Feasibility of medical radioisotope production based on the proton beams at China Spallation Neutron Source

The utilization of a proton beam from the China Spallation Neutron Source(CSNS)for producing medical radioisotopes is appealing owing to its high current intensity and high energy.The medical isotope production based on the proton beam at the CSNS is significant for the development of future radiopharmaceuticals,particularly for theα-emitting radiopharmaceu-ticals.The production yield and activity of typical medical isotopes were estimated using the FLUKA simulation.The results indicate that the 300-MeV proton beam with a power of 100 kW at CSNS-II is highly suitable for proof-of-principle studies of most medical radioisotopes.In particular,this proton beam offers tremendous advantages for the large-scale production of alpha radioisotopes,such as 225Ac,whose theoretical production yield can reach approximately 57 Ci/week.Based on these results,we provide perspectives on the use of CSNS proton beams to produce radioisotopes for medical applications.

Generating Proton Beams Exceeding 10 MeV Using High Contrast 60TW Laser

A prototype of a laser driven proton accelerator is built at Peking University. Protons exceeding IOMeV are accelerated from micrometer-thick aluminum targets irradiated by tightly focused laser pulse with 1.8 J energy and 30fs duration. The beam energy spectrum and charge distribution are measured by a Thomson parabola spectrometer and radiochromic fihn stacks. The sensitivity of proton cut-off energy to the focusing of the laser beam, the pulse duration, and the foil thickness are systematically investigated in the experiments. Stable proton beams have been produced with an optimized parameter set, providing a cornerstone for the future applications of laser accelerated protons.

Numerical Approach of Interactions of Proton Beams and Dense Plasmas with Quantum-Hydrodynamic/Particle-in-Cell Model

A one dimensional quantum-hydrodynamic/particle-in-cell （QHD/PIC） model is used to study the interaction process of an intense proton beam （injection density of 1017 cm-3） with a dense plasma （initial density of -10^21 cm^-3）, with the PIC method for simulating the beam particle dynamics and the QHD model for considering the quantum effects including the quantum statistical and quantum diffraction effects. By means of the QHD theory, the wake electron density and wakefields are calculated, while the proton beam density is calculated by the PIC method and compared to hydrodynamic results to justify that the PIC method is a more suitable way to simulate the beam particle dynamics. The calculation results show that the incident continuous proton beam when propagating in the plasma generates electron perturbations as well as wakefields oscillations with negative valleys and positive peaks where the proton beams are repelled by the positive wakefields and accelerated by the negative wakefields. Moreover, the quantum correction obviously hinders the electron perturbations as well as the wakefields. Therefore, it is necessary to consider the quantum effects in the interaction of a proton beam with cold dense plasmas, such as in the metal films.

High energy electron beam generation during interaction of a laser accelerated proton beam with a gas-discharge plasma

The study of the interaction between ion beam and plasma is very important to the areas of inertial fusion energy and high energy density physics. With detailed one-dimensional electromagnetic particle-in-cell simulations, we investigate here the interaction of a laseraccelerated proton beam assuming an ideal monoenergetic beam with a gas-discharge plasma.After the saturation stage of the two-stream instability excited by the proton beam, significant high energy electrons are observed, with maximum energy approaching 2 MeV, and a new twostream instability occurs between the high energy electrons and background electrons. The trajectories of plasma electrons are studied, showing the process of electron trapping and detrapping from the wakefield.

Investigation of the confinement of high energy non-neutral proton beam in a bent magnetic mirror

By using the particle-in-cell(PIC)simulation method,we studied how the proton beam is confined in a bent magnetic mirror.It is found that the loss rate of the charged particles in a bent mirror is less than that in the axi-symmetric mirror.For a special bent mirror with the deflection angle of the coilsα=45°,it is found that the loss rate reaches maximum value at certain ion number density where the ion electrostatic oscillation frequency is equal to the ion cyclotron frequency.In addition,the loss rate is irrelevant to the direction of the proton beam.Our results may be helpful to devise a mirror.In order to obtain the least loss rate,we may choose an appropriate deflection angle,and have to avoid a certain ion number density at which the ion electrostatic oscillation frequency is equal to the ion cyclotron frequency.

Residual Nuclides Induced in Cu Target by a 250 MeV Proton Beam

Residual nuclide production is studied experimentally by bombarding a Cu target with a 250 MeV proton beam. The data are measured by the off-line γ-spectroscopy method. Six nuclides are identified and their cross sections are determined. The corresponding calculated results by the MCNPX and GEANT4 codes are compared with the experimental data to check the validity of the codes. A comparison shows that the MCNPX simulation has a better agreement with the experiment. The energy dependence of residual nuclide production is studied with the aid of MCNPX simulation, and it is found that the mass yields for the nuclides in the light mass region increase significantly with the proton energy.

Proton beam therapy of periorbital sinonasal squamous cell carcinoma: Two case reports and review of literature

BACKGROUND Sinonasal malignancies are rare but demanding due to complex anatomy,usually late diagnosis,and inconsistent therapy strategy based on multimodality approaches.Squamous cell carcinoma(SCC)is the most common histology,with poorer prognosis.In the setting of orbital invasion,an orbital exenteration may be required.However,in case of primary rejection of disfiguring surgery or unresectable disease,proton beam therapy(PBT)should be largely considered,allowing for better sparing of neighboring critical structures and improved outcomes by dose escalation.CASE SUMMARY A 62-year-old male presented with a recurrent SCC in the nasal septum abutting frontal skull base and bilateral orbits at 7 mo after primary partial nasal amputation.Because of refusal of face-deforming surgery and considerable adverse effects of conventional radiotherapy,the patient underwent a PBT by hyperfractionated accelerated scheme,resulting in complete response and moderate toxicities.After 2 years,a nasal reconstruction was implemented with satisfactory appearance and recurrence-freedom to date.Another patient with an initially extended sinonasal SCC,invading right orbit and facial soft tissue,declined an orbital exenteration and was treated with a normofractionated PBT to the gross tumor and elective cervical lymphatics.The follow-up showed a continuous tumor remission with reasonable late toxicities,such as cataract and telangiectasia on the right.Despite T4a stage and disapproval of concurrent chemotherapy owing to individual choice,both patients still achieved outstanding treatment outcomes with PBT alone.CONCLUSION PBT enabled orbit preservation and excellent tumor control without severe adverse effects on both presented patients with locally advanced sinonasal SCC.

In Vivo Dosimetry of an Anthropomorphic Phantom Using the RADPOS for Proton Beam Therapy

The radiation positioning system (RADPOS) combines an electromagnetic positioning sensor with metal oxide semiconductor field-effect transistor (MOSFET) dosimetry, enabling simultaneous online measurement of dose and spatial position. Evaluation points can be determined with the RADPOS. The accuracy of in-vivo proton dosimetry was evaluated using the RADPOS and an anthropomorphic head and neck phantom. MOSFET doses measured at 3D positions obtained with the RADPOS were compared with treatment plan values calculated using a simplified Monte Carlo (SMC) method. MOSFET responses, which depend strongly on the linear energy transfer of the proton beam, were corrected using the SMC method. The SMC method was used to calculate only dose deposition determined by the experimental depth-dose distribution and lateral displacement of protons due to the multiple scattering effect in materials and incident angle. This method thus enabled rapid calculation of accurate doses in even heterogeneities. In vivo dosimetry using the RADPOS, as well as MOSFET doses, agreed with SMC calculations in the range of ?3.0% to 8.3%. Most measurement errors occurred because of uncertainties in dose calculations due to the 1-mm position error. The results indicate that uncertainties in measurement position can be controlled successfully within 1 mm when using the RADPOS with in-vivo proton dosimetry.

An Overview of the Control System for Dose Delivery at the UCSF Dedicated Ocular Proton Beam

Since 1978, the University of California San Francisco (UCSF) Ocular Tumor Program has been using particle therapy for treating ocular patients with malignant as well as benign eye disease. Helium ion beams were used initially and were produced by two synchrotron-based systems: first by the 184-inch synchro-cyclotron and later by the Bevalac, at the Lawrence Berkeley National Laboratory (LBNL). Since 1994, protons, produced by a cyclotron-based system at the Crocker Nuclear Laboratory (CNL) Eye Treatment Facility (ETF), have been used for this purpose. The CNL cyclotron produces a 67.5 MeV beam, allowing for a uniquely homogeneous beam for eye treatment, without degradation of the beam or manipulation of the beam line. This paper describes, in detail, the control system for beam delivery, as implemented for measuring and delivering the radiation to ocular tumors at CNL. The control system allows for optimal delivery and rapid termination of the irradiation after the desired dose is achieved. In addition, several safeguard systems are discussed, as these are essential for such a system in the event of failure of software, electronics, or other hardware. The QA analysis shows that the total range of the proton beam is 30.7 ± 1.0 mm in water at iso-center. The beam distal penumbra (80% - 20%) is 1.1 mm for a range-modulated beam at a collimator to iso-center distance of 50 mm. Daily QA checks confirm that the range and modulation is within 0.1 mm. The beam flatness and symmetry in a 25 mm diameter beam are ±1% - 2%. Variation in the daily dosimetry system, as compared to standard dosimetry, is within ±3.5%, with a mean variation of 0.72(±1.9)% and 0.85(±2.3)% for segmented transmission ionization chambers IC1 (upstream) and IC2 (downstream), respectively. From May 1994 to the end of 2015, UCSF has treated 1838 proton ocular patients at the Davis ETF. During this period, no treatments were missed due to any cyclotron or control system failures. The overall performance, maintenance, and quality assurance of the cyclotron and the ocular control system have been excellent.

Proton Beam Therapy for Hepatocellular Carcinoma after the Fontan Procedure

Background: Hepatocellular carcinoma (HCC) is more likely to occur in patients with a history of Fontan surgery, possibly due to long-term liver congestion. Proton beam therapy (PBT) may be effective for HCC that develops after Fontan surgery. Methods: Six lesions in 5 patients (3 females, 2 males) received PBT. The median age of the patients was 33 (range 21 - 42) years, and the median age at the time of the Fontan procedure was 6 (5 - 13) years. Four patients had multiple HCC at the time of PBT. The median tumor size was 57 (22 - 80) mm and 4 patients were classified as Child-Pugh B. Two patients received transcatheter arterial chemoembolization before PBT. The schedule of PBT was 66 Gy (RBE) in 10 fractions for 2 lesions, 72.6 Gy (RBE) in 22 fractions for 2 lesions, and 74 GyE (RBE) in 37 fractions for 2 lesions. Results: The median follow-up period was 31 (10 - 46) months, and the numbers of survivors, deaths from primary diseases, and deaths from other diseases were 3, 1, and 1, respectively. There were no local recurrences, one intrahepatic metastasis, one lung metastasis, and one intrathoracic metastasis. Conclusion: Although experiences on a small number of patients cannot conclude things, we believe that PBT can be a reasonable choice of radical treatment for HCC occurring after the Fontan procedure.

Proton beam therapy in apneic oxygenation treatment of an unresectable hepatocellular carcinoma: A case report and review of literature

Presented here is the clinical course of a 63-yearold patient with a central, large and unresectable hepatocellular carcinoma(HCC) with liver metastases and tumor invasion of the portal and hepatic veins. After the tumor had been diagnosed, the patient was immediately treated with proton beam therapy(PBT), at a total dose of 60 Gy(relative biological effectiveness) in 20 fractions administered within 4 wk. To manage the respiratory movements, at the Rinecker Proton Therapy Center, apneic oxygenation was given daily, under general anesthesia. The patient tolerated both the PBT and general anesthesia very well, and did now show any signs of acute or late toxicity. The treatment was followed by constant reductions in the tumor marker alpha-fetoprotein and the cholestatic parameters gamma-glutamyltransferase and alkaline phosphatase. The patient commenced an adjuvant treatment with sorafenib, given at 6-wk intervals, after the PBT. Follow-up with regular magnetic resonance imaging has continued for 40 mo so far, demonstrating remarkable shrinkage of the HCC(maximal diameter dropping from approximately 13 cm to 2 cm). To date, the patient remains free of tumor recurrence. PBT served as a safe and effective treatment method for an unresectable HCC with vascular invasion.

Reirradiation of recurrent breast cancer with proton beam therapy:A case report and literature review

BACKGROUND Locoregional recurrence of breast cancer is challenging for clinicians,due to the various former treatments patients have undergone.However,treatment of the recurrence with systemic therapy and subsequent reirradiation of chest wall is accompanied by increased toxicities,particularly radiation-induced cardiovascular disease.Reirradiation by proton beam therapy(PBT)enables superior preservation of adjacent organs at risk as well as concurrent dose escalation for delivery to the gross tumor.This technology is expected to improve the overall outcome of recurrent breast cancer.CASE SUMMARY A 47-year-old female presented with an extensive locoregional recurrence at 10 yr after primary treatment of a luminal A breast cancer.Because of tumor progression despite having undergone bilateral ovarectomy and systemic therapy,the patient was treated with PBT BE total dose of 64.40 Gy to each gross tumor and 56.00 Gy to the upper mediastinal and retrosternal lymphatics including the entire sternum in 28 fractions.Follow-up computed tomography showed a partial remission,without evidence of newly emerging metastasis.At 19 mo after the PBT,the patient developed a radiation-induced pericardial disease and pleural effusions with clinical burden of dyspnea,which were successfully treated by drainage and corticosteroid.Cytological analysis of the puncture fluid showed no malignancy,and the subsequent computed tomography scan indicated stable disease as well as significantly decreased pericardial and pleural effusions.The patient remains free of progression to date.CONCLUSION PBT was a safe and effective method of reirradiation for locoregionally recurrent breast cancer in our patient.

Preliminary Result of Hyperfractionated High-Dose Proton Beam Radiotherapy for Pediatric Skull Base Chordomas

Objective: Proton beam therapy (PBT) may provide good local control for skull base chordoma and reduced toxicities, especially for pediatric patients. Methods: We evaluated the efficacy and safety of hyperfractionated high-dose PBT in6 pediatric patients with newly-diagnosed skull basechordoma who were treated with PBT at our institute from 2011 to 2015. The patients were 5 males and one female, and the median age was 9 years old (range: 5 - 13). All patients received surgery before PBT. The median period between surgery and PBT was 57 days (range: 34 - 129 days). The treatment dose was 78.4 GyE in 56 fractions (twice per day). Results: All patients received PBT without severe acute toxicity. The median follow-up period was 27 months (range: 21 - 71 months). At the last follow-up, all patients were alive and all tumors were well controlled. Acute and late toxicities were generally acceptable, with only grade 1 and 2 events. Late toxicities included growth hormone abnormality and cortical hormone abnormality. One patient needed growth hormone and cortical hormone replacement therapy. Conclusion: Although the number of pediatric patients was small, our overall findings in the 6 cases indicate that hyperfractionated high-dose PBT is safe and effective for pediatric patients with skull base chordoma.

Proton Beam Ocular Treatment in Eyes with Intraocular Silicone Oil: Effects on Physical Beam Parameters and Clinical Relevance of Silicone Oil in EYEPLAN Dose-Volume Histograms

Proton beam therapy (PBRT) is an essential tool in the treatment of certain ocular tumors due to its characteristic fall-off and sharp beam parameters at critical structures. Review of clinical cases in our ocular PBRT program identified patients with silicone oil used as an intraocular tamponade following pars plana vitrectomy for repair of retinal detachment. Patient’s eye may be filled with silicone oil prior to PBRT for an ocular tumor. The objective of this study was to extend our knowledge of the physical characteristics of proton beams in silicone oil by measuring dose within a silicone tank itself, hence better representing the surgical eye, as well as applying the range changes to EYEPLAN software to estimate clinical impact. The relevant proton beam physical parameters in silicone oil were studied using a 67.5 MeV un-modulated proton beam. The beam parameters being defined included: 1) residual range;2) peak/plateau ratio;3) full width at half maximum (FWHM) of the Bragg peak;and 4) distal penumbra. Initially, the dose uniformity of the proton beam was confirmed at 10 mm and 28 mm depth, corresponding to plateau and peak region of the Bragg peak using Gefchromic film. Once the beam was established as expected, three sets of measurements of the beam parameters were taken in: a) water (control);b) silicone-1000 oil and water;and c) silicone-1000 oil only. Central-axis depth-ionization measurements were performed in a tank (“main tank”) with a 0.1cc ionization chamber (Model IC-18, Far west) having walls made of Shonka A150 plastic. The tank was 92 mm (length) × 40 mm (height) × 40 mm (depth). The tank had a 0.13 mm thick kapton entrance window through which the proton beam was incident. The ionization chamber was always positioned in the center of the circular field of diameter 30 mm with the phantom surface at isocenter. The ionization chamber measurements were taken at defined depths in increments of 2 mm, from 0 to 35 mm. To define the effect of silicone oil on the physical characteristics of proton beam, the above-defined three sets of measurements were made. In the first run (a), the Bragg-peak measurements were made in the main tank filled with water. In the second run (b), a second smaller tank filled with 10 mm depth silicone oil was placed in front of the water tank and the measurements were repeated in water. In the third run (c), the water in the main tank was replaced with silicone oil and the measurements were repeated in silicone directly (no second tank in runs “a” and “c”). Finally, the effects of change in range on dose distribution based on the EYEPLAN®treatment planning software of patients with lesions in close proximity to the disc/macula as well as ciliary body tumors were studied. The uniformity of the radiation across the treatment volume shows that the radiation field was uniform within ± 3% at 10 mm depth and within ±4% at 28 mm depth. Parameters evaluated for the three runs (a, b, c) included: 1) residual range;2) peak/plateau ratio;3) FWHM of the Bragg curve;and 4) distal penumbra. The measured data revealed that the un-modulated Bragg peak had a penetration at the isocenter of: a) 30 mm in water;b) 31.5 mm in silicone and water;and c) 32 mm range in silicone oil. The peak/plateau ratio of the depth dose curve is 3.1:1 in all three set-ups. The FWHM is: a) 9 mm in water;b) 10 mm in silicone and water;and c) 11 mm in silicone oil. The distal penumbra (from 90% to 20%) was: a) 1.1 mm;b) 1.4 mm;and c) 2 mm. Clinical relevance of the extended distal range in silicone was studied for impact in EYEPLAN treatment software, including cases in which tumors were in close proximity to the optic disc/nerve and macula as well as cases in which anterior ciliary body tumors were treated. The potential change of range by 2 mm in silicone would impact the dose-volume histograms (DVH) importantly for the posterior structures. In ciliary body/anterior tumors, an increase in distal range in silicone could result in optic disc/macula dose and length of optic nerve treated, compared with original EYEPLAN model DVHs. The use of silicone oil as a surgical tamponade in the treatment of retinal detachments has important implications for PBRT treatment planning. In patients with intraocular silicone oil, the physical parameters of the beam should be closely examined and DVHs for posterior structures should be analyzed for potential increased doses to the macula, disc, and length of optic nerve in the field. The change in beam parameters due to silicone oil is essential to consider in treatment planning and DVH interpretation for ocular patients with posterior as well as anterior ocular tumors.

Biological Dose Estimation Model for Proton Beam Therapy

Purpose: The recommended value for the relative biological effectiveness (RBE) of proton beams is currently assumed to be 1.1. However, there is increasing evidence that RBE increases towards the end of proton beam range that may increase the biological effect of proton beam in the distal regions of the dose deposition. Methods: A computational approach is presented for estimating the biological effect of the proton beam. It includes a method for calculating the dose averaged linear energy transfer (LET) along the measured Bragg peak and published LET to RBE conversion routine. To validate the proposed method, we have performed Monte Carlo simulations of the pristine Bragg peak at various beam energies and compared the analysis with the simulated results. A good agreement within 5% is observed between the LET analysis of the modeled Bragg peaks and Monte Carlo simulations. Results: Applying the method to the set of Bragg peaks measured at a proton therapy facility we have estimated LET and RBE values along each Bragg peak. Combining the individual RBE-weighted Bragg peaks with known energy modulation weights we have calculated the RBE-weighted dose in the modulated proton beam. The proposed computational method provides a tool for calculating dose averaged LET along the measured Bragg peak. Conclusions: Combined with a model to convert LET into RBE, this method enables calculation of RBE-weighted dose both in pristine Bragg peak and in modulated beam in proton therapy.

Periodic Measurements of Passive Proton Beam Width Using Radiochromic Film in Fixed Gantry System

Background and Aim: Irradiation methods such as double scattering method and spot scanning method have been used in proton beam treatment devices. In the scattering method, a ridge filter or a range modulation wheel is used to create a spread-out Bragg peak, but the distribution at the patient position may change due to positional deviation of the incident beam. Therefore, assessment of the incident position of the beam is very important even in the scattering method. To investigate the width and distribution of the proton beam before entering the RMW, a radiochromic film was installed at the outlet of the transport pipe and the entrance of the profile-monitoring detector. Methods: In this study, the distributions of the beam at the exit of the transport pipe and the entrance of the monitor detector were measured using films. The beam width was measured from the full width at half maximum of the profile obtained from the distribution. Measurements were conducted every month for 10 months. Results: Beams of widths ranging from 1.82 to 2.30 mm in the horizontal direction and 4.25 to 5.33 mm in the vertical direction were outputted from the exit of the transport pipe. Beams of widths ranging from 2.16 to 2.67 mm in the horizontal direction and 4.06 to 5.31 mm in the vertical direction were outputted from the entrance of the monitor detector. The maximum width fluctuation for 10 months was 0.55 mm in the horizontal direction and 1.26 mm in the vertical direction at the entrance of the monitor detector. Conclusions: The distribution was obtained before the proton beam was scattered by the scatterer, and then we propose a method to periodically measure and monitor the changes in the beam distributions every month.

Proton beam therapy for locally advanced lung cancer: A review

Protons interact with human tissue differently than do photons and these differences can be exploited in an attempt to improve the care of lung cancer patients. This review examines proton beam therapy(PBT) as a component of a combined modality program for locally advanced lung cancers. It was specifically written for the non-radiation oncologist who desires greater understanding of this newer treatment modality. This review describes and compares photon(X-ray) radiotherapy(XRT) to PBT. The physical differences of these beams are described and the clinical literature is reviewed. Protons can be used to create treatment plans delivering significantly lower doses of radiation to the adjacent organs at risk(lungs, esophagus, and bone marrow) than photons. Clinically, PBT combined with chemotherapy has resulted in low rates of toxicity comparedto XRT. Early results suggest a possible improvement in survival. The clinical results of proton therapy in lung cancer patients reveal relatively low rates of toxicity and possible survival benefits. One randomized study is being performed and another is planned to clarify the clinical differences in patient outcome for PBT compared to XRT. Along with the development of better systemic therapy, newer forms of radiotherapy such as PBT should positively impact the care of lung cancer patients. This review provides the reader with the current status of this new technology in treating locally advanced lung cancer.

Robustness Evaluation of a Novel Proton Beam Geometry for Head and Neck Patients Treated with Pencil Beam Scanning Therapy

Background: To evaluate the robustness of head and neck treatment using proton pencil beam scanning (PBS) technique with respect to range uncertainty (RU) and setup errors (SE), and to establish a robust PBS planning strategy for future treatment. Methods and Materials: Ten consecutive patients were planned with a novel proton field geometry (combination of two posterior oblique fields and one anterior field with gradient dose match) using single-field uniform dose (SFUD) planning technique and the proton plans were dosimetrically compared to two coplanar arc VMAT plans. Robustness of the plans, with respect to range uncertainties (RU = ± 3% for proton) and setup errors (SE = 2.25 mm for proton and VMAT), in terms of deviations to target coverage (CTV D98%) and OAR doses (max/mean), were evaluated and compared for each patient under worst case scenarios. Results: Dosimetrically, PBS plans provided better sparing to larynx (p = 0.005), oral cavity (p < 0.001) and contralateral parotid (p = 0.004) when compared to VMAT. CTV D98% variations were higher from SE than from RU for proton plans (-1.1% ± 1.3 % vs -0.4% ± 0.7% for nodal CTV and -1.4% ± 1.2 vs -0.4% ± 0.5% % for boost CTV). Overall, the magnitudes of variation of CTV D98% to combined SE and RU were found to be similar to the impact of the SE on the VMAT plans (-1.6% ± 1.9% vs -1.7% ± 1.4% for nodal CTV and -1.9% ± 1.6% vs -1.3% ± 1.5% for boost CTV). Compared to VMAT, a larger range of relative dose deviations were found for OARs in proton plans, but safe doses were maintained for cord (41.8 ± 3.6 Gy for PBS and 41.7 ± 3.9 Gy for VMAT) and brainstem (35.2 ± 8.4 Gy for PBS and 36.2 ± 5.1 Gy for VMAT) in worst case scenarios. Conclusions: Compared to VMAT, proton plans containing three SFUD fields with superior-inferior gradient dose matching had improved sparing to larynx, contralateral parotid and oral cavity, while providing similar robustness of target coverage. Evaluation of OAR dose robustness showed higher sensitivities to uncertainties for proton plans, but safe dose levels were maintained for cord and brainstem.

Proton beam therapy for downstaging hepatocellular carcinoma with lobar portal vein tumor thrombosis to living donor liver transplantation

Introduction Liver transplantation(LT)is considered as the definitive standard treatment for hepatocellular carcinoma(HCC)with the advantage of addressing both malignancy and the underlying cirrhosis,thus,providing the best overall and recurrence-free survival.Unfortunately,only 20-25%of patients meet the eligibility criteria for LT.

Thermal analysis and optimization of proton beam window for the CSNS

The proton beam window （PBW） is one of the key devices of China Spallation Neutron Source （CSNS）. It is the boundary between transport line and target. This paper will present a new PBW structure and detailed thermM-stress analysis. The energy deposition and scattering effect need to be low when the beam passes through the PBW, so proper selection of material and structure is important. According to the study of energy deposition, A5083-O is selected as the PBW material. A single-double layer structure is first proposed based on the study of cooling structures. Thermal analysis and structural optimization are discussed, and transient analysis is done to show the effect of the beam pulse. Besides, safety is confirmed for cases of cooling tunnel blockage, beam profile shrinkage, or centroid orbit offset. All these analyses show the newly designed PBW structure can meet the requirements of the CSNS well.