Opening

Introduction of accelerators

• Frank Tecker (CERN)

Use of Accelerators in Medicine

• Manjit Dosanjh (University of Oxford (GB))

Clinical specifications - particle therapy

• Felipe Calvo

Interaction of particles with matter and targets

• Danas Ridikas

Conventional X-ray therapy

• Laimonas Jaruševičius

1 slide 1 minute

Clinical specifications - nuclear medicine

• Bart Cornelissen

Radiobiology, RBE, dose

• Peter van Luijk

About 130 years ago, the first cancer patient was treated with X-rays that had just been discovered by Wilhelm Röntgen. Although that treatment did have a pronounced effect on the gastric tumour of the patient, overall the treatment was not very successful and the patient died 20 days later. From that initial experience until now, the discipline of radiation biology investigated mechanisms and processes responsible for biological responses to radiation that enabled evolution of radiotherapy into a treatment that plays an important role in approximately 50% of all cancer patients at some stage of the management of their disease. In this lecture the fundamentals of biological responses to radiation, and how these support current radiotherapy practices will be discussed.

Case study Intro

• Maurizio Vretenar (CERN)

Sources for medical accelerators

• Nadia Gambino

Ion sources have a wide range of applications, ranging from industry to research, including particle therapy. For medical applications, the ion source plays a crucial role, as it is the first major component of the accelerator and is responsible for generating the ion beam. In this lecture, the fundamentals of ion sources used in particle therapy accelerators will be presented. The lecture will focus on four main topics: a) the basic principles of ion sources (mainly plasma-based) and the fundamental physics underlying their operation; b) the key requirements for medical ion sources; c) the main types of ion sources employed in particle therapy, including beam extraction systems and the selection of the desired ion charge state; d) the characterization and commissioning of the ion source and critical aspects related to long-term beam current stability, intensity drifts and hardware degradation over time. An outlook will be given on future trends in medical ion source development related to novel plasma generation techniques to improve the ionization efficiency, better diagnostics systems, compactness and use of AI for advanced beam control methods via real-time adjustments of the ion source set-point.

Linacs for medicine: protons, ions, electrons

• Maurizio Vretenar (CERN)

The lecture will start reviewing the basic principles of linear accelerators: coupled resonator systems, traveling and standing waves, bases of beam optics in linacs. It will then review the main applications of linacs for medicine: electron linacs for radiotherapy, proton and ion linacs as injectors for synchrotrons, and as stand-alone high-energy proton linacs for proton therapy.

Future trends in radiation therapy

• Felipe Calvo

Dose delivery commissioning and verification

• Abdallah Qubala

Synchrotrons I

• Elena Benedetto (Foundation Tera-Care (CH))

Quality Assurance - detectors, devices for beam characteristics

• Markus Stock

Visit Nucleo and Pauls Stradiņš Clinical University Hospital Buses leave at 13:45, return ~17:45. Visits of - Nucleo - Pauls Stradiņš Clinical University Hospital.

Cyclotrons

• Alexander Gerbershagen (PARTREC, UMCG, University of Groningen (NL))

Patient positioning and verification systems

• Markus Stock

Synchrotrons II

• Elena Benedetto (Foundation Tera-Care (CH))

Technologies for acceleratos

• Maurizio Vretenar (CERN)

This lecture will introduce the main subsystems required for the operation of an accelerator. Starting from the energy conversion from the wall plug to the beam, will be introduced the main features of radio-frequency acceleration, covering RF cavity technology and RF power generation and distribution. Magnets used for accelerators will be briefly described, covering both normal-conducting and superconducting systems. Power converters and vacuum equipment will be described, in particular for their impact on accelerator operation. The lecture will conclude with a general overview of the infrastructure required for operation of a particle accelerator.

Round table - Linacs, Cyclotrons, Synchrotrons in particle therapy and isotope production

Case study discussion with lecturers

Seminar: Improving access to Radiation Therapy in Lower-Middle income countries

• Graeme Campbell Burt (Lancaster University (GB))

Beam lines and degraders

• Alexander Gerbershagen (PARTREC, UMCG, University of Groningen (NL))

Gantries

• Marco Giuseppe Pullia

Control systems for medical accelerator facilities

• Mark Plesko (Cosylab)

Integration, operation and risk management in a medical accelerator facility

• Alberto Degiovanni (CERN)

Boron neutron capture therapy

• Saverio Altieri

Case study discussion with lecturers

Entertainment Seminar

• Linda Zonne-Zumberg

Imaging (for hadron therapy and radioisotopes)

• Joao Seco

Treatment planning + patient selection

• Richard Amos

FLASH therapy

• Marie-Catherine Vozenin

Ultra-high dose rate, FLASH radiotherapy has now emerged as one of the most promising innovations over the last decade in the field of radiation oncology, with the potential to eradicate radiation resistant primary tumors and improve the therapeutic index of radiotherapy. A biological effect called the FLASH effect for which rapid delivery of radiation doses is necessary but not always sufficient. FLASH may position modern radiation therapy over the next few years to become the center of safe, affordable and efficient anti-cancer care. While work is in progress, FLASH-dedicated research is challenging and exciting as it involves muti-disciplinary expertise at the interface of physics, chemistry, biology and clinics. Interestingly, while the FLASH effect has been demonstrated in preclinical in vivo models with electron, photon, proton and heavier ion beams, the optimal beam parameters required for safe clinical translation in terms of dosimetry, radioprotection and treatment planning systems are still under investigations. and will be. It has been reported to occur when using single and hypo-fractionated dose regimens in several experimental animal models (mice, rat, zebrafish, pig, cats) and in multiple organs (lung, skin, gut, brain) by numerous groups worldwide and emerging evidence suggests that FLASH could also be delivered with standard fractionation regimen. The current knowledge, limitations and challenges for safe clinical translation will be presented in this lecture. Similarly, while pre-clinical in vivo data seem to show that the majority anti-tumor efficacy of cytotoxic doses is not dependent on dose rate, while normal tissues seem generally dose rate sensitive, some tumors show enhanced sensitivity to FLASH while others are resistant. Some normal tissue (such as the liver) might be insensitive to FLASH due to intrinsic biochemical characteristics. Mechanistic investigations have also been performed at the physico-chemical and biological levels. Current results tend to suggest that the FLASH effect is biochemical and depends upon the biological milieu. Mechanisms involving the preservation of redox and metabolic homeostasis as well as reduction of the peroxidation of biomolecules have been demonstrated and more recently FLASH-specific induction of dedicated transcription factors involved in the activation of intrinsic regenerative and radio-resistance signals in normal tissue vs death program in tumors have been shown using omics methodologies. The perspectives of these new findings will also be presented along with their relevance for safe clinical translation.

Mini Beams, partial irradiation

• Yolanda Prezado

Targets, Radioisotope Production, radiochemistry I

• Thierry Stora (CERN)

Case study discussion with lecturers

Targets, Radioisotope Production, radiochemistry II

• Thierry Stora (CERN)

Certification I (legal, industrial aspects)

• Caterina Brusasco

Particle accelerators are increasingly deployed as commercial systems in industrial and medical applications, including radiation processing and advanced radiotherapy. As market products, they must comply with stringent regulatory requirements that demand demonstration of safety and performance before market access. In the medical field, regulations require not only safety but also evidence that the device achieves its intended clinical performance, such as accurate and reliable dose delivery. Demonstrating compliance is challenging due to the complexity and novelty of accelerator technologies, which involve high-energy radiation, radio-frequency systems, cryogenics, and robotic motion, all introducing specific hazards that are not fully covered by conventional industrial safety frameworks. Standards play a key role in bridging regulatory requirements and technical implementation. Process standards (e.g., quality management, risk management, usability, and software lifecycle) and product standards (e.g., IEC 60601 series) support structured design, verification, and validation. The IEC 60601 series, including particular standards for radiotherapy, is widely recognized for demonstrating basic safety and essential performance. Accredited testing ensures reliable evidence of conformity. For emerging technologies, participation in standardization activities remains essential to address gaps and align innovation with regulatory expectations.

Future Accelerator Trends

• Rasmus Ischebeck (Paul Scherrer Institut)

Special applications of SC magnets

• Enrico Felcini (CNAO)

Certification II (legal, industrial aspects)

• Caterina Brusasco

Particle accelerators are increasingly deployed as commercial systems in industrial and medical applications, including radiation processing and advanced radiotherapy. As market products, they must comply with stringent regulatory requirements that demand demonstration of safety and performance before market access. In the medical field, regulations require not only safety but also evidence that the device achieves its intended clinical performance, such as accurate and reliable dose delivery. Demonstrating compliance is challenging due to the complexity and novelty of accelerator technologies, which involve high-energy radiation, radio-frequency systems, cryogenics, and robotic motion, all introducing specific hazards that are not fully covered by conventional industrial safety frameworks. Standards play a key role in bridging regulatory requirements and technical implementation. Process standards (e.g., quality management, risk management, usability, and software lifecycle) and product standards (e.g., IEC 60601 series) support structured design, verification, and validation. The IEC 60601 series, including particular standards for radiotherapy, is widely recognized for demonstrating basic safety and essential performance. Accredited testing ensures reliable evidence of conformity. For emerging technologies, participation in standardization activities remains essential to address gaps and align innovation with regulatory expectations.

Case study discussion with lecturers

Case study presentation preparation

Mixed Ion Beams

• Elisabeth Renner (Technische Universität Wien (AT))

A recent proposal for online treatment monitoring in ion beam therapy is the irradiation of patients with mixed helium (4He2+) and carbon ion (12C6+) beams. In this approach, both ion species are accelerated simultaneously and extracted to the patient. Because, at the same extraction energy per nucleon, 4He2+ has an approximately three times greater range in matter than 12C6+, the 12C6+ beam can be used for treatment, while the 4He2+ beam is available for range verification in a detector placed behind the patient. The lecture will focus primarily on accelerator concepts for delivering such mixed ion beams, with an outlook on proposed mixed-beam imaging systems. After the lecture, students will be able to describe the status of the research field, compare different options for generating mixed ion beams, and explain the beam-dynamics implications related to the small relative charge-to-mass offset between the two ion species, ∆(m/q)/(m/q) = 0.065 %. They will also be able to describe the principles of proposed mixed-beam imaging solutions and identify some open questions on the path to possible clinical application.

Emerging Accelerator Technologies

• Toms Torims (CERN)

Seminar: The Advanced Particle Therapy Center for the Baltic States

• Brigita Abakevičienė

Radiation protection for medical accelerators and radionuclides

• Saverio Braccini

AI application for medical accelerators - accelerator side

• Adnan GHRIBI

AI application for medical accelerators - medical side

• arnold pompos (UT Southwestern, Dallas, TX)

Case study presentations

Case study presentations

Closing

• Frank Tecker (CERN)