In the year 2000, thanks to the acquired competences and to the results of the LIBO Collaboration, TERA proposed the integration of a new technology in a nuclear medicine centre based on a commercial proton cyclotron producing 30 MeV protons.
The cyclotrons in use for the production of isotopes for PET have an energy of about 18 MeV; a cyclotron of 30 MeV allows to produce the isotopes used for SPECT (Single Photon Emission Computed Tomography) as well as the usual PET radioisotopes and many more radioisotopes used in diagnostics and in tumour therapy.
The Institute for Advances Diagnostics and Radiotherapy (IDRA) has therefore been conceived.
At the heart of IDRA is a "cyclinac", i.e. the combination of a cyclotron and a hadron linac.
One of the proton beams is used for the production of PET isotopes, for which a space for chemistry and for diagnostics tomography is foreseen.
The second beam is used for the production, on solid targets, of all other radioisotopes.
The third beam is sent to the hadron linac, accelerating protons later distributed into treatment rooms.
IDRA is a unique project, as it made available for physicians the best radiodiagnostics as well as deep proton therapy (thanks to a hadron linac powered by ten klystron-modular systems).

ADVANTAGES OF A CYCLINAC ACCELERATOR WITHIN THE CONTEXT OF AN IDRA CENTRE

High Versatility: the first stage of proton acceleration is made with an high current cyclotron (150-300 µA), with almost continuous beam, capable of producing Isotopes for Advanced Radio-Diagnostic.

The Energy of the Cyclotron is chosen according to the boundary conditions of each project. The standard proposal of ADAM foresees a 30 MeV Cyclotron, but 18 MeV as well as 60-70 MeV MeV Cyclotron can be forsaw.

With an 18MeV one can start from conventional FDG production planta to evolve toward Theraphy.

With a 60-7 MeV one can  make innovative isotopes and eventually foresee an ad hoc beam to make research on radio-pharmaceuticals.

The Cyclotron can be a commercial machine or an especially tailored one.

Modularity: the second stage of a Cyclinac  is made by a proton Linac.

This machine is built by successive modules which increase the injection energy - 18 or 30 or 70 MeV - to the final level of 230 MeV needed for Proton Treatment of adult patients.

To reach 230 MeV one can foresee a first stage of 70-75 MeV to treat eye melanomas, then reach 160 MeV for pediatric pathologies and finally 230 MeV to treat adults.

From the Linear Accelerator one can derive 2 or 3 beams (or more) to create the needed treatment rooms.

As one can demonstrate, the use of a rotating gantry (which is one of the most expensive ancillaries) is not strictly necessary to afford most of the pathologies.

Nevertheless the gantry option can be adopted at any stage of the life of the Centre.

Technical Advantages: the use of a Linear Accelerator for therapy allows to control electronically the energy of the beam « pulse by pulse ».  This possibility permits the control of the beam also in depth within about +/- 15 mm.

This allows a 3D painting of the neoplastic volume as well as a synchronised follow up of moving organs, trough tumor multipainting obtainable by fast cycling the Linac at 200 times/second.

Scientific Synergies : come from to the co-habitation of the most innovative Radio-Diagnostic and Endotherapy techniques with the most innovative Radio-Therapy methods. This aspect represents not only a major cultural step forward but also an elegant opportunity to complement advanced therapies (i.e. treat localised neoplasies with protons and complement the treatment of metastasis with  isotopes).

Economical and Financial Considerations: ADAM denominates IDRA the centres adopting a Cyclinac.

IDRA means Institute for Diagnostic and Advanced Hadrontherapy.

The investment for an IDRA depends, as it’s obvious, on the number and kind of facilities with which one intends to equip the Centre.

The distinctive element of an IDRA is the Linear Accelerator which gives a large number of options and choices.

The cost of the linear accelerator (specific know-how of ADAM) is more or less proportional to the increase of energy between extraction and injection.

A very high percentage of elective pathologies for Proton Therapy can be afforded without installing any gantry.

Combining two fixed beams, plus pulsing the beam in depth, and improving the performance of the positioning system of the patient, more than 80-85% of the cases can be successfully afforded.

ADAM has started investigations to profit at best, through the Treatment Planning Software, of the  capacity of the LINAC to control pulse by pulse the beam in depth every 5 milliseconds.

Further improvements to increase the percentage of patients that can be treated without a gantry can be obtained acting on the positioning system of the patient .

Return on the Investment: this evaluation depends strictly from specific conditions of the project. In any case it is for sure that a Cyclinac Machine has more revenue sources with respect to standard solutions.

Revenues came from both Isotope Beams and Therapy Beams. In addition one can foresee also research beams on both areas to be rented.

Further saves are obtained on the operation costs through synergies on part of the personnel between the Isotopes Production Area and the Proton Therapy one.

Timing: The construction of the accelerating machines can be envisaged within an order of magnitude of  3 years from the executive project of a Centre.

The isotopes production can enter into operation before the commissioning and operation of the Therapeutic area.