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how radiation kills cells- radiobiology
business topic- 4 therapies and history of development- health care, proton therapy centers taking advantage for money
intensity modulation and conformal multi-leaf collimators
neutron capture therapy

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Lower pH levels in the extracellular space promote the invasive and metastatic potential of cancer cells
diet induced acidosis and carinogenesis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571898/

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“We should think about cancer as an evolutionary process, not necessarily as a molecular process.”

“These microenvironmental forces, specifically hypoxia, acidosis, and reactive oxygen species, are not only highly selective but also can induce genetic instability,”

malignant cancers are dynamically evolving clades of cells living in distinct microhabitats that almost certainly ensure the emergence of therapy-resistant populations. Cytotoxic cancer therapies also impose intense evolutionary selection pressures on the surviving cells and thus increase the evolutionary rate. Importantly, the principles of Darwinian dynamics also embody fundamental principles that can illuminate strategies for the successful management of cancer.

response to therapy is transitory because of the evolution and proliferation of a resistant population of cancer cells.

cancer cells, they wrote, cannot anticipate future environmental conditions or evolutionary dynamics. They believe this may offer an advantage when designing new therapies by “directing” the natural-selection processes to prevent resistant cancer populations from developing

treating cancer as a chronic disease: adaptive therapy

https://academic.oup.com/jnci/article/104/23/1773/1044571/Cancer-and-Natural-Selection

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is disease part of natural selection?
are cancer centers prolonging cancer?
should we go to the long extent we are going to today in order to treat cancer: are side effects worse than cancer?

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Interventional radiology and

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Radiation Oncology - Learn about innovative radiation therapy treatment options at Mayo Clinic.

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Tumor cells typically have a lower oxygen content than normal tissue
the oxygen effect acts to decrease the sensitivity of tumor tissue.[9]The oxygen effect may be quantitatively described by the Oxygen Enhancement Ratio (OER). Generally it is believed that neutron irradiation overcomes the effect of tumor hypoxia

Fast Neutron Therapy Wikipedia

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uses radioactive isotopes for therapy which is part of radiation oncology.

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IUHPTC
from old machinery and need for money to update
increase of photon therapy
decrease of prostate cancer and increase of other treatments
too much labor costs
development of other proton facilities in Ohio and MN
no chance to break even with limited demand and low supply

but proton center needed for pediatric cancers
provides good education
maybe build single room facility near Riley Children Hospital

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neutrons a lot stronger than protons, but harder to control

LET radiation

flood patient with boron and neutrons but boron leaked into other areas

antibodies attached to nuclear weapons for bone marrow and leukemia: best way to destroy original bone marrow and then get a transplant
Bismuth213 and Actinium able to be used

LFTR

a single alpha particle can kill entire cell
antibody attaches to metastatic cancer cell with actinium on it and kills cell

https://www.youtube.com/watch?v=3eQLJielY58&index=1&list=WL&t=928s

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Tumor cells have less repair capabilities than normal cells
DNA breaks from charged particles
cyclotron cannot be changed energy while synchrotron can change magnetic field

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X-ray by Wilhelm Rontgen 1895

invention of cyclotron- 1929- Ernest Lawrence

1930s experimental neutron therapy

1945- synchrotron principle

Robert R Wilson- radiological use of fast protons and ions 1946

first machine used- 184 inch cyclotron and hadron therapy 1947 and ended 1986

@ Berkeley

EO Lawrence and John Lawrence promoted use of cyclotrons and John is father of nuclear medicine

1975- begin of carbon therapy

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International Journal of Particle Therapy

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International Journal of Particle Therapy

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Particle Therapy Cooperative Group (PTCOG)

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There seems to be precious little public interest in physics. But the interest is very real; we simply don't know how to engage it effectively. The latent public interest presents itself on two fronts: (1) the practical curiosity to know "how things work," and (2) a deep fascination for the cosmic questions such as the origin of the universe, our place in time and space, and whether we are alone in the universe.[3] In both the practical and cosmic questions, we pass back and forth between the accelerator and the cathedral.

The vision sees physics not only as a purveyor of technology, but, in addition, recognized as a vital liberal art, shaping community and culture.

In a 1988 papal letter, the Pope said, "While [science and religion] can and should support each other as distinct dimensions of a common human culture, neither ought to assume that it forms a necessary premise for the other."

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PROTONS PROVIDE EFFECTIVE PROSTATE TREATMENT 1993

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PROTONS PROVIDE EFFECTIVE PROSTATE TREATMENT 1993

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Loma Linda has treated more than 250 prostate patients with proton therapy. Protons offer an effective alternative treatment to surgery and conventional radiation therapy. Because of the prostate gland's location - at the outlet of the bladder and anterior to the rectum - conventional radiation can cause side effects such as diarrhea, rectal irritation (proctitis) and/or urinary frequency or burning sensations. With protons, heavier doses and distribution can be delivered directly to the prostate

Most of the men at Loma Linda started out with unusually high PSA levels (25 or higher), but after six weeks of proton therapy, their PSA levels were reduced to near-normal single digits. This is a clear demonstration that proton treatment is effective and works without any harmful side effects.

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PROTON THERAPY LIVES UP TO ITS PROMISE 1993

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PROTON THERAPY LIVES UP TO ITS PROMISE 1993

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Many said it was too complicated and the machine (the first proton-beam accelerator built for hospital use), if ever built, would never run long enough to treat patients on a routine basis. Some predicted that the accelerator would be a white elephant. Others complained that its untested medical benefits and high price tag would make it the ultimate example of medical technology run amok. Some said that proton therapy would prove useless in the treatment of most cancers.

The skeptics are being proven wrong. When physicists unveiled the proton accelerator for the first time in 1989 at Fermi National Accelerator Laboratory, physicians at Loma Linda, who had been intrigued with proton cancer therapy since the early 1970's, predicted it would become a major tool in the war on cancer. Protons were first suggested as a potential cancer therapy in 1946 by Robert Wilson, who established Fermilab. Wilson's vision proved to be accurate.

The world's first and so far only hospital-based Proton Treatment Center opened in October, 1990. When the Center's first gantry came on line in 1991, it was another milestone in medical history. The gantry is a device that looks like a giant Ferris wheel as it rotates a full 360 degrees and allows physicians to direct the proton beam from virtually any angle and treat rumors anywhere in the body.
The Proton Center will reach another milestone later this summer when the second of three gantry systerns becomes operational. A third gantry will come on line this year, representing the last major hurdle in the development of a full-scale, state-of-the-art system that has the potential to replace most forms of radiation therapy and possibly render some types of surgery unnecessary.

The accelerator itself represents a major engineering accomplishment. In the past 30 months, the machine has been "down" for maintenance less than 4 days. It has been operating nearly 99 percent of the time needed to treat 35-45 patients a day.

Approximately one-half million localized cancers are treated in the U.S. each year with radiation alone or in conjunction with other forms of treatment such as surgery and chemotherapy. Now a successful new weapon, proton therapy, is finding its way into the anticancer arsenal. And, despite the fact that protons are in the early stages of clinical development, they are getting widespread attention worldwide as well as in the U.S. The success at Loma Linda, especially with treatment of tumors in the eye, brain, head and neck, lung, pancreas, bladder, and prostate, has stimulated interest for proton facilities within the scientific and medical communities of France, Switzerland, Japan, Russia, Canada, Germany, Italy, and Czechoslovakia.

X-rays (conventional radiation), are harder to control than protons. X-rays tend to scatter and damage healthy tissues to the sides of and behind a tumor. The results are unnecessary side effects. To avoid complications, physicians often lower radiation dosages to spare healthy tissue. But that can allow malignant cells to survive. Protons, on the other hand, go precisely where the physicians want them to go and no farther. So, while a tumor is being bombarded by protons, surrounding normal tissue is left intact; the patient is spared debilitating side effects.

At Loma Linda, 500 patients have been treated at the Proton Treatment Center since it opened. With two more gantries available, that number will double by the end of this year. The patients, who come from just about every state in the union and from foreign countries, are living proof that proton therapy is having an effect on the control of cancer and the relief of pain and suffering. These people represent a new hope and a new era in the possibility for an improved quality of life for cancer patients

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HISTORY AND HERITAGE OF PROTON-BEAM THERAPY: ROBERT R. WILSON 1992

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HISTORY AND HERITAGE OF PROTON-BEAM THERAPY: ROBERT R. WILSON 1992

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Dr. Wilson's 1946 paper- He identified the characteristics of proton beams which had enormous potential for patient treatments: low skin dose; well-collinated beams; easily controllable range in tissue; and precision exposure of defined target volumes. He described how the accelerators then under construction could produce such beams. His article got the attention of radiation therapists and other physicians. Proton beams began to be used therapeutically in the mid-1950s; the Proton Treatment Center at Loma Linda is a direct descendant of the interest generated by Wilson's paper.

Dr. Wilson's interest in the medical use of high-energy particles grew out of the neutron therapy work he witnessed at the University of California, Berkeley- he was student during 1930's

In 1943 he joined Los Alamos Laboratory, just then being formed to build the first atomic bomb. He helped organize the laboratory and brought his Princeton colleagues there to form the Cyclotron Group

They investigated several "excited states" of the proton; they measured the production of K-mesons by an x-ray beam; they studied the scattering of electrons by protons. The latter investigations determined the shape of the proton and neutron, and confirmed the point-like structure of the electron.

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RADIOBIOLOGICAL RESEARCH AT THE PROTON TREATMENT CENTER

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RADIOBIOLOGICAL RESEARCH AT THE PROTON TREATMENT CENTER

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Therapeutic use of proton beam- At the Proton Treatment Center, this endeavor has two major components: physics studies and radiobiological investigations. The former seek to optimally exploit the capabilities of the proton synchrotron and the beam delivery systems. The latter seek to understand the effects of proton and conventional irradiations in cells, tissues, organs and animals (including humans), particularly in relation to different dose-delivery schedules and different total radiation doses.

One focus of current study is the brain. A primary goal on this avenue of investigation is to identify the sequence of cell population changes that produce the tissue and organ changes, commonly known as late reactions, found months to years after a therapeutic course of irradiation has been completed. A second goal is to identify new time-dose strategies; that is, to develop proton radiation treatment schedules capable of improving cancer control while sparing normal brain tissue.

Because of its precision, the proton beam opens up a new dimension in radiobiologic studies in animals. One can confine the dose to a tightly configured volume, sparing adjacent tissue; that tissue then can be used as an effective experimental control. Pictures suggest this capability far better than words. Figure 1 shows a rat immobilized before the beam-delivery nozzle of the 100 MeV proton beam. The illuminated area corresponds to the proton-irradiated segment of the rat's brain; at the edge of the light field, the proton dose is 50 percent of maximum. Figure 2 shows a coronal section of rat brain obtained 11 months after a single proton dose of 40 Gray (4000 rad). Obvious change is seen on the left, including periventricular demyelination, necrosis and cyst formation. The right side, however, appears normal; this segment is used to compare and contrast tissue alterations observed on the irradiated side. Figure 3 shows the isodose lines from the proton beam; the 90 percent line encompasses the area of periventricular necrosis seen in figure 2.

When organs are irradiated, radiation biologists try to identify the kinetic changes occurring in the various tissue populations making up those organs. This task is straightforward enough in a two-dimensional laboratory dish containing tissue cultures wherein cells can be counted, but has heretofore been frustrated in the animal. As the radiation dose is increased, it is necessary to identify such changes in the three dimensions of tissue. Researchers from Loma Linda University and Loma Linda University Medical Center have begun experiments designed to yield these important measurements.
Figure 3

In collaboration with Paul McMillan, PhD, professor of anatomy at Loma Linda University, investigators in the department of radiation medicine are applying stereologic techniques to a new problem. The techniques will enable one to calculate, from biopsy specimens, the population changes in three-dimensional tissue volumes and, by extension, in organs. Although stereologic techniques are well-known in other disciplines, such as anatomy and geology, their application in radiation biology is being pioneered at Loma Linda.

With the assistance of Joseph Thompson, MD, of the section of neuroradiologoy, and Andrew Kennedy, MD, of the LLUMC house staff, radiation medicine investigators are performing histologic analyses to document and interpret changes observed on magnetic resonance images. This work seeks to determine the degree to which histologic changes can be inferred from image changes, and thus, the degree to which MRI can be employed as a measure of the brain's response to irradiation. If imaging results can be correlated precisely with histologic events, the images may be useful as monitors of therapeutic response. Thus far, the effort has enabled the investigators to identify graded changes in the brain following different total doses and different fractions of proton irradiation.

The immediate goal of this three-dimensional work is to test the hypothesis that the microvasculature is the tissue most sensitive to irradiation; that damage to the microvessels results in changes in other tissues, which in turn produce the well-known long-term sequelae. Two-dimensional measurements of the microvasculature, made on microscopic sections, do not sufficiently describe postradiation population effects; nor do they show the relationships within or between the components of tissue volumes. Using a special staining technique they developed, however, and employing computer-assisted three-dimensional reconstructions, Dr. McMillan and Marie-Helene Archambeau are evaluating the changes in brain microvessels and are comparing those changes observed with the same vessels in unirradiated brain tissue.

He has determined the dose survival of V-79 cells for the horizontal proton beam, and is now obtaining the same data for the more energetic gantry beam. These data are being compared with data from conventional radiation therapy machines, to determine the relative response of cells to similar doses from proton and photon radiations. From these data it will be possible to specify the efficiency of the protons

In another area of concern, LLU and LLUMC investigators are measuring the different tissue and organ responses patients may have after conventional radiation treatment. The results enable researchers to evaluate what may be expected to occur in similarly irradiated normal human tissues.

New studies have been undertaken to determine the true boundary between normal brain and tumor contained within it.

LLUs proton beam capability provides researchers with a new tool for many investigations. Michael Moyers, PhD, of medical physics, and Michael Kirby, PhD, of pediatrics, are applying a unique perspective in using proton beams as a tool to define tissue function. They are developing proton microbeams to study the effects of radiation-injured cells on physiologic processes. The proton beam's precision makes it feasible to irradiate critical brain centers (nuclei) of a few cells, to estimate
their role in a process such as vision.

Loma Linda University Medical Center, however, has the potential for serving patients with disease in anatomic sites heretofore not treatable with protons, because it has the first accelerator and facility in the world designed for treating patients in a clinical setting. The facility has been designed to exploit proton beams as fully as possible, and to integrate that exploitation with clinical realities. This increased potential available with proton-beam therapy demands research to optimally exploit the potential. The department of radiation medicine's research program seeks to aid in this scientific effort by undertaking carefully designed and meticulously performed investigations, to apply new tools to old problems in such a way that clinical advances may build on a sound and objective basis.

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Loma Linda University Medical Center in California

Harvard Cyclotron Laboratory built by Wilson at the Lawrence Berkeley Laboratory at the University of California in Berkeley

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Last month, scientists at the Fermi National Accelerator Laboratory here unveiled the first proton beam accelerator built for hospital use. When the machine is ready for operation next year at Loma Linda University Medical Center near Los Angeles, many believe it will prove itself a major breakthrough in the war on cancer.

Others, however, think the proton accelerator is a white elephant. They complain that its untested medical benefits and enormous price make it the ultimate example of medical technology run amok. Some doctors say proton therapy will prove useless in the treatment of most cancers.

The cost -- $40 million, including the special building needed to house the machine -- dwarfs the cost of the next most expensive medical device: the Positron Emitting Tomography scanner, which shows metabolic activity within the brain and can cost about $5 million

Adds James Slater, the Loma Linda physician directing the project: "It's the most complicated machine ever used in a hospital setting by far."

Last year, the project nearly fell victim to federal budget cutters, when the Office of Management and Budget concluded it was a pork barrel project.

X-rays, for instance, are harder to tame than protons. Not only do X-rays have a tendency to scatter - hitting good tissue around a malignancy - but they also strike, and damage, healthy tissue behind a tumor. In that respect they are like subatomic runaway trains.

Nausea, pain, new cancer and even death are sometimes side effects of conventional radiotherapy. To avoid complications, doctors often lower radiation dosages to spare healthy tissue. But that can allow malignant cells to live and persist in their destructive course.

Protons, however, are more like crack combat troops. The subatomic particles strictly obey doctors' commands. Found in the nuclei of atoms, protons go precisely where doctors want them to and no farther. So while a tumor is being bombarded to death by protons, surrounding. normal tissue isn't.

Protons were first suggested as a potential cancer therapy in 1946 by Robert Rathbun Wilson, who established the Fermi National Accelerator Laboratory. But it wasn't until the 1970's that patients were first exposed to protons in physics labs at Harvard University, the University of California at Berkley, at Fermi and at several institutions abroad.

physics research machines moonlighting to treat cancer patients. At Harvard, where 174 patients with malignant tumors at the base of the brain have been treated, the therapy has had an 85% cure rate, compared with a 35% cure rate for conventional therapies

But the hospital didn't do much more than think about it because the needed computing technology and magnetic resonance imaging were either prohibitively expensive or nonexistent... Perfected in the 1980's, it sets up a magnetic field.

The contraption is definitely larger than life, its most notable feature being a trio of three-story-tall gantries resembling giant hamster runs. Each 90-ton gantry will have at its center an enclosed treatment table.

The Food and Drug Administration has approved proton therapy as a cancer treatment, so patients treated on the Loma Linda device will qualify for reimbursement by Medicare and other insurance. Loma Linda stresses that patients won't be turned away for inability to pay.

Loma Linda is sure there will be enough patient demand for its machine. Harvard treats as many as 12 people a day running full tilt. Patients typically have a two month wait for its machine, says Herman Suit, the chairman of Harvard Medical School's department of radiation medicine. "There's no excess capacity," he says.

Eventually, the hospital envisions a time when radiation therapy will be synonymous with proton therapy. Dr. Slater predicts the U.S. will have 100 machines eventually, with the cost of a machine falling to $10 million, about half what Loma Linda's prototype is costing.

The beam is virtually useless in cancers that have spread beyond the original site. Such metastacized cancers account for more than two-thirds of all malignancies says Y. Joe Kwon, a radiation oncologist in Victorville, Calif.

"There's some usefulness, no doubt about it. But the candidates for proton therapy are limited," says Dr. Kwon. "It won't make a major impact on the cure rate for all cancers. It will make a little dent, but it will cost a lot to make that dent."

Says Thomas DeLaney, a branch chief and senior Investigator at the National Cancer Institute: "The effort should be supported, but I think the number of machines necessary is small. We should have them, just like aircraft carriers, but that doesn't mean every state should have one."

"I can't understand why the hell they built this ridiculous unit," says Joseph Imperato, a radiation oncologist and assistant professor at the Northwestern University Medical School. "It's a great physics project, but some of the medical claims are lunatic," he says.

The deeper a tumor is in the body, the fewer proven differences there are between what conventional radiation and protons can do, he says. Also, significant side effects from conventional radiation affect no more than five percent of cancer patients, he says. He fears that people suffering from cancer may draw false hope from the Loma Linda machine, a device that, so far, has few demonstrated uses.

Says Dr. Imperato: "If my administrator came to me tomorrow and asked me if he should spend $20 million to get one, I'd say to him, 'You're crazy, out of your mind. It's a waste of money'"

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NEW PROTON ACCELERATOR DRAWS BEAD ON CANCER CELLS

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NEW PROTON ACCELERATOR DRAWS BEAD ON CANCER CELLS

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The compact accelerator is designed to do something that other radiation devices cannot -- destroy diseased cells while leaving healthy cells basically ulnharmed.

A proton beam, on the other hand, overcomes this drawback by delivering a much higher radiation dose to the tumor than it does to surrounding tissue.

Dr. James Slater, a Loma Linda cancer specialist. "In order for cancer radiation therapy to advance we needed to improve our ability to focus a beam inside the body. The proton accelerator does that," he said. "It's a superior tool that's going to produce a major improvement in cancer therapy."

Doctors have known that proton beams might be a powerful weapon against cancer, but the technology to produce flexible beams in adequate amounts has not been available.

As a result, only a small number of patients have been treated with proton beams-about 6,000 over the last 15 years. But the results have been so good that physicians expect the technique will result in more cures.

One of the most dramatic improvements has been achieved with an eye cancer known as ocular melanoma, a tumor that grows on the inside of the eye. Standard therapy, which consisted of removing the eye, produced dismal results, with the cancer reappearing at some other site in the body in 65 percent of patients.

Since physicians started treating this cancer with a proton beam produced by an old atom smasher at Harvard University, however, they have been able to eliminate the cancer in 96 percent of cases without having to remove the eye, said Livdahl.

Furthermore, there is no loss of vision in 75 percent of the treated eyes, he said.

In an effort to break the logjam over the limited availability of proton beams, Loma Linda officials in 1986 asked Fermilab physicists if they could build an accelerator to produce protons for cancer therapy. Loma Linda is building a new $40 million proton beam radiation facility.

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CANCER THERAPY FACILITY AT FERMILAB FINDS ITS PLACE IN MODERN HEALTH CARE 1980

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CANCER THERAPY FACILITY AT FERMILAB FINDS ITS PLACE IN MODERN HEALTH CARE 1980

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In the late 1960s and early 1970s, an attempt at using neutrons was started at Hammersmith Hospital in London. With improved understanding and more sophisticated equipment, some of the results were gratifying, he said. From this second cautious beginning, interest spurted and spread to this country and to others throughout the world. In the past 10 years, 4,000 patients have been treated at neutron therapy facilities, most of them in the past few years.

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FERMILAB BUILDS PROTON ACCELERATOR TO TREAT CANCER 1989

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FERMILAB BUILDS PROTON ACCELERATOR TO TREAT CANCER 1989

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The U.S. Department of Energy's Fermi National Accelerator Laboratory at Batavia has announced the first successful operation of a small proton accelerator to treat rare cancers.

It was designed and built at Fermilab for Loma Linda University Medical Center in California, where it will be used to treat cancer and other diseases by focusing a beam of protons to eradicate diseased cells

Use of protons for cancer therapy was first proposed by Robert Wilson, the first Fermilab director, immediately after World War II while he was at Harvard University. Pioneering work has been carried out for many years at the Harvard Cyclotron Laboratory

The work has proved that proton therapy has significant advantages over other methods of cancer treatment such as X-rays or neutrons. The greatest advantage is that the proton beam limits the radiation dose to the disease site, reducing the side effects of treatment while killing disease cells.

The new accelerator built at Fermilab is the first designed specifically for therapy. It has several special features, such as precise energy control and long beam spill that are included to make therapy easier and more efficient.

The facility at Loma Linda will have four treatment rooms, three with gantries to bring the beam to the disease site from any desired angle and one specialized room for treatment of the head and neck. It will be possible to treat many more patients than has been possible in the past. New treatment aids planning methods are being developed in the center.

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FERMILAB: ITS ROLE IN PROTON THERAPY DEVELOPMENT IN U.S 1989

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FERMILAB: ITS ROLE IN PROTON THERAPY DEVELOPMENT IN U.S 1989

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The Fermilab Neutron Therapy Facility has been in operation for more than ten years and has treated more than 1,600 patients

the ability to make use of the localized dose of protons depends on knowing the location of the tumor. The technology to perform this localization was not fully developed at that time, and the physicians collaborating with Fermilab urged them to produce neutrons with the proton beam and to perform therapy with neutrons. Neutrons are somewhat more efficient than protons or electrons at killing cells, but do not have the great advantages of protons in localizing the dose

Proton Therapy Cooperative Group (PTCOG)

fabricate a 70 to 250 MeV proton synchrotron and assist in the design and procurement of a beam transport and delivery system for installation at Loma Linda University Medical Center.

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Specific Ionization's affect on precision (why do proton beams ionize)

Linear Energy Transfer (LET)

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NEUTRONS AGAINST CANCER: FERMILAB CANCER THERAPY FACILITY 1979

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NEUTRONS AGAINST CANCER: FERMILAB CANCER THERAPY FACILITY 1979

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Neutrons act on human tissues much like x-rays. These radiations destroy cells by changing their genetic character and thus creating offspring that cannot survive. There are, however, some cells in the tumor that are oxygen deficient (hypoxic cells) and these are known to be resistant to the effects of x-rays.

These cells are believed to be responsible for the reappearance of the tumor after conventional (x-ray) therapy

Robert R. Wilson, Fermilab Director from its founding in 1968 until July, 1978, proposed as early as 1947 that proton accelerators could be used to treat cancer victims

cancer is the most curable dreaded disease we have. The cure rate is about 50 percent. If the cancer is caught in its early stages, that cure could be as high as 90 percent." It is the leading cause of death in people under 55, he added.

50 patients a week

The potential for improvement in the management of cancer patients with radiation therapy has come about from the intense cooperative interaction among the physical sciences, biological sciences and medical sciences.

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Radiological Use of Fast Protons, Robert R.Wilson, 1946

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Radiological Use of Fast Protons, Robert R.Wilson, 1946

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except for electrons the particles which have been accelerated to high energies by machines have not been directly used therapeutically due to the very short penetration in tissue of protons, deuterons, and alpha particles from present accelerators

new technology being built to get protons up to 125-400 Mev- 200 Mev can penetrate 27cm

The dosage is proportional to the ionization per centimeter of path, or specific ionization, and this varies almost inversely with the energy of the proton

better precision

Effects/limits

range straggling- energy loss of the proton is a statistical effect due essentially to the production of ions along its path

multiple scattering-its effect is to spread the end of the beam out transversely

nuclear absorption and scattering of the protons

probability of a proton impinging on a nucleus after traveling 10 cm. in tissue will be about 25 percent

elastic scattering of the protons by nuclei

helps in understanding of alpha particles and heavier nuclei (deuteron- proton and neutron)

compares electrons and protons

protons have higher specific ionization and less straggling and scatter, but equipment for electrons is better

big particles can be dangerous if misfired

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Northwestern Medicine

Siteman Cancer Center

Cincinnati proton therapy center

Florida- UF health, Ackerman cancer center, miami cancer center

UH Proton Therapy Center- Cleveland

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Technology already used in Nuclear Medicine

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Technology already used in Nuclear Medicine

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Single Photon Emission Computed Tomography or SPECT

Positron Emission Tomography or PET scans (two most common imaging modalities in nuclear medicine)

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Data from past Proton Therapy treatments

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Data from past Proton Therapy treatments

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Fermilab History and Archives Project | Historic Neutron Therapy

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A new type of radiation therapy, called neutron therapy, is being offered as an experimental program at Fermilab. To conduct this research, the Laboratory has established a Cancer Therapy Facility (CTF). This research program, together with three other centers in the United States, tests the effectiveness of neutron beams by comparing them with conventional radiation in the management of certain tumors.

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To what extent did the research of neutron therapy affect our understanding of radiation oncology.