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Four considerations before embarking on a carbon therapy center

March 25, 2019
Rad Oncology Proton Therapy
From the March 2019 issue of HealthCare Business News magazine

Many existing carbon centers were developed from institutional research accelerator equipment, but commercial systems are now being offered by manufacturers such as Hitachi and Toshiba, while others are developing integrated systems. Such systems are capable of using both protons and heavy ions, and can accommodate a combination of proton and carbon treatment rooms.

The existing institutional and commercial carbon systems use synchrotron accelerators (a carbon cyclotron is under development, as well). The typical energies required for heavy ions are in the range of 400-450 MeV, significantly greater than the 230-330 MeV for protons, and necessitate a synchrotron diameter of 65 to 80 feet due to the greater particle mass. Accelerators using multiple ions also require multiple injectors (typically linear accelerators) located inside the ring, in an adjacent room, or at an upper level.

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Currently, most carbon facilities provide fixed beam treatment only, but the Heidelberg Ion Treatment Center in Germany includes the first custom-built gantry – weighing 600 tons. More recently, a superconducting cryogenic gantry has been developed in Japan which is smaller and lighter (but still larger than a proton gantry).

Horizontal and vertical, or inclined fixed beams, have been used in most existing carbon facilities. It’s important to consider the fact that the greater particle mass of carbon requires larger bending radii. Compared to proton therapy, vertical beam lines are much higher, often requiring three- to four-story shielded upper levels.

Impacts to planning, architecture, and facility design
The design and planning implications of large carbon equipment is considerable. For one, the shielded concrete bunkers and needed space for equipment are significantly larger. Although the basic clinical diagram and patient flow is similar to that of proton, the necessary technical space requires much more area in plan, as well as height in section. This also means that existing proton centers cannot be easily modified for carbon equipment; separate or adjacent carbon facilities must be built.

Some of the major variations required for carbon therapy, as compared to proton, include:
• Synchrotron room is twice as wide and long, but similar height;
• Beamline at main level is similar, but vertical fixed beams require an upper beam line of up to four stories high;
• Gantry bunkers are much larger and higher/deeper;
• Fixed beam rooms are similar in plan, but require an upper level for vertical beams;

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