Proposal for Comprehensive Quality Control of Heavy-Ion Medical Accelerator

Dong-wook Kim; Dong-oh Shin; Young-hoon Shin; Hyun-do Heo

doi:10.14316/pmp.2017.28.2.67

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Kim, Shin, Shin, and Heo: Proposal for Comprehensive Quality Control of Heavy-Ion Medical Accelerator

Technical Report

Progress in Medical Physics 2017;28(2):67-75.

Published online: 17 June 2017

DOI: https://doi.org/10.14316/pmp.2017.28.2.67

Proposal for Comprehensive Quality Control of Heavy-Ion Medical Accelerator

Dong-wook Kim^∗, Dong-oh Shin^†, Young-hoon Shin^†, Hyun-do Heo^§,

^∗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

Received 30 June 20176 July 2017 Accepted 8 July 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.

Keywords: Heavy ion, Medical instrument, Quality control, Dose distribution, Dose limit

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Fig. 1.

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).

Table 1.

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

Table 2.

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

Table 3.

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

Table 4.

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	%

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