Background: Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research. Methods: To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane. The results of 68 studies are reported using a narrative approach, highlighting CNAO’s clinical activity over the last 10 years of CIRT. Results: The ballistic and radiobiological hallmarks of CIRT make it an effective option in several rare, radioresistant, and difficult-to-treat tumours. CNAO has made a significant contribution to the advancement of knowledge on CIRT delivery in selected tumour types. Conclusions: After an initial ramp-up period, CNAO has progressively honed its clinical, technical, and dosimetric skills. Growing engagement with national and international networks and research groups for complex cancers has led to increasingly targeted patient selection for CIRT and lowered barriers to facility access.

In this study a procedure for range verification in proton therapy by means of a planar in-beam PET system is presented. The procedure consists of two steps: the measurement of the β+-activity induced in the irradiated body by the proton beam and the comparison of these distributions with simulations. The experimental data taking was performed at the CNAO center in Pavia, Italy, irradiating plastic phantoms. For two different cases we demonstrate how a real-time feedback of the delivered treatment plan can be obtained with in-beam PET imaging

The Superconducting Ion Gantry (SIG) project is the contribution from INFN (the Italian National Institute for Nuclear Physics) to the international SIGRUM project with the aim of exploring new technological solutions for the critical elements of a 430 MeV/u carbon ion gantry. The project includes the design and construction of a cos $\theta$ 4 T superconducting dipole demonstrator magnet whose main scope is to prove the feasibility of winding and assembling an accelerator magnet type with a relatively small radius of curvature (1.65 m). In addition to the complexity due to the curvature, the target field ramp rate is 0.4 T/s and the cooling system must not adopt liquid helium. This paper discusses the design activities carried out in the last year on the electromagnetic and thermal domains and reports on the present concepts and infrastructure for the first winding trials.

A collaboration between CERN, CNAO, INFN, and MedAustron has been formed aiming at designing a light rotating gantry suitable for hadron therapy based on 430 MeV/n carbon ion beams. After a first design for a 3 T dipole field, as the backbone of the gantry magnetic system, now the collaboration is looking at an alternative design, for at least 4 T field with a faster ramp rate. The magnet is designed according to the cosθ layout to be wound with Nb-Ti superconducting Rutherford cable. One of the main challenges is the very small curvature radius of 1.65 m with a relatively large aperture, of 70-90 mm. Another challenge is the use of indirect cooling despite the cycling operation of 0.4 T/s. The paper reports the preliminary investigation for a 4.5 T dipole. The design will be followed by the construction of a 1 m long demonstrator to be manufactured and tested at INFN (LASA laboratory) in about three years. The conductor is a Rutherford cable of 2.6 µm Nb-Ti filament size, embedded in a Cu-Mn alloy matrix. The resulting gantry is very compact: the collaboration is working on integration between gantry structure and magnets to allow reducing the rotating weight in the range 50-80 tons, which is a factor 4 to 5 less than the present state-of-the-art.