CONTENTS -- PREFACE -- CHAPTER 1 INTRODUCTION -- 1.1 Cancer and Radiation Therapy -- 1.2 Historical Development of Radiation Therapy -- 1.3 Modern Tools for Conventional Radiotherapy -- 1.3.1 Main Parameters of Conventional Therapy Beams -- 1.3.2 Elements of Conventional Accelerator System -- 1.3.3 Reasons for Development of Non-conventional Radiotherapies -- 1.4 Glossary -- 1.4.1 Beam Intensity -- 1.4.2 Beam Range in an Absorbing Medium -- 1.4.3 Bragg Peak Modulation -- 1.4.4 Range Adjustment -- 1.4.5 Radiation Field -- 1.4.6 Field Homogeneity on a Transverse Section -- 1.4.7 Homogeneity Region in a Plane Orthogonal to the Beam Direction -- 1.4.8 Field Homogeneity along the Beam Axis -- 1.4.9 Field Symmetry -- 1.4.10 Lateral Penumbra -- 1.4.11 Distal Dose Fall-off -- CHAPTER 2 PHYSICAL AND RADIOBIOLOGICAL PROPERTIES OF HADRONS -- 2.1 Basic Facts in Radiotherapy -- 2.1.1 Dose-Effects Curves -- 2.1.2 RBE Dependence on LET and OER -- 2.2 An Introduction to Hadrontherapy -- 2.3 Energy Loss -- 2.3.1 Nuclear Energy Loss -- 2.3.2 Electronic Energy Loss -- 2.3.3 Range and Bragg Curves -- 2.3.4 Track Formation and Radial Dose Distribution -- 2.4 Interaction of Hadrons with Biological Matter -- 2.4.1 Cellular Organization and the Target of Radiation Action -- 2.4.2 Hadrons' Track in Biological Matter -- 2.4.3 RBE of Hadrons -- 2.4.4 Fractionation and Oxygen Effect -- CHAPTER 3 STATUS OF CLINICAL RESEARCH IN PROTONTHERAPY -- 3.1 Precision in Radiotherapy and the Role of Protons in Improving Treatment Precision -- 3.1.1 Precision in Conventional Radiotherapy -- 3.1.2 Role of Proton Beams in Improving Treatment Precision -- 3.1.3 Range Uncertainties of the Protons in the Patients -- 3.2 Clinical Experience in Protontherapy. Patient Statistics -- 3.3 Clinical Indications for Protontherapy -- 3.3.1 Ocular Melanomas.

3.3.2 Skull Base and Cervical Chordomas and Chondrosarcomas -- 3.3.3 Intracranial Tumors -- 3.3.4 Pituitary Tumors -- 3.3.5 Arteriovenous Malformations (AVM) -- 3.3.6 Adenocarcinoma of the Prostate -- 3.4 Hadrontherapy Diseases Categories -- 3.5 Number of Hadrontherapy Patients World-Wide -- CHAPTER 4 HADRONTHERAPY FACILITIES WORLD-WIDE -- 4.1 Hadrons Acceleration and Beam Delivery Technologies for Radiotherapy -- 4.1.1 Accelerator for Radiotherapy with Hadrons -- 4.1.2 Energy Selection System -- 4.1.3 Beam Transport -- 4.1.4 Gantry -- 4.1.5 Beam Delivery Systems -- 4.2 Historical Development of Hadrontherapy Centers -- 4.2.1 Hadrontherapy Centers Localized in the Research Facilities -- 4.2.2 Second Generation of Research Hadrontherapy Facilities -- 4.2.3 Hospital-Based Dedicated Hadrontherapy Facilities -- 4.3 Planned Hadrontherapy Centers -- 4.4 International Collaborations for Design an Universal Protontherapy Center -- 4.5 Firm Project of Protontherapy Centers -- CHAPTER 5 REQUIREMENTS FOR HADRONTHERAPY CENTERS -- 5.1 Medical and Technical Performance Specifications for the Clinical Proton Beam -- 5.1.1 Beam Range in Absorbing Medium -- 5.1.2 Bragg Peak Modulation -- 5.1.3 Range Adjustment -- 5.1.4 Field Size -- 5.1.5 Field Homogeneity and Symmetry -- 5.1.6 Lateral Penumbra -- 5.1.7 Distal Dose Fall-off -- 5.1.8 Average Dose Rate -- 5.1.9 Dose Accuracy -- 5.1.10 Beam Intensity Requirements -- 5.1.11 Source to Axis Distance (SAD) -- Source to Surface Distance (SSD) -- 5.1.12 Displacement of the Beam Axis from the Isocenter -- 5.1.13 Gantry Rotation -- 5.1.14 Time Structure of the Extracted Beam -- 5.1.15 Beam Abort Time -- 5.2 Performance Specification for the General Facility -- 5.2.1 Treatment Rooms -- 5.2.2 Facility Availability -- 5.2.3 Treatment Beams -- 5.2.4 Dosimetry Reproducibility -- 5.2.5 Control System.

5.2.6 Radiation Safety of the Facility -- 5.2.7 Operation Costs -- 5.3 Protontherapy Equipment System -- 5.4 Building Design -- CHAPTER 6 PROTONTHERAPY ACCELERATORS -- 6.1 Performance Specifications for Accelerators Systems -- 6.1.1 Energy -- 6.1.2 Beam Intensity -- 6.1.3 Quality of the Extracted Beam -- 6.1.4 Accelerator Beam Monitoring -- 6.1.5 Physical Characteristics of Accelerators -- 6.1.6 Costs of the Dedicated Proton Accelerator -- 6.2 Operating Principles of Proton Accelerators -- 6.2.1 Cyclotron -- 6.2.2 Proton Synchrotron -- 6.2.3 Proton Linear Accelerator -- 6.2.4 Synchrocyclotron -- 6.2.5 Advantages and Disadvantages of Accelerators Used for Protontherapy -- 6.3 Examples of Cyclotrons for Protontherapy -- 6.3.1 A Room Temperature Design Cyclotron - Cyclone 235 -- 6.3.2 Compact Superconducting Cyclotron Design - CAL/Siemens -- 6.4 Examples of Synchrotrons for Protontherapy -- 6.5 Examples of Linear Accelerators for Protontherapy -- 6.5.1 Standing Wave Design -- 6.5.2 Booster Linear Accelerator -- CHAPTER 7 BEAM TRANSPORT AND DELIVERY SYSTEMS -- 7.1 Effects of Material in the Beam Path -- 7.1.1 Multiple Scattering -- 7.1.2 Range Straggling -- 7.1.3 Beam Fragmentation -- 7.2 Performance Specifications for Beam Transport System -- 7.2.1 Beam Parameters -- 7.2.2 Beam Switching and Tuning -- 7.2.3 Beam Diagnostics, Monitoring and Safety -- 7.3 Performance Specifications for Treatment Beam Line (Nozzle) -- 7.3.1 Specifications for Nozzle Using Scattering -- 7.3.2 Specifications for Nozzle Using Scanning -- 7.4 Beam Transport Systems -- 7.4.1 LLUMC Beam Transport System -- 7.4.2 NPTC Beam Transport System -- 7.5 Beam Preparation for Clinical Use -- 7.5.1 Variable Range Shifters -- 7.5.2 Range Modulation -- 7.5.3 Transverse (Lateral) Spreading of Particle Beams -- 7.5.4 Collimators -- 7.5.5 Dynamic Beam Shaping.

CHAPTER 8 PROTON GANTRIES -- 8.1 Specifications for the Proton Gantries -- 8.2 Proton Gantries Solutions -- 8.2.1 Corkscrew Gantry -- 8.2.2 Large Throw Gantry -- 8.2.3 Compact Gantry -- 8.2.4 ITEP Proposal of Anti-Gantry (AG) -- CHAPTER 9 RADIATION DETECTORS -- 9.1 Dosimetry Principles -- 9.2 Beam Monitoring, Dosimetry and Microdosimetry -- 9.2.1 Monitoring Chain -- 9.2.2 Reference Dosimetry -- 9.2.3 Systems for Relative Dosimetry -- 9.2.4 Microdosimetry -- 9.3 Phantoms -- 9.4 Dosimetry Intercomparisons and Protocol for Protontherapy Beams -- 9.5 Examples of Monitoring and Dosimetry Systems -- 9.6 Cost Estimations -- CHAPTER 10 TREATMENT ANCILLARY FACILITIES -- 10.1 Performance Specifications for Treatment Ancillary Facilities -- 10.1.1 Performance Specifications for Pre-Treatment Equipment and Diagnostic Tools -- 10.1.2 Performance Specifications for Treatment Planning Software and Hardware -- 10.1.3 Performance Specifications for Patient Positioning and Alignment Devices -- 10.2 Treatment Planning Software and Hardware -- 10.2.1 Algorithms -- 10.2.2 Assessment of a Plan and Comparison of Competing Plans -- 10.2.3 Eye Treatment Planning -- 10.2.4 Available Systems for Treatment Planning -- 10.3 Patient Positioning and Alignment Devices -- 10.3.1 Immobilization Techniques and Devices -- 10.3.2 Therapeutic Couch and Chair -- 10.3.3 Verification of Patient Positioning -- 10.3.4 Treatment Simulation -- 10.3.5 Examples of Patient Handling Systems in the Existing Proton Facilities -- 10.4 Systems for Irradiation Gated by Respiration of the Patient -- 10.4.1 HIMAC Respirated-Gated Beam Control System -- 10.4.2 NAC Stereophotogrammetric (SPG) System -- CHAPTER 11 CONTROL SYSTEM OF THE PROTONTHERAPY CENTER -- 11.1 Control System of the Protontherapy Center.

11.2 Control System Proposed for Italian Hadrontherapy Center -- 11.3 Safety Systems -- 11.3.1 Safety Requirements -- 11.3.2 Safety System Proposed for Italian Hadrontherapy Center -- CHAPTER 12 SHIELDING FOR PROTON FACILITY -- 12.1 Performance Specifications for Shielding -- 12.1.1 Radiation Exposure -- 12.1.2 Attenuation in Shielding -- 12.1.3 Neutron Sources -- 12.1.4 Attenuation in Mazes and Ducts -- 12.1.5 Activation -- 12.2 Bunker Project for Italian Hadrontherapy Center -- 12.2.1 Beam Loss Sources -- 12.2.2 Shielding Project -- CHAPTER 13 GLOBAL COSTS AND FINANCIAL ANALYSIS OF THE ACTIVITIES OF THE PROTON CENTER -- 13.1 Cost Considerations of Hadrontherapy -- 13.2 Comparison of Treatment Costs -- 13.3 Global Costs of Existing the Proton Facilities -- 13.3.1 Costs of the Equipment -- 13.3.2 Operational Expenses of Existing Proton Facilities -- 13.3.3 Staff Requirements and Costs -- CHAPTER 14 PROPOSAL OF A DEDICATED PROTONTHERAPY FACILITY -- 14.1 Clinical Requirements for a Dedicated Protontherapy Center -- 14.1.1 Equipment for Protontherapy Facility -- 14.1.2 Building for Protontherapy Facility -- 14.2 Conclusions -- REFERENCES -- INDEX.