The status of CNAO

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The CNAO (Italian acronym that stands for National Centre for Oncological Hadrontherapy) has been realised in Pavia, Italy. It is a clinical facility created and financed by the Italian Ministry of Health and conceived to supply hadrontherapy treatments to patients recruited all over the Country. A qualified network of clinical and research institutes, the CNAO Collaboration, has been created to build and to run the centre. This organizational model turned out to be very efficient and fruitful to reach the goal of introducing the most advanced techniques and procedures of hadrontherapy. Three treatment rooms with four beam ports (three horizontal and one vertical) are operational and one experimental room has been built. Beams of protons with kinetic energies up to 250MeV and beams of carbon ions with maximum kinetic energy of 400MeV/u are transported and delivered by active scanning systems. The machine operation started in 2009 with the commissioning of the high-technology components that form the acceleration chain from the sources to the patient. The dosimetry and radiobiology tests have been completed with proton beams and CNAO obtained the authorisation to start treating patients. Statistics from the Italian Association of Radiotherapists and Oncologists (AIRO) have estimated that more than 3% of the overall Italian radiotherapy annual patients, i.e. more than 3000 new patients per year, would preferably be treated with hadrontherapy, but this number is steadily increasing. Pre-selection criteria are defined on the basis of established clinical protocols and the hospitals and the clinics in the network will address to the CNAO those patients that satisfy the criteria. This paper outlines the project development, the technical aspects of the realisation and commissioning and the clinical issues relevant for the patients treatments at CNAO.