Nuclear Instruments and Methods in Physics Research B 331 (2014) 6–9

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Nuclear Instruments and Methods in Physics Research B

journal homepage: www.elsevier.com/locate/nimb

Recent progress of HIMAC for sophisticated heavy-ion cancer

radiotherapy
K. Noda a,⇑, T. Furukawa a, T. Fujimoto b, Y. Hara a, T. Inaniwa a, Y. Iwata a, K. Katagiri a, N. Kanematsu a,
K. Mizushima a, T. Miyoshi b, S. Mori a, T. Murakami a, Y. Sano b, S. Sato a, T. Shirai a, E. Takada a, Y. Takei a,
S. Yonai a
a
National Institute of Radiological Sciences, Chiba 263-8555, Japan
b
Accelerator Engineering Cooperation, Chiba 263-8555, Japan

a r t i c l e i n f o a b s t r a c t

Article history: The NIRS has carried out carbon-ion radiotherapy (RT) with HIMAC since 1994. On the basis of their ten-
Received 28 September 2013 year HIMAC experience, NIRS has developed a standard-type CIRT facility in order to boost availability of
Received in revised form 20 December 2013 carbon-ion RT in Japan. Work has been carried out at its pilot facility at Gunma University since 2010. The
Accepted 22 December 2013
current projects of the pilot facility include Saga-HIMAT and i-ROCK, promoted by the Kanagawa prefec-
Available online 3 February 2014
tural cancer center. Toward the further sophisticated conformal carbon-ion RT with HIMAC, the NIRS has
since 2006 been developing new treatment technologies, such as a fast 3D rescanning with a pencil beam
Keywords:
and a compact rotating gantry.
Heavy-ion therapy
Beam scanning
Ó 2014 Elsevier B.V. All rights reserved.
Heavy-ion synchrotron

1. Introduction in clinical studies, a new treatment research facility was

Heavy-ion beams are very suitable for deeply seated cancer
treatment, not only because of their high-dose localization around
the Bragg peak, but also because of the high biological effect in this
region. Based on this knowledge, the NIRS constructed the Heavy-
Ion Medical Accelerator in Chiba (HIMAC) [1], the world’s first hea-
vy-ion accelerator facility dedicated to medical use, and initiated
HIMAC treatment in 1994. In 2003, HIMAC carbon-ion RT was
approved as a highly advanced medical technology in Japan. As a
result, during the years 2004 and 2005, NIRS carried out design
and R&D work for a standard-type carbon-ion RT facility in Japan
[2] in order to boost availability of carbon-ion RT treatment by
reducing construction costs. A pilot facility was constructed and
has been successfully operated by GHMC (Gunma University
Heavy-Ion Medical Center) since 2010.
In addition, since 2006, NIRS has been engaged in a ‘‘New Treat-
ment Research Project’’ [2] to explore sophisticated RT such as
‘‘adaptive cancer radiotherapy’’, which can accurately treat tumors
even as they change size and shape during treatment. For r adap-
tive cancer RT against both static and moving tumors, the NIRS
has developed a fast 3D rescanning technique with respiratory-
gated irradiation. In order to apply the new technologies developed
⇑ Corresponding author. Address: National Institute of Radiological Sciences, 4-9-
1 Anagawa, Chiba 263-8555, Japan. Tel.: +81 43 251 2111; fax: +81 43 251 1840.
E-mail address: noda_k@nirs.go.jp (K. Noda).
constructed and has been operating successfully since 2011. At
present, two rooms with fixed beam-delivery systems are open
for static-tumor treatments, and the respiratory-gated 3D rescan-
ning system for moving-tumor treatment is scheduled to open in
2014. To complete this system, a compact heavy-ion rotating
gantry has been developed with superconducting technology in
order to realize the intensity modulated carbon-ion RT (IMCT)
combined with pencil-beam 3D scanning for more accurate and
shorter-course treatment.
2. Standard carbon-ion radiotherapy facility
The specifications for the standard carbon-ion RT facility in
Japan were determined based on clinical statistics accumulated
for more than ten years at the HIMAC; these are summarized in
Table 1.
Following the pilot facility at GHMC, two more CIRT facilities
were constructed in Japan: the Saga-HIMAT (Saga Heavy Ion Med-
ical Accelerator in Tosu) and the Kanagawa Prefectural project. The
Saga-HIMAT facility [3] was based on the design of the pilot facil-
ity. The facility has three treatment rooms. The first treatment
room employs both horizontal and vertical beam-delivery systems
with the beam-wobbling method, has been in operation since
August 2013. The second treatment room employs both horizontal
and 45° beam-delivery systems, and is in the pre-clinical commis-
sioning stage. It is expected to be open for operation in April 2014.

0168-583X/$ - see front matter Ó 2014 Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.nimb.2013.12.036
 K. Noda et al. / Nuclear Instruments and Methods in Physics Research B 331 (2014) 6–9
Table 1
Specifications of standard C-ion RT facility.
Ion species Carbon
Beam delivery Beam wobbling with ridge filter (passive method)
Energy 400–140 MeV/n
Range/SOBP/lateral-size 250/40–150/220 mm
Max. dose rate 5 GyE/min
Beam intensity 1.2
109 pps
Treatment room 3: H&V, H, V*
Irradiation method Gating/layer stacking
*
H: horizontal beam-delivery system, V: vertical one.
While the third room is currently empty, it will be designed to
employ the fast 3D rescanning method developed by NIRS. An
aerial view of the facility is shown in Fig. 1.
The Kanagawa Prefectural Government constructed a carbon-
ion RT facility called the i-ROCK (Ion-beam Radiation Oncology
Center in Kanagawa) in the Kanagawa Prefectural Cancer Center.
Although the accelerator system is based on the pilot-facility de-
sign, the beam-delivery system employs the NIRS scanning design
described in the next section. Treatment at the facility is scheduled
in 2015.
3. New treatment research project
3.1. Development of new beam-delivery method
In order to achieve adaptive cancer radiotherapy, a new beam-
delivery method based on a pencil-beam 3D scanning method is vi-
tal for both static and moving tumor treatments. The NIRS first
developed the phase-controlled rescanning (PCR) method with a
pencil-beam [4]. In the PCR method, rescanning completes irradia-
tion on one slice during one gated period. Since the movement of
the target is close to ‘‘zero’’ on average, we can obtain a uniform
dose distribution even when irradiating a moving target. The PCR
method requires two main technologies: (1) an intensity-modula-
tion technique capable of ensuring constant irradiation time on
each slice with a different cross section; and (2) fast pencil-beam
3D scanning to complete iterative rescanning within a reasonable
time period.
3.1.1. Intensity modulation
We have developed a spill control system [5] to deliver the
beam with intensity modulation, based on the improvement of
the RF-KO slow extraction method [6–8].
3.1.2. Fast 3D scanning
For the fast pencil-beam 3D scanning, the following three key
technologies were developed: (a) new treatment planning for
Fig. 1. Aerial view of the Saga-HIMAT.
7
raster scanning; (b) extended flattop (FT) operation of the
synchrotron; and (c) a high-speed scanning magnet.
3.1.2.1. New treatment planning [9]. The raster-scanning method is
employed instead of spot scanning in order to save beam-on/off
time when moving spot-position. In raster-scanning, on the other
hand, the dose delivered during moving spot-position should be
taken into account in treatment planning. It should be noted that
this dose is proportional to the delivered intensity. Owing to the
high reproducibility and uniformities in the time structure of the
extracted beam through the spill control system, we can predict
the dose delivered during spot-position movement and incorpo-
rate its contribution into treatment planning. Consequently, we
can increase beam intensity, which results in shorter irradiation
time.
3.1.2.2. Extended FT operation. Owing to a high beam-utilization
efficiency of around 100% in the scanning method, as well as an
intensity upgrade to 2  1010 carbon-ions, we can complete the
single-fractional irradiation of almost all treatment procedures in
a single-cycle operation of the synchrotron. This operation scheme,
which can be realized using a clock-stop technique in the FT
period, can increase treatment efficiency, especially for respira-
tory-gated irradiation. This extended FT operation can shorten
irradiation time by a factor of two. On the basis of this operation
scheme, a multiple-energy operation in single-cycle has been
developed, and this 11-step energy operation is routinely used
for the hybrid energy scan [13].
3.1.2.3. High-speed scanning magnet. Scanning speed is designed to
be 100 mm/ms and 50 mm/ms in the horizontal and vertical direc-
tions, respectively; this is around one order of magnitude faster
than conventional scans. In order to increase scanning speed, we
designed a scanning magnet with slits in both ends of the magnetic
poles that, according to thermal analysis, included an eddy-current
loss and a hysteresis loss. The power supply of the scanning mag-
net was designed for fast scanning and consisted of a two-stage
circuit: the first stage for voltage forcing by IGBT switching
elements, and the second stage for FT-current control by FET
switching ones.
3.2. Experimental study
A test irradiation port was designed and constructed for the fast
raster-scanning experiment in order to verify the design goal. It
had the same configuration as the fixed beam-delivery system
adapted to the new treatment research facility, and described in
the next section. Using this test port, we verified the physical dose
distribution of the proposed technologies for both static and mov-
ing targets [10,11] and the survival curve of the HSG cell line, as
designed.
3.3. New treatment research facility
It was important that the technologies developed by the new
treatment research project should be verified by clinical studies.
Therefore, the NIRS constructed the new treatment research facil-
ity, which is connected to the existing HIMAC accelerator. In the
treatment hall located beneath the facility, three treatment rooms
were prepared to treat more than 800 patients a year. Two of them
were equipped with fixed beam-delivery systems in both the hor-
izontal and vertical directions, while the other one was equipped
with a rotating gantry. Two treatment-simulation rooms were also
prepared to rehearse patient positioning, and to observe any
changes during treatment in target size and shape with X-ray CT.
Furthermore, six rooms were devoted to patient preparation before
8 K. Noda et al. / Nuclear Instruments and Methods in Physics Research B 331 (2014) 6–9
Fig. 2. Aerial view of the existing HIMAC and new treatment research facility.
irradiation. An aerial view of the new treatment facility with the
HIMAC is shown in Fig. 2.
In order to carry out the clinical study in a manner identical to
the existing HIMAC treatment, it was necessary that the residual
range be more than 25 cm. Thus, the maximum ion energy in the
fixed beam-delivery system was designed to be 430 MeV/n, corre-
sponding to a residual range of 30 cm in the carbon-ion beam, and
22 cm in the oxygen-ion beam. The maximum lateral-field and
SOBP sizes were 22 cm  22 cm and 15 cm, respectively, in order
to cover all treatments with the HIMAC. The rotating gantry system
employed a maximum energy of 430 MeV/n, a maximum lateral-
field of more than 18 cm  18 cm, and a maximum SOBP size of
15 cm.
3.4. Clinical study
After a pre-clinical study using the beam-delivery system in the
new treatment research facility, the clinical study was initiated in
May 2011, and has continued to the present. In the first year, one of
treatment rooms was opened for 11 patients. At this stage, the irra-
diation areas of all patients were verified by PET imaging using an
auto-activation method. Furthermore, the energy degrader method
was employed for slice changes with the extended-FT operation of
the HIMAC synchrotron. After the second room had been prepared
as the second stage, 121 patients were treated in half-day opera-
tions in two rooms from September 2012 to March 2013. In this
stage, as the hybrid energy scan was applied for slice changes,
the lateral dose distribution improved significantly compared to
Fig. 3. Image view of the rotating gantry.
those with the energy-degrader method. In addition, since an auto-
matic patient positioning system was applied to practical
treatment in these clinical studies (consisting of entering time,
positioning time, irradiation time and exiting time), treatment
times were significantly reduced to less than 15 min, on average,
down from 25 min in the conventional HIMAC treatment.
As the third stage, the respiratory-gated irradiation using pen-
cil-beam 3D scanning is scheduled for moving-tumor treatments
in the winter of 2013.
4. Future plans
4.1. Energy scan by accelerator
The energy-degrader method for slice changes has some disad-
vantages. These include (1) deterioration of the penumbra size due
to the increase in beam size caused by multiple scattering and frag-
mentation; and (2) production of secondary neutrons when the
beam passes though the energy degrader. In response, GSI devel-
oped a full energy scan by the synchrotron itself; this scan has been
employed by the HIT facility [12]. With the full energy scan, how-
ever, it takes a long time to create the many operation patterns
corresponding to each acceleration and extraction of the beam.
The NIRS developed the hybrid energy scan [13] in order to save
a significant amount of beam-commissioning time and to dramat-
ically suppress the deterioration of the penumbra size compared
with that of the energy-degrader method. In this scheme, eleven-
step energies can be changed with a one-cycle operation of the
synchrotron [14], with a smaller change of beam energy by thin
energy degraders. Owing to the one-cycle operation of the syn-
chrotron, the hybrid energy scan developed by NIRS also reduces
irradiation time considerably. In order to obtain better dose distri-
bution, the full energy scan with one-cycle operation of the
synchrotron was developed in the NIRS-HIMAC [14,15], and will
be applied to practical treatment in 2014 or 2015.
4.2. Rotating gantry
As the third stage, a compact heavy-ion rotating gantry [16],
which will be installed in the third room, has been developed using
superconducting technology. The image view of the rotating gantry
is shown in Fig. 3. It is expected to be completed within a period of
two years. It is also expected to realize intensity-modulated car-
bon-ion RT (IMCT) combined with pencil-beam 3D scanning for
more accurate and shorter-course treatments. A design key is the
use of combined-function superconducting magnets, which allow
us to design the compact rotating gantry. Having optimized the
layout of the gantry, as well as of the beam optics, we determined
that the length and radius of the gantry should be approximately
13 and 5.5 m, respectively, comparable to those of proton gantries.
This rotating gantry will have ten superconducting magnets. In
2012, two of them were completed. Both the mechanical move-
ment and excitation-level change tests have already been carried
out. The experimental results are in good agreement with the ex-
pected ones. Field measurements are currently being carried out.
Within two years, this rotating gantry will be completed and initi-
ated into the clinical study, once the pre-clinical study is finished.
5. Summary
On the basis of the HIMAC treatment experience, NIRS devel-
oped a standard-type carbon-ion RT facility, which is a downsized
version of the HIMAC facility, in order to boost the availability of
carbon-ion RT in Japan. The pilot facility was constructed and the
GHMC has been successfully conducting operations there since
 K. Noda et al. / Nuclear Instruments and Methods in Physics Research B 331 (2014) 6–9
2010. The Saga-HIMAT project began offering cancer treatments in
August 2013, based on the beam-wobbling method, as well as
methods used by GHMC. The i-ROCK project promoted by the
Kanagawa prefectural cancer center, on the other hand, was de-
signed and constructed based on fast 3D rescanning technology,
because this technology was verified by clinical studies at the NIRS.
The i-ROCK will open in 2015. At present, NIRS is developing a
compact heavy-ion rotating gantry with superconducting technol-
ogy for more accurate heavy-ion RT; the system will be completed
in 2015. Such sophisticated technologies will boost heavy-ion
radiotherapy worldwide.
Acknowledgements
This work was carried out as a part of the Research Project with
Heavy Ions at NIRS-HIMAC.
9
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