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Optimization of Medical Accelerators

Periodic Reporting for period 2 - OMA (Optimization of Medical Accelerators)

Reporting period: 2018-02-01 to 2020-01-31

The OMA network has been built around 15 early stage researchers (ESRs) working on dedicated projects to maximize the benefits of the use of particle beams for cancer treatment. The network consists of an international consortium of 38 partner organizations working in this field. It has provided a cross-sector interdisciplinary environment for beyond state-of-the-art research, researcher training, and new collaborations. The network has pushed technologies and simulation techniques significantly beyond the state-of-the-art and developed solutions that are now applied in clinical practice.

The project has also established a comprehensive and unique postgraduate training concept that can also be applied to other research areas and that was presented to educators at national and international learning and teaching events. The Fellows have benefited from a well-rounded training and successfully completed their projects within the network.
In addition to research training in their host institution, the Fellows have received wider network-based training. This instruction has included scientific schools and topical workshops which provide them with skills and knowledge in wider research, as well as career development.

The OMA Complementary Skills School was organized in April 2017 to allow first Fellows from the AVA (Accelerators Validating Antimatter Physics) ITN to join, providing an opportunity for the Fellows of two major European Training Initiatives to establish close links and discuss possible collaboration. The first OMA School on Medical Accelerators was organized in June 2017 at CNAO, allowing networking with the Medicis-Promed ITN, overlapping in some parts of the programme such as the poster session, and thus stimulating discussions between the two networks. The OMA School on Monte Carlo Simulations was organized at LMU Munich in November 2017, and was attended by all OMA Fellows as well as Fellows from the LIV.DAT doctoral training centre on Big Data Science. Finally, the Advanced Researcher Skills and Technology Transfer Workshop in June 2019 was organized jointly with the AVA network, bringing together 30 Marie Curie Fellows. Through this approach the OMA Fellows gained significant interdisciplinary and cross-sector exposure and an exceptional opportunity to build close connections with a very wide scientific community. In addition, more ESRs benefitted from the OMA training programme by getting the opportunity to join our schools.

The connections initiated through the joint training events also laid the foundation for a number of outreach and communication activities with global reach. The OMA website provides information about all network partners, Fellows and projects, and is regularly updated with project news. The OMA Express newsletter is distributed every three months to update the network on the progress of the project. A project leaflet has also been printed and a glossy A4 brochure has been produced, showcasing each of the Fellows, their research projects and the partners involved in the network, thus acting as an application dossier for the ESRs. This promotional material has been used to raise the profile of the project by distribution at conferences around the world and via all project partners. All material is available via the project website. OMA was presented to a wider scientific community at many international conferences including the International Particle Accelerators Conference and Beam Instrumentation Conference. It has also been presented at other meetings for a wider scientific and medical community.

OMA also organized a number of high impact international outreach events: This included a pan-European event to celebrate the 150th birthday of Marie Skłodowska–Curie and promote the Marie Skłodowska Curie Actions, an annual Physics of Star Wars event, outreach talks by research leaders and Fellows in countries around the world, and an international Symposium on Accelerators for Science and Society. These activities have reached Millions of people around the world online and in print.
OMA has significantly advanced knowledge in proton/ion beam therapy and related key technologies as outlined in previous sections. Some of the numerous links between projects with a focus on their innovation potential are highlighted in this summary.

From a clinical perspective, uncertainty in the Bragg Peak position, i.e. the range of the beam inside the patient, is one of the main reasons prohibiting even more precise and targeted irradiation. Significantly reduced safety margins and therefore also side-effects could be gained by accurate prediction and verification of this range. The first direct measurement device in clinical use is the prompt gamma slit camera investigated and improved by ESR3. In support of prompt gamma detection, but possibly also other related strategies such as prompt particle measurement for ion beams, ESR10 provided means for tailoring treatment plans for improved detectability. The calorimeter developed by ESR5 was also used as a fast range detector for mixed C/He beams for online range monitoring. ESR15 developed a gantry design enabling high energy proton beams that penetrate the patient and can thus be used to generate proton CT images, but also pilot shots for range verification in the treatment position.

Cancers of moving organs are common and treatment options are often dismal, such as for advanced stage lung cancer or pancreatic cancer. Radiotherapy can play a major role in improving local control of primary lesions, but is currently limited by toxicity - existing technology is not capable of delivering sufficient dose to the tumour without incurring prohibitive side-effects. Together with improved range estimation, the characterisation (ESR8), detection (ESR11) and compensation (ESR9) of motion will help to overcome this barrier by permitting a fast, safe and conformal treatment of moving targets with particle therapy.

A key challenge for particle therapy is the size and cost of the facilities, hindering a more wide-spread use in spite of clear dosimetric and in some cases also proven clinical superiority. Striving towards more compact, cost-effective facilities will thus promote the field as a whole and benefit patients in need of better care. A possible road towards this goal is the introduction of novel accelerator technology as investigated by ESR13 or super-conducting, compact gantries (ESR15), which make up a major cost factor of modern proton but even more so ion beam facilities. An improved workflow leading to a higher patient throughput will help to reduce cost also in existing facilities, for example by increasing accelerator performance (ESR14) or by providing more user-friendly, safe and reliable software to operate facilities (ESR12).