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    Topical course on Medical Accelerators, 15-26 June 2026, Jurmala, Latvia

    → Europe/Zurich
    Baltic Beach Hotel & SPA Juras street 23/25, Jurmala, LV 2015 Latvia
    Christine Vollinger (CERN), Frank Tecker (CERN)
    Description

    In collaboration with Riga Technical University, the CERN Accelerator School is proud to present a CAS course on Medical Accelerators in Latvia.

    Particle accelerators, known since decades as cornerstones of fundamental physics research, nowadays evolved into indispensable tools for society across diverse fields.  This course focuses on profound and widespread accelerator applications in medicine, particularly in oncology and in nuclear medicine. By bridging the communities of accelerator science and medical physics, we will provide a comprehensive overview of the field from both technological and clinical perspectives.

     

    Course Content

    Through a combination of lectures, case studies, and practical discussions, you will gain a deep understanding of:

    • Medical and Biological Foundations: An introduction to radiobiology and oncological issues, setting the stage for therapeutic applications.
    • Accelerator Essentials: The fundamental principles of accelerators and beam delivery systems.
    • Types of Accelerators: The specific design and operational particularities of linear accelerators, cyclotrons, and synchrotrons in medical settings.
    • Clinical Applications: Various medical treatment types and their technical implementations, from traditional radiation therapy to advanced techniques.
    • Isotope Production: The use of accelerators for the production and handling of short-lived radioisotopes, as essential elements for medical imaging.
    • Regulatory Framework: The critical regulatory topics governing the use of accelerators in a clinical environment.
    • Future Concepts: An overview of novel acceleration techniques and future treatment modalities.

     

    Who Should Attend?

    This course is designed for a diverse audience, including:

    • Early-career professionals - from accelerator laboratories, university departments, and companies manufacturing accelerator equipment - who would like to learn about medical applications of accelerators.
    • Medical physicists and professionals - in hospitals and medical centres - who wish to deepen their understanding of the machines they use.
    • Postgraduate students and PhD candidates - from accelerator science, engineering, medical physics, or related fields – who wish to join the field.
    • Experienced professionals interested in new trends and advancements in the field.

    We welcome applications from all countries and nationalities. Please note that applicants are responsible for ensuring that their registration fee and travel costs are covered by their home institute, employer, or themselves.

     

    Important Application Information

    Early applicants will be given priority in the selection process. With a limited number of participants, we strongly advise you to apply early to secure your place. Waiting until the application deadline approaches may reduce your chances of being selected. Also keep in mind that there is a limited number of single rooms available which will be given on a first-come-first serve principle. Once the course is full, we will close the registration.

    We also offer a limited number of student grants for participants from countries with developing accelerator fields who would otherwise be unable to attend. Note that grant applications must fulfil the same requirements as standard applications. More details can be found under the 'Apply for a Student Grant' section.

     

    We would like to express our gratitude to Euro-Labs. By sponsoring five extra grant students, they enable more talented researchers to join and benefit from our training program.

    Important dates

    • Wednesday 8 October 25 - registration opens
    • Friday 27 March 26 – deadline for grant applications
    • Monday 13 April 26 – final deadline for applications (unless course is fully booked before)
    • Thursday 30 April 26- registration fee payment deadline
    • Monday 15 June 26 (afternoon/evening) - participants arrivals
    • Friday 26 June 26 (morning) - departure
    Timetable_Medical2026_ver2.51.pdf
    Timetable_Medical2026_ver2.6.pdf
    School administrator(s): Delphine Rivoiron and Maria Filippova
    • Monday 15 June
      • 08:30
        Arrival day and Registration
    • Tuesday 16 June
      • 1
        Opening
        Opening-Medical-2026r.pdf
        Opening-Medical-2026r.pptx
      • 2
        Introduction of accelerators

        This introductory lecture outlines the fundamental physics, technology, and design of particle accelerators, emphasizing their widespread societal applications across medicine and industry.
        The presentation introduces the three primary accelerator configurations - linear accelerators (linacs), cyclotrons, and synchrotrons – used for medical applications.
        Beginning with the basics of relativistic kinematics and the limits of electrostatic systems, the presentation details radio-frequency (RF) acceleration and the principle of phase stability required for longitudinally stable acceleration . Transverse beam dynamics are addressed by examining magnetic bending and quadrupole focusing (such as FODO cells) governing betatron oscillations.
        The lecture concludes with a comparison of the different accelerator configurations for their use in conventional radiotherapy, medical radioisotope production, and advanced proton/carbon-ion hadron therapy.

        Speaker: Frank Tecker (CERN)
        Intro-Acc-Medical-2026.pdf
        Intro-Acc-Medical-2026.pptx
      • 10:40
        Coffee break
      • 3
        Use of Accelerators in Medicine

        From Röntgen's first X-ray image in 1895 to today's advances in proton therapy, FLASH radiotherapy, VHEE beams and theranostics, accelerator science has transformed the way we diagnose, image and treat disease.
        Over the 130 years, successive advances in radiation sources and accelerator technology have repeatedly expanded what medicine can achieve. From the discovery of X-rays and the early
        use of radiation for therapy, through cobalt teletherapy and the development of clinical linear accelerators, accelerator science has enabled the treatment of increasingly complex and deep-
        seated diseases. Visionaries such as Röntgen, Lawrence, Kaplan, and Wilson helped shape a field in which discoveries originating in physics laboratories were translated into routine clinical practice.
        Today, accelerators underpin not only modern radiotherapy but also the production of medical isotopes, positron emission tomography (PET), and emerging theranostic approaches that combine diagnosis and treatment within a personalised medicine framework. At the same
        time, new frontiers including FLASH radiotherapy, Very High Energy Electron (VHEE) therapy, and next-generation particle therapy facilities promise further advances in treatment effectiveness and patient outcomes.
        This talk traces the remarkable journey from the discovery of X-rays and the earliest radiation treatments through the development of cyclotrons, synchrotrons, cobalt units, and clinical linear accelerators, to the sophisticated accelerator-based technologies used in modern healthcare.
        Along the way, there are highlights how breakthroughs in physics and engineering repeatedly translated into new clinical capabilities: first enabling physicians to see inside the body, then to treat disease, later to target tumours with increasing precision, and today to personalise diagnosis and therapy. The story illustrates how accelerator science has become one of the most successful contributors to healthcare, improving the diagnosis and treatment of millions of patients worldwide.
        Looking towards the future, emerging technologies promise to move beyond physical precision towards biological optimisation, opening new possibilities for personalised medicine. The talk provides a historical perspective on how accelerator innovation has shaped medicine and explores how the next generation of scientists and engineers may help
        define its future.

        Speaker: Manjit Dosanjh (University of Oxford (GB))
        Dosanjh-Accelerators in Medicine-Abstract 16.06.2026.pdf
        Dosanjh-CAS-16. 06.2026-Final.pdf
      • 12:15
        Lunch
      • 4
        Clinical specifications - particle therapy

        Traditional medicine has evolved into precision medicine, driven by advances in molecular diagnostics and the treatment of most diseases. Cancer remains a predominant and growing reality within healthcare, representing a complex group of neoplastic diseases and a common cause of death. Cancer is a curable disease, and radiotherapy contributes significantly to its definitive control in two out of every three patients.
        Evidence Update: Advancing Clinical Benefit
        By 2025, more than 170 proton therapy centers worldwide were either operational or in development. In 2022, over 35,000 patients treated with particle therapy were recorded in the PTCOG Registry. Published evidence regarding the clinical outcomes of proton therapy has increased substantially over the past 15 years. Data are now available demonstrating how dosimetric advantages translate into meaningful clinical benefits across various cancer settings. In 2023, the American Society for Radiation Oncology (ASTRO) updated its proton therapy recommendations supported by health insurance coverage, encompassing 66 disease presentations, including 32 new indications added since the initial 2017 report.
        Value in Healthcare: Metrics and Models
        Healthcare value metrics for a technology such as proton therapy include cost-related factors associated with cancer control outcomes, medical management of toxicity and complications, and disability-adjusted life years (DALYs). A comprehensive analysis of cost-effectiveness and survival outcomes is appropriate for understanding how dosimetric benefits contribute to clinical performance. There is long-standing international consensus that pediatric oncology patients are preferred candidates for proton therapy. Adult cancer patients may also be considered candidates within a multifactorial framework aimed at enhancing normal tissue tolerance (particularly in patients with comorbidities) and preserving immune competence through protection against lymphopenia.
        Clinical Horizon 2030
        By 2030, more than 4,000 patients will be enrolled in randomized trials incorporating a proton therapy component, and 280 studies will have been completed and be ready for analysis (ClinicalTrials.gov). The expansion of proton therapy technology will continue to parallel the growth of medical knowledge generated by innovative academic institutions. The dosimetric advantages associated with proton therapy provide a level of protection against unnecessary radiation exposure in humans. Achieving a significant expansion in its medical application will require major technological advances in system miniaturization and a substantial reduction in overall capital investment costs.

        Speaker: Felipe Calvo
        CAS Felipe Calvo 1.pdf
        CAS Felipe Calvo 1.pptx
      • 5
        Interaction of particles with matter and targets

        Understanding the interaction of ionising radiation with matter is a cornerstone of modern radiological physics, medical imaging, and radiation safety. This lecture (after a brief introduction of the International Atomic Energy Agency and its main missions) provides an overview of the fundamental mechanisms by which energetic particles and high-energy photons transfer their energy to absorbing media. The course is structured into three primary areas:
        • Charged Particle Interactions: Explores the Coulomb interactions of directly ionising radiation (e.g., electrons, protons, alpha particles and heavier ions). Concepts such as ionization, excitation, Bremsstrahlung, and nuclear reactions as well as stopping power and the Bragg peak are detailed to explain how dose is distributed with depth.
        • Photon Interactions: Examines the processes of indirectly ionising radiation (X-rays and gamma rays). The lecture covers the probability, cross-sections, and energy dependence of four principal interactions:
        o Photoelectric Effect: Dominant at low energies and high atomic number Z materials.
        o Compton Scattering: The primary mechanism in tissue-equivalent materials across intermediate diagnostic energy ranges.
        o Pair Production: Essential in high-energy applications like radiation therapy.
        o Photonuclear Reactions: Occurring at higher energies when atomic nuclei are excited via the capture of incident photons and relax by emitting one or several elementary particles.
        • Neutron Interactions: Examines the various processes governing neutron-matter interactions, focusing on how a neutron's kinetic energy dictates its behavior. These include:
        o Scattering Processes: The mechanisms of elastic scattering (vital for neutron moderation) and inelastic scattering (which transfers significant energy to recoil nuclei).
        o Absorption and Nuclear Reactions: How thermal and fast neutrons trigger neutron capture (n,g), fission (n,f), charged particle emission (n,chp) and other transmutation reactions.
        o Cross-Sections & Mean Free Path: Understanding microscopic and macroscopic interaction probabilities and how they govern reaction rates and neutron attenuation.
        Finally, the lecture relates the presented material with accelerators used in nuclear medicine such as electron linacs, medical cyclotrons, high energy proton and carbon therapy facilities as well as low energy particle accelerators used to produce neutrons needed for innovative treatment techniques such as Boron Neutron Capture Therapy (BNCT).

        Speaker: Danas Ridikas
        DRidikas4CAS2026.pdf
        DRidikas4CAS2026.pptx
      • 16:00
        Coffee break
      • 6
        Conventional X-ray therapy

        This lecture traces the evolution of conventional external-beam radiotherapy from Röntgen's discovery of X-rays to today's image-guided, adaptive, and AI-assisted treatment, framed against the global burden of cancer and the central role radiotherapy plays in curative, adjuvant, and palliative care. It reviews the key technical requirements of modern RT — ablative dose delivery, organ-at-risk sparing, and motion management — and compares major delivery platforms (C-arm linacs, CyberKnife, TomoTherapy/Radixact, Halcyon/Ethos, and MR-Linac), illustrated with clinical cases of stereotactic body radiotherapy for lung and liver metastases. The talk also covers online adaptive MR-guided workflows and real-time intrafraction motion monitoring, emerging AI applications in auto-contouring and plan optimisation, the rationale for combining radiotherapy with immunotherapy, and future directions including proton therapy and the CERN Baltic initiative for an Advanced Particle Therapy centre for the Baltic States.

        Speaker: Laimonas Jaruševičius
        JURMALA2026_xray radiotherapy.pdf
      • 7
        1 slide 1 minute
        1S1M_Medical_2026.pptx
        GEORGIOS DIANOS 1SLIDE1MINUTE.pptx
      • 18:45
        Welcome reception
      • 20:00
        Dinner
    • Wednesday 17 June
      • 8
        Clinical specifications - nuclear medicine
        Speaker: Bart Cornelissen
        CAS course 170626.pdf
        CAS course 170626.pptx
      • 9
        Radiobiology, RBE, dose

        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.

        Speaker: Peter van Luijk
        250617 Basic Radiobiology.pdf
        250617 Basic Radiobiology.pptx
      • 10:40
        Coffee break
      • 10
        Case study Intro

        Presentation of the case study

        Speaker: Maurizio Vretenar (CERN)
        jurmala_case_study_challenge_final_17.06.pdf
        jurmala_case_study_challenge_final_17.06.pptx
      • 12:15
        Lunch
      • 11
        Ion Sources for Medical Accelerators

        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.

        Speaker: Nadia Gambino
        Ion_Sources_for_Medical_Accelerators_NG_Uploaded.pdf
        Ion_Sources_for_Medical_Accelerators_NG_Uploaded.pptx
      • 12
        Linacs for medicine: protons, ions, electrons

        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.

        Speaker: Maurizio Vretenar (CERN)
        CAS_medical_06_26_linacs_v2.pdf
        CAS_medical_06_26_linacs_v2.pptx
      • 16:00
        Coffee break
      • 17:45
        Poster session
      • 20:00
        Dinner
    • Thursday 18 June
      • 14
        Dose delivery commissioning and verification

        Accurate dose delivery in scanned particle therapy requires a precise connection between the physical beam and the treatment planning system (TPS). This lecture covers the principles of dose delivery commissioning and verification, emphasizing how measured beam data build and validate TPS models. Key topics include beam data acquisition, depth/lateral dose modeling, and absolute dose calibration. The lecture also examines the effects of spot size, spacing, and scanning grid on homogeneity and efficiency. Experimental validation uses simple and complex geometries, as well as end-to-end tests from imaging to delivery. Demonstrated agreement between measurements and calculations confirms system control and ensures reliable clinical dose delivery.

        Speaker: Abdallah Qubala
        Abstract.docx
        Abstract.pdf
        CERN Accelerator School 2026_Abdallah Qubala_Final.pdf
      • 15
        Synchrotrons I

        After introducing the (accelerator) components of a full medical facility, I’ll discuss the synchrotrons key features and main components, with focus on the small, low-energy machines for medical applications.
        I’ll talk about closed orbit, beam rigidity, RF cavities, acceleration in synchronism with magnet ramp-up, dipoles to bend and quadrupoles to focus the beam.
        Finally, I’ll give you the key concepts of transverse beam dynamics (linear optics) using as little formula as possible: phase space representation, tune, Hills equation, beam ellipse, emittance and periodic beta function.

        Speaker: Elena Benedetto (Foundation Tera-Care (CH))
        EBenedett_CAS26_synchrotrons_1_v2.pdf
        EBenedett_CAS26_synchrotrons_1_v2.pptx
        EBenedett_CAS26_synchrotrons_1_v3.pdf
        EBenedett_CAS26_synchrotrons_1_v3.pptx
      • 10:40
        Coffee break
      • 16
        Quality Assurance - detectors, devices for beam characteristics

        The clinical implementation of proton and carbon-ion therapy relies on a comprehensive quality assurance (QA) framework that ensures accurate beam delivery throughout commissioning and routine operation. Owing to the distinctive physical and biological characteristics of charged particle beams, QA in particle therapy requires dedicated detectors, specialized dosimetric procedures, and facility-specific verification strategies that differ substantially from those used in conventional photon radiotherapy.
        This lecture provides an overview of detector systems, dosimetry equipment, and measurement methodologies used for commissioning and quality assurance in modern particle therapy facilities. The presentation introduces the fundamental principles of absolute and relative dosimetry, including current reference dosimetry standards and the challenges associated with achieving high accuracy in proton and carbon-ion beams. Various detector technologies are discussed, including ionization chambers, diodes, diamond detectors, scintillation-based systems, radiochromic films, multilayer ionization chambers, and advanced two- and three-dimensional dosimetry devices. Their respective advantages, limitations, and application domains are reviewed with particular emphasis on spatial resolution, water equivalence, LET dependence, and suitability for clinical QA workflows.
        The lecture further covers the role of phantoms and measurement systems for beam characterization, imaging system verification, CT calibration, and end-to-end testing. Key beam parameters relevant for accelerator and treatment system commissioning are presented, including practical range, residual range, spread-out Bragg peak characteristics, lateral penumbra, spot size, dose homogeneity, and biological dose concepts such as relative biological effectiveness (RBE). Particular attention is given to the additional challenges introduced by high-LET carbon-ion beams and their implications for dosimetric measurements and treatment verification.
        Drawing on commissioning experience from the MedAustron particle therapy facility, the presentation illustrates comprehensive strategies for validating scanning beam delivery systems. Topics include depth-dose measurements, integral radial dose profiles, spot characterization in air and water, transverse beam profiles, monitor calibration, and the generation of reference datasets for treatment planning systems and machine QA programs. The importance of detector qualification and independent validation of commercially available QA equipment is highlighted through practical examples demonstrating significant performance deviations identified during commissioning.
        Finally, the lecture addresses current trends in QA optimization aimed at reducing valuable accelerator beam time while maintaining high confidence in treatment delivery. The transition from measurement-based patient-specific QA toward independent dose calculation and Monte Carlo-based verification methodologies is discussed, together with their respective strengths, limitations, and integration into a comprehensive quality management program. The presentation concludes by highlighting ongoing opportunities for research and innovation in detector development, high-LET dosimetry, automation, and data-driven QA approaches that will support the next generation of particle therapy facilities.

        Speaker: Markus Stock
      • 12:15
        Lunch
      • 17
        Visit Nucleo and Pauls Stradiņš Clinical University Hospital

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

      • 20:00
        Dinner
    • Friday 19 June
      • 18
        Cyclotrons

        This lecture introduces the cyclotron as a compact and commonly used accelerator for medical and nuclear applications. Starting from the non-relativistic condition for a constant revolution period, it develops the basic principles of RF acceleration, harmonic operation, magnetic rigidity, isochronism, and phase stability. The lecture then discusses the practical consequences of relativistic mass increase, including the distinction between synchrocyclotrons and isochronous cyclotrons, and explains how magnetic-field shaping, sector focusing, spiral sectors, and betatron motion are used to preserve stable orbits over many turns. The cyclotron-specific methods for injection and extraction are also explained.

        Speaker: Alexander Gerbershagen (PARTREC, UMCG, University of Groningen (NL))
        Gerbershagen_CAS_2026_Cyclotrons.pdf
        Gerbershagen_CAS_2026_Cyclotrons.pptx
      • 19
        Patient positioning and verification systems

        Particle therapy places exceptionally high demands on patient positioning and image guidance because the finite range of protons and ions makes dose delivery highly sensitive to anatomical variations, setup uncertainties, and motion. This lecture provides an overview of patient positioning systems (PPS) and patient position verification systems (PPVS) developed for modern particle therapy facilities, highlighting their strong interdependence with accelerator and beamline design.
        Topics like reviewing the impact of setup errors, range uncertainties, anatomical deformations, and intra-fraction motion on dose delivery are addressed. Current clinical solutions based on six-degree-of-freedom robotic positioning systems are discussed, including implementations at major particle therapy centers and commissioning approaches that demonstrate sub-millimeter geometric accuracy under varying mechanical loads and rotational configurations. Particular attention is given to the integration of robotic positioning with imaging and collision-avoidance systems in clinical environments.
        A major focus is placed on the renewed interest in gantry-less particle therapy and upright patient positioning. Driven by the substantial size and cost of proton and especially carbon-ion gantries, several contemporary solutions propose moving the patient rather than the beam. Historical and current upright treatment systems are reviewed together with commercial developments, clinical implementation efforts, and ongoing research into anatomical changes, organ deformation, and treatment planning challenges associated with the transition from supine to upright treatment geometries. European research activities, including the UPLIFT doctoral network, are highlighted.
        The lecture further surveys the evolution of image-guided particle therapy, from early orthogonal radiography systems to modern solutions employing planar imaging, in-room CT, cone-beam CT, and dedicated proton therapy imaging platforms. Experiences from major centers and the implementation of advanced ring-imaging systems are presented, together with commissioning methodologies addressing geometric accuracy, image quality, and clinical workflow integration. Examples from MedAustron demonstrate the use of customized cone-beam CT solutions, region-of-interest imaging strategies, and dedicated workflows for ocular treatments.
        Finally, emerging technologies including proton CT, MR guidance, adaptive particle therapy, and advanced treatment verification concepts are discussed. While numerous positioning and verification solutions are now clinically available, many next-generation imaging and adaptation approaches remain at the research stage. The presentation concludes by outlining opportunities for future accelerator and treatment system developments that could enable more precise, adaptive, and cost-effective particle therapy.

        Speaker: Markus Stock
        PPS and PPVS_18082026.pdf
        PPS and PPVS_18082026.pptx
      • 10:40
        Coffee break
      • 20
        Synchrotrons II

        In this second lecture on medical synchrotrons, I’ll touch on the (multi-turn) injection and the (slow resonant-) extraction processes and hardware. I will then discuss pro and cons of synchrotrons, the requirements for the next generation medical synchrotrons and the solutions currently under development.

        Speaker: Elena Benedetto (Foundation Tera-Care (CH))
        EBenedett_CAS26_synchrotrons_2_v1.pdf
        EBenedett_CAS26_synchrotrons_2_v1.pptx
      • 12:15
        Lunch
      • 21
        Technologies for accelerators

        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.

        Speaker: Maurizio Vretenar (CERN)
        CAS_medical_06_26_accelerator_technologies.pdf
        CAS_medical_06_26_accelerator_technologies.pptx
      • 22
        Round table - Linacs, Cyclotrons, Synchrotrons in particle therapy and isotope production
      • 16:00
        Coffee break
      • 23
        Case study discussion with lecturers
      • 24
        Seminar: Improving access to Radiation Therapy in Lower-Middle income countries

        Access to sufficient healthcare is something that everyone should have globally, yet in many parts of the world radiotherapy provision is lacking. IAEA recommends that there is one machine per every 200,000 people but in many countries there are no machines, and in many countries that do have provision there is one machine for a population of 10’s Millions. Of particular interest is the countries identified as Lower-Middle Income Countries (LMIC) which have sufficient funds and infrastructure to have radiotherapy provision but lack the access required. Critical studies in the past 5 years have tried to quantify the scale of the issue, understand where the critical points are, and look at trying to address some of these. This includes access to trained staff and training material, access to spare parts, inadequate maintenance, environmental issues, and logistical issues. These factors will de discussed in the seminar along with possible ways of addressing them.

        Speaker: Graeme Campbell Burt (Lancaster University (GB))
        CAS presentation.pdf
        CAS presentation.pptx
      • 20:00
        Dinner
    • Saturday 20 June
      • 25
        Beam lines and degraders

        This lecture covers the beam transport and delivery systems that delivers the beam from the medical accelerator to the patient. It briefly covers the physical motivation for hadron therapy, focusing on the Bragg peak and the need to control range, transverse dose distribution, and irradiation time. The lecture then introduces magnetic rigidity, beam transport, degraders, energy selection systems, chromaticity, and dispersion suppression, with particular attention to fixed-energy cyclotron facilities where the treatment energy is produced by controlled energy degradation. Gantry concepts are discussed from the viewpoint of beam optics, mechanical constraints, achromaticity, scanning geometry, and phase-space matching. The second part of the lecture compares passive scattering with pencil-beam scanning, including upstream and downstream scanning, multiple Coulomb scattering, range shifters, nozzles, and the implication for clinical methods of mitigating the organ motion, volumetric rescanning, and large momentum acceptance bends.

        Speaker: Alexander Gerbershagen (PARTREC, UMCG, University of Groningen (NL))
        Gerbershagen_CAS_2026_Beamlines_and_degraders.pdf
        Gerbershagen_CAS_2026_Beamlines_and_degraders.pptx
      • 26
        Gantries

        In particle therapy, gantries are beamlines installed on a rotating structure that allows irradiating the patient from any direction in the vertical plane.
        This allows optimizing the irradiation directions when defining the treatment plan, e.g. choosing directions that are less sensitive to small variations in the patient anatomy or directions that avoid irradiating critical structures.
        In this lecture an overview is given of proton and carbon ion gantries and a few aspects to consider when designing a gantry are illustraded.
        In a second part of the lecture, a few concepts about beams and the beam optics description of gantries are introduced with particular focus on matching gantries and matching to gantries.

        Speaker: Dr Marco Giuseppe Pullia
        Pullia - CAS 2026 - Gantries.pdf
        Pullia - CAS 2026 - Gantries.pptx
      • 10:40
        Coffee break
      • 27
        Control systems for medical accelerator facilities

        This presentation introduces the role of control systems in medical accelerator facilities, emphasizing that they are architecture and systems-engineering problems before they are software problems. It explains how control systems support day-to-day clinical and technical operation across the full patient journey, including treatment planning, patient positioning, image guidance, accelerator control, dose delivery, safety systems, workflow management, and emerging functions such as proton imaging. The presentation highlights the layered nature of accelerator control—human-machine interfaces, supervisory control, device controllers, timing and synchronization, protection systems, and real-time dose delivery—while showing how these components integrate into reliable treatment-session execution.

        The presentation also examines how medical accelerator control systems are developed, stressing that success depends on requirements, architecture, risk management, traceability, documentation, verification, commissioning, and certification as much as on implementation. It discusses standards such as ISO 13485, ISO 14971, IEC 62304, and IEC 60601, along with practical challenges in hardware selection, integration, project organization, and change management. The concluding message is that non-technical issues often dominate project outcomes: the right team, disciplined early-stage engineering, strong traceability, risk mitigation, and controlled use of AI for reviewable and testable tasks are essential to delivering safe, certifiable, and maintainable medical accelerator control systems.

        Speaker: Mark Plesko (Cosylab)
        Plesko CS CAS 20.6.2026.pdf
        Plesko CS CAS 20.6.2026.pptx
      • 12:15
        Lunch
      • 28
        Integration, operation and risk management in a medical accelerator facility

        This lecture presents a comprehensive overview of the installation, commissioning and operational aspect of a medical accelerator facility, focusing on the integration of hardware and software and on clinical commissioning. The lecture will touch aspects of daily operational workflows, highlighting the critical role of beam reproducibility, ongoing quality assurance, and multidisciplinary coordination among physicists, radiation therapy technologists, nurses and radiation oncologists. Finally, the session addresses risk management strategies, covering structural radiation shielding, automated interlock networks, and proactive hazard mitigation protocols designed to ensure patient safety and regulatory compliance. Attendees will gain insights into important aspects to consider for the planning and setup of a radiation therapy facility based on particle accelerators.

        Speaker: Alberto Degiovanni (CERN)
        2026-06-20_Presentation CAS_AD.pdf
        2026-06-20_Presentation CAS_AD.pptx
      • 29
        Accelerators for boron neutron capture therapy

        Boron Neutron Capture Therapy (BNCT) has been experiencing a major revival in recent years thanks to the development of particle accelerator-based facilities (AB-BNCT) for neutron production. These systems can be installed directly in hospitals.

        The advent of these machines has made it possible to abandon nuclear reactors, which had been a limiting factor in the spread of BNCT both due to the limited number of available plants and because they were designed for purposes other than the medical treatment of patients.

        The talk will illustrate the basic principles of this radiotherapy, which features cellular-level selectivity. It will briefly touch on topics related to boron carriers, the BNCT radiation field and dosimetry, and neutron sources already in use and under development based on proton and/or deuteron accelerators. Electrostatic accelerators, radiofrequency electrodynamic accelerators, and cyclotrons will be reviewed. The high currents required to produce epithermal neutron fluxes of the order of 109 cm-2 s-1 impose stringent requirements on the target materials (Li and Be) due to both thermal loading and radiation damage (blistering). Some systems already used for patient treatment and the BNCT facility currently being installed at the CNAO in Pavia will be illustrated.

        Acronims

        BPA - BoronoPhenylAlanine,
        BSA - Beam Shaping Assembly,
        BSH - UndecaHydrododecaborate Disodium,
        BNCT - Boron Neutron Capture Therapy,
        CBE - Compoud Biological Effectiveness,
        CNAO - Centro Nazionale di Adroterapia Oncologica (National Center for Oncological Hadrontherapy),
        NTCP - Normal Tissue Complication Probability,
        RBE - Relative Biological Effectiveness,
        ppm - part per million (micro gram / gram),
        TCP - Tumour Control Probability

        Speaker: Saverio Altieri
        altieri-CAS-20-06-26-def.pdf
        altieri-CAS-20-06-26-def.pptx
      • 16:00
        Coffee break
      • 30
        Case study discussion with lecturers
      • 31
        Entertainment Seminar: Latvian traditions during the solstice period
        Speaker: Linda Zonne-Zumberg
        (1)Saucejas - Janit's Sedej Ozolaai.mp3
        Jāņu tradīcijas RTU.pdf
        Jāņu tradīcijas RTU.pptx
        Saites youtube.docx
        Video fragments
      • 20:00
        Dinner
    • Sunday 21 June
      • 08:30
        Excursion
      • 20:00
        Dinner
    • Monday 22 June
      • 32
        Imaging (for hadron therapy and radioisotopes)

        Imaging plays a central role in particle therapy and radionuclide applications, spanning treatment planning, image guidance, functional characterization, particle range verification, and response assessment. We will introduce the main imaging modalities used in these fields and discuss their complementary roles and emerging applications. Computed tomography (CT), including dual-energy CT (DECT), will be presented as a fundamental tool for anatomical imaging, treatment planning, and estimation of particle stopping properties. Magnetic resonance imaging (MRI) will be discussed both for its excellent anatomical soft-tissue contrast and for functional imaging, providing information on tissue physiology, perfusion, diffusion, oxygenation, and metabolism. Positron emission tomography (PET) will be introduced as a molecular imaging technique with applications in radionuclide imaging, treatment planning, and assessment of treatment response and particle range. Particular attention will be given to imaging techniques developed for in vivo verification of particle-beam range, one of the key challenges in proton and ion therapy. These will include PET-based range verification through imaging of irradiation-induced positron emitters, prompt-radiation imaging approaches for monitoring secondary radiation generated during particle irradiation, including the development of prompt-gamma spectroscopy, and emerging ultrasound and ionoacoustic techniques that exploit acoustic signals generated by particle energy deposition. Through these examples, the course will demonstrate how anatomical, functional, molecular, and treatment-induced imaging can be combined to improve treatment accuracy, verify particle range, and provide quantitative information on radiation delivery and biological response in particle therapy and radionuclide-based treatments.

        Speaker: Joao Seco
        Imaging_SECO.pptx
      • 33
        Treatment planning + patient selection

        The goal of radiotherapy is to deliver a therapeutic dose of ionizing radiation to a tumour whilst simultaneously minimizing risk to surrounding healthy tissues. Clinical efficacy is improved when the tumour control probability (TCP) is high and the normal tissue complication probability (NTCP) is low, i.e. the therapeutic ratio is increased. One of the key methods of achieving a favourable therapeutic ratio is through effective treatment planning.

        The application of proton and heavier-ion beams for radiotherapy offer the potential for an increased therapeutic ratio compared to conventional x-ray-based radiotherapy techniques. However, to fully realize this potential benefit, ion beam specific considerations need to be taken into account during the treatment planning process. The aim of this lecture is to introduce general concepts of the radiotherapy treatment planning process and to highlight proton beam specific issues related to physical and biological uncertainties.

        In addition to treatment planning, selecting the most appropriate patients to receive proton or ion beam therapy is important. This lecture shall also highlight some key points related to patient selection.

        Speaker: Richard Amos
        Treatment planning_Amos.pdf
        Treatment planning_Amos.pptx
      • 10:40
        Coffee break
      • 34
        FLASH therapy

        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.

        Speaker: Marie-Catherine Vozenin
        MCVozenin_CASCERN26.pdf
      • 12:15
        Lunch
      • 35
        Mini Beams, partial irradiation

        Minibeam Radiation Therapy (MBRT) is an innovative form of Spatially Fractionated Radiation Therapy (SFRT) that has emerged as a promising strategy to increase the therapeutic window of radiotherapy. Unlike conventional irradiation, which aims to deliver homogeneous dose distributions, MBRT employs arrays of submillimetric beamlets that generate highly heterogeneous dose patterns characterized by alternating high-dose peaks and low-dose valleys. This spatial modulation has been shown to substantially reduce normal tissue toxicity while maintaining, and in some cases improving, tumour control.
        Over the past decade, MBRT has evolved from a purely preclinical concept into a translational radiation modality compatible with clinically relevant photon, proton and heavy-ion beams. Experimental studies performed in multiple tumour models have consistently demonstrated remarkable normal tissue sparing, preservation of organ function and enhanced therapeutic indices compared with conventional radiotherapy. Recent investigations further indicate that these benefits cannot be explained solely by dose redistribution. Instead, MBRT appears to trigger distinct biological responses involving vascular remodelling, immune activation, oxidative stress regulation and intercellular communication.
        From a physics perspective, MBRT illustrates how beam geometry itself can become a critical determinant of biological outcome. Parameters such as beam width, spacing, depth-dependent broadening and peak-to-valley dose ratio influence tissue responses in ways that are not captured by conventional dosimetric metrics. Consequently, MBRT poses unique challenges for beam generation, dosimetry, Monte Carlo modelling and treatment planning, while simultaneously opening new opportunities for biologically optimized irradiation strategies.
        This lecture reviews the physical foundations of MBRT, the technologies currently used for minibeam generation, the underlying radiobiological mechanisms, and the most important preclinical and translational achievements. Particular emphasis is placed on proton and heavy-ion MBRT, recent veterinary and first-in-human applications, and future developments combining spatial fractionation with immunotherapy, FLASH irradiation and advanced particle therapy.

        Speaker: Yolanda Prezado
        cas.prezado.pdf
        cas.prezado.pptx
      • 36
        Targets, Radioisotope Production, radiochemistry I

        The lecture will address the main elements and related challenges associated with the production of radionuclides for biomedical research. The lecture is plit into 2 sessions. The first lecture will introduce the main techniques for the production of radionuclides dedicated to biomedical research, based on accelerators, nuclear reactors and mass separators. The different steps ranging from target manufacturing, their operation and the subsequent radiochemical purification will be introduced. These sequential steps must be commensurate with the radionuclide half-life under consideration, that may range from a few minutes to weeks. Notions of radionuclidic and radiochemical purities will be introduced as essential components to characterize a radionuclide produced for biomedical applications.

        Speaker: Thierry Stora (CERN)
        CAS_medical_isotopes_2026_stora.pdf
        CAS_medical_isotopes_2026_stora.pptx
      • 16:00
        Coffee break
      • 37
        Case study discussion with lecturers
      • 20:00
        Dinner
    • Tuesday 23 June
      • 38
        Targets, Radioisotope Production, radiochemistry II

        In the second lecture, non-conventional or emerging radionuclides, and advanced production concepts will be introduced. A special focus with target design and operation compatible with high power accelerators will be reviewed. In addition, special cases highlighting the potential to reach new radionuclides production capacity and new purity grades will be shown. A special focus on isotope mass separation as a recent source for innovation will be highlighted. Finally, the challenges associated with the use of these radionuclides in clinical settings will be outlined.

        Speaker: Thierry Stora (CERN)
      • 10:40
        Coffee break
      • 12:15
        Lunch
      • 41
        Special applications of SC magnets

        This lecture explores the basic principles of superconducting magnet design for medical accelerators. It briefly traces the history of superconductivity, discussing the critical parameters and their evolution over time, as well as operational margins, quench dynamics, and cooling strategies.
        Next, it compares resistive and superconducting technologies and examines various magnet designs, such as cos-theta, Canted Cos-Theta (CCT), superferric, and toroidal configurations. Finally, the lecture focuses on superconducting magnets for hadron therapy gantries, reviewing commercial systems and cutting-edge initiatives, including the EuroSIG cos-theta, HITRIplus CCT, NIMMS superferric designs, and the GaToroid torus.

        Speaker: Enrico Felcini (CNAO)
        2026_06_23_CAS_SC_Magnets_Felcini.pdf
        2026_06_23_CAS_SC_Magnets_Felcini.pptx
      • 16:00
        Coffee break
      • 43
        Case study discussion with lecturers
      • 20:00
        Dinner
      • 21:00
        Cinema event
    • Wednesday 24 June
      • 44
        Case study presentation preparation
      • 12:15
        Lunch
      • 45
        Mixed Ion Beams

        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.

        Speaker: Elisabeth Renner (Technische Universität Wien (AT))
        2026_MedicalCAS_MixedBeams_Renner.pdf
      • 46
        Emerging Accelerator Technologies
        Speaker: Dr Toms Torims (CERN)
        CAS Lecture Emerging Accelerator Technologies_23-06-2026.pdf
        CAS Lecture Emerging Accelerator Technologies_23-06-2026.pptx
      • 16:00
        Coffee break
      • 47
        Seminar: The Advanced Particle Therapy Center for the Baltic States

        Since 2022, with the active work of CERN Baltic Group in close collaboration with Next Ion Medical Machine Study (NIMMS) group of the European Organization for Nuclear Research (CERN), an initiative has been started for the development of an innovative particle therapy center in the Baltic States - “Advanced Particle Therapy center for the Baltic States” (APTCB). A dedicated working group was developed within the framework of CERN Baltic Group, which has evolved into “APTCB: Feasibility Study Strategy Group”. Proposed initiative would foster broad, multi-disciplinary research programme development, enable access to advanced cancer treatment modalities, contribute to breakthrough innovation development and cross-sectoral economic growth in the region, while strengthening integration of the Baltic States in a broader European scientific research network Concept for the proposed facility was developed in Spring of 2022, followed by active engagement with political, scientific and medical community stakeholders, resulting in a workshop in 2023 “Particle therapy - future for the Baltic States? State-of-play, synergies and challenges”. Workshop outcomes, discussions with stakeholders and experience of similar projects has shown a need for a multi-disciplinary Feasibility Study as the next step of investigation for the future of the initiative. This work aims: to present the status of the initiative, most recent stakeholder engagement activities and outline the developments of core technology; to present the development of Proposal for Feasibility Study Implementation Plan, focusing on the detailed multi-disciplinary working plan; to present brief overview of initial data collection study of radiotherapy practices in the Baltic States as relevant for the Feasibility Study development. Focus is given towards the future of the initiative –the Feasibility Study –outlining the motivation of the facility, proposed organizational structure of the investigation and detailing the working plan. In the preparation of the Feasibility Study, initial data collection study has been performed on radiotherapy practices in the Baltic States, with relevant finding presented in this work. Looking forward, a detailed Feasibility Study investigation is an essential next step towards the development of such an ambitious infrastructure as APTCB due to multi-disciplinarity, high complexity and necessary costs, as well as relatively broad scope. Envisioned pathways for the launch of the Feasibility Study are presented in the conclusion.

        Speaker: Dr Brigita Abakevičienė
        APTCBS_2026_Jurmala_BrigitA.pdf
      • 20:00
        Dinner
    • Thursday 25 June
      • 48
        Radiation protection for medical accelerators and radionuclides

        This lecture introduces the fundamental concepts of radiation protection and their application to medical accelerator facilities. The main regulatory, authorization, and operational requirements will be reviewed, with a particular focus on cyclotrons used for the production of medical radionuclides. Drawing on more than a decade of experience at the Bern medical cyclotron laboratory, practical examples will illustrate key aspects such as shielding, radiation monitoring, activation, radioactive waste management, and radiation safety procedures. The lecture aims to provide participants with both the theoretical background and practical insights required for the safe operation of medical accelerator installations.

        Speaker: Saverio Braccini
        Radiation_Protection_S_Braccini.pdf
        Radiation_Protection_S_Braccini.pptx
      • 49
        AI application for medical accelerators - accelerator side

        Accelerators used in cancer radiotherapy share the physical principles of research machines but operate under constraints that fundamentally reshape how artificial intelligence can be deployed: stringent uptime requirements driven by patient scheduling, layered hardware safety interlocks that define the boundary of AI intervention, clinical regulatory obligations (IEC 62304, EU AI Act), and fault events rare by design — inverting the data-abundance assumption on which standard machine learning relies.

        This lecture covers AI applications on the accelerator side — the machine that produces and conditions the therapeutic beam — and is explicitly scoped to exclude treatment planning and patient-facing clinical AI. Three application categories are treated: unsupervised fault detection on RF cavity waveforms via convolutional autoencoders; automated beam tuning via Bayesian optimisation on a differentiable beam-physics surrogate; and neural-network surrogate models extended to real-time digital twins. Open challenges — explainability, cross-facility transfer, and control-system integration — are framed as open accelerator-physics problems accessible to early-career practitioners.

        Speakers: Adnan GHRIBI, Adnan Ghribi (Centre National de la Recherche Scientifique (FR))
        AI applications - The accelerator side
      • 10:40
        Coffee break
      • 50
        AI application for medical accelerators - medical side
        Speaker: arnold pompos (UT Southwestern, Dallas, TX)
        Arnold Pompos CAS school CERN 06_25_2026 FINAL PRESENTED.pdf
        Arnold Pompos CAS school CERN 06_25_2026 FINAL PRESENTED.pptx
      • 12:15
        Lunch
      • 51
        Case study presentations
        1-Cycl1Draft.pptx
        2-PROMISE_presentation.pdf
        3-Group 3.pptx
        4-Group4-Majorini-CAS-Case-Study.pptx
        5-CARAMBA.pdf
        6-Group6-CAS-CaseStudy-Final.pptx
        7-CAS School Group 7 Presentation (1).pptx
        8-Hauora Medical Center - Group 8.pdf
        Case-studies-groups.pdf
        Case-studies-groups.pptx
        Team 5 - Caramba
      • 52
        Case study presentations
      • 16:00
        Coffee break
      • 53
        Closing
        Speaker: Frank Tecker (CERN)
        Closing-Medical-2026.pdf
        Closing-Medical-2026.pptx
      • 20:00
        Gala dinner
    • Friday 26 June
      • 08:30
        Departure Day