# Publications

2021
Konrad P. Nesteruk, Mislav Bobić, Arthur Lalonde, Brian A. Winey, Antony J. Lomax, and Harald Paganetti. 11/28/2021. “CT-on-Rails Versus In-Room CBCT for Online Daily Adaptive Proton Therapy of Head-and-Neck Cancers.” Cancers, 13, 23, Pp. 5991. Publisher's VersionAbstract
Purpose: To compare the efficacy of CT-on-rails versus in-room CBCT for daily adaptive proton therapy. Methods: We analyzed a cohort of ten head-and-neck patients with daily CBCT and corresponding virtual CT images. The necessity of moving the patient after a CT scan is the most significant difference in the adaptation workflow, leading to an increased treatment execution uncertainty $\sigma$. It is a combination of the isocenter-matching $\sigma$i and random patient movements induced by the couch motion $\sigma$m. The former is assumed to never exceed 1 mm. For the latter, we studied three different scenarios with $\sigma$m = 1, 2, and 3 mm. Accordingly, to mimic the adaptation workflow with CT-on-rails, we introduced random offsets after Monte-Carlo-based adaptation but before delivery of the adapted plan. Results: There were no significant differences in accumulated dose-volume histograms and dose distributions for $\sigma$m = 1 and 2 mm. Offsets with $\sigma$m = 3 mm resulted in underdosage to CTV and hot spots of considerable volume. Conclusion: Since $\sigma$m typically does not exceed 2 mm for in-room CT, there is no clinically significant dosimetric difference between the two modalities for online adaptive therapy of head-and-neck patients. Therefore, in-room CT-on-rails can be considered a good alternative to CBCT for adaptive proton therapy.
Jeppe Brage Christensen, Michele Togno, Konrad Pawel Nesteruk, Serena Psoroulas, David Meer, Damien Charles Weber, Tony Lomax, Eduardo G Yukihara, and Sairos Safai. 2021. “Al 2 O 3 :C optically stimulated luminescence dosimeters (OSLDs) for ultra-high dose rate proton dosimetry.” Physics in Medicine & Biology, 66, 8, Pp. 085003. Publisher's VersionAbstract
The response of Al 2 O 3 :C optically stimulated luminescence detectors (OSLDs) was investigated in a 250 MeV pencil proton beam. The OSLD response was mapped for a wide range of average dose rates up to 9000 Gy s −1 , corresponding to a ∼150 kGy s −1 instantaneous dose rate in each pulse. Two setups for ultra-high dose rate (FLASH) experiments are presented, which enable OSLDs or biological samples to be irradiated in either water-filled vials or cylinders. The OSLDs were found to be dose rate independent for all dose rates, with an average deviation <1% relative to the nominal dose for average dose rates of (1-1000) Gy s −1 when irradiated in the two setups. A third setup for irradiations in a 9000 Gy s −1 pencil beam is presented, where OSLDs are distributed in a 3×4 grid. Calculations of the signal averaging of the beam over the OSLDs were in agreement with the measured response at 9000 Gy s −1. Furthermore, a new method was presented to extract the beam spot size of narrow pencil beams, which is in agreement within a standard deviation with results derived from radiochromic films. The Al 2 O 3 :C OSLDs were found applicable to support radiobiological experiments in proton beams at ultra-high dose rates.
Konrad P. Nesteruk, Michele Togno, Martin Grossmann, Anthony J. Lomax, Damien C. Weber, Jacobus M. Schippers, Sairos Safai, David Meer, and Serena Psoroulas. 2021. “Commissioning of a clinical pencil beam scanning proton therapy unit for ultra-high dose rates (FLASH).” Medical Physics, 48, 7, Pp. 4017–4026. Publisher's VersionAbstract
Purpose: The purpose of this work was to provide a flexible platform for FLASH research with protons by adapting a former clinical pencil beam scanning gantry to irradiations with ultra-high dose rates. Methods: PSI Gantry 1​ treated patients until December 2018. We optimized the beamline parameters to transport the 250 MeV beam extracted from the PSI COMET accelerator to the treatment room, maximizing the transmission of beam intensity to the sample. We characterized a dose monitor on the gantry to ensure good control of the dose, delivered in spot-scanning mode. We characterized the beam for different dose rates and field sizes for transmission irradiations. We explored scanning possibilities in order to enable conformal irradiations or transmission irradiations of large targets (with transverse scanning). Results: We achieved a transmission of 86% from the cyclotron to the treatment room. We reached a peak dose rate of 9000 Gy/s at 3 mm water equivalent depth, along the central axis of a single pencil beam. Field sizes of up to 5 × 5 mm2 were achieved for single-spot FLASH irradiations. Fast transverse scanning allowed to cover a field of 16 × 1.2 cm2. With the use of a nozzle-mounted range shifter, we are able to span depths in water ranging from 19.6 to 37.9 cm. Various dose levels were delivered with precision within less than 1%. Conclusions: We have realized a proton FLASH irradiation setup able to investigate continuously a wide dose rate spectrum, from 1 to 9000 Gy/s in single-spot irradiation as well as in the pencil beam scanning mode. As such, we have developed a versatile test bench for FLASH research.
Carla Winterhalter, Michele Togno, Konrad Pawel Nesteruk, Frank Emert, Serena Psoroulas, Marie Vidal, David Meer, Damien Charles Weber, Antony John Lomax, and Sairos Safai. 2021. “Faraday cup for commissioning and quality assurance for proton pencil beam scanning beams at conventional and ultra-high dose rates.” Physics in Medicine & Biology. Publisher's Version
Konrad P. Nesteruk and Serena Psoroulas. 2021. “Flash irradiation with proton beams: Beam characteristics and their implications for beam diagnostics.” Applied Sciences (Switzerland) 11 (5), Pp. 1–11.Abstract
FLASH irradiations use dose-rates orders of magnitude higher than commonly used in patient treatments. Such irradiations have shown interesting normal tissue sparing in cell and animal experiments, and, as such, their potential application to clinical practice is being investigated. Clinical accelerators used in proton therapy facilities can potentially provide FLASH beams; therefore, the topic is of high interest in this field. However, a clear FLASH effect has so far been observed in presence of high dose rates (>40 Gy/s), high delivered dose (tens of Gy), and very short irradiation times (<300 ms). Fulfilling these requirements poses a serious challenge to the beam diagnostics system of clinical facilities. We will review the status and proposed solutions, from the point of view of the beam definitions for FLASH and their implications for beam diagnostics. We will devote particular attention to the topics of beam monitoring and control, as well as absolute dose measurements, since finding viable solutions in these two aspects will be of utmost importance to guarantee that the technique can be adopted quickly and safely in clinical practice.
K. P. Nesteruk, A. Bolsi, A. J. Lomax, D. Meer, S. Van De Water, and J. M. Schippers. 2021. “A static beam delivery device for fast scanning proton arc-therapy.” Physics in Medicine and Biology, 66, 5.Abstract
Arc-therapy is a dose delivery technique regularly applied in photon radiation therapy, and is currently subject of great interest for proton therapy as well. In this technique, proton beams are aimed at a tumor from different continuous ranges of incident directions (so called 'arcs'). This technique can potentially yield a better dose conformity around the tumor and a very low dose in the surrounding healthy tissue. Currently, proton-arc therapy is performed by rotating a proton gantry around the patient, adapting the normally used dose-delivery method to the arc-specific motion of the gantry. Here we present first results from a feasibility study of the conceptual design of a new static fast beam delivery device/system for proton-arc therapy, which could be used instead of a gantry. In this novel concept, the incident angle of proton beams can be set rapidly by only changing field strengths of small magnets. This device eliminates the motion of the heavy gantry and related hardware. Therefore, a reduction of the total treatment time is expected. In the feasibility study presented here, we concentrate on the concept of the beam transport. Based on several simple, but realistic assumptions and approximations, proton tracking calculations were performed in a 3D magnetic field map, to calculate the beam transport in this device and to investigate and address several beam-optics challenges. We propose and simulate corresponding solutions and discuss their outcomes. To enable the implementation of some usually applied techniques in proton therapy, such as pencil beam scanning, energy modulation and beam shaping, we present and discuss our proposals. Here we present the concept of a new idea to perform fast proton arc-scanning and we report on first results of a feasibility study. Based on these results, we propose several options and next steps in the design.
2019
Konrad P. Nesteruk, Ciro Calzolaio, Mike Seidel, and Jacobus M. Schippers. 2019. “Beam optics of a superconducting proton-therapy gantry with a large momentum acceptance.” International Journal of Modern Physics A, 34, 36.Abstract
In proton therapy, the last part of the beam transport system is installed on a rotatable gantry, so that the beam can be aimed at the tumor from different angles. Since such a gantry system consists of many dipole and quadrupole magnets, it is typically a 100-200 tons device of more than 10 m in diameter. The use of superconducting (SC) magnets for proton therapy allows gantries to be significantly lighter and potentially smaller, which is attractive for this medical application. In addition to that, SC combined function magnets enable beam optics with a very large momentum acceptance. The latter can be advantageous for patient treatment, since the irradiation time can then be significantly reduced by avoiding magnet current changes. To design such an achromatic system, we performed precise high-order calculations. To reach the required accuracy and to check consistency of the obtained results, we have used different simulation tools in our iterative design approach. Here, we will describe our beam optics calculations in the code COSY Infinity and particle tracking using OPAL (open source software from PSI) in 3D field maps obtained from detailed magnet calculations performed in Opera. Our method has shown to be advantageous in a complicated beam optics study and it reduces the risk of systematic errors in a design.
K. P. Nesteruk, C. Calzolaio, D. Meer, V. Rizzoglio, M. Seidel, and J. M. Schippers. 2019. “Large energy acceptance gantry for proton therapy utilizing superconducting technology.” Physics in Medicine and Biology, 64, 17.Abstract
When using superconducting (SC) magnets in a gantry for proton therapy, the gantry will benefit from some reduction in size and a large reduction in weight. In this contribution we show an important additional advantage of SC magnets in proton therapy treatments. We present the design of a gantry with a SC bending section and achromatic beam optics with a very large beam momentum acceptance of ±15% (corresponding to about ±30% in the energy domain). Due to the related very large energy acceptance, approximately 70% of the treatments can be performed without changing the magnetic field for synchronization with energy modulation. In our design this is combined with a 2D lateral scanning system and a fast degrader mounted in the gantry, so that this gantry will be able to perform pencil beam scanning with very rapid energy variations at the patient, allowing a significant reduction of the irradiation time. We describe the iterative process we have applied to design the magnets and the beam transport, for which we have used different codes. COSY Infinity and OPAL have been used to design the beam transport optics and to track the particles in the magnetic fields, which are produced by the magnets designed in Opera. With beam optics calculations we have derived an optimal achromatic beam transport with the large momentum acceptance of the proton pencil beam and we show the agreement with particle tracking calculations in the 3D magnetic field map. A new cyclotron based facility with this gantry will have a significantly smaller footprint, since one can refrain from the standard degrader and energy selection system behind the cyclotron. In the treatments, this gantry will enable a very fast proton beam delivery sequence, which may be of advantage for treatments in moving tissue.
Konrad P. Nesteruk, Luca Ramseyer, Tommaso S. Carzaniga, and Saverio Braccini. 2019. “Measurement of the Beam Energy Distribution of a Medical Cyclotron with a Multi-Leaf Faraday Cup.” Instruments, 3, 1, Pp. 4.Abstract
Accurate knowledge of the beam energy distribution is crucial for particle accelerators, compact medical cyclotrons for the production of radioisotopes in particular. For this purpose, a compact instrument was developed, based on a multi-leaf Faraday cup made of thin aluminum foils interleaved with plastic absorbers. The protons stopping in the aluminum foils produce a measurable current that is used to determine the range distribution of the proton beam. On the basis of the proton range distribution, the beam energy distribution is assessed by means of stopping-power Monte Carlo simulations. In this paper, we report on the design, construction, and testing of this apparatus, as well as on the first measurements performed with the IBA Cyclone 18-MeV medical cyclotron in operation at the Bern University Hospital.
K. P. Nesteruk. 2019. “A New System for Online Measurement of the Beam Emittance of Particle Accelerators for Research and medical Applications.” Journal of Instrumentation, TH, 001. Publisher's Version
2018
K. P. Nesteruk, M. Auger, S. Braccini, T.S. Carzaniga, A. Ereditato, and P. Scampoli. 2018. “A system for online beam emittance measurements and proton beam characterization.” Journal of Instrumentation, 13, 1.Abstract
A system for online measurement of the transverse beam emittance was developed. It is named 4PrOBaM (4-Profiler Online Beam Emittance Measurement) and was conceived to measure the emittance in a fast and efficient way using the multiple beam profiler method. The core of the system is constituted by four consecutive UniBEaM profilers, which are based on silica fibers passing across the beam. The 4PrOBaM system was deployed for characterization studies of the 18 MeV proton beam produced by the IBA Cyclone 18 MeV cyclotron at Bern University Hospital (Inselspital). The machine serves daily radioisotope production and multi-disciplinary research, which is carried out with a specifically conceived Beam Transport Line (BTL). The transverse RMS beam emittance of the cyclotron was measured as a function of several machine parameters, such as the magnetic field, RF peak voltage, and azimuthal angle of the stripper. The beam emittance was also measured using the method based on the quadrupole strength variation. The results obtained with both techniques were compared and a good agreement was found. In order to characterize the longitudinal dynamics, the proton energy distribution was measured. For this purpose, a method was developed based on aluminum absorbers of different thicknesses, a UniBEaM detector, and a Faraday cup. The results were an input for a simulation of the BTL developed in the MAD-X software. This tool allows machine parameters to be tuned online and the beam characteristics to be optimized for specific applications.
2017
David Edward Potkins, Saverio Braccini, Konrad Pawel Nesteruk, Tommaso Stefano Carzaniga, Anna Vedda, Norberto Chiodini, Jacob Timmermans, Stephane Melanson, and Morgan Patrick Dehnel. 2017. “A Low-cost Beam Profiler Based on Cerium-doped Silica Fibers.” In Physics Procedia, 90: Pp. 215–222. Elsevier B.V.Abstract
A beam profiler called the Universal Beam Monitor (UniBEaM) has been developed by D-Pace Inc. (Canada) and the Albert Einstein Center for Fundamental Physics, Laboratory for High Energy Physics, University of Bern (Switzerland). The device is based on passing 100 to 600 micron cerium-doped optical fibers through a particle beam. Visible scintillation light from the sensor fibers is transmitted over distances of tens of meters to the light sensors with minimal signal loss and no susceptibility to electromagnetic fields. The probe has an insertion length of only 70 mm. The software plots the beam intensity distribution in the horizontal and vertical planes, and calculates the beam location and integrated profile area, which correlates well with total beam current. UniBEaM has a large dynamic range, operating with beam currents of ∼pA to mA, and a large range of particle kinetic energies of ∼keV to GeV, depending on the absorbed power density. Test data are presented for H- beams at 25keV for 500 $μ$A, and H+ beams at 18MeV for 50pA to 10 $μ$A. Maximum absorbed power density of the optical fiber before thermal damage is discussed in relation to dE/dx energy deposition as a function of particle type and kinetic energy. UniBEaM is well suited for a wide variety of beamlines including discovery science applications, radio-pharmaceutical production, hadron therapy, industrial ion beam applications including ion implantation, industrial electron beams, and ion source testing.
Tommaso Stefano Carzaniga, Martin Auger, Saverio Braccini, Maruta Bunka, Antonio Ereditato, Konrad Pawel Nesteruk, Paola Scampoli, Andreas Türler, and Nicholas van der Meulen. 2017. “Measurement of 43Sc and 44Sc production cross-section with an 18 MeV medical PET cyclotron.” Applied Radiation and Isotopes, 129, Pp. 96–102.Abstract
43Sc and 44Sc are positron emitter radionuclides that, in conjunction with the $\beta$− emitter 47Sc, represent one of the most promising possibilities for theranostics in nuclear medicine. Their availability in suitable quantity and quality for medical applications is an open issue and their production with medical cyclotrons represents a scientific and technological challenge. For this purpose, an accurate knowledge of the production cross sections is mandatory. In this paper, we report on the cross section measurement of the reactions 43Ca(p,n)43Sc, 44Ca(p,2n) 43Sc, 46Ti(p,$\alpha$)43Sc, and 44Ca(p,n)44Sc at the Bern University Hospital cyclotron. A study of the production yield and purity performed by using commercially available enriched target materials is also presented.
D. Lasi, M. Tulej, M. B. Neuland, P. Wurz, T.S. Carzaniga, K. P. Nesteruk, S. Braccini, and H. R. Elsener. 2017. “Testing the radiation hardness of thick-film resistors for a time-of-flight mass spectrometer at jupiter with 18 MeV protons.” In IEEE Radiation Effects Data Workshop. Vol. 2017-July. Institute of Electrical and Electronics Engineers Inc.Abstract
The Neutral and Ion Mass Spectrometer onboard ESA Jupiter mission JUICE employs thick-film resistors (from ∼1 $Ømega$ to ∼1 MQ), screen-printed on ceramic elements, to realize high-voltage ion optical elements and decontamination heaters. Despite the relevant space heritage, these materials were never employed before in a radiation environment comparable to Jupiter's magnetosphere. With this study, we prove the suitability of these materials for the NIM instrument by means of irradiation up to ∼ 16-85 Mrad in vacuum with 18 MeV protons. To allow an accurate calculation of the dose, the chemical composition of the samples is determined by Laser Mass Spectrometry. Thanks to a custom-designed irradiation station, the temperature and the electrical parameters of the sample are monitored in real-time during the irradiation, or the sample can be subject to high-voltages representative of the operating conditions in space. All in all, the materials proved to be radiation-hard in the investigated dose range, with few exceptions where permanent damages occur.
M. Auger, S. Braccini, T.S. Carzaniga, N. Chiodini, A. Ereditato, K. P. Nesteruk, P. Scampoli, and A. Vedda. 2017. “UniBEaM: A silica fiber monitor for charged particle beams.” In AIP Conference Proceedings. Vol. 1845. American Institute of Physics Inc.Abstract
A beam monitoring detection technique based on silica fibers has been developed by AEC-LHEP. The light signal produced in a doped silica fiber crossing the beam is collected to measure the beam profile. Two types of detectors have been constructed and tested. The first one operates in vacuum and was tested at the 18 MeV medical proton cyclotron at the University Hospital in Bern. It is able to measure currents form a few pA to 20 $μ$A. It can be employed to optimize the production of radioisotopes, in particular using solid targets. The second one operates in air and was tested with high-energy pion and proton beams at the CERF facility at CERN. This paper reports on both detectors with focus on the most recent results obtained with the second detector.
2016
Martin Auger, Saverio Braccini, Antonio Ereditato, Marcel Häberli, Elena Kirillova, Konrad P. Nesteruk, and Paola Scampoli. 2016. “Accelerator and detector physics at the Bern medical cyclotron and its beam transport line.” Nukleonika, 61, 1, Pp. 11–14.Abstract
The cyclotron laboratory for radioisotope production and multi-disciplinary research at the Bern University Hospital (Inselspital) is based on an 18-MeV proton accelerator, equipped with a specifically conceived 6-m long external beam line, ending in a separate bunker. This facility allows performing daily positron emission tomography (PET) radioisotope production and research activities running in parallel. Some of the latest developments on accelerator and detector physics are reported. They encompass novel detectors for beam monitoring and studies of low current beams.
M. Auger, S. Braccini, T.S. Carzaniga, A. Ereditato, K. P. Nesteruk, and P. Scampoli. 2016. “A detector based on silica fibers for ion beam monitoring in a wide current range.” Journal of Instrumentation, 11, 03, Pp. P03027–P03027. Publisher's VersionAbstract
A detector based on doped silica and optical fibers was developed to monitor the profile of particle accelerator beams of intensity ranging from 1 pA to tens of $μ$A. Scintillation light produced in a fiber moving across the beam is measured, giving information on its position, shape and intensity. The detector was tested with a continuous proton beam at the 18 MeV Bern medical cyclotron used for radioisotope production and multi-disciplinary research. For currents from 1 pA to 20 $μ$A, Ce 3+ and Sb 3+ doped silica fibers were used as sensors. Read-out systems based on photodiodes, photomultipliers and solid state photomultipliers were employed. Profiles down to the pA range were measured with this method for the first time. For currents ranging from 1 pA to 3 $μ$A, the integral of the profile was found to be linear with respect to the beam current, which can be measured by this detector with an accuracy of $\sim$1%. The profile was determined with a spatial resolution of 0.25 mm. For currents ranging from 5 $μ$A to 20 $μ$A, thermal effects affect light yield and transmission, causing distortions of the profile and limitations in monitoring capabilities. For currents higher than $\sim$1 $μ$A, non-doped optical fibers for both producing and transporting scintillation light were also successfully employed.
M. Auger, S. Braccini, T.S. Carzaniga, A. Ereditato, K. P. Nesteruk, and P. Scampoli. 2016. “A detector based on silica fibers for ion beam monitoring in a wide current range.” Journal of Instrumentation, 11, 03, Pp. P03027–P03027. Publisher's VersionAbstract
A detector based on doped silica and optical fibers was developed to monitor the profile of particle accelerator beams of intensity ranging from 1 pA to tens of $μ$A. Scintillation light produced in a fiber moving across the beam is measured, giving information on its position, shape and intensity. The detector was tested with a continuous proton beam at the 18 MeV Bern medical cyclotron used for radioisotope production and multi-disciplinary research. For currents from 1 pA to 20 $μ$A, Ce 3+ and Sb 3+ doped silica fibers were used as sensors. Read-out systems based on photodiodes, photomultipliers and solid state photomultipliers were employed. Profiles down to the pA range were measured with this method for the first time. For currents ranging from 1 pA to 3 $μ$A, the integral of the profile was found to be linear with respect to the beam current, which can be measured by this detector with an accuracy of $\sim$1%. The profile was determined with a spatial resolution of 0.25 mm. For currents ranging from 5 $μ$A to 20 $μ$A, thermal effects affect light yield and transmission, causing distortions of the profile and limitations in monitoring capabilities. For currents higher than $\sim$1 $μ$A, non-doped optical fibers for both producing and transporting scintillation light were also successfully employed.
2015
A. Ariga, T. Ariga, S. Braccini, A. Ereditatoa F. Giacoppo, K. P. Nesteruk, C. Pistillo, and P. Scampolia. 2015. “Characterization of the dose distribution in the halo region of a clinical proton pencil beam using emulsion film detectors.” Journal of Instrumentation, 10, 1.Abstract
Proton therapy is a high precision technique in cancer radiation therapy which allows irradiating the tumor with minimal damage to the surrounding healthy tissues. Pencil beam scanning is the most advanced dose distribution technique and it is based on a variable energy beam of a few millimeters FWHM which is moved to cover the target volume. Due to spurious effects of the accelerator, of dose distribution system and to the unavoidable scattering inside the patient's body, the pencil beam is surrounded by a halo that produces a peripheral dose. To assess this issue, nuclear emulsion films interleaved with tissue equivalent material were used for the first time to characterize the beam in the halo region and to experimentally evaluate the corresponding dose. The high-precision tracking performance of the emulsion films allowed studying the angular distribution of the protons in the halo. Measurements with this technique were performed on the clinical beam of the Gantry1 at the Paul Scherrer Institute. Proton tracks were identified in the emulsion films and the track density was studied at several depths. The corresponding dose was assessed by Monte Carlo simulations and the dose profile was obtained as a function of the distance from the center of the beam spot. copy; 2015 IOP Publishing Ltd and Sissa Medialab srl.
M. Auger, S. Braccini, A. Ereditato, K. P. Nesteruk, and P. Scampoli. 2015. “Low current performance of the Bern medical cyclotron down to the pA range.” Measurement Science and Technology, 26, 9.Abstract
A medical cyclotron accelerating H- ions to 18 MeV is in operation at the Bern University Hospital (Inselspital). It is the commercial IBA 18/18 cyclotron equipped with a specifically conceived 6 m long external beam line ending in a separate bunker. This feature is unique for a hospital-based facility and makes it possible to conduct routine radioisotope production for PET diagnostics in parallel with multidisciplinary research activities, among which are novel particle detectors, radiation biophysics, radioprotection, radiochemistry and radiopharmacy developments. Several of these activities, such as radiobiology experiments for example, require low current beams down to the pA range, while medical cyclotrons are designed for high current operation above 10 $μ$A. In this paper, we present the first results on the low current performance of a PET medical cyclotron obtained by ion source, radio-frequency and main coil tuning. With this method, stable beam currents down to () pA were obtained and measured with a high-sensitivity Faraday cup located at the end of the beam transport line.