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The Seventh Blaise Pascal Lecture Wednesday May 19 2010Wednesday May 19, 2010
Ecole PolytechniqueAmphi Faurre
Medical Applications of Laser IonMedical Applications of Laser Ion Acceleration
Toshiki TajimaBlaise Pascal Chair,
Fondation Ecole Normale SupérieureInstitut de Lumière Extrême
andandLMU,MPQ, Garching
Acknowledgments for Advice and Collaboration: G. Mourou, M. Molls, F. Nuesslin, M. Abe, M. Murakami, V. Malka, J. Fuchs, C. Labaune, P. Mora, F. Krausz, D. Habs, T. Esirkepov, S. Bulanov, S. Kawanishi, M. Hegelich, Y. Kishimoto, D. Jung, D. Kiefer, X. Yan, A. Henig, R. Hoerlein, S. Steinke, W. Sandner, Y. Fukuda, A. Faenov, M. Tampo, P. Bolton, N. Rostoker, F. Mako, L. Yin, T. Pikuz, A. Pirozhkov, M. Borghesi, M. Gross, M. Zepf, Y. Gauduel
Chaotic (and thus Violent) Mutations
Cancer causinghuman genomemutations: scary!(Time Magazine)( g )
fundamental to biologyfundamental to biology
5-year survival rates after curative treatment in early cancer stages
M. Molls/ Japan Apr 09
Radiotherapyalone
Surgery alone
Chemotherapy alonea o e
Prostate 79 % (5 y)66 �– 79 % (10 y) 75 �– 85 % Ø
Lung 6 �– 50 %(Stereotact. RT: > 50 %) 30 �– 80 % Ø
Cervix 63 91 % 74 91 % ØCervix 63 �– 91 % 74 �– 91 % Ø
Skin up to 100 % up to 100 % Ø
60 80 % (T1 T2) comparable withAnus 60 �– 80 % (T1, T2)33 �– 58 % (T3, T4)
comparable with results after RT Ø
Rectum ~ 65 % 78 �– 82 % Ø
3Ø: no data in the literature: CHEMOTHERAPY has no curative potential in solid tumors (exception: testicular cancer)
In the last decades: no improvement of survival in metastatic cancer diseases
(macroscopic metastases)M. Molls/ Japan Apr 09p p
4
Data from "Tumor Center München"
M. Molls/ Japan Apr 09
Chemotherapy (medical cancerChemotherapy (medical cancer treatment) has no curativetreatment) has no curative potential in solid tumors!
WHY?WHY?
5
Radiation ChemotherapyM. Molls/ Japan Apr 09
Homogeneous dose distribution The tumor cell kill depends on intrinsic radiation sensitivity DNA repair capacity
Inhomogeneous dose distributionThe tumor cell kill depends on the transport of the substance to the clonogenic cells andradiation sensitivity, DNA repair capacity,
repopulation, oxygenation status etc.. However, the entire tumor can be irradiated homogeneously with that dose, which is
the substance to the clonogenic cells and molecular targets, DNA repair capacity, repopulation, pO2, pH, MDR, etc.. In macroscopic tumors not all the subvolumes of g y
necessary to kill all clonogenic tumor cells, even the most resistant ones.
the tumor, clonogenic cells and relevant molecular targets are reached by those doses of the medical substance which are needed for cell killfor cell kill.
6
Tumor-cells
(Molls, TU München; according to Tannock: Lancet 1998, Nature 2006)
1010
6 Chemoth cycles
106
1086 Chemoth. cycles
104
106
Surger102
104
0 1 2 3 4 5 6
ry
0
10
month0 1 2 3 4 5 6
Macroscopic Tumor: 5mm (more than 107 cells)
7
Microscopic Tumor: < 5mm (1 �– 107 cells)
Cell kill after Chemotherapy: only about 3 logarithmic steps (ordinate)M. Molls/ Japan Apr 09
M. Molls/ Japan Apr 09Prof. Molls (TUM/MAP) says:
䇾Solid tumors which consist in more than about 1000 ll tl t b d b di lcells apparently can not be cured by medical
treatment. This holds true especially for macroscopic tumors which consist in more than 1 to 10 million cells (exception: testicular cancer)( p )
The main problem:The medical substances don�‘t reach all dividing tumor cells and respective molecular targets in a p gconcentration which is high enough to kill the cells. After medical treatment there remain dividing cells
8
After medical treatment there remain dividing cells from which tumor regrowth is starting.䇾
Breast Cancer: Improvement of survival by better diagnostic and earlier detection of the tumorand earlier detection of the tumor
(Patients with breast carcinoma in Brisbane, Australia; Webb et al, The Breast 2004)
Diagnosis Diagnosis1981 - 84 1990 �– 94
Patients 469 520Average age 56 J 53 JAverage age 56 J 53 JTumor < 1cm 11% 22%Tumor > 2cm 44% 34%Tumor > 2cm 44% 34%Lymph node metast. 50% 38%Stage 1 32% 46%gStage 2 61% 47%Stage 3 7% 7%
95 y survival 74% 84%
M. Molls/ Japan Apr 09
Brilliant X-raysDiffraction enhanced imaging: breast, ex vivo
M. Molls/ Japan Apr 09
g g ,
1 CT ex vivo, 2 Brilliant X-ray image ex vivo, 3 Histology
collagen strandsskin-muscle
Ca in collagen
12 3fat1
1: Toshiba AsteionTSX - 021ACT (80 kV )
2
2: DEI 33 keV
3
3: Histology
10CT-scanner (80 kVp)
Bravin et al. Phys Med Biol 52:2197-211, 2007D.Habs
Small-angle X-ray scattering (SAXS)
normal tissuenormal tissue contains collagen fibrils in regular, hexagonal-like arrangement
cancer cells degrade regular structure of collagen fibrils making
canceroushealthy
collagen fibrils, making them thinner and their axial period longer
micro-x-ray beam
vision: direct cancer diagnosis without biopsy
micro x ray beam
11
vision: direct cancer diagnosis without biopsyfrom D.HabsM. Molls/ Japan Apr 09
phase tomograms
contact: [email protected] & www: http://people.epfl.ch/franz.pfeiffer
absorption tomograms
F. Pfeiffer et al., Phys. Med. Biol. 52, 6923
State-of-the-art 3D phase-contrast tomography at highly brilliant synchrotron radiation sources
(@ESRF Grenoble/ France)
(2mm size)
contact: franz pfeiffer@psi ch &[email protected] & www: http://people.epfl.ch/franz.pfeiffer
F. Pfeiffer et al., Phys. Med. Biol. 52, 6923 (2007)
Small tumor detection(by such method as Phase Contrast Imaging)
Early tumor detection:
�• Less chance of metastasis
�• Higher Quality-of-Life (QoL)
�• Fit for laser acceleration approach
(compact laser accelerator:
t d f l d )15
not good for large dose)
Sharpness of Dose of Proton Therapy
pro
X-ray IMRT Proton IMRT
ostate caancerrrectum
Surgical sharpness of dose compared withSurgical sharpness of dose compared with X-ray Intensity Modulated Radio Therapy(X-ray IMRT)( y )
Suggested Strategy for L I A l tLaser Ion Accelerator
�• Detect early and small (laser-drivenDetect early and small (laser driven brilliant coherent X-rays): micro tumors
�• Small spot irradiation(including scanning): ideal for laser acceleration of ions, as ion therapy is nearly surgically sharp
�• Feedback necessary:�• Feedback necessary: irradiate verify irradiate verify �….
�• Shallow tumors and other shallow treatments (e g ARMD) firsttreatments (e.g. ARMD) first
�• Other industrial applications
Toward Compact Laser-Driven Ion Therapypy
PET or ray image of autoradioactivation
Proton accelerator+gantry
laserlaser
Laser particle therapy (image-guided diagnosis irradiation dose verification)targeting at smaller pre-metastasis tumors with more accuracy
Small tumor treatment
�• 1kg tumor (10cm x10cm x 10cm): 70J proton energy @ 70Gyp gy @ y
�• 1g tumor (1cm x 1cm x 1cm): 70mJ1 t (1 1 1 ) 70 J�• 1mg tumor (1mm x 1mm x 1mm): 70 J
takes about 108 protons at ~100MeV (only 10% of p ( ythe beam assumed to be used to inject, and in turn 10% of which stops at tumor; with 10% laser to pproton efficiency, laser energy of 70mJ); takes 105
protons per laser shot (if 2minutes therapy at 10Hz)p p ( py )
Within grasp!
Spot-Scanning Simulation of Laser Proton Radiotherapy
(Simulation of dose distribution)
ba
distribution)
ba
Spot scanning simulation of laser proton radiotherapy for eyec d
Spot-scanning simulation of laser proton radiotherapy for eye melanoma (a,b) and ARMD (c,d).
Particle-in-cell simulation (PIC) software which calculates the properties of
22laser-accelerated protons, Monte-Carlo simulation software, and visualization tools for the dose evaluation were used. Iso-dose curve:Blue: 25%, Sky blue: 50%, Yellow: 75%, Orange: 90%, Red: 110%. Miyajima(JAEA)2005
Recent breakthroughs in LIAFrom incoherent (or heating) of electrons
to Coherent drive of themto Coherent drive of them
TNSA (T t N l Sh th A l ti )
CAIL (Coherent Acceleration of Ions by Laser)
TNSA (Target Normal Sheath Acceleration)
Tajima et al., 2009
Comparison of the phase space dynamics:toward more Adiabatic Accelerationtoward more Adiabatic Acceleration
TNSA (metallic boundary)
I t i idthIon trapping width:vtr,ion ~ c a0(m/M)
CAIL (with CP)
CAILRev. Accel. Sci. Tech.(Tajima, Habs, Yan, 2009)
Optimal Thickness Scaling
Normalized thickness ~ a0 (normalized intensity)Optimal acceleration of ions
Maximal energy of protons (MeV)LLNL
Normalized thickness a0 (normalized intensity)
LLNL(redef. Ipeak)
a=eE/me c13
55 (MeV)LLNL
(T.Esirkepov et al.2006)
Recent Experimental Breakthroughs
Leadership Nanometer target:by Dieter Habs
LMU,
DLCSharp contrast laser
double plasma,MPQ,Max-Born Institute, LANL
pmirrors
LANL,RAL,PMRC More coherent
electron dynamicselectron dynamicsin ~ a0
Recent experiments in CAIL Regime
Ultrathin film : = a0 , where = d n / nc ( = /a0)CAIL Regime: Overcomes old TNSA regime
0 , c ( 0)High laser contrast: not to destroy ultrathin target
=1
MAP + MBI
(Henig et al, 2009;Steinke et al.)
Conversion efficiency of laser to ion energy
100Two orders of magnitude higher efficiency in CAIL
5x1019 W/cm2 203x10NOVA
100
] 5x10 W/cm6x1019
2x1020
3x10NOVA10
nerg
yci
ency
[%]
RAL
1x10197x1019
2x10
1
er−i
on e
nesi
on e
ffici
e
ASTRA
RAL
187x10
2x10180.1
Lase
rco
nver
sio
thin foil RPA
ASTRA Tajima, et al(2009)
2x1018
0.01
c thin foil RPAthick foil TNSA
0.0110 100 103 104
Laser pulse duration [fs]
Maximum energies of ions
1022 1021 W/cm21000
V/u]
1022
1001020
ergy
[MeV
/
NOVA 203x102x1020
197x102x10201910
1019
ff ion
ene
rg
RAL
2x1020
5x10 2x102019
1
10
protons, nm foilm cu
toff
io
ASTRAprotons, TNSA
RAL5x10
10187x1018
1 protons, nm foil
carbon, clustercarbon, nm foil
Max
imum ASTRA
10 100 103 1040.1
carbon, clusterM
Laser pulse duration [fs]Tajima et al.(2009)
Toward monoenergy spectrum�• Circularly polarized laser irradiation
more adiabatic acceleration more monoenergymore adiabatic acceleration more monoenergy
Carbon spectrum for three consecutive shots using circular polarized light at 5 *10^19 W/cm2 and a DLC foil target thickness of 5.9 nm
Energy Gain in Laser Ion acceleration: CAIL (Coherent Acceleration of Ions by Laser) regime
�• When electron dynamics by laser drive is sufficiently y y ycoherent, with coherence parameter of electrons, the ion energy in terms of electron energy is :
Ion energy
(th h t th l t ti th hi h th i )
Electron energy = ponderomotive energy
(the more coherent the electron motion, the higher the ion energy)
ponderomotive energy
maximizes at = 1
CAIL Theory PredictionCAIL (Coherent Acceleration of Ions by Laser) theory has definitiveprediction of max energies
Tajima et alTajima et al. RAST(2009)
For the case of LANLexperiment prediction (relative long pulse with nm targets)
Circularly polarized laser driven
CP laser drives ions out of ultrathin (nm) foil adiabaticallyMonoenergy peak emerges
Bucket trapping ions
Ion
Ion m Vi,trpopulatio
mom
emn
laser
on ntum
laser
P d ti f d i l t
Vi,tr = c (a0m/M)
Ponderomotive force drives electrons,Electrostatic force nearly cancelsSlowly accelerating bucket formed
(X. Yan et al: 2009)
Toward more adiabatic acceleration(4)
The more adiabatic, the longer accelerated, the higher energy, g , g gy
Energy by CP tends to increase as ~ a02
800
1000
CP
V)
1PW
600
800LP
rgy(
MeV
100TW
200
400
ax. E
ner 100TW
0 10 20 30 40 50 60 70 80
0
M
0 10 20 30 40 50 60 70 80Normalized laser amplitude a0
Concave Ultrathin Target Enhances Energy
Concave target focuseslaser energy, doubling the ion energygy
(Wang et al. 2010)
Energy Doubler: Concave Target
At 1020W/cm2 the concave target lets over 100MeV protons, doubling energy over a flat target
Wang et al. 2010
Monoenergetic electron bunch
Ultrathin (2nm) foil (CP) irradiation drives monoenergetic electrons
Ideal for driving coherent brilliant X-rays for phase contrast imagingfor phase contrast imaging
(Kiefer et al, 2009)
MAP MBIMAP + MBI
Adiabatic (Gradual) Acceleration Accelerating structure
Inefficient if suddenlysuddenly
accelerated
protonsAccelerating structure (cf.human trapping width:
vtr,human ~ 1m/s << cs )
Efficient whenwhen
gradually acceleratedaccelerated
Adiabatic acceleration (2) Thick metal target
Most experimental
c
Most experimental configurations of
proton acceleration(2000-2009)
laser protons electronsInnovation (�“Adiabatic
Acceleration�”)(2009-)
= Method to make the electronsc = Method to make the electrons within ion trapping width
H i ELI t tiGraded, thin (nm), or clustered
target and/or circular polarization
However, in ELI automaticvtr, ion ~ c a0(m/M) ~ c
(ultrarelativistic a0 ~ M/m )
Why laser-Cluster Interaction ?Why is Laser-Cluster Interaction Strong?
�clusterd phase" vs. "gas", "plasma", "solid phase"
gas࣭plasma࣭solid l t
"Small particle system" and enhanced fluctuation
gas࣭plasma࣭solid cluster like large molecular
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Transverse polarization manifest!
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"Small particle system" and enhanced fluctuation࣭free energy originated from
the surface ࠉ is NOT neglected.
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44R. H. Doremus, J. Chem. Phys. 40, 2389 (1964)A. Kawabata and R. Kubo, J. Phys. 40, 1765 (1966) (Y.Kishimoto)
Cluster target: order of magnitude energy gainenergy gain
With a modest (140mJ) laser, to go beyond 15MeV/nucleon by clustertargettarget
Clustered target allows another leap in energy of ions
Fukuda et al. (PRL 2009)
Clustered target allows another leap in energy of ions
Off axisparabolaProbe beam
(a) (b) Laser beam
Laser beam
Z
Probe beam
Z = 8.5 mm
Cluster jet x�’
X Y 20
to shadowgraph imaging optics Z = 5.5 mm
FSSRimaging optics Z 5.5 mm
Ly O VIIIHe OVII(c)Z = 3.5 mm4.0 mm
3.8 mm
X =
Z = 1.5 mm2.1 mm
Z = 0.7 mm
2 mm
1.8 mm
1 3 mmerbe
am
Orifice output
x = 6.5 mm
1.3 mm
18.627 Å 18.627 ÅFig.15
Lase
Faenov et al., 2009
CR 39 (Side)(a)
Cluster ions strongly energizedz�’
Laser beamOff axisparabola
1 µm C3H6 foilZ
FSSR( Front)
Laser beam parabola
x�’
X Y 202020
FSSR(Side)
( Front) Clusterjet
1 µm C3H6 foilCR 39 (Front)
1010100 100Ei (keV)
200 200
Ly1010100 100
Ei (keV)200 200
He
(b)
0 01
0.1
f(v)*
107
Ly
Front0.01
0.1
f(v)*
107
He
Side
Front
1E-3
0.01 Side
1E-3
0.01
Faenov et al.,-0.006 -0.003 0.000 0.003 0.006
v/c-0.006 -0.003 0.000 0.003 0.006
v/c
Fig.11
2009
Laser-carbon cluster interaction 㼍㻞 㼘㼍㼙㼐㼍㻤㻞㻜 㻺㼤㼥㻝㻞㻤 㼜㼍㼞㼠㼕㼏㼘㼑㻝㼙㼕㼘㼘㼕㼛㼚㻛㼟㼜
㻞㼤㻝㻜㻠
㻞㻚㻡㼤㻝㻜㻠
㼍㻞㻌㼘㼍㼙㼐㼍㻤㻞㻜㻌㻺㼤㼥㻝㻞㻤㻌㼜㼍㼞㼠㼕㼏㼘㼑㻝㼙㼕㼘㼘㼕㼛㼚㻛㼟㼜
㼀㼛㼠㼍㼘㻲㼕㼑㼘㼐㻵㼛㼚㻱㼛㼚
a0=4 Ion energyl l th
㻝 㻝㻜㻠
㻝㻚㻡㼤㻝㻜㻠
㼚㼑㼞㼓㼥㻌㼇㼍㻚㼡㻚㼉 electron
~ pulse length(laser energy)
㻡㼤㻝㻜㻟
㻝㼤㻝㻜㻠
㻱㼚
ionlaser
㻜㻜 㻞㻜㻜 㻠㻜㻜 㻢㻜㻜 㻤㻜㻜 㻝㻜㻜㻜
㼀㼕㼙㼑㻌㼇㼒㼟㼉
Kishimoto (2009)
Maximum energy vs. laser intensity
㼑㼚㼑㼞㼓㼥㻚㼢㼟㻚㼍
㼍㼠 㼠㻩㻣㻜㻜㼒㼟㼑㼏
Cluster target scaling
㻞 㻝㻜㻞
㻞㻚㻡㼤㻝㻜㻞
㼍㼠㻌㼠㻩㻣㻜㻜㼒㼟㼑㼏
㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑㼂㼉
C i h
㻝㻚㻡㼤㻝㻜㻞
㻞㼤㻝㻜
㼑㼂㼉
Consistent to the Theory by Yan et al (2009)
㻝㼤㻝㻜㻞
㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑 Yan et al. (2009),
though it is based on thin film case
㻡㼤㻝㻜㻝
20max 112 aQ
㻜㻝 㻞 㻟 㻠 㻡 㻢 㻣 㻤
Pulse Strength㻌㼍㻜
Kishimoto, 2009
Ion Energy spectrum r=125 m
㻵㼛㼚㻌㻱㼚㼑㼞㼓㼥㻌㻰㼕㼟㼠㼞㼕㼎㼡㼠㼕㼛㼚
㼒㻱㼕㼘㼛㼓㼋㼍㻠㼋㼘㻤㻞㻜㼋㻺㼤㼥㻝㻞㻤㼋㼜㻝㼙㼋㼞㻝㻞㻡㼚㼙㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑㼂㼉
㻵㼛㼚㻌㻱㼚㼑㼞㼓㼥㻌㻰㼕㼟㼠㼞㼕㼎㼡㼠㼕㼛㼚
㼒㻱㼕㼘㼛㼓㼋㼍㻠㼋㼘㻤㻞㻜㼋㻺㼤㼥㻝㻞㻤㼋㼜㻝㼙㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑㼂㼉
㻝㼤㻝㻜㻙㻠
㻝 㻝㻜 㻝㻜㻜 㻝㻜㻜㻜 㻝㻜㻠
㻝㻜㻡
㻝㻜㻢
㼠㻩㻝㻜㻜㻌㼇㼒㼟㼑㼏㼉㼠㻩㻟㻜㻜㻌㼇㼒㼟㼑㼏㼉
㻝㼤㻝㻜㻙㻢
㻝㼤㻝㻜㻙㻡 㻝 㻝㻜 㻝㻜㻜 㻝㻜㻜㻜 㻝㻜
㻠㻝㻜㻡
㻝㻜㻢
㼠㻩㻡㻜㻜㻌㼇㼒㼟㼑㼏㼉㼠㻩㻣㻜㻜㻌㼇㼒㼟㼑㼏㼉
㻝㼤㻝㻜㻙㻢
㼚㻌㼒㻔㻱㼕㻕
㻝㼤㻝㻜㻙㻤
㻝㼤㻝㻜㻙㻣
㼚㻌㼒㻔㻱㼕㻕
㻝㻜
㻝㼤㻝㻜㻙㻤
㻰㼕㼟㼠㼞㼕㼎㼡㼠㼕㼛㼚
㻝㼤㻝㻜㻙㻝㻜
㻝㼤㻝㻜㻙㻥
㻰㼕㼟㼠㼞㼕㼎㼡㼠㼕㼛㼚
㻝㼤㻝㻜㻙㻝㻞
㻝㼤㻝㻜㻙㻝㻜
㻜 㻝 㻞 㻟 㻠 㻡 㻢㻝㼤㻝㻜
㻙㻝㻞
㻝㼤㻝㻜㻙㻝㻝
㻜 㻝 㻞 㻟 㻠 㻡 㻢㻝㼤㻝㻜
㻜㻝㼤㻝㻜
㻝㻝㼤㻝㻜
㻞㻝㼤㻝㻜
㻟㻝㼤㻝㻜
㻠㻝㼤㻝㻜
㻡㻝㼤㻝㻜
㻢
㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑㼂㼉
㻝㼤㻝㻜㻜㻝㼤㻝㻜
㻝㻝㼤㻝㻜
㻞㻝㼤㻝㻜
㻟㻝㼤㻝㻜
㻠㻝㼤㻝㻜
㻡㻝㼤㻝㻜
㻢
㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑㼂㼉
150.98MeV 178.84MeV114.9MeV 171.71MeV
Kishimoto, 2009
Ion Energy vs. Cluster RadiusCluster target scaling: ion energy ~
1/(cluster radius)
㻡
㼑㼚㼑㼞㼓㼥㻚㼢㼟㻚㼞㼍㼐㼕㼡㼟
㼍㼠㻌㼠㻩㻣㻜㻜㼒㼟㼑㼏
㻝㻚㻣㼤㻝㻜㻡
㻝㻚㻤㼤㻝㻜㻡
㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑㼂㼉
㻝㻚㻡㼤㻝㻜㻡
㻝㻚㻢㼤㻝㻜㻡
㼑㼂㼉
㻡
㻝㻚㻠㼤㻝㻜㻡
㻱㼚㼑㼞㼓㼥㻌㼇㼗㼑
Kishimoto Tajima
㻝㻚㻞㼤㻝㻜㻡
㻝㻚㻟㼤㻝㻜㻡 Kishimoto,Tajima
(2009)
㻝㻚㻝㼤㻝㻜㻡
㻝㻡㻜 㻞㻜㻜 㻞㻡㻜 㻟㻜㻜 㻟㻡㻜 㻠㻜㻜 㻠㻡㻜 㻡㻜㻜
Radius [nm]
Conclusions�• Cancer: unsolved problem, as fundamental to biology�• Ion beam radiotherapy: superior cure to chemotherapy, though
expensive today�• Detection and cure of small unmetastasized tumor = future
(fundamental cure better quality of life better fit for compact laser(fundamental cure, better quality of life, better fit for compact laser accelerator)
�• Compact laser ion acceleration: niche for small tumors�• Breakthroughs in laser ion acceleration: overcomes the previous
paradigm (TNSA) with the new conditions�• Higher energies higher efficiency and less energy spreadHigher energies, higher efficiency, and less energy spread�• With compact laser (1020W/cm2) 100MeV protons possible�• Feedback therapy essential for small tumors�• Laser-driven compact coherent X-ray source : detect small tumors�• A lot more medical applications on the horizon
Merci Beaucoup et a la Prochaine Fois