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Proton Partners International (PPI) joined NEX on 28 February and from day one it became one of the largest companies on the market. The introduction price was 225p, valuing the proton beam therapy provider at £334m, and the share price ended the week at 2275p (210p/245p). Woodford-related interests own 41.9% of Proton (www.proton-int.com) and they invested £20m at 200p a share on admission and promised to invest up to £80m at a maximum price of 176p each. Woodford received a further £1m worth of shares at 200p each in consideration for these arrangements. Proton is four years old and it has completed three centres offering proton beam therapy for cancer patients with another planned in Liverpool. Each cancer centre has cost between £35m and £42m. There is also a cancer diagnostics subsidiary. In the eleven months to January 2019, revenues were £1.11m and the loss was £18.6m.
Formation Group (FRM) owns 4.35 million shares in Proton Partners International, which it acquired in March 2018 at 115p each. The 225p a share flotation price means that the value of the 2.85% stake has nearly doubled to £9.78m. At Formation’s AGM, the resolutions to reappoint Grunberg and Co as auditor and for the board to authorise its remuneration were not passed. Michael Kennedy has resigned from the board.
Trading in Dozen Savings (DS01) 5% secured bonds March 2020 commenced on 1 March. So far £91,000 worth have been issued. The plan is to raise up to £7m. The company has been created to offer the bonds to customers of its financial services-focused parent company, Project Imagine (www.projectimagine.com). The bonds cost £100 each and the price at the end of the first day of trading was £107.50 (£90/£125). The FCA has granted Project Imagine an e-money licence and an investment licence.
IFA consolidator AFH Financial (AFHP) says that trading is in line with expectations in the first four months of the year. Past acquisitions are achieving more than 90% of their deferred consideration targets.
Field Systems Designs (FSD) reported a lower profit in the six months to November 2018 because of delays in energy form waste business. Two of these projects have still not been completed. Sales to the water sector have been strong, but they are likely to decline as the latest water regulation AMP6 period. In the six months to November 2018, revenues were flat at £11.8m, but pre-tax profit fell from £168,000 to £46,000.
Sandal (SAND) reported a dip in interim revenues from £1.88m to £1.73m and that led to a swing from profit to loss. EnergieMiHome home automation product sales were lower than expected but the products are being sold in more outlets.
Ace Liberty and Stone (ALSP) has spent £6.17m on two properties that are both let to the Communities and Local Government department, as Jobcentre Plus centres, on leases with an unexpired term of 8.4 years. The property in Bolton cost £2.54m and has a net initial yield of 7%. The Northampton site cost £3.63m and has a net initial yield of 6.75%.
Milamber Ventures (MLVP) says that investee company Essential Learning has been placed in liquidation after problems with historic data led to the company losing its government-funded training contracts. Milamber invested £228,000 in Essential in a two year period and provided services worth £270,000. It also issued £100,000 worth of shares to Essential minority shareholder Goldvista Properties. Goldvista has loaned Milamber £310,000 and this is likely to be converted into shares. Goldvista’s £6,000 loan to Essential has been written off. The shares issued to Gravity Investment Group for a 15% stake in Essential have been cancelled. Milamber is conducting due diligence on apprenticeship training businesses.
Inqo Investments Ltd (INQO) has raised £1m at 90p a share and the cash will be used to invest in healthcare, education and eco-tourism businesses in Africa that are two-to-three years from profitability and have a positive social impact.
Trading in Via Developments (VIA1) debentures has been suspended because the accounts for the year to September 2018 have not been published.
Karoo Energy (KEP) says it intends to move to AIM “as soon as practically possible”. A general meeting has been called for 18 March in order to gain shareholder approval to issue shares at the time of the move.
Altona Energy (ANR) has left AIM and the board intends to visit a vanadium mine in China that could become part of a joint venture. Altona still intends to invest in the Arckaringa coal project in South Australia.
John Eckersley is stepping down as chief executive of Capital for Colleagues (CFCP) in order to focus on his role as managing partner of Castlefield Partners and Alistair Currie will become chief executive.
Internet of Things products supplier LightwaveRF (LWRF) is raising up to £3m through a placing, subscription and open offer at 8.5p a share. Year-on-year growth in sales in the first quarter was 156% taking the figure to £1.15m.
Churchill China (CHH) and Portmeirion (PMP) have bought the stake in ceramic materials supplier Furlong Mills that was previously owned by Dudson. Churchill has paid £454,000 for 9.5%, which takes its stake to 55.6%. This means that Furlong will be consolidated in Churchill’s figures. In 2017, revenues were £8.6m and pre-tax profit was £500,000. Portmeirion spent £363,000 to take its stake to 44.4%.
President Energy (PPC) is raising up to £6.5m at 8p a share, including a £2.8m debt for equity swap by the chief executive, to invest in its gas infrastructure and accelerate its drilling programme.
Itaconix (ITX) has secured an exclusive global supply agreement with Nouryon for bio-based polymers used in hair care, skin care and cosmetics. This contract comes after a joint development agreement with Nouryon and follows the previous supply agreement for polymers used in detergents. Nouryon will sell the polymers to its own customers in the personal care sector for use in their consumer products.
Audioboom (BOOM) is raising £1.5m at 1.3p a share and this cash will enable the podcast company to make upfront payments for content. Audioboom says that it is on course to achieve higher revenues in 2019 than in the 13 months to December 2018. The success in generating revenues and orders is helping to attract content providers.
Parity (PTY) has won a two-year contract with the Department for Education for the digital transformation of the Funding and Contracting Service, which makes £6bn of payments each year. The deal could be worth up to £4.5m. Matthew Bayfield has taken over as chief executive of Parity from Alan Rommel, who is chief operating officer. Bayfield plans to focus more on the data consultancy activities.
Westmount Energy Ltd (WTE) is nearly doubling its shareholding in JHI Associates Inc to 3% and the investment is 81.8% of Westmount’s gross assets. JHI’s main asset is a 17.5% carried interest in the Canje block, offshore Guyana, which is operated by ExxonMobil. The first well could be drilled by early next year.
Verona Pharma (VRP) used up £18.1m of cash in its operating activities in 2018. There is still £64.5 in the bank. Verona generated positive data for ensifentrine (RPL554) used as a treatment for COPD in a phase IIb clinical trial. The focus is COPD and further trials for cystic fibrosis are unlikely in the short-term. Financial resources will be focused on progressing the nebulised ensifentrine to a phase III study. Verona is likely to seek partners for its dry powder and pressured meter dose inhaler formulations. The results of the part one of the dry powder inhaler clinical trial for COPD could be available before the end of the first quarter. The second phase should then commence with results expected in the second half of the year.
Trading in Herencia Resources (HER) shares has been suspended because it appears that pre-conditions for the financing that has been negotiated are not likely to be met. More cash is required to enable the company to continue trading.
Telematics supplier Quartix (QTX) increased its fleet sales, but insurance business fell and overall revenues profit are set to decline in 2019. In 2018, revenues were £25.7m and pre-tax profit was £8.1m, but that figure is forecast to fall to £6.5m this year.
VietNam Holding Ltd (VNH) has published a prospectus for its move to a premium listing, which should happen on 8 March.
Adamas Finance Asia Ltd (ADAM) has commenced a share buy back scheme for up to $500,000 of shares at a maximum price of 79 cents a share, which is a 25% discount to pro forma NAV. Adamas has separately agreed to buy back 730,529 shares at 10 cents each. The first tranche of 159,847 shares has been issued to China Aerospace for its stake in Hong Kong Mining.
NetScientific (NSCI) says that it will not get the required backing for the resolution to cancel the AIM quotation, so it has adjourned its general meeting. Shareholders owning more than 30% are against the plan.
MyCelx Tech (MYX) has raised $1.83m at 230p a share in order to finance the potential increase in demand for water treatment services.
Telit (TCM) has sold its automotive division for $105m and has received $67.5m in cash, but it has granted the buyer a loan of $38.5m for a six week period because other debt finance was not obtained in time.
Air Partner (AIR) says that its pre-tax profit will be at least £5.8m in the year to January 2019. The charter division was boosted by strong demand for freight and commercial jets. The consulting and training division has won new contracts.
G3 Exploration Ltd (G3E) plans its third demerger in its time as a quoted company. This time shares in Green Dragon Gas, which owns its producing assets, will be distributed to shareholders. Green Dragon Gas will then either be sold or float on the Hong Kong Stock Exchange.
Wealth manager Walker Crips Group (WCW) says that political uncertainty has hit broking commissions and the launch of new products, which means that the 2018-19 results will be lower than for 2017-18. Chief executive Sean Kin Wai Lam has bought 15,000 shares at 28p each.
Laura Ashley (ALY) has rejected the bid approach by Flacks and says that the indicative offer of 2.748p a share fails to provide a fair value for shareholders.
London Finance and Investment Group (LFI) has a 43.8% stake in NEX-quoted Western Selection. In the six months to December 2018, NAV fell from 65.4p a share to 62p a share. The interim dividend is unchanged at 0.55p a share.
BigDish (DISH) has launched a new restaurant bookings website and upgraded its technology. It is also widening its coverage to include Southampton.
Path Investments (PATH) says that the period of exclusivity included in its heads of agreement with ARC Marlborough has been extended to 29 March. The plan is to acquire ARC, which has a nickel and cobalt project in Queensland, via a share issue.
Oil and gas firm Curzon Energy (CZN) has raised £95,000 at 1.58p a share, which is a 21% premium to the market price. The cash will be invested in a gas project in Texas.
National Milk Records (NMRP) increased its interim revenues from £10.5m to £11.7m, although some of this was due to seasonal factors and one-off testing business. Pre-tax profit improved from £0.96m to £1.13m. Net debt was £2.06m at the end of December 2018. Every part of the business grew its revenues. Milk volumes are set to be strong in the second half, although milk margins are been squeezed by a decline in the milk price and higher feed costs.
Barkby (BARK) has completed the acquisition of Centurian Automotive for an initial payment of £201,000 in shares at 4.775p each, with up to £251,000 more based on performance over three years. Operating profit in each of the years is required to be at least £200,000 in order to achieve the full payment. The consideration represents a discount to net assets and will be equivalent to up to 20% of Barkby. In the year to March 2018, the automotive dealer made a pre-tax profit of £123,000 on revenues of £5.6m.
Sandal (SAND) says there was a significant increase in Energie MiHome sales in December, particularly later in the month, but trading is still below expectations because of a lack of cash to spend on marketing. The stock overhang has been unwound. A Wi-Fi adapter plug has been added to the range, which is being rolled out in Denman’s Electrical Wholesale branches.
Sport Capital Group (SCG) owned Palermo Football Club for less than one month before selling it back to the previous management team. It was bought for a nominal sum and is being sold for a nominal value, following further due diligence. The company’s representatives joined the board in December and resigned last week. Debt will be settled at the same time. Sports Capital had been trying to raise up to £20m over the next few months.
Trading has recommenced in the shares of EcoVista (EVTP) after it published its results for the year to August 2018. There was a £142,000 property revaluation gain and net assets were £1.39m. There are plans to launch a €10m Eurobond issue to fund further property site acquisitions in London, Hertfordshire and Essex.
Gold explorer Tectonic Gold (TTAU) has completed stage one drilling on the Specimen Hill project in Queensland and each hole drilled intersected gold. Geological modelling results will be available in March. A further 7,500 metres of drilling is being planned.
Auxico Resources Canada Inc (AUAG) has raised $400,000 at 20 cents a unit (one share and one-half warrant). The expenses of the placing were $28,000. The cash will be used for assessing coltan opportunities in Colombia and Brazil. NQ Mining (NQMI) has raised £54,000 at 11p a share.
Panoply Holdings (TPX) has made its third acquisition since floating in December. UK-based GreenShoot Labs provides digital services using artificial intelligence technology. There is no initial consideration and any payment will depend on performance.
Marketing and media services provider Ebiquity (EBQ) traded in line with expectations last year. The disposal of the advertising intelligence was completed on 2 January. This cut net debt to around £8m. The continuing business is expected to continue to grow at 8% a year.
Online merchandising software and services provider ATTRAQT Group (ATQT) increased its 2018 revenues by 26% to £17.1m and the loss declined from £4.1m to £2.7m. The largest customer has renewed for two years. Annual recurring revenues are £16m.
GRC International (GRC) has acquired data consulting business DQM Group for an initial £5.9m with up to £5m in deferred consideration, although it is not expected to be more than £3.5m. This is a significantly earnings enhancing deal.
Cabot Energy (CAB) is consolidating 100 shares into one new share and raising up to £2.85m at 10p per consolidated share. The cash will pay off trade creditors. The main focus is Canada but Cabot believes its Italian oil and gas exploration assets could still be valuable even though the Italian government has suspended exploration work and is reviewing the situation.
The administrator has sold most of the businesses of Patisserie Holdings (CAKE) but there will be no money for shareholders. Dublin-based Causeway Capital has acquired Patisserie Valerie and AF Blakemore acquired Philpotts for a total of £13m, of which £3m is deferred. Baker and Spice was sold to the Department of Coffee and Social Affairs for £2.5m. The AIM quotation will be cancelled on 25 February. Paul Mumford of Cavendish Asset Management believes that the company’s banks should have supported a rescue and been more attentive to what was happening at the company. He thinks that shareholders should seek compensation from the banks.
Malvern International (MLVN) has confirmed that it moved into profit in 2018. The education business has doubled its London-based revenues and this made up for difficult trading in Malaysia.
Realm Therapeutics (RLM) is selling is hypochlorous acid assets for $10m and intends to leave AIM. Realm already had $18.8m in the bank at the end of 2018. The plan is to use the cash to complete a strategic transaction in the life sciences sector. The ADSs will continue to be listed on Nasdaq.
Stride Gaming (STR) has started a strategic review. The choices are acquisitive or organic expansion or the sale of the online gaming company.
Renalytix AI (RENX) has secured a joint venture with laboratory and clinical trials operator AKESOgen and this will enable Renalytix AI to provide additional services in the US. The artificial intelligence-based kidney diagnostics already has a presence in New York and the new joint venture is based in Georgia.
Administrators have been appointed to Utilitywise (UTW) but none of the subsidiaries is in administration. Shareholders are not likely to get anything from the administration process. Unitlitywise was unable to raise the cash it required to keep going and meet liabilities.
Heavitree Brewery (HVT) improved full year revenues from £7.3m to £7.61m and pre-tax profit grew from £1.55m to £2.25m, although that included profit on the sale of pubs and other property of £824,000, up from £6,000. The previous year had benefited from the write-back of a bad debt provision. The final dividend is being increased from 4p a share to 4.25p a share. Heavitree no longer has to cover a pension scheme deficit because three people transferred out of the scheme.
Bowmark Capital has launched a 110p a share recommended cash bid for Tax Systems (TAX) and MXC Capital Ltd (MXC) has accepted with its 25.6% stake. The bid values the tax software provider at £100.6m.
Kodal Minerals (KOD) has published the results of the drilling programme at the Bougouni lithium project. These will be used to update the JORC resource, which should happen by the end of February. Kodal has met with the Mali authorities to update them.
Insignals Neurotech is the third Portuguese spin out for Frontier IP (FIPP) and it will hold a 33% stake. Insignals is developing technology for brain stimulation surgery.
Scientific Digital Imaging (SDI) has made another scientific instruments acquisition and it has raised £2.5m at 34p a share to help finance it. A further £100,000 was raised via PrimaryBid. Graticules manufactures reticules and graticules and fits with the digital imaging division. It cost £3.4m and has added 6% to next year’s earnings per share.
Strategic Minerals (SML) has announced a trebled resource at Redmoor, in which it has a 50% stake. There is an inferred tin equivalent contained metal of 137,000 tonnes.
James Latham (LTHM) has acquired the timber merchant that has the rights to sell Accoya wood in Ireland. Abbey Woods will cost an initial €1.825m with a further €300,000-€400,000 depending on completion accounts. Further deferred consideration of up to €400,000 depending on performance over two years. Last year, Abbey Woods generated EBITDA of €379,000 on revenues of €7.5m and it has operations in Dublin and Cork.
Vast Resources (VAST) says that the tranche B offtake finance from Mercuria Energy Trading did not happen. This means that the planned December and January repayments of the loan from Sub Sahara Goldia Investments have not been made Talks continue with potential finance providers to replace the cash to invest in 80%-owned copper, silver, gold, zinc, lead, tungsten, molybdenum Baita Plai project. Bergen Global Opportunities Fund is pausing the second tranche of the $3m bridge facility because the share price has been below 0.2p for two days. A placing has raised £896,000 at 0.135p a share and this will repay the £525,000 owed to Bergen. There are discussions with a potential cornerstone investor for a diamond project in Zimbabwe.
RiverFort Global Opportunities (RGO) has subscribed for shares in Pires Investments (PIRI), that will give it a 24.3% stake. RiverFort is taking nearly 50% of the shares issued in a placing that raised £782,000 at 2.4p a share for Pires. The cash will be used for new investments.
Trading in the shares of African Battery Materials (ABM) will resume on Monday 18 February following the issue of 200 million shares at 0.5p each. The cash will be used to pay creditors and leave enough to finance the business for 12 months. Andrew Bell has been appointed executive chairman and Paul Johnson as executive director.
Windar Photonics (WPHO) will undershoot the 2018 forecast, but there should be higher orders from Vestas and another manufacturer next year. Even so, 2019 forecasts are likely to be reduced. Total 2018 revenues were 59% ahead at €3.5m and higher gross margins meant that the loss before interest, tax, depreciation and amortisation fell from €1.22m to €360,000. The end of year order book was worth €1m.
Nostra Terra Oil and Gas (NTOG) has more than trebled its proved and probable reserves to 2.43 million barrels of oil. Net proved reserves are 764,030 barrels of oil.
President Energy (PPC) has updated the reserves position. The Argentina and Louisiana reserves are valued at almost $300m, which is equivalent to 21p a share. That is more than twice the market capitalisation. Production is predominantly oil but gas production will increase this year.
Harwood Wealth Management (HW.) has acquired IFA Castleton Financial Planning for up to £1.6m.
Trading in the shares of Urals Energy (UEN) has been suspended following the resignation of Allenby as nominated adviser. A general meeting, which will be held on 22 February, has been called by Adler Impex SA in order to remove three directors and appoint four other directors. Oil production was 1,690 barrels/day in January. Loans made without board approval have meant that the company is short of cash.
Waste-to-energy technology developer PowerHouse Energy (PHE) is confident that it could sign up a customer in the next quarter. There is increasing interest and six potential sites are being assessed. Potential engineering, procurement and construction contractors have approached PowerHouse. Development partner Waste2Tricity is in negotiations with Toyota Tsusho, which would be a way of entering the Japanese market.
Braveheart Investment Group (BRH) has reduced its stake in Remote Monitored Systems (RMS) from 5.9% to 1.32%. Stephen Jones increased his stake from below 3% to 14.5% in just over one month.
Dewscope Ltd, where Mark Horrocks is a director, has cut its stake in Sabien Technology (SNT) from 12.7% to less than 3%. Chris Akers has also reduced his stake from 16.9% to less than 3% and Brendan Adams has cut his shareholding from 4.2% to under 3%. These stakes were acquired on 14 December, when the mid-price was 0.11p. On 11 February, when the shares were sold, the share price increased from 0.145p to 0.175p. Sabien reported a decline in interim revenues from £462,000 to £342,000, but the loss was reduced from £233,000 to £207,000 due to cost reductions.
TV programme producer DCD Media (DCD) expects to report revenues of £7.3m and a small EBITDA in 2018. Trading has started well in 2019 helped by business that was delayed from last year.
HaloSource (HAL) is seeking shareholder approval for the disposal of assets to Strix (KETL) for $1.3m. The cash will pay creditors and fund the winding down of the business. The AIM quotation will be cancelled on 12 March.
WANdisco (WAND) has raised $17.5m at 546p a share to provide cash to support relationships with partners. WANdisco has become an advanced technology partner with Amazon Web Services.
Adamas Finance Asia Ltd (ADAM) is issuing 6.1 million shares to China Aerospace for a 6.8% stake in Hong Kong Mining Holdings, where Adamas already has a 84.8% stake. This is a complicated deal, but Adamas can tell China Aerospace where to transfer these shares. It means that Adamas will not necessarily increase its shareholding in the mining company. Sorting out what was effectively a stock overhang should make it easier to do a deal that will unlock cash for Adamas.
NetScientific (NSCI) has concluded its strategic review and it has decided to cancel its AIM quotation. The remaining cash will be spent on the investee companies with the best prospects of providing a return before the company runs out of money.
Angus Energy (ANGS) is repaying the £1.5m initial advance from YA II and RiverFort Global Opportunities. Angus has raised £2.2m at 4p a share.
The University of British Columbia has ordered a polariser system from Polarean Imaging (POLX).
Begbies Traynor (BEG) has made the earnings enhancing acquisition of profitable Newcastle insolvency practice KRE. The initial payment is £450,000 with up to £150,000 more based on revenue targets over 12 months.
Full year figures will be lower than expected at IFA Tavistock Investments (TAVI) but a maiden dividend is still on the cards.
Crossword Cybersecurity (CCS) will report a 45% increase in 2018 revenues, with most of the growth coming from software.
Cryptocurrency mining services provider Argo Blockchain (ARB) is refocusing its business. All existing contracts will be terminated by the beginning of April. The focus will be Argo’s own currency mining. Ongoing costs will be cut by one-third. Net cash is £15m and that is much more than the market capitalisation of Argo. The cash outflow should be stemmed in the second half of 2019. Hadron Capital recently increased its stake to 7.6%.
Trading is in line at fasteners supplier Trifast (TRI) even though the UK automotive market is weak. More than two-thirds of sales are overseas. Additional UK stocks for Brexit are worth around £2m.
Commercial aircraft leasing company Avation (AVAP) expects to report a doubled interim profit on revenues that have risen from $52.4m to $58m.
Outdoor digital media company Grand Vision Media Holdings (GVMH) has signed a partnership agreement with Rakuten Bank in Japan to add to the one it signed with CY Group in South Korea. GVMH’s marketing services will help its partners promote themselves to Chinese tourists. GVMH has glasses-free 3D technology.
Helen Sachdev has been appointed as a non-executive director of Athelney Trust (ATY) and Frank Ashton has taken on the role of executive chairman. Discussions continue with Gresham House Asset Management about taking over the management of the company’s investments.
Future (FUTR) has secured a new £90m revolving credit facility and it is acquiring CyclingNews.com and Procycling Magazine, which generate annual revenues of £2m. This deal widens the sports publishing activities.
REA Holdings (RE.) significantly increased palm oil production in 2018, even though extraction rates were lower than expected. The Kota Bangun coal concession is heading towards reopening the mine, although there are local disputes.
by Virginia Greco, CERN.
The accelerator technology underpinning Europe’s first particle-therapy facilities, driven by the TERA Foundation during the past 25 years, is poised to unleash new treatment modes in more compact ways.
Last September the TERA Foundation – dedicated to the study and development of accelerators for particle therapy – celebrated its 25th anniversary. Led by visionary Italian physicist Ugo Amaldi, TERA gathered and trained hundreds of brilliant scientists who carried out research on accelerator physics. This culminated in the first carbon-ion facility for hadron therapy in Italy, and the second in Europe: the National Centre for Cancer Hadron Therapy (CNAO), located in Pavia, which treated its first patient in 2011.
The forerunner to CNAO was the Heidelberg Ion-Beam Therapy Centre (HIT) in Germany, which treated its first patient in 2009 following experience accumulated over 12 years in a pilot project at GSI near Darmstadt. After CNAO came the Marburg Ion-Beam Therapy Centre (MIT) in Germany, which has been operational since 2015, and MedAustron in Wiener Neustadt, Austria, which delivered its first treatment in December 2016.
While conventional radiotherapy based on beams of X-rays or electrons is already widespread worldwide, the treatment of cancer with charged particles has seen significant growth in recent years. The use of proton beams in radiation oncology was first proposed in 1946 by Robert Wilson, a student of Ernest Lawrence and founding director of Fermilab. The key advantage of proton beams over X-rays is that the absorption profile of protons in matter exhibits a sharp peak towards the end of their path, concentrating the dose on the tumour target while sparing healthy tissues. Following the first treatment of patients with protons at Lawrence Berkeley Laboratory in the US in 1954, treatment centres in the US, the former USSR and Japan gradually appeared. At the same time, interest arose around the idea of using heavier ions, which offer a higher radio-biological effectiveness and, causing more severe damage to DNA, can control the 3% of all tumours that are radioresistant both to X-rays and protons. It is expected that by 2020 there will be almost 100 centres delivering particle therapy around the world, with more than 30 of them in Europe (see “The changing landscape of cancer therapy”).
Europe entered the hadron-therapy field in 1987, when the European Commission launched the European Light Ion Medical Accelerator (EULIMA) project to realise a particle-therapy centre. The facility was not built in the end, but interest in the topic continued to grow. In 1991, together with Italian medical physicist Giampiero Tosi, Amaldi wrote a report outlining the design of a hospital facility for therapy with light ions and protons to be built in Italy. One year later, the pair established the TERA Foundation to raise the necessary funding to employ students and researchers to work on the project. Within months, TERA could count on the work of about 100 physicists, engineers, medical doctors and radiobiologists, who joined forces to design a synchrotron for particle therapy and the beamlines and monitoring systems necessary for its operation.
Ten years of ups and downs followed, during which TERA scientists developed three designs for a proton-therapy facility initially to be built in Novara, then in the outskirts of Milan and finally in Pavia. Political, legislative and economic issues delayed the project until 2001 when, thanks to the support of Italian health minister and oncologist Umberto Veronesi, the CNAO Foundation was created. The construction of the actual facility began four years later.
“We passed through hard times and we had to struggle, but we never gave up,” says Amaldi. “Besides, we kept ourselves busy with improving the design of our accelerator.”
Meanwhile, in Austria, experimental physicist Meinhard Regler had launched a project called Austron – a sort of precursor to the European Spallation Source. In 1995, together with the head designer – accelerator physicist Phil Bryant – he proposed the addition of a ring to the facility that would be used for particle therapy (and led to the name of the project being changed to MedAustron). Amaldi, Regler and Bryant then decided to work on a common project, and the “Proton-Ion Medical Machine Study” (PIMMS) was created. Developed at CERN between 1996 and 2000 under the leadership of Bryant and with the collaboration of several CERN physicists and engineers, PIMMS aimed to be a toolkit for any European country interested in building a proton–ion facility for hadron therapy. Rather than being a blueprint for a final facility on a specific site, it was an open study from which different parts could be included in any hadron-therapy centre according to its specific needs.
The design of CNAO itself is based on the PIMMS project, with some modifications introduced by TERA to reduce the footprint of the structure. The MedAustron centre, designed in the early 2000s, also drew upon the PIMMS report. Built between 2011 and 2013, with the first beam extracted by the synchrotron in autumn 2014, MedAustron received official certification as a centre for cancer therapy in December 2016 and, a few days after, treated its first patient. “In the past few years we have worked hard to provide the MedAustron trainees with a unique opportunity to acquire CERN’s know-how in the diverse fields of accelerator design, construction and operation,” says Michael Benedikt of CERN, who led the MedAustron accelerator project. Synergies with other CERN projects were also created, he explains. “The vacuum control system built for MedAustron was successfully used in the Linac4 test set-up, while in the synchrotron a novel radiofrequency system that was jointly developed for the CERN PS Booster and MedAustron is used. The synchrotron’s power converter control uses the same top-notch technology as CERN’s accelerators, while its control system and several of its core components are derived from technologies developed for the CMS experiment.”
All the existing facilities using hadrons for cancer therapy are based on circular cyclotrons and synchrotrons. For some years, however, the TERA Foundation has been working on the design of a linear accelerator for hadron therapy. As early as 1993, Amaldi set up a study group, in collaboration with the Italian institutions ENEA and INFN, dedicated to the design of a linac for protons that would run at the same frequency (3 GHz) as the electron linacs used for conventional radiotherapy. The linac could use a cyclotron as an injector, making it a hybrid solution called a cyclinac, which reduces the sizes of both accelerators while allowing the beam energy to be rapidly changed from pulse to pulse by acting on the radiofrequency system of the linac. In 1998 a 3 GHz 1.2 metre-long linac booster (LIBO) was built by a TERA–CERN–INFN collaboration led by retired CERN engineer Mario Weiss, and in 2001 it was connected to the cyclotron of the INFN South Laboratories in Catania where it accelerated protons from 62 MeV to 74 MeV. This was meant to be the first of 10 modules that would kick protons to 230 MeV.
In 2007 a CERN spin-off company called ADAM (Applications of Detectors and Accelerators to Medicine) was founded by businessman Alberto Colussi to build a commercial high-frequency linac based on the TERA design. Under the leadership of Stephen Myers, a former CERN director for accelerators and technology and initiator of the CERN medical applications office, ADAM is now completing the first prototype. It is called Linac for Image Guided Hadron Therapy (LIGHT), and the full accelerator comprises: a proton source; a novel 750 MHz RF quadrupole (RFQ) – designed by CERN – which takes the particles up to 5 MeV; four side-coupled drift-tube linacs (SCDTL) – designed by ENEA – to accelerate the beam from 5–37.5 MeV; and a different type of accelerating module, called coupled-cavity linac (CCL) – the LIBO designed by TERA – which gives the final kick to the beam from 37.5 to 230 MeV. The complex will be 24 m long, similar to the circumference of a proton synchrotron.
Compared to cyclotrons and synchrotrons, linear accelerators are lighter and potentially less costly because they are modular. Most importantly, they produce a beam much more suited to treat patients, in particular when the tumour is moving, as in the lungs. The machine developed by ADAM is modular in structure to make it easier to maintain and more flexible when it comes to upgrading or customising the system. In addition, thanks to an active longitudinal modulation system, the beam energy can be varied during therapy and thus the treatment depth changed. LIGHT also has a dynamic transversal modulation system, allowing the beam to be rapidly and precisely modulated to “paint the tumour” many times in a short time – in other words, delivering a homogeneous dose to the whole cancerous tissue while minimising the irradiation of healthy organs. The energy variation of cyclotrons and synchrotrons is 20–100 times slower.
“The beauty of the linac is that you can electronically modulate its output energy,” Myers explains. “Since our accelerator is modular, the energy can be changed either by switching off some of the units or by reducing the power in all of them, or by re-phasing the units. Another big advantage of the linac is that it has a small emittance, i.e. beam size, which translates into smaller, lighter and cheaper magnets and allows to have a simpler and lighter gantry as well.” In the last decade, LIBO has inspired other TERA projects. Its scientists have designed a linac booster for carbon ions (while LIBO was only for protons) and a compact single-room facility called TULIP, in which a 7 m-long proton linac is mounted on a rotating gantry.
The new frontier of hadron therapy, however, could be helium ion treatment. Some tests with these ions were done in the past, but the technique still has to be proven. TERA scientists are currently working on a new accelerator for helium ions, says Amaldi. “Helium can bring great benefit to medical treatments: it is lighter than carbon, thus requiring a smaller accelerator, and it has much less lateral scattering than protons, resulting in sharper lateral fall-offs next to organs at risk.” In order to accelerate helium ions with a linac, we need either a longer linac compared to the one used for protons or higher gradients, as demonstrated by high-energy physics research at CERN and elsewhere in Europe. The need for future, compact and cost-effective ion-therapy accelerators is being addressed by a new collaborative design study coordinated by Maurizio Vretenar and Alessandra Lombardi of CERN, dubbed “PIMMS2”. A proposal, which includes a carbon linac, is being prepared for submission to the CERN Medical Application group, potentially opening the next phase of TERA’s impressive journey.
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