, with the physical prototype currently under fabrication. Experimental results will be provided in future work.

In this work, MAX FLASH system (Multi-Angle ultrahigh dose rate megavolt-level X-ray radiation system for FLASH radiotherapy) is presented. This system consists of a rapid RF power distribution network and five linacs vertically installed at different coplanar angles. The distribution network can switch all power to one terminal linac between pulses. Electron beams are accelerated to 10 MeV with more than 400 mA peak currents in the high-performance linac and then convert into X-ray at a compact rotating target. The system aims for a compact FLASH radiotherapy clinical facility with a gantry 3 meter in diameter and 2.5 meter in length, which can be installed in most of hospital radiotherapy treatment rooms. There is reserved space in the gantry for a coplanar CBCT to implement for image guidance. The gantry can rotate to an optimized angle for a better conformality before radiation while the system remains stationary and switches the operating linac during radiation. Construction of the first system prototype, with 40 Gy/s dose rate at 80 cm source-axis-distance, is supposed to be finished in the summer of 2024.

By using a high-energy electron beam (beam energy of several hundred MeV) strongly focused on the tumor lesion area, radiotherapy can be performed with a relatively simple beam generation and handling system while resulting in a suitable shape of the deposition energy curve in a tissue-like material. Quadrupole magnets are typically used for beam focusing, which makes the beam delivery system complex and challenging from an engineering point of view. In the Geant4 simulation toolkit, we performed a feasibility study of an alternative solution, in which focusing is achieved by using a bent silicon crystal with an appropriately shaped exit surface. However, the focusing strength is still not high enough. Research to find the optimal crystal shape to achieve the ideal focusing strength is ongoing. Such a crystal lens can be a very light object (mass in the order of grams), allowing for a much simpler beam delivery system for radiotherapy facilities.

The world's smallest carbon ion treatment facility has been commissioned at Yamagata University. The treatment system consists of an ECR ion source, a linac cascade of 0.6 MeV/u RFQ and 4 MeV/u IH-DTL, a 430 MeV/u slow extraction synchrotron, and irradiation systems of a fixed horizontal beamline and a compact rotating gantry using superconducting combined function magnets. The size of the building is 45 x 45 m, realized by placing the irradiation rooms not on the same level as the synchrotron, but above it, connected by a vertical beam transport. The most advanced accelerator technology of this machine is to control the beam range up to 300 mm in 0.5 mm steps without any physical block range shifter. To achieve this range step, 600 beam energies were provided in the synchrotron and in the beam transport and tuned to control the beam size in the treatment room. Initial commissioning and daily/monthly quality assurance were carried out by interpolation of beam energy and gantry angle. After tuning the beam size and correcting the beam axis in the treatment rooms, precise dose measurement was performed for clinical irradiation. After the clinical commissioning, the facility started treatment irradiation in February 2021 with a fixed beam port and in March 2022 with a gantry beam port. After March 2023, the gantry angle was operated with a 15-degree step. By November 2023, 1330 patients had been treated.