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Instruments and Experimental Techniques, Vol. 45, No. 2, 2002, pp. 262271.

Translated from Pribory i Tekhnika Eksperimenta, No. 2, 2002, pp. 126135. Original Russian Text Copyright 2002 by Kats.

PHYSICAL INSTRUMENTS FOR ECOLOGY, MEDICINE, AND BIOLOGY

New Schemes of Systems for the Irradiation of Reclining Patients with Beams of Heavy Charged Particles from Different Directions
M. M. Kats
Institute of Theoretical and Experimental Physics, ul. Bolshaya Cheremushkinskaya 25, Moscow, 117259 Russia
Received April 12, 2001; in nal form, September 11, 2001

AbstractWe describe new spatial and optical schemes for the irradiation of reclining patients with proton and carbon-ion beams from different directions. All of these schemes are based on a rotating medical cabin. The optimal choice for the position of the rotation axis of magnetic facilities and the trade-off selection of the effective scanning distance are proposed. The new schemes are qualitatively compared to the known systems.

INTRODUCTION The systems providing the irradiation of a reclining patient from the optimal direction and with an optimal dose distribution throughout the target volume are necessary components of the modern center of radiation therapy with beams of heavy charged particles [15]. As a rule, the particle beam in these systems is rst deected, and, then, by a turn through 90, returned to the initial direction. This is done with the use of magnetic-channel components fastened to the rigid threedimensional frame. The frame rotates about the original-beam axis with a high accuracy. The center of the target is located at a point that can be irradiated from different spatial directions upon turning the frame. The radii of rotation of the proton and ion (12C) beams in standard magnets with a eld of 1.6 T are 1.5 and 3.9 m, respectively. The magnetic channel has to transport the beams with a marked phase-space volume without any loss. Therefore, all the known systems of this type measure 10 10 10 m, and the mass of rotated equipment is ~100 t. The size, mass, and cost of these systems are the factors that essentially hinder the wide application of the proton- and ion-beam therapy. We discuss the possible ways for making such systems cheaper and qualitatively compare different irradiation systems. CRITERION FOR COMPARING THE IRRADIATION SYSTEMS The systems are proposed to be compared by a value of the bending moment of the entire rotated equipment,

the frame with the magnets and their counterweights, the medical cabin, and its counterweight: K, t m = Mi Ri + McabRcab. (1) Since the mass of the magnets reects their cost and performance and the bending moment is associated with the working hours of the rotary-frame fabrication, the quantity K actually characterizes the cost of the most expensive part of the irradiation system with its properties being xed (the K value is given in the gure captions for all the systems). REVIEW OF PRESENT-DAY SYSTEMS FOR THE IRRADIATION 1. System by IBA The new proton-therapy centers being built in the USA and Japan [2] will use, as a rule, rotary isocentric (with a target at the center of rotation) systems by IBA [3] to transport beams from different directions to a motionless patient lying on the horizontal treatment coach. These systems operate with a symmetric achromatic incoming beam; the last turning magnet is separated by 3 m from the center of the target (Fig. 1). The IBA system can control the dose distribution over the target with the use of devices conventionally called nozzles. The nozzle comprises collimators, lters, scanning magnets, ionization chambers, etc. It is located between the last magnet and the target. This system uses the scanning magnets to distribute the dose throughout the target volume. The center of these magnets and the center of the target are separated by 2.5 m. This distance is an important characteristic of

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2 1

r1 = 2 m

D(0)/D(X) = (SAD)2/(SADX)2

(2)

(human skin is particularly sensitive to irradiation). Hence, for the irradiation to be optimal, it is desired that the beam be shifted in parallel to the direction of irradiation or the scanning magnets and the target be far apart (e.g., SAD > 40 m). 2. The general properties of the rotary isocentric systems with the parallel scanning and a symmetric emerging beam are described in [1]. Characteristic layouts of the magnets and counterweights in such systems for the transportation of proton- and carbon-ion beams are shown in Figs. 2 and 3. The scanning magnets are located ahead of the last turning magnet, thus making it possible to minimize the distance from the magnets to axis of their rotation. The size of such a setup depends, in the main, on the maximum magnetic rigidity of particles (their momentumto-charge ratio) P/Z. For protons with P/Z = 0.7 GeV/c, the rotated system has a diameter D = 8 m (the radius of rotation of the beam axis is 3 m) and a length L = 8 m. For carbon ions with P/Z = 1.9 GeV/c D = 12 m (the radius of rotation of the beam axis is 5 m) and L = 16 m. As shown in [1], the characteristics of the last magnet and the position of the scanning magnets may be selected so that the scanning beam displaces in parallel to the direction of irradiation. When scanning in two directions, the weight of the magnets is virtually fully concentrated in the last magnet, and this weight is determined by the maximum transverse dimensions of the irradiated target (in this case, 200 200 mm) and slightly depends on the phase-space volume of the beam. The weight, the power consumption, and the moment of inertia of this system are governed exactly by the last bending magnet. It is impossible to signicantly improve this system through the necessity to satisfy two conditions: the target position be xed and the scanning be carried out with the parallel beam displacement. The xed position of the target is the traditional medical practice. It is evident that such systems transporting beams of protons and, especially, carbon ions, are very bulky and expensive. 3. PIMMS system. A new, promising system was proposed in 1999 by the PIMMS group, CERN [4]. The system (Fig. 4) comprises a magnetic channel (located close to the rotation axis) and a medical cabin (located
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5 5

10m

Fig. 1. Diagram of the system by IBA for the irradiation with the proton beam. K = (10 t 4 m + 5 t 2 m) 2 = 100 t m. Notation also used for the next schemes: (1) magnetic quadrupole lens; (2) turning magnet; (3) system for the beam distribution throughout the target volume (nozzle), comprising the collimators, lters, beam monitors, and scanning magnets; (4) patient on the treatment coach; (5) counterweight; (6) scanning magnets; (7) rotary frame, R0 is the radius of an orbit in a 1.6-T eld; R is the radius of rotation of the beamaxis; r is the radius of rotation of the center of gravity of all elements; and D and L are the systems dimensions.

1 1 1
B = 1.6 R0 = 1.5 m r1 = 2.5 m

2
R=3m

6 2
r2 = 1.5 m

20 t

SAD > 40 m L=8m D=8m

10 m

Fig. 2. System for the irradiation with the proton beam with the parallel (SAD > 40 m) scanning of the target. The maximum transverse dimensions of the target are 200 200 mm. K = (20 t 2.5 m) 2 = 100 tm. (The patient is depicted as lying on the treatment coach; the medical man is near him.) Vol. 45 No. 2 2002

3m

r2 = 4 m

3t

SAD = 2.5 m

the irradiation quality and denoted by SAD (sourceaxis distance). Such an arrangement of the scanning magnets fails to be optimal. In fact, we can suppose that a diverging beam emerges from the center of the scanning magnets during the scanning. The closer this center to the target (the smaller SAD), the higher the overdose D(0) on the bodys surface for the prescribed dose D(X) at the depth X is,

2
B = 1.6 R0 = 1.5 m 2t

10 t

1 3

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R0 = 3.5 m B = 1.8

5T

2
R=5m

1 6
r=4m

60 T

1 2 1

r = 1.5 m

4
SAD > 40 m

D = 12 m L = 16 m

5 5 7

10 m

Fig. 3. Diagram of the isocentric system for the irradiation with the beam of 12C ions with the parallel (SAD > 40 m) scanning of the target. The maximum transverse dimensions of the target are 200 200 mm. K = (5 t 5 m + 60 t 4 m) 2 = 530 tm.

B = 1.8 R0 = 3.5 m

d = 3 m, l=4m

20 T r=3m

r = 1.05 m

2
60 T L = 7 m, D = 14.5 m

SAD > 40 m

10 m

Fig. 4. System by the PIMMS group for the irradiation with the carbon-ion beam with the parallel scanning of the target. The maximum transverse dimensions of the target are 200 200 mm. K = (2 t 5.5 m + 60 t 1.05 m) 2 = 148 tm. D and L are the sizes of the space of the cabin and elevator translation, and d, l are the cabin dimensions.

far from this axis), both rotating through the same angle about the original-beam axis. The medical cabin is a conventional room for the radiation therapy with medical instruments and a treatment coach for a reclining patient. When turned, the cabin will not change its initial orientation; i.e., the cabin oor and the treatment coach are always horizontal. An auxiliary elevator provides fast and convenient access to the cabin for the medical personnel at any position of the cabin. The instruments inside the cabin and the coach design help to register the targets center to the beam. The coach can rotate about the vertical axis through the center of the target; incidentally, the patient remains in the horizontal position. The cabin has thin walls in the directions of irradiation. Instruments for monitoring the beam during the irradiation are also disposed in the cabin. The cabin can move in the vertical plane along a circle centered at the injected-beam axis so that the object of irradiation is always located exactly on the path of the beam turned in the magnet. Thus, the system for the comfortable (from the medical point of view) irradiation of a moved patient has been rst proposed. Note that the attempts to investigate and use systems with mobile targets have already been made [2, 58], but have not been approved by medical experts. A characteristic feature of the PIMMS magnetic optics is the use of a specic scheme for the beam transportation from the accelerator to the system entrance.
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The magnetic channel of the system consists of a few quadrupole lenses located directly on the axis of rotation, two scanning magnets, and one large magnet (90, a 200 200-mm gap, and a mass of 62 t). The magnet entrance lies on the injected-beam axis. After a turn in the magnet, the beam is directed towards the medical cabin. Since the magnet is rather close to the rotation axis, the mass of its counterweight is only 20 t and the precise rotation of the frame is not such an intricate problem as it is in the above systems. The medical cabin is 4 m long and 3 m in diameter; its estimated total mass with the treatment coach, the instruments, a patient and a doctor is 2 t. We estimate the K value for the PIMMS system as one-third of that for the conventional system with the parallel scanning (Fig. 3). ROTARY SYSTEM (WITH A MEDICAL CABIN) WITH THE PARALLEL SCANNING AT THE OPTIMAL POSITION OF THE ROTATION AXIS The basis is a conventional system with a symmetric incoming beam and with the parallel scanning (Figs. 24), but the magnet arrangement has been changed so that the moment bending the frame relative to the rotation axis is minimized, and the magnets themselves, without counterweights, are balanced with respect to the rotation axis. At the same time, the medical cabin rotates about the same axis, and the radius of rotation is the minimum allowable by the disposition of the supports for the frame rotation and provides comfort for the patient. The end part of the system with two scanning magnets and a large magnet (90 and a 200 200-mm gap) is the same as in the projects shown in Figs. 2, 3, and 5. This implies that the center of mass of all the magnets in the system is close to the center of mass of the last magnet, and the axis of rotation passes approximately through that point. For the entrance point of the magnetic channel to lie on the rotation axis, the rst part of the system should be modied. With this aim in view, the angles of rotation in the rst two magnets should be decreased so that two quadrupole lenses could be placed between the magnets. The other possibility is to place a portion of quadrupole lenses ahead of the rst magnet. Spatial diagrams of such systems for proton and ion beams are shown in Figs. 5 and 6. The K estimates take into account the contribution due to the medical cabin. The beam optics is similar to that in [1]. A diagram of the envelopes for the ion beam with a phase-space volume of 3 mm mrad and dP/P = 0.1% is shown in Fig. 7 for the system from Fig. 6. Structurally, the medical cabin and the auxiliary elevator can execute the translatory motion in two directions instead of the rotation; in this case, the counterweights are not needed. However, we assume their rotaINSTRUMENTS AND EXPERIMENTAL TECHNIQUES

d = 3 m, l = 4 m r = 3.5 m

1 1

21 1 1 6
r = 0.5 m

20 t

2
D = 11 m L=7m

7 4

SAD > 40 m

10 m

Fig. 5. System for the irradiation with the proton beam with the parallel scanning and the optimal position of the rotation axis of the magnets. The maximum transverse dimensions of the target are 200 200 mm. K = (2 t 3.5 m + 10 t 0.5 m) 2 = 24 t m.

tion to simplify the estimation of K. The cabin displacements for protons are within 4 and 8 m in the horizontal and vertical planes, respectively; for ions, these values are 6 and 12 m. When both the magnets and the medical cabin rotate, there is no necessity to mechanically maintain a high accuracy in matching the centers of the beam and the target. It is enough to provide the required precision of the frame and medical-cabin positions (e.g., by xing them with pins with a step of 1 and an accuracy of 0.1) and maintain the needed accuracy of the beam incidence onto the target (0.5 mm) by the appropriate correction of the beam direction. Such an approach makes it possible to considerably simplify the production of the rotary equipment. It can be used not only in rotary systems, since each direction of irradiation may be associated with its own set of currents in the magnetic components (in this case, the currents in the magnetic correctors of the beam direction). The memory of the control computer sufces to do this. In comparison with the conventional isocentric systems with the parallel scanning (Figs. 2, 3), the value of K for the new variants (with the same parallel scanning) is reduced by a factor of 45; in comparison with the PIMMS system (Fig. 5), by a factor of 1.5. This result has been achieved owing to the absence of counterweights and the smallness of the radii of rotation for heavy elements (~0.25 instead of (0.7 + 1.5) m,
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d = 3 , l = 4 m

1
5t

1 6 2

r = 5.5 m 60 t

B = 1.8 R0 = 3.5 m

r = 1.2 m

D = 14 m, L=7m

SAD > 40 m

10 m

Fig. 6. System for the irradiation with the 12C-ion beam with the parallel scanning and the optimal position of the rotation axis of the magnets. The maximum transverse dimensions of the target are 200 200 mm. K = (2 t 5.5 m + 30 t 1.2 m) 2 = 94 t m.

Y = 120 mm Vertical plane

1 1

X = 120 mm

Horizontal plane (plane of rotation of the beam) Zb = 0 Ze = 20.9 Z, m

Fig. 7. Diagram of the envelopes for the 12C-ion beam in the magnetic channel of the system with the parallel scanning and the optimal position of the rotation axis for the cases of maximum (100 mm) and zero deections of the beam by the scanning magnets from the target center. The beam size is 3 mm mrad 0.1%. INSTRUMENTS AND EXPERIMENTAL TECHNIQUES Vol. 45 No. 2 2002

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where is the radius of path curvature for a particle with the maximum magnetic rigidity in the appropriate magnetic eld). POSSIBILITIES OF REDUCING THE SCANNING DISTANCE We see in Figs. 5 and 6 that the major weight (power consumption and cost) in these schemes is still concentrated in the last turning magnet, and this results from the parallel scanning in which the gap size is equal to the maximum transverse dimension of the target. The smaller the scanning distance SAD (the larger the allowable angle of the beam deection from the direction of irradiation during the scanning), the smaller are the gap and the mass of the last magnet. Using Eq. (2), we easily estimate the ratio of the dose on the patients skin D(0) to the dose D(X) = 1.0 at a depth X versus X and SAD. (These estimates disregard either the inherent beam dimensions or the effects of the target size and multiple scattering.) This formula shows that a pronounced (by 2030%) increase in the skin irradiation dose is expected only for thick targets (X 0.2 m) at SAD 4 m. Proceeding from the practice of irradiating targets with electron and photon beams, medical experts would desire that SAD 3 m. According to international recommendations, SAD = 2.5 m is considered to be permissible [9]. ROTARY SYSTEMS (WITH A MEDICAL CABIN) WITH SAD = 3 m AND AN OPTIMAL POSITION OF THE ROTATION AXIS Since the last magnet-to-target distance in Figs. 5 and 6 is comparable to the minimal SAD value, the scanning magnets are proposed to be placed immediately behind the last turning magnet, and the target should be located within a 3-m distance of the scanning magnet. This system may utilize the devices by IBA for distributing the beam over the target, i.e., the old equipment with the use of scatterers and collimators as well as new scanning facilities. Diagrams of this type of systems for proton and carbon-ion beams are shown in Figs. 8 and 9, and an optical system for the ion-beam transportation, which is characteristic of SAD = 3 m, is presented in Fig. 10. The radius of rotation of the medical cabin exceeds that in the systems displayed in Figs. 5 and 6 by ~1 m. However, it is very important that the scanning process in the new systems will not involve the last turning magnet; therefore, its size is governed only by the phasespace volume of the beam and is independent of the maximum transverse dimensions of the target. That is why the last magnet, which determines the properties of the previous variants of the systems, may have a significantly lower weight and cost. In addition, note that
INSTRUMENTS AND EXPERIMENTAL TECHNIQUES

d = 3 m, l = 4 m

D = 12 , L = 7 m

2
L = 6 m, D=3m

2 11 1 1 1

2 6

SAD = 3 m

10 m
Fig. 8. System for the proton beam with the medical cabin (with the optimal position of the rotation axis of the magnets) and SAD = 3 m. K = (2 t 4.5 m + 2 t 0.5 m) 2 = 20 t m.

some difculties arise with the power supply of the scanning magnets in the system for the ion irradiation in this geometry. By our estimates, the K value for the proton system with SAD = 3 m is ~5 times smaller than for a similar system by IBA (see Fig. 1) for the parallel-scanning system (Fig. 2); for the ion system with SAD = 3 m, it is less by a factor of ~3 than for the PIMMS system. ROTARY SYSTEMS (WITH A MEDICAL CABIN) WITH SAD = 7 m AND THE OPTIMAL POSITION OF THE ROTATION AXIS The following modications are a trade-off of the SAD value (i.e., irradiation quality) against the possible cheapening of the rotary equipment. Only a small (by the deection angle) magnet with an increased cross section of the magnetic gap is proposed to be inserted between the scanning magnets and the target; in this case, the gap size is much less than the target size. For illustration, layouts of the system with SAD = 7 m are shown in Figs. 11 and 12 for proton and carbon-ion beams, respectively; the relevant diagram for the envelopes of the carbon-ion beam is given in Fig. 13. Note that the scanning quality in these modications is almost optimum. However, if the K value for the transportation system of the carbon-ion beam is estimated to be a factor ~2.5 less that for the PIMMS system (Fig. 4) and a factor of 1.5 less than for the system with a shift of the axis and the parallel scanning
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KATS

d = 3 m, l = 4 m

2
5T

1 2
r = 1.5 m

r = 5.5 m

3T

B = 1.8 R0 = 3.5 m

L = 14 m, D=5m

7T

1T D = 14 m, L=7m

4
SAD = 3 m

10 m

Fig. 9. System for the 12C-ion beam with the medical cabin (with the optimal position of the rotation axis of the magnets) and SAD = 3 m. K = (2 t 5.5 m + 8 t 1.5 m) 2 = 46 t m.

Y = 120 mm Vertical plane

1 1

X = 120 mm

Horizontal plane (plane of rotation of the beam) Zb = 0 Ze = 19.8 Z, m

Fig. 10. Diagram of the envelopes in the system for the 12C-ion beam (with dimensions of 3 mm mrad 0.1%) with the medical cabin (the position of the rotation axis of the magnets is optimal) and SAD = 3 m for the cases of maximum (100 mm) and zero deections of the beam by the scanning magnets from the target center. INSTRUMENTS AND EXPERIMENTAL TECHNIQUES Vol. 45 No. 2 2002

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d = 3 m, l = 4 m

(Fig. 6), the use of this idea to transport protons, according to the criterion introduced, seems to be useless, because of the dominant effect of the cabin cost. COMPARISON OF THE OLD AND NEW VARIANTS
B = 1.6 R0 = 1.5 m

r2 = 6 m

1 1

2 1 1 1
r1 = 1.5 m

2 6 2
3T

L1 = 6 m D1 = 3 m

D2 = 15 m L2 = 7 m

SAD = 7 m

The K values for all the systems described are entered in the table. The systems are classied in the following parameters: without moving the patient (isocentric) and with the mobile medical cabin; with an optimal displacement of the axis of magnet rotation and without a displacement; and according to the SAD value. The K estimates are presented for each system type with proton and ion beams and for different sizes of the maximum eld of irradiation. In the case where the medical cabin is used, the individual contributions of the medical cabin and the rotated magnetic equipment to K are given. Of course, all the estimates are tentative. However, we see that the new schemes proposed are expected to make the rotary equipment signicantly cheaper in all the variants. Note that the spatial and magnetooptic schemes of these systems are close to the isocentric systems with the parallel scanning [1]; that is why the main conclu-

10 m

Fig. 11. System for the proton beam with the medical cabin (with the optimal position of the rotation axis of the magnets) and SAD = 7 m. K = (2 t 6 m + 3 t 1.5 m) 2 = 33 t m.

d = 3 m, l = 4 m

B = 1.8 R0 = 3.5 m

5t

1 1 1 2

6t

2
r=2m D = 14 m L=6m

2
7t D = 15 m L=7m

7 4

r=6m SAD = 7 m

10 m

Fig. 12. System for the carbon-ion beam with the medical cabin (with the optimal position of the rotation axis of the magnets) and SAD = 7 m. K = (2 t 6 m + 7 t 2 m) 2 = 52 t m. INSTRUMENTS AND EXPERIMENTAL TECHNIQUES Vol. 45 No. 2 2002

270 Y = 120 mm Vertical plane

KATS

X = 120 mm

Horizontal plane (plane of rotation of the beam) Zb = 0 Ze = 21.0 Z, m

Fig. 13. Diagram of the envelopes in the system for the 12C-ion beam (with a phase-space volume of 3 mm mrad 0.1%) with the medical cabin (the position of the rotation axis of the magnets is optimal) and SAD = 7 m for the cases of maximum (100 mm) and zero deections of the beam by the scanning magnets from the target center.

sions of [1] remain valid for the rotary systems with a rotated medical cabin: (1) The size of the frame with the rotated magnets depends mainly on the magnetic rigidity of particles P/Z. (2) In the parallel scanning, the weight of the magnets is governed by the maximum target size and slightly depends on the phase-space
Comparison of various systems by a value of K, t m Field of irradiation Isocentric In parallel, SAD > 40 m PIMMS, eccentric In parallel Eccentric 24 = 14cab + 10mag In parallel (Fig. 6) The axis is displaced Eccentric 33 = 24cab + 9mag The axis is displaced, SAD = 7 m (Fig. 12) Eccentric 20 = 18cab + 2mag The axis is displaced, SAD = 3 m (Fig. 9) IBA Isocentric, SAD = 2.5 m Protons 200 200 mm 100 (Fig. 2)

volume of the beam. (3) The smaller the SAD, the stronger is the effect of the phase-space volume of the beam on the weight of the rotating magnets. (4) All the systems described can adequately transport beams with signicant phase-space volumes and focus them on the target.

Carbon ions 200 200 mm 530 (Fig. 3) 148 (Fig. 5) 94 = 22cab + 72mag (Fig. 7) 58 = 24cab + 34mag (Fig. 13) 46 = 22cab + 24mag (Fig. 10) 300 300 mm 1060 296 166 = 22cab + 144mag 75 = 24cab + 51mag 46 = 22cab + 24mag

300 300 mm 200

34 = 14cab + 10mag 37 = 24cab + 13mag 20 = 18cab + 2mag 100 (Fig. 1)

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ACKNOWLEDGMENTS I thank M. Pullia for information on the developments of the PIMMS group; Yu.M. Antipov, V.M. Breev, and E.I. Minakova for useful discussions and advices. REFERENCES
1. Kats, M., Abstracts of Papers, EPAC1998, Stokcholm, 1998. 2. PARTICLES 26, 2000, vol. 6, pp. 1011. 3. Cohilis, P. and Jongen, Y., in The Design of Compact Proton Accelerators, TERRA, 1996.

4. PIMMSProtonIon Medical Machine Study, Bryant, P., Ed., CERN-2000-006. 5. Pedroni, E., Abstracts of Papers, EPAC2000, Vienna, 2000. 6. Kats, M.M. and Onosovskii, K.K., Prib. Tekh. Eksp., 1994, no. 4, p. 146. 7. Kats, M.M. and Onosovskii, K.K., Prib. Tekh. Eksp., 1996, no. 1, p. 147. 8. Astrakhan, B., AntyGANTRY6.2000. PTCOG 10.1999. Particles 6.200. 9. Cho, W. Cho, W., Ludewigt, B., Renner, T., Performance Specications for Proton Medical Facility. LBL-33749, 1993.

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