pmp Progress in Medical Physics Progress in Medical Physics 2508-4445 2508-4453 Korean Society of Medical Physics 10.14316/pmp.2017.28.2.67 pmp-28-67 Technical Report Proposal for Comprehensive Quality Control of Heavy-Ion Medical Accelerator KimDong-wook ∗ ShinDong-oh † ShinYoung-hoon † HeoHyun-do § Department of Radiation Oncology, School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea Department of Radiation Oncology, School of Medicine, Kyung Hee University Hospital, Seoul, Korea Research Institute of Radiological & Medical Science, Korea Institute of Radiological Medical Sciences, Seoul, Korea Department of Radiation Oncology, Inha University Hospital, Incheon, Korea Corresponding author Hyun-do Heo (hyundohuh@gmail.com) Tel: 82-32-890-3073 Fax: 82-32-890-3082 62017 1762017 282 6775 30062017 06072017 08072017 Copyright © 2017 Korean Society of Medical Physics 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Prior to the introduction of a medical apparatus based on heavy-ion medical accelerator in Korea, a study is needed on quality control in clinical operation for the safe and appropriate usage of the instrument. Data relevant for the study were obtained via information sharing sessions and visits by the Particle Therapy Co-Operative Group (PTCOG) and other related academic associations. Furthermore, investigative analysis of the European and Japanese performance evaluation guidelines for heavy ion, as well as research on relevant literature, were conducted. In addition, instrumental standards were analyzed through an investigation of the current usage status of the heavy-ion medical accelerator, and further analysis was conducted on the evaluation methods for the performance, safety, and significance of the instrument. Based on these analyses, regular quality control procedures for heavy-ion medical accelerators in hospitals and other institutes were extrapolated. It is hoped that the results of this study will facilitate hospitals that have introduced heavy-ion medical accelerators, or are considering the implementation of the instrument, in their understanding of the fundamental standards and capabilities of the treatment system, as well as in establishing and carrying out quality control procedures for clinical operations such that it will contribute to the safety of patients and the efficiency of medical practitioners.

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Organizational chart for safe operation of radiation therapy system. Top-most box: Chief of heavy-ion medical treatment center, Second row – left: radiation oncology specialist, Second row – right: Medical practitioner (quality control personnel), Third row – left: Nurse, Third row – center: radiologic technician, Third row – right: Technician team (Engineers).

International/domestic trends in of heavy-ion medical accelerator usage (as of Dec 2014).

Classification Nation Facility Region Accelerator type Remarks
Operational (11) Japan HIMAC Chiba Synchrotron  
    HIBMC Hyogo Synchrotron  
    GHMC Gunma Synchrotron  
    HIMAT Saga Synchrotron  
    i-Rock Yokohama    
  Germany HIT Heidelberg Synchrotron  
    MIT Marburg Synchrotron  
  China IMP-CAS Lanzhou Synchrotron  
    SPHIC Shanghai Synchrotron  
  Italy CNAO Pavia Synchrotron  
  Austria MedAustron Wiener Synchrotron  
Under Construction (2) China HITFiL Lanzhou Synchrotron 2014
  Korea KIRAMS Busan Synchrotron 2017
Construction Plan (6) USA Mayo Rochester Synchrotron  
  Saudi Arabia KACST Riyadh Cyclotron  
  Malaysia USM Penang Synchrotron  
  Taiwan Chang Yung-Fa Foundation Taipei Synchrotron  
  Russia ITEP Moscow Synchrotron  
  Australia ANSTO Clayton Synchrotron  

Capabilities of key heavy-ion medical accelerators currently operational.

Facility classification HIMAC GHMC HIT CNAO KHIMA
Ion source   NIRS-10,18, PIG NIRS-10 GHz SUPERNANOGAN SUPERNANOGAN SUPERNANOGAN
        Pantechnik Pantechnik Pantechnik
inject layout Vender NIRS-OLD NIRS-NEW GSI+IAP Frankfurt GSI GSI
  Layout RFQ+Alvarez DTL RFQ+IH-APF DTL RFQ+IH-KONUS RFQ+IH-KONUS RFQ+IH-KONUS
        DTL DTL DTL
  Energy (MeV/u) 0.8/6.0 0.6/4.0 0.3/7.0 0.4/7.0 0.4/7.0
Synchrotron RF 100 MHz 200 MHz 216 MHz 216.8 MHz 216.8 MHz
Layout Length 7.3/24 m 2.5/3.5 m 1.2/4.0 m 1.4/3.77 m 1.4/3.77 m
  Name NIRS-OLD NIRS-NEW GSI+HIT PIMSS/TERA KHIMA
  Energy (MeV/u) 100~800 140~400 50~400 60~400 60–400
  Diameter (m) 41 21 21 25 27.5
  structure (cells) 12 6 2 2 2
  Extraction method RF-KO-SE RF-KO-SE RF-KO-SE Betatron Core RF-KO-SE
  Spill time (s) 1 1.6 1~10 1~10 1~10

Key capabilities of radiation therapy equipments based on heavy-ion medical accelerator.

Performance evaluation criterion Assessment reference standards Unit Reference conditions
Beam type Carbon u  
Beam range 3.0~27.0 g/cm2 Chosen energy range 110~430 MeV/u
Bragg peak optimization 0.1~0.2 g/cm2 Energy steps 250 steps
Beam optimizaion accuracy ≤±0.025 g/cm2 Energy accuracy ≤±0.505~0.219 MeV/u
Beam adjustment region accuracy 0.1 g/cm2 Energy adjustment range 2.03~0.878 MeV/u
Distal beam dose <2 mm Lateral dose between 80%~20%
Mean dose rate <2 Gy/min Min/Max number of beams 4×106~4×108
FWHM 4~10 mm  
Beam FWHM step 1 mm  
Beam FWHM accuracy ≤±0.2 mm  
Beam incidence axis height 120 cm  

Physical properties of radiation therapy treatment equipment based on heavy-ion medical accelerator.

Performance evaluation criterion Reference standard Unit
Precision of Bragg peak position ±1 mm, %
Homogeneity incident surface (transverse profile) 5 %
Energy conformity ±1 mm
SOBP conformity and homogeneity ±5 %
Dose at standard volume ±3 %
Form accuracy of volume subjected to radiation ±2, ±5 (minimum) mm, %
Precision of dose distribution in non-homogeneous phantom 24 data points; <5, single point: ±7 %
Precision of dose distribution in non-homogeneous phantom 24 data points; <5, single point: ±7 %
Determination of absorbed dose in water at standard conditions ≤±1 %