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Clinical Experience of SAGA HIMAT.

SAGA HIMAT [1], the fourth carbon ion beam therapy facility in Japan, is located in Tosu city, Saga prefecture (Figures 1 and 2). The SAGA HIMAT Project is a collaborative work among the local governments, regional industries, and medical societies in the Kyushu area. The initial cost of this facility was approximately ¥15 billion, which was covered by donations, investments, and local government aid. The facility is managed by a nonprofit organization, SAGA HIMAT Foundation. At SAGA HIMAT [2], carbon ions are accelerated to up to 70% of light speed by 2 linear accelerators and a synchrotron. The accelerated ion beams are transported to treatment rooms A and B. The range of extracted energy is 140 to 400 MeV/u (Table 1). Room A has horizontal and 458 oblique beam lines; room B has horizontal and vertical beam lines. Broad beams are used and each outlet measures 15 cm3 15 cm (Figures 3 and 4). In preparation for treatment, radiation technologists create an immobilization device customized for each patient placed on a mock treatment couch. Dose compensation boluses adjusted to the shape of the irradiation fields are designed from the computed tomography (CT) simulation data and produced by outside manufacturers. We also have a regular CT scanner and magnetic resonance imaging for diagnosis. Treatment room C is now under construction for pencil beam scanning therapy. SAGA HIMAT is a stand-alone outpatient clinic specialized for carbon ion cancer therapy. The patients initially visit a cancer treatment facility of their choice, receive a diagnosis and staging of the cancer, and are referred to our institution for carbon ion