The International Agency for Research on Cancer has estimated a 25% risk of tumor incidence in the European population. Cases are expected to rise, reaching 23.6 million new cancers per year by 2030, at a huge cost to the healthcare system and citizens. Prevention and early diagnosis remain essential tools, and nuclear imaging plays an important role in non-invasive diagnosis. At the same time, the treatment of tumors through radiotherapy with photons and charged particles is in continuous development. A deep synergy between the world of technological research, applied physics, and clinical practice has led to an increase in the quality of treatments thanks to the use of innovative irradiation/monitoring techniques and increasingly efficient and effective planning. Diagnostic imaging and tumor treatment with radiotherapy and innovative therapy are two fundamental aspects of this research line.

Improving the performance of nuclear imaging techniques plays a fundamental role. Theranostic medical imaging techniques exploit radiation to monitor physiological processes inside the patient’s body during radiotracer administration and potentially also in the subsequent phase, thanks to the development of wearable dosimetry.

Charged Particle Therapy (CPT) using protons and carbon ions is a well-established, valid alternative to photon radiotherapy (RT) for cancer treatment, in combination with or as an alternative to surgical removal and chemotherapy. However, the advantages of CPT treatments in the ballistic precision of dose delivery are not yet fully exploited. A large fraction of physicians and medical physicists still consider beam range uncertainty as one of the main obstacles to CPT becoming common practice, as large safety margins are required, reducing its potential impact and therapy effectiveness. In this context, the need arises to design, build, and test a detector capable of detecting multiple types of secondary particles—including protons, prompt photons, and neutrons—to monitor treatments. The project is ambitious, as there are currently no detectors capable of operating in real time; the advantage of a tracking detector is the ability to integrate a large number of tracks and then rely, during the reconstruction phase, on neural networks trained for this type of event.

This research line aims to contribute to the study of nuclear imaging techniques and the development of dedicated tools for measuring nuclear cross-sections, treatment monitoring, and the development of advanced computing and Artificial Intelligence tools for the planning and monitoring of innovative radiotherapy treatments.

Diagnostic Imaging

To overcome limitations, a wearable γ-ray detector is being developed, allowing dense temporal sampling of the washout time-activity curve (TAC). This approach enables the characterization of patient-specific pharmacokinetics, making it possible to personalize the activity to be administered in subsequent treatment cycles. To ensure patient compliance, the detectors are designed to be compact and lightweight, based on plastic scintillators doped with high atomic number (high-Z) elements. In this context, the feasibility and expected performance of the proposed detection system under clinically realistic conditions are studied through Monte Carlo simulations. Such a personalized approach could significantly increase the median survival of patients, currently standing at around 30 months.

Innovative Radiotherapy

CREF participates in the FOOT experiment, funded by INFN, which aims to measure the double-differential cross-sections in angle and energy for fragments produced by beams used in CPT on the constituent elements of human body tissue.

The primary goal of this research line is to develop a compact and reliable tracker to monitor in real time the secondary radiation produced during treatments. This device will make it possible to verify morphological changes in the patient, monitor the absorbed dose distribution and induced neutron radiation, utilizing an array of scintillating fiber trackers with customized electronics, optimized through fast Monte Carlo simulations.