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ADVANCED PARTICLE THERAPY CENTER FOR THE BALTIC STATES ( APTCB ) Development of a modern large-scale scientific research Core idea infrastructure and clinical treatment centre in the Baltic States of APTCB by integrating CERN-designed particle accelerator technology Aims To foster multidisciplinary research of To contribute to the breakthrough innovation development APTCB To provide cross-sectoral economic growth in the Baltic States Multi-functional facility Enabling broad research programme in domains Scientific research of clinical, natural and technological sciences institution Attracting highly skilled researchers from all Baltic States and beyond Providing the established proton therapy and Clinical treatment contributing to helium ion therapy research center Enabling novel radioisotope production for modern nuclear medicine approaches Increasing the capacity and “know-how” of Industry involvement local industries in particle accelerator technologies infrastructure Providing long term R&D possibilities for the establishment of a regional innovation ecosystem  Involved in APTCB initiative CERN Baltic Group NIMMS (Next Ion Medical Machine Study) Group of 14 scientific universities and research CERN-based initiative, working on cutting-edge institutions in the Baltic States - Estonia, Latvia particle accelerator technology development for a and Lithuania - with the aim of coordination new generation of compact and cost-effective of scientific collaboration with CERN, and ion-therapy facilities strenghtening of local scientific communities in high-energy physics and accelerator sciences Central focus: helium synchrotron technology Crucial collaborators as core of the APTCB Overall development of the initiative, facility is based upon technologies stakeholder engagement activities developed by NIMMS Envisioned infrastructure Clinical medical space Treatment beam Static Animal house with a gantry treatment beam + biology laboratories Helium Research synchrotron beamline Linear Ion accelerator sources NIMMS developed helium synchrotron ( HeLICS ) Radioisotope as the base of APTCB facility Technical space production area Multi-faceted motivation for APTCB initiative Scientific research driven Clinically driven APTCB has significant potential of delivering long-term socio-economic return as Big Science center Boosting local innovation ecosystems Enhancing the capacity of national economies to generate, adopt, and commercialize advanced technologies Providing environment for highly-skilled MedAustron facility workforce development Improving career prospects for early-stage Particle therapy centres in Europe, Developing high technology-driven research researchers, engineers and specialists ENLIGHT 2018 programmes in clinical sciences, medical physics, high-energy physics, nuclear physics, Delivering wide-ranging societal benefits, such Transformative clinical role by offering material sciences, radiochemistry, accelerator as public access to cutting-edge cancer advanced cancer treatment modalities physics and technologies and several other treatment therapies, cultural engagement and including: clinically established proton related fields technological spillovers therapy, emerging cutting-edge helium ion therapy, production of innovative Attracting international expertise Enabling economies of scale in knowledge radioisotopes for nuclear medicine generation Driving competence development in Enabling pre-clinical, clinical and radiobiology early-stage researchers Incentivizing innovation and product research development across industries Encouraging collaboration with high-tech Contributing to research necessary for industries and open science communities, clinical translation of novel approaches: contributing to the creation of a Baltic helium ion therapy, FLASH therapy, etc. innovation ecosystem Economically driven Improving therapeutic outcomes, minimizing side effects and elevating the standard of care  Main milestones Spring ’22 Development of the facility concept and dedicated working group Aug ’22 Baltic Assembly support - adressing the prime ministers of the Baltics Oct - Nov ’22 Bi-lateral stakeholder discussions in the three Baltic States May ’23 NIMMS HeLICS implementation in the Baltic States presented at the International Particle Accelerator Conference 25th of May ’23 Workshop at CERN: “Particle therapy - future for the Baltic States?” From the inception of the initiative: several discussions with different scientific universities, medical professional societies, and political stakeholders in the Baltic States Oct ’23 Report of the Workshop approved by the CERN Baltic Group Spring ’24 Workshop findings published in Health and Technology special issue focused on innovations in particle therapy From the start of 2024 Jan and Oct ’24 Presentation of the initative at Work towards CERN Medical Applications Steering Committee - proposal of the CERN engagement at the highest level Feasibility Study Apr ’24 Initial discussions with a potential collaborator - Heidelberg Ion-Beam Therapy center - currently the only institution globally with availability of helium ion therapy Throughout 2024 Collaborative effort with local radiotherapy facilities, University of Oxford and the International Agency for Research on Cancer to assess current practices in the Baltic States Dec ’24 The APTCB Feasibility Study Strategy Group is established by the CERN Baltic Group  Next significant milestone: Feasibility Study In order to proceed with this promising initiative, a full-scale Feasibility Study of the project is needed To investigate the feasibility of APTCB facility implementation Main aims of To identify and evaluate potential alternative solutions the Feasibility Study To provide a fact-based Feasibility Study Report to be used as the decision-making tool for the approval of APTCB facility Carried out by Baltic States scientific institutions, involving also Involved regional medical communities and organisations in relevant fields, researcher groups and all other relevant local and institutions international stakeholders, while consulting with international experts. CERN NIMMS - a close collaborator on the techology itself Expected duration 2 years Alternative solutions for the facility Clinics Education and Regulatory and Epidemiology and training legal approvals APTCB Economics Technology and and Innovation Implementation Risk analysis Information and and evaluation data flow Centralized co-ordination and funding between the 3 Baltic States is necessary for the launch of the Feasibility Study  APTCB Feasibility Study: Work plan CLINICAL TECHNOLOGY ECONOMICS AND AND AND EPIDEMIOLOGY IMPLEMENTATION INNOVATION Research programme in Research programme in Research on long-term clinical sciences natural and technical sciences funding, business engagement Relevant medical statistics Technical requirements of Organizational structure in the region the facility and governance model Eligibility criteria for proton Integration study and Full cost estimation and therapy future upgradability economic benefit analysis Patient referral, connections Basis of cost estimates for Evaluation of revenue streams with PT community the accelerator and the facility Researchers or PhD students Researchers or PhD students Researchers or PhD students from each of the Baltic countries from each of the Baltic countries from each of the Baltic countries TRANSVERSAL TASKS Alternative solutions for the facility Aspects on regulatory and legal approvals Risk analysis and evaluation Information flow between work groups for cost estimates Education and training necessities APTCB Feasibility Study: Organizational structure COLLABORATION BOARD SCIENTIFIC ADVISORY STAKEHOLDER ADVISORY BOARD STEERING COMMITTEE BOARD CERN Baltic Group named Feasibility Study Coordinator and Deputy Coordinator + 4 Working Group Coordinators + 1 Technical Expert from CERN 4 Working Group Coordinators + Involvement of Technical Expert from CERN Task Coordinators of Task Coordinators of Task Coordinators of Task Coordinators of “Clinics and Epidemiology” “Technology and Implementation” “Economics and Innovation” Transversal Tasks Working Group Working Group Working Group  APTCB Feasibility Study: Expected outcomes Risk analysis and risk management strategy Feasibility Study Finalized proposal for layout of the facility Report Finalized beam-time usage proposal Finalized list of selection criteria for the choice Summary of all the factual basis of the most suitable construction site collected during the investigation Initial proposal for the expected staging during the development of the facility The Feasibility Study Report is Initial basis for a business plan for the facility to be used as a decision making tool for the future of the Roadmap for the innovation and industry collaboration strategy APTCB project : facility construction and implementation of the proposal Roadmap for the regulatory compliance Reinforcement of the synergies between the different Baltic research groups and medical societies, while strengthening the collaboration between Baltic research groups and CERN Long-term timeline of APTCB 1. Design Should include the full APTCB facility with possible space for expansion 2. Staged construction and commisioning Stage a : L + I Stage b : L + I + S + R 20 – 30 years Stage c : L + I + S + R + F Stage d : L + I + S + R + F + G 3. “START - UP” phase Proton / helium ion research & proton treatment ( 1 shift/day ) 4. “RAMP - UP” phase Proton / helium ion research & proton/helium ion treatment ( 1 shift/day ) 5. FULL OPERATION phase L - Low energy accelerator I - Isotope production line and room Proton / helium ion research & proton/helium ion treatment ( 2+ shifts/day ) S - Synchrotron R - Research beamline and room 6. (Future expansion and Decommissioning) F - Fixed line G - Gantry treatment room ADVANCED PARTICLE THERAPY CENTER FOR THE BALTIC STATES Anchored in research excellence, the initiative provides an opportunity for transformative scientific and socio-economic development in the Baltic States Establishing the Baltic States as one of the leaders in accelerator-driven biomedical research Expanding Europe's capacity for clinical translation of helium ion therapy Enabling regional access to high technology based cancer care Fostering a local high-tech innovation ecosystem with global relevance UNIFYING OPPORTUNITY WITH ENORMOUS POTENTIAL FOR THE BALTIC STATES TULEVIKKU VAATAV KIIRITUSRAVI KESKUS BALTI RIIKIDELE ( ADVANCED PARTICLE THERAPY CENTER FOR THE BALTIC STATES - APTCB ) Luua mastaapne tulevikku vaatav teadustaristu ja kiiritusravi keskus APTCB Baltimaades, võttes kasutusele CERNis välja töötatud osakeste põhieesmärk kiirendamise tehnoloogia Tõhustada multidistsiplinaarseid teadusuuringuid APTCB Aidata kaasa murrangulisele innovatsioonile eesmärgid Toetada valdkonnaülest majanduskasvu Balti riikides Multifunktsionaalsus Võimaldada laiapõhjalisi teadusuuringuid arsti- ja terviseteaduste, loodusteaduste ning tehnika Teaduskeskus ja tehnoloogia valdkonnas Kaasata kõrgkvalifitseeritud teadlasi Baltimaadest ja kaugemalt Pakkuda prootonravi ja panustada heeliumioonravi arendamisesse Täppisravi keskus Radionukliidide tootmine tänapäevase nukleaarmeditsiini tarbeks Suurendada tööstusettevõtete võimekust ja oskusteavet osakeste kiirendite vallas Ettevõtlusinkubaator Pikaajalised teadus- ja arendustegevuse võimalused innovatsiooni ökosüsteemi loomiseks piirkonnas  APTCB algatuse osapooled CERNi Balti rühm NIMMS (Next Ion Medical Machine Study) Rühma kuulub 14 teadusülikooli ja uurimisasutust NIMMS on CERNi algatus tipptasemel Balti riikidest – Eestist, Lätist ja Leedust – osakestekiirendi tehnoloogi ja uue eesmärgiga koordineerida teaduskoostööd põlvkonna kompaktsete kulutõhusate CERNiga, tugevdamaks piirkonnas tegutsevaid ioonravi rajatiste arendamiseks teaduskogukondi kõrge energiaga füüsika ja kiirenditeaduste alal Keskne fookus: heeliumsünkrotroni tehnoloogia Võtmetähtsusega partnerid, sest APTCB Algatuse üldine arendamine, keskmeks on NIMMSi poolt välja sidusrühmade kaasamine arendatud tehnoloogiad Kavandatud taristu Raviruumid Kiiritusravi allikas Staatiline Vivaarium koos portaaliga kiiritus + bioloogia laborid Heelium- sünkrotron Uuringuseadmed Iooniallikad Lineaarkiirendi NIMMSi poolt välja töötatud heeliumsünkrotron Radionukliidide ( HeLICS ) on APTCB rajatise alus Tehnoruumid tootmine Laiapõhjaline vajadus APTCB loomiseks Teadusuuringud Meditsiiniline Suure teaduskeskusena on APTCB-l märkimisväärne potentsiaal kestva sotsiaal- majandusliku kasu toomiseks Innovatsiooni ökosüsteemide võimestamine lokaalsel tasemel Riikide majandusekasvu hoogustamine kõrgtehnoloogiate loomise ning nende rakendamise ja kommertsialiseerimise kaudu MedAustron Keskkonna loomine kõrge kvalifikatsiooniga tööjõu arendamiseks Osakeste kiiritusravi keskused Euroopas, Kõrgtehnoloogilised teadusuuringud arsti- ja Nooremteadlaste, -inseneride ja ENLIGHT 2018 terviseteadustes, meditsiinifüüsikas, kõrge -spetsialistide karjääri väljavaadete energia füüsikas, tuumafüüsikas, parandamine Transformatiivne meditsiiniline roll, materjaliteadustes, radiokeemias, pakkudes tulevikku vaatavaid kiirendifüüsikas ja -tehnikas ning mitmes Ühiskonna ja avalikkuse teenimine, tagades vähiravimeetodeid, sealhulgas: prootonravi, teises sidusvaldkonnas tipptasemel vähiravi kättesaadavuse, arendatavat tipptasemel heeliumioonravi, kultuurilise nihke ja tehnoloogiasiirde innovatiivseid radiofarmatseutikume Rahvusvaheliselt tunnustatud oskusteabe nukleaarmeditsiini jaoks kaasamine Oskusteabe loomisel mastaabisäästu võimaldamine Prekliinilised, kliinilised ja radiobioloogilised Nooremteadlaste pädevuste arendamin teadusuuringud Innovatsiooni ja tootearenduse ergutamine Koostöö ergutamine Uudsed siirdemeditsiini teadusuuringud kõrgtehnoloogiaettevõtetega ja avatud heeliumioonravi, FLASH-ravi jmt. alal teaduse kogukondadega, toetades Baltimaade innovatsiooniökosüsteemi Ravi tulemuslikkuse parandamine, loomist Majandusareng kõrvaltoimete vähendamine ja ravistandardite tõstmine  Peamised verstapostid Kevad 2022 APTCB rajatise kontseptsiooni loomine ja spetsiaalse töörühma moodustamine August 2022 Balti Assamblee toetus ja pöördumine kolme Balti riigi peaministrite poole Oktoober–november 2022 Kahepoolsed arutelud sidusrühmadega kolmes Balti riigis Mai 2023 Rahvusvahelisel osakeste kiirendite konverentsil esitleti NIMMS HeLICSi rakendamise kavatsust Baltimaades 25. mai 2023 CERNis toimus töötuba „Osakesteravi – tulevik Balti riikidele?“ Algusest alates: arutelud Balti riikide teadusülikoolide, meditsiinivaldkonna erialaühenduste ja poliitiliste sidusrühmadega Oktoober 2023 Töötoa aruande kinnitamine CERNi Balti rühma Kevad 2024 Töötoa tulemused avaldati poolt ajakirja Health and Technology erinumbris, mis keskendus osakesteravile Alates 2024. aasta Jaanuar ja oktoober 2024 Algatuse tutvustus algusest CERNi meditsiinirakenduste juhtkomitees – Teostatavusuuringu CERNi kõrgeimal osalustasemel ettepaneku ettevalmistamine Aprill 2024 Esmased arutelud võimaliku koostööpartneriga, Heidelbergi Ioonravi Keskusega, mis ainsa asutusena maailmas pakub heeliumiioonravi Läbi 2024. aasta Koostöö kohalike kiiritusravi osutajatega, Oxfordi Ülikooli ja Rahvusvahelise Vähiuuringute Agentuuriga, et hinnata praegust ravipraktikat Balti riikides Detsember 2024 CERNi Balti rühm moodustab APTCB teostatavusuuringu strateegiagrupi  Järgmine oluline verstapost: Teostatavusuuring Selle paljulubava algatuse arendamine eeldab täiemahulise teostatavusuuringu tegemist Uurida APTCB rajamise teostatavust Teostatavusuuringu Uurida ja hinnata võimalikke alternatiivseid lahendusi peamised eesmärgid Koostada faktipõhine teostatavusuuringu aruanne, mida kasutataks otsustustoena APTCB arendamise vaagimiseks Balti riikide teadusasutused, kaasates piirkonna Kaasatud meditsiinikogukondi ja valdkondlikke organisatsioone, uurimisrühmi ning teisi asjakohaseid kohalikke ja rahvusvahelisi asutused sidusrühmi ja rahvusvaheliselt tunnustatud eksperte. CERN NIMMS on vahetu koostööpartner tehnoloogia arendamisel Eeldatav kestus 2 aastat Rajatise alternatiivsed lahendused Ravi Haridus ja Regulatiivsed ja Epidemioloogia ja väljaõpe õiguslikud aspektid APTCB Majandus Tehnoloogia ja ja innovatsioon Rakendused Riskianalüüs Teabe- ja ja hindamine andmevoog Teostatavusuuringu käivitamiseks on vajalik kolme Balti riigi poolne tsentraliseeritud koordineerimine ja rahastamine  APTCB teostatavusuuring: Tööplaan RAVI TEHNOLOOGIA MAJANDUS JA JA JA EPIDEMIOLOOGIA RAKENDUSED INNOVATSIOON Arsti- ja terviseteaduslikud Loodusteaduslikud ja Kestva rahastuse ja uuringud tehnikateaduslikud uuringud ettevõtlusekaasamise analüüs Asjakohane tervise- ja Organisatsiooniline struktuur tervishoiuvaldkonna statistika Tehnilised nõuded rajatisele ja juhtimismudel Integratsiooniuuring ja Terviklik kuluhinnang ja Prootonravi näidustused majandusliku kasu analüüs tulevased uuendused Patsientide suunamine, ühenduse pidamine Kiirendi ja rajatise maksumuse Rahavoogude analüüs prootonravi kogukonnaga hindamise põhimõtted Teadurid või doktorandid Teadurid või doktorandid Teadurid või doktorandid igast Balti riigist igast Balti riigist igast Balti riigist LÄBIVAD ÜLESANDED Rajatise alternatiivsed lahendused Regulatiivsed ja õiguslikud aspektid Riskianalüüs ja -hindamine Teabevoog valdkondadevaheliste kuluhinnangute jaoks Hariduse ja väljaõppe vajadused APTCB teostatavusuuring: Organisatsiooniline struktuur KOOSTÖÖNÕUKOGU SIDUSRÜHMADE TEADUSNÕUKODA JUHTKOMITEE CERNi Balti rühma poolt nimetatud teostatavusuuringu NÕUKODA koordinaator ja koordinaatori asetäitja + 4 töögruppide koordinaatorit + 1 tehniline ekspert CERNist 4 töögruppide koordinaatorit + CERNist kaasatud tehniline ekspert „Ravi ja epidemioloogia“ „Tehnoloogia ja rakenduste“ „Majanduse ja innovatsiooni“ Läbivate ülesannete töögrupi ülesannete töögrupi ülesannete töögrupi ülesannete töögrupi koordinaatorid koordinaatorid koordinaatorid koordinaatorid  APTCB teostatavusuuring: Oodatavad tulemused Riskianalüüsi ja riskijuhtimise strateegia Teostatavusuuringu Rajatise põhiplaani lõplik kavand aruanne Kiirgusvoo kasutusaja lõplik kavand Lõplik loetelu rajatisele sobivaima asukoha Kõigi tasuvusuuringu käigus leidmise valikukriteeriumitest kogutud faktipõhiste andmete Esialgne ettepanek rajatise arenduse etappide kokkuvõte kohta Rajatise äriplaani esialgsed aluspõhimõtted Teostatavusuuringu aruannet kasutatakse otsustustoena APTCB Innovatsiooni ja ettevõtluskoostöö strateegia teekaart projekti tuleviku vaagimiseks rajatise ehitamise ja kasutuselevõtmise kohta Regulatiivse vastavuse teekaart Sünergiate tugevdamine Baltimaade erinevate teadusgruppide ja meditsiinivaldkonnaerialaühenduste vahel, tihendades samaaegselt Baltimaade teadusgruppide ja CERNi vahelist koostööd APTCB pikk ajakava 1. Kavandamine Etapp d Etapp c Kiiritusravi allikas Staatiline Peaks hõlmama täielikult APTCB rajatise ja selle võimaliku koos portaaliga kiiritus laienemise 2. Etapiviisiline ehitus ja kasutuselevõtt Etapp a : L + I Etapp b Etapp b : L + I + S + R Heelium- 20 – 30 aastat Etapp c : L + I + S + R + F sünkrotron Uuringuseadmed Etapp d : L + I + S + R + F + G 3. Käivitusfaas Lineaarkiirendi Prootonite / heeliumi ioonide uurimine ja prootonravi (1 vahetus päevas) Iooniallikad 4. Võimendusfaas Radionukliidide tootmine Prootonite / heeliumi ioonide uurimine ja kiiritusravi prootonite/ heeliumi ioonidega (1 vahetus päevas) Etapp a 5. Täismahulise toimimise faas L - Madala energiaga kiirendi Prootonite / heeliumi ioonide uurimine ja kiiritusravi prootonite/ I - Isotoopide tootmisliin ja -ruum heeliumi ioonidega (2 või enam vahetust päevas) S - Sünkrotron R - Uurimisseadmed ja ruum 6. (Tulevane laienemine ja käitusest kõrvaldamine) F - Statsionaarne liin G - Portaalraviruum  TULEVIKKU VAATAV KIIRITUSRAVI KESKUS BALTI RIIKIDELE Tipptasemel teadusuuringutele tuginev algatus annab võimaluse Baltimaade murranguliseks teaduslikuks ja sotsiaalmajanduslikuks arenguks Tagada Balti riikidele juhtpositsioon kiirendipõhistes biomeditsiinilistes teadusuuringutes Laiendada Euroopa võimekust heeliumiioonravi kliiniliseks rakendamiseks Võimaldada piirkonnas kõrgtehnoloogial põhineva vähiravile kättesaadavus Edendada piirkonnas globaalse tähtsusega kõrgtehnoloogilist innovatsiooni ökosüsteemi BALTI RIIKIDE JAOKS TOHUTU POTENTSIAALIGA ÜHENDAV VÕIMALUS CERN Baltic Group Proposal for Feasibility Study of Advanced Particle Therapy Centre for the Baltics Implementation plan Document has been prepared by CERN Baltic Group "Advanced Particle Therapy Centre for the Baltic States" (APTCB) and "Advanced Particle Therapy Centre for the Baltic States: Feasibility Study Strategy Group" (APTCB FSSG) Working Groups: Convener of the APTCB WG: Prof. Toms Torims (Riga Technical University, LV) Deputy Convener of the APTCB WG: Prof. Diana Adlienė (Kaunas University of Technology, LT) Convener of the APTCB FSSG WG: Assoc. Prof. Erika Korobeinikova (Lithuanian University of Health Sciences, LT) Deputy Convener of the APTCB FSSG WG: Kristaps Palskis (Riga Technical University, LV) Assoc. prof. Brigita Abakevičienė (Kaunas University of Technology, Convener of CERN Baltic Group, LT) Assoc. prof. Karlis Dreimanis (Riga Technical University, Deputy Convener of CERN Baltic group, LV) Dr. Maurizio Vretenar (CERN, CH) Dr. Alberto Degiovanni (Riga Technical University, LV) Dr. Andris Ratkus (Riga Technical University, LV) Prof. Saulė Mačiukaitė-Žvinienė (Vilnius University, LT) Dr. Giedrė Kvedaravičienė (Vilnius University, LT) Dr. Eduard Gershkevitsh (North Estonia Medical Centre, EE) Prof. Maija Radziņa (University of Latvia and Riga Stradins University, LV) Dr. Jevgenijs Proskurins (Riga Stradins University, LV) Dr. Gediminas Stankūnas (Lithuanian Energy Institute, LT) Dr. Andrius Tidikas (Lithuanian Energy Institute, LT) Assoc. prof. Elīna Pajuste (University of Latvia, LV) Prof. Kristaps Jaudzems (University of Latvia, LV) Dr. Šarūnas Meškinis (Kaunas University of Technology, LT) Dr. Erika Rajackaitė (Kaunas University of Technology, LT) Assoc. prof. Laimonas Jaruševičius (Lithuanian University of Health Sciences, LT) Dr. Jonas Venius (National Cancer institute, LT) Dr. Juras Kišonas (National Cancer institute, LT) Prof. Sergei Nazarenko (Tallinn University of Technology, EE) Assoc. prof. Fjodor Sergejev (Tallinn University of Technology, EE)  Executive summary Overview particle accelerator research facility would The Advanced Particle Therapy Centre for the bridge gap in scientific research, technological Baltics (APTCB) is an initiative established in and healthcare domains. It would expand the 2022 by CERN Baltic Group (CBG). The main access to advanced cancer therapies and enhance goal of the initiative is to develop a modern participation of regional scientific groups in EU- large-scale scientific research infrastructure, funded research and innovation programmes. often referred to as Big Science Centre, and Clinical Potential clinical treatment centre in the Baltic States by The European Commission’s Mission on integrating CERN NIMMS designed HeLICS Cancer (2023) underscores the urgency of particle accelerator technology. Proposed reducing inequalities in cancer care across infrastructure would foster multidisciplinary Member States. The APTCB could play a research, contribute to the breakthrough transformative role by offering advanced cancer innovation development, cross-sectoral treatment modalities including: economic growth, and strengthen regional • clinically established proton therapy; integration of Baltic States into the European • emerging cutting-edge helium ion therapy; Research Area. • production of innovative radioisotopes for At this stage, a dedicated, scientifically and nuclear medicine. factually driven Feasibility Study is necessary APTCB would also contribute to research to consider any future developments of the necessary for clinical translation of other novel initiative and envision such a facility. The main approaches such as FLASH therapy. goal of the Feasibility Study would be to These technologies mark a new era in high- investigate the feasibility of implementation of precision oncology, improving therapeutic the proposed facility and possible scenarios. outcomes, minimizing side effects, and elevating This document presents the overall concept of the standard of care. Their implementation would the envisioned centre, rationale of its also foster innovation in medical technologies development, with the focus on the proposed and high-impact clinical and fundamental design of the planned Feasibility Study. research. Strategic Relevance. Alignment with EU Multidisciplinary Research priorities Equally central to the APTCB’s mission is the The APTCB would serve as a catalyst for promotion of world-class research beyond deep-tech commercialization, industrial clinical research. The facility would form a solid collaboration and the emergence of local high- base for high technology-driven research tech ecosystems in the Baltic States. programmes in medical physics, high-energy It aligns closely with EU strategic priorities in physics, nuclear physics, material sciences, healthcare innovation, cancer treatment, and radiochemistry, accelerator physics and medical artificial intelligence, contributing to the technologies and several other related fields. It reduction of regional disparities in research and would attract international expertise, drive development capacity. competence development in early-stage Addressing a Critical Regional Gap researchers and encourage collaboration with The absence of such a multi-disciplinary high-tech industries and open science large-scale infrastructure in the Baltic States communities, contributing to the creation of a places the region at a significant disadvantage Baltic innovation ecosystem. compared to Western Europe. A dedicated  Proposal for Feasibility Study Implementation Plan Economic Impact Feasibility Study is to be led by Baltic Big Science Centres have demonstrated their scientific institutions in close collaboration with potential to deliver long-term socio-economic CERN. Feasibility study will also involve both returns. The APTCB could provide the following local and international stakeholders through the benefits: Stakeholder Advisory Board. To ensure • boost innovation ecosystems and enhance communication with international experts, the capacity of national economies to Scientific Advisory Board will also be formed by generate, adopt, and commercialize advanced renowned experts in relevant domains of APTCB technologies; initiative. The technical design for full-scale • provide environment for high-skilled implementation will be based on CERN NIMMS workforce development, including upskilling HeLICS technology, while alternative and improved career prospects for early-stage approaches will be investigated. researchers, engineers, and professionals in Feasibility Study will be structured in 3 core various fields; Working Groups focusing investigations on • deliver wide-ranging societal benefits, such as crucial domains of the facility: public access to cutting-edge cancer treatment • clinical needs and regional epidemiology therapies, cultural engagement, and assessment; technological spillovers; • technological aspects and • create public value through Big Science implementation of it; infrastructure, enabling economies of scale in • economics and innovation. knowledge generation and incentivizing Each Working Group will address scientific, innovation and product development across clinical, and innovation aspects of the respective industries. domain. Additionally, transversal tasks will Stakeholder Support cover legal frameworks, risk analysis, The initiative has progressed through the coordination, education planning, and alternative dedicated efforts of two Working Groups within implementation approaches, combing inputs CBG and has secured strong backing from from 3 Working Groups. stakeholders across the medical, scientific, and The study would be also benchmarked policy sectors in the Baltic States. against leading European centres such as CNAO, Framework of the Feasibility Study MedAustron, and HIT, to ensure optimized A dedicated, scientifically and factually driven technology investment, cost-effective Feasibility Study is essential to assess the operations, and sustainable business models. viability and implementation scenarios of the The duration of the Feasibility Study is proposed APTCB facility. Outcome of it - a planned to be two years, while earlier termination comprehensive Feasibility Study Report - will is possible upon finishing investigations. support informed decision-making on continuation of the initiative. Proposal for Feasibility Study Implementation Plan Health and Technology (2024) 14:965–972 https://doi.org/10.1007/s12553-024-00875-2 ORIGINAL PAPER “Particle therapy - future for the Baltic states?” – synthesis of the expert workshop report Kristaps Paļskis1,2 · Erika Korobeinikova3,4 · Dace Bogorada-Saukuma5 · Anna Maria Camarda6 · Rebecca Taylor2,7 · Elena Benedetto8,9 · Edgars Mamis2,10 · Maija Radziņa10,11,12 · Andrejs Ērglis10 · Diana Adliene13 · Manjit Dosanjh2,14 · Maurizio Vretenar2 · Toms Torims1 Received: 8 March 2024 / Accepted: 19 April 2024 / Published online: 6 May 2024 © The Author(s) 2024 Abstract Background Baltic States remains one of the few regions in the Europe without a dedicated particle therapy center. An initiative since 2021 has been started by CERN Baltic Group on a novel particle therapy center development in the region in partnership with CERN NIMMS collaboration. With a conceptual design idea in early 2022 and stakeholder engagement activities in late 2022 - next step forward was necessary for the initiative for a more in-depth analysis. Methods A dedicated workshop “Particle therapy - future for the Baltic States? State-of-play, synergies and challenges” was held. The workshop was attended by medical community from the Baltics, as well as CERN technical experts and par- ticle therapy practicing clinicians, with scientific programme split in 5 main areas of investigation. Results Current cancer epidemiology statistics and RT technological possibilities in the region were analyzed, with first estimates of eligible number of patients calculated. Technological development level of the proposed accelerator complex was discussed, as well the clinical needs and synnergy possibilities with the nuclear medicine field. Conclusions The current state and calculated first estimates presented here have shown a promising starting point, which prompts even further in-depth work – a feasibility study for development of a novel particle therapy center in the Baltic States. 1 Background and introduction deaths globally in 2020 [1]. In 2022 alone, 19.98 million new cancer cases and 9.3 million cancer deaths were reg- According to data of the World Health Organization istered [2]. Throughout the years, various regions around (WHO), cancer remains one of the most significant causes the world have seen an increase in the incidence rates, with of death globally – accounting for nearly one in every six current estimates predicting an increase of almost 3 times 7 Kristaps Paļskis Imperial College London, London, United Kingdom [email protected] 8 SEEIIST Association, Geneva, Switzerland 1 9 Riga Technical University, Riga, Latvia Fondation Tera-Care, Geneva, Switzerland 2 10 European Organization for Nuclear Research (CERN), University of Latvia, Riga, Latvia Meyrin, Switzerland 11 Latvian Radiology Association, Riga, Latvia 3 Lithuanian University of Health Sciences, Kaunas, Lithuania 12 Riga Stradins University, Riga, Latvia 4 Lithuanian Society for Radiation Therapy, Kaunas, Lithuania 13 Kaunas University of Technology, Kaunas, Lithuania 5 Latvian Therapeutic Radiology Association, Riga, Latvia 14 University of Oxford, Oxford, United Kingdom 6 The National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy 13 966 Health and Technology (2024) 14:965–972 by year 2050–58.6 million cases globally [3]. With global costs of particle accelerator used. Currently, approximately cancer burden expected to grow, effective cancer manage- 130 centres in the world offer PT, out of which only 13 offer ment strategies are to be considered in healthcare systems the unique opportunities of carbon ion therapy [9], while and novel treatment methods to be explored and researched. many new development projects are in construction or plan- Out of the three primary methods for cancer treatment – ning stages. surgery, chemotherapy and radiotherapy (RT) – RT as treat- Analysing access to particle therapy, the Baltic States ment modality in course of care is beneficial and required – Lithuania, Latvia and Estonia – is one of the European in more than 50% of patients [4]. RT is frequently used in regions without a dedicated proton or carbon ion therapy the treatment of the most widespread cancer types – breast, treatment centre (see Fig. 1.). Therefore, in 2021, a collabo- lung, colorectal, cervical and others. Despite the benefits ration of research institutions and universities in the region of RT in cancer care path, the access to these technologies – CERN Baltic Group (CBG) [10] – started dedicated and globally is inadequate, especially in countries categorized as focused efforts on exploring possible particle therapy devel- low- or middle- income [4]. Even further, a specific modal- opment paths in the region. As the name suggests, the main ity of RT – particle therapy (PT), using positively charged goal of CBG is about strengthening collaboration of Baltic ions instead of gamma photons in conventional therapy – States with the European Organization for Nuclear Research has proven to be favourable in certain types of cancer. While (CERN). Already from first discussions, development of a clinical evidence base needs to be expanded further, proton dedicated facility, not a commercial solution, was deemed therapy has already shown benefits in the reduction of nor- more attractive for the region – providing more capabili- mal tissue complications in selected types of cancer and car- ties and research opportunities. Such a collaboration frame- bon ion therapy –in treatment of radioresistant and hypoxic work has already proven to be successful within the CERN tumours [5–8]. Despite this, the access to this type of treat- PIMMS study, which resulted in CNAO and MedAustron ment globally is even more challenging due to increased ion therapy centres [11]. Fig. 1 Particle therapy centres in Europe (ENLIGHT data, 2020) [12] 13 Health and Technology (2024) 14:965–972 967 Table 1 Overview of main cancer statistics metrics in the Baltic States Table 2 Cancer localizations with highest incidence rates (as percent- for year 2021 (2020, if specific data unavailable) age of total) in Lithuania and Estonia from 2018 to 2022 (numeri- Lithuania Latvia Estonia Total cal data are not provided for Latvia due to lack of national cancer of registry) region Lithuania Estonia Inhabitants (millions) 2.801 1.884 1.331 6.016 Cancer Prostate – 13% Non-melanoma Registered cancer cases 17,073 12,051 8907 38,031 localizations Non-melanoma skin cancer skin cancer – 15% Cancer deaths 8168 5892 3840 17,900 with – 13% Prostate – 12.9% highest Lung, trachea, bronchus – 9% Lung, trachea, Crude cancer incidence 610 640 669 632 incidence Breast – 9% bronchus – 9.6% rate (per 100 000) Colon – 6% Breast – 9.2% Crude cancer mortal- 292 313 289 298 Colon – 7.2% ity rate (per 100 000) As of data from 2021 (or 2020 depending on data avail- The initiative took the form of a dedicated working group ability within the country), the 3 Baltic States have a total “Advanced Particle Therapy centre for the Baltic States” of 6.02 million inhabitants with a total of 38,031 newly within CBG in April 2022. The conceptual design idea registered cancer cases and 17,900 cancer causes deaths - was developed by the working group in the spring of 2022. a crude (non-age-specific) cancer incidence and mortality Until the end of 2022, active engagement and discussions rate on average for region being 632 and 298 per 100 000 took place with relevant stakeholders – medical profes- inhabitants, respectively. Country specific data are given in sionals involved in RT, scientific university representatives Table 1. and involved political bodies. Following these events, key According to data collected for the year of 2020, a total areas were identified that should be taken as first for fur- of 13 045 patients within the 3 countries received RT (both ther exploration and in-depth analysis: statistics and overall external beam and brachytherapy) as part of their cancer situation with cancer management in the region and clinical treatment course – 6343, 4146 and 2556 for Lithuania, indications for PT eligibility, as well as technical aspects Latvia and Estonia, respectively. RT in the Baltic States is on proposed particle accelerator complex for such a facil- delivered with state-of-the-art linear accelerators − 27 in ity and integration of another clinical area – nuclear medi- total for the region. Almost all the units are capable of deliv- cine. To address and work on these areas, workshop with ering modern RT techniques – intensity modulation (IMRT), medical professionals from the Baltic region, CERN techni- volumetrically modulated arcs (VMAT), as well as the high cal experts and PT practicing clinical representative from precision stereotactic techniques (SRS, SRT, SBRT) and CNAO was held on May 25th, 2023 at CERN - “Particle incorporating image guidance in therapy (IGRT). The num- therapy - future for the Baltic States? State-of-play, syner- ber of linear accelerator for RT for the given population gies and challenges”. can be deemed sufficient, in accordance with international The aim of this work is to present key findings and points guidelines (4 units per 1 million) [14], [15]. Data regard- made during the workshop, as well to indicate overall con- ing medical personnel working in RT practice was also col- clusions and future outlooks of the initiative. lected – a total of 86 radiation oncologists, 129 radiation therapy technologists (RTT) and 67 medical physicists in the 3 countries as of 2021. 2 Overview of current status of Additionally, more in-depth data were also collected, radiotherapy technologies in the Baltic such as percentage of incidence and mortality for certain States cancer types and cancer localizations typically treated with protons or carbon ions (paediatrics, brain tumours, head This section reports on key data presented regarding the and neck region and others). Cancer types with the highest cancer burden and RT treatment statistics within the region. incidence rate follow the global trends [2]: prostate, non- Data regarding cancer statistics and access to RT technolo- melanoma skin cancer, lung and breast cancer (see Table 2). gies – both diagnostic and treatment units, were collected Similarly, the trends are also followed for highest mortality during participation of Baltic States in the “Access to Radio- rate: lung, colorectal, stomach and liver. therapy Technologies” (ART) study during 2022, held by Exploring indications specific for particle therapy, more The International Cancer Expert Corps (ICEC) organization in-depth analysis was done regarding paediatric cancers. [13]. Additional data corresponding to aspects specific to PT Over the period 2018–2022, a total of about 1000 paediatric were collected in a tailored questionnaire to RT-practising cancer cases have been registered in the 3 countries, out of clinical institutions within the region. which about 1/5 (211 patients) have received RT as part of their treatment course. 41 of these patients were treated in 13 968 Health and Technology (2024) 14:965–972 the last reported year – 2022, with the most common indica- Although this is a very simplified approach, it does pro- tions being leukaemia, central nervous system tumours and vide first estimates for assessing the feasibility of PT in the lymphoma. region. According to the statistics of European PT centres [26], on average 223 adult patients and around 150 paediat- ric patients are treated per centre, as per data of 2020. First 3 Eligibility for particle therapy: statistics estimates do suggest that the number of PT eligible patients implications in Baltic States case from the Baltic States might be sufficient for such a facility. Though, more in-depth analysis should be done in the future Though various international guidelines exist from sources based on cancer incidence and RT practice for different can- such as the American Society for Radiation Oncology cer types in the clinics within the Baltic States. This is a (ASTRO) [16], as well as the healthcare systems of the currently on-going work and to be extended even further. United Kingdom [17] and Japan [18], overall, the most It should be noted, due to lacking clinical evidence in common indications for particle therapy in treatment cen- particular cancer types, throughout the years alternative tres are central nervous system (CNS), skull base, head and methods have been developed for patient selection for PT. neck, and paranasal sinus tumours [5–8]. Clinical experi- Such examples are cost-effectiveness assessment, dosimet- ence was shared from The National Centre for Oncological ric comparison and recently emerging normal tissue compli- Hadrontherapy by Dr. Anna Maria Camarda, outlining clin- cation probability (NTCP) modelling. The latter approach ical indications with the highest benefit and existing clinical proves to be a beneficial estimation tool in head and neck evidence - skull base chordoma, chondrosarcoma, sinonasal tumours, with development efforts for algorithms as well carcinoma, brain tumours, head and neck tumours, radio- in brain, breast and other types of cancer [27–29]. As these resistant tumours and others [19]. For future perspectives, tools would be highly beneficial in the case of the Baltic particle therapy could also provide clinical benefits in the States, the necessity of modern cancer registries becomes of treatment of lymphoma, lung, breast, and prostate can- uttermost importance. cers. However, a significant increase in clinical evidence is needed, as the current evidence is either conflicting, incon- clusive, or lacking in general [19, 20]. 4 A novel path – helium ion therapy In order to provide initial estimates of eligible number of cancer patients for PT, a literature review was conducted to From the technical perspective, the core technology consid- study possible mathematical estimation approaches. Results ered for development of such a facility is the helium synchro- of the literature review study are summarized in Table 3. tron – a compact medical synchrotron in active development Based on the data provided in the Table 3 and the data by the Next Ion Medical Machine Study (NIMMS) collabo- collected previously – 13,045 RT receiving patients in year ration [30] at CERN. The choice of helium-4 ions as the 2020 for all 3 countries, one can do a simple mathematical design particle for the machine has been made to address estimate: the recent re-emergence of interest in application of this ion type for cancer therapy. A clear research interest can be seen ● based on Burnet et al. estimates [22]: around 196 pa- in ion therapy centres both in Europe and Asia [31–33]. As tients eligible; the role of helium ion therapy for cancer treatment is yet ● based on Glimelius et al. estimates [23]: around 1957 to be explored, particle accelerator systems for helium ion patient eligible. therapy would be highly beneficial to allow the necessary clinical research. From clinical perspective, use of helium-4 ions for can- Table 3 Overview of publications studying RT patient eligibility for cer therapy was already explored in the early stages of PT PT back at Lawrence Berkley National Laboratory [34], with Percentage of patients esti- the current renaissance mainly emerging from Heidelberg mated to benefit from PT Ion Therapy centre, with the first patient treated in 2022 Ebner et al. (2022) [21] 2.2% of RT patients (consid- ered eligible and treated) [31]. From a physical perspective, use of helium ions com- Burnet et al. (2020) [22] 1.5% of RT patients (consid- pared to protons could greatly increase the dose conformal- ered eligible and treated) ity due to reduced range straggling and lateral scattering Glimelius et al. (2005) [23] 14–15% of RT patients (con- (see Fig. 2.) and also increase the biological effectiveness. sidered eligible due to benefit) While in comparison to carbon ion beams, helium provided Burnet et al. (2022) [24] 4.3% of RT patients (consid- reduced fragmentation tail and more importantly - smaller ered eligible due to benefit) and less demanding accelerator system would be necessary. Lee et al. (2021) [25] 10% of RT patients (treated) 13 Health and Technology (2024) 14:965–972 969 Fig. 2 Comparison of physical percentage depth doses for vari- ous types of ionizing radiation Early treatment plan modelling studies have indeed shown facility allows more customizability and opportunities for helium-4 ions as a possible evolution of proton therapy, research and skill development of the personnel. Most of reducing the normal tissue toxicity in certain clinical sce- the components necessary for the technology are rather narios [35–37]. standard, with additional R&D mainly required for FLASH One of the main design considerations for the develop- delivery: beam extraction, beam delivery system and deliv- ment of this accelerator is also to reduce the footprint of ery method itself, as well as dosimetry, beam monitoring the facility and the cost, compared to carbon ion therapy and other safety systems. With these unique opportunities, facilities. The technology under development is a compact such a facility would allow development of a vast program normal conducting (1.65 Tesla magnets) synchrotron with both in clinical domain and scientific research. an estimated footprint of about 2200 m2 [38]. The system is designed for acceleration of fully stripped helium-4 ions with treatment relevant energies up to 220 MeV/u, with the 5 Beyond particle therapy – possible possibility of proton acceleration, as well, correspondingly integration of nuclear medicine to energies of about 700 MeV, thus usable for full-body radiography applications and research. A flexible extraction Although the core function of the accelerator complex is system is foreseen, able to deliver ultra-high dose rates suit- the use in particle therapy, as mentioned, the dual func- able for the novel FLASH therapy. The linear accelerator tion linear accelerator will also allow parallel production injector system could also provide novel dual functionality, of radioisotopes for nuclear medicine. The usage of a lin- being able to produce radioisotopes for nuclear medicine. ear accelerator would allow more efficient production with A schematic representation of the preliminary design of a deuteron and alpha particle beams compared to cyclotrons facility incorporating the proposed accelerator is given in due to increased beam transmission [38, 39]. Production of Fig. 3. In the preliminary design of the facility two treat- radioisotopes would be completely independent from the ment rooms are foreseen, with a dedicated beam-line for ion therapy and scientific research functions, as it would be research, though possible adaptations can be considered in done with additional beam pulses in the linear accelerator further development stages of the initiative. structure only. Operation mode for the synchrotron is fore- Although the design particle of the machine is helium-4 seen at 1 Hz, while for the linear accelerator – at 50 Hz. As ion, the synchrotron could also deliver clinically established the linear accelerator can be modulated on pulse-to-pulse proton therapy as for helium-4 ion usage the process of clin- basis, the beam can be independently adapted for the differ- ical trials is yet to start. Adopting such a design for a clinical ent functions of the facility [38, 39]. 13 970 Health and Technology (2024) 14:965–972 Fig. 3 Preliminary layout of the proposed facility using helium synchrotron While various radioactive isotopes for production have a unique opportunity for the region to evolve both in clini- been considered from the technical possibility perspective, cal and scientific research capacity. From the technological survey data from clinical users were presented within the point of view, the accelerator complex provides customiz- framework of the PRISMAP Consortium [40–42]. With a ability to user needs, vast research spectrum possibilities, total of 114 respondents from 30 European countries and while keeping R&D risk minimal owing to standard tech- 104 different institutions (out of which 48 respondents from nology usage in the design. The customizability also cor- research institutions and 40 clinical institutions) the main responds to the envisioned usage of such a facility – both as interests and demands for the future in nuclear medicine a scientific research centre and a clinical treatment facility. are for theragnostic and targeted alpha therapy isotopes – One of the key considerations before further developments actinium-225 and other alphas emitters, copper-64 and iso- was, of course, whether the number of patients eligible for topes from scandium and terbium families. Possible use of particle therapy would be sufficient to run such a facility. such isotopes would also be a novelty for the Baltic States, The first estimates presented here have shown a promising as currently only more conventional isotopes are used such starting point, which prompts for more in-depth analysis of as fluorine-18, technetium-99m, iodine-123 and iodine-131, this aspect in the future. lutetium-177, radium-223. An important aspect regarding the availability of cancer Integrating these clinical interests into the technical statistics data for such an initiative was also put forward. For design of the facility is highly important. As production of long-term goals of this initiative, development strategies are non-conventional isotopes could be done in the proposed needed to provide state-of-the-art national cancer registries. facility, possible export pathways should be considered in Improvements can be considered for the existing registries co-operation with the 2 soon-operational cyclotron produc- in Lithuania and Estonia, though this aspect is even more tion facilities in Lithuania and Latvia [43][44]. important in Latvia, as currently a dedicated registry is lack- ing, which already complicated some of the data collection 5.1 Findings of the workshop. Future outlooks procedures. A consensus within the workshop was reached that the creation and improvement of national cancer regis- Development of a particle therapy centre within the Baltic tries are crucial for the success of such a proposed facility, States based on NIMMS helium synchrotron technology is as this data is necessary to make joint decisions between the 13 Health and Technology (2024) 14:965–972 971 Code availability Not applicable. 3 Baltic States on the number of eligible patients, as well as patient referral and reimbursement system functioning. Declarations From a clinical perspective, strengthening the support of the Baltic medical community for this initiative is crucial. Ethics approval Not applicable. A long-term project of this scale cannot be planned without clear and direct support from the medical communities of Consent to participate Not applicable. the region. Throughout the workshop, the importance of scientific Consent for publication Not applicable. research function was discussed heavily, as well. As the Competing interests The authors have no relevant financial or non- helium synchrotron would be a custom-made particle accel- financial interests to disclose. erator, the scientific research function of the proposed facil- ity is of high importance, with a broad programme to be Open Access This article is licensed under a Creative Commons foreseen. Pre-clinical and clinical research will be of high Attribution 4.0 International License, which permits use, sharing, importance to develop the role of helium ion therapy in adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the cancer treatment. The facility would also provide research source, provide a link to the Creative Commons licence, and indicate opportunities in medical physics, dosimetry, accelerator if changes were made. The images or other third party material in this physics, and related technology development, while the use article are included in the article’s Creative Commons licence, unless of the linear accelerator for radioisotope production – in indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended nuclear medicine, nuclear physics, radiochemistry, material use is not permitted by statutory regulation or exceeds the permitted science, and others. The proposed facility has a large scien- use, you will need to obtain permission directly from the copyright tific research potential, thus a more detailed programme is holder. To view a copy of this licence, visit http://creativecommons. to be developed in the future within the foreseen feasibility org/licenses/by/4.0/. study, as discussed next. Findings of the workshop have gathered support both from medical communities and political bodies within the References Baltic States for further investigations of the feasibility of 1. Cancer. accessible online: https://www.who.int/news-room/ such a facility. Such investigations are planned to be carried fact-sheets/detail/cancer. out in a dedicated longer-term feasibility study done by Bal- 2. Cancer Today. accessible online: https://gco.iarc.fr/today/. tic States specialists and researchers in close collaboration 3. Cancer Tomorrow. accessible online: https://gco.iarc.fr/ with CERN experts. The length of the feasibility study is tomorrow/. 4. World Health Organization. Technical specifications of Radio- envisioned to be 2 years, with the finalization of the pro- therapy Equipment for Cancer Treatment. 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Langendijk JA, Lambin P, De Ruysscher D, Widder J, Bos M, dictional claims in published maps and institutional affiliations. Verheij M. Selection of patients for radiotherapy with protons 13 CERN Baltic Group https://indico.cern.ch/category/10023/ September 16, 2025 To: Ministry of Social Affairs of the Republic of Estonia Support Request for Feasibility Study of Advanced Particle Therapy Centre for the Baltic States (APTCB) We are pleased to present the initiative of national and regional importance in scientific research excellence – “Advanced Particle Therapy Center for the Baltic States (APTCB)”. As the initiative has reached the stage of launching the dedicated Feasibility Study, we would like to invite Ministry of Social Affairs of the Republic of Estonia to consider possibilities of co-funding this next stage. APTCB initiative aims to strengthen the economic competitiveness of the Baltic States by fostering broad, multi-disciplinary research programme development, contributing to the breakthrough innovation development and strengthening integration of the Baltic States in a broader European scientific research network. Additionally, the initiative aims to minimize inequalities in access to advanced cancer care in the Baltic States, by enabling high precision radiation oncology modalities - improving therapeutic outcomes, minimizing side effects, and elevating the standard of care. To address these aspects, the main goal of APTCB initiative is the development of a large- scale scientific research infrastructure in the Baltic States. With dual functionality, proposed infrastructure enables the state-of-the-art clinical cancer treatment with particle therapy. The initiative aligns closely with the strategic European Union priorities in healthcare innovation and cancer treatment, contributing to the reduction of regional disparities in research and development capacity. The initiative is developed by the CERN Baltic Group – union of 14 universities and research institutions within the Baltic States – in close collaboration with NIMMS (Next Ion Medical Machine Study) group in CERN (European Organization for Nuclear Research). An interest in support of APTCB has been expressed by the following research institutions of CERN Baltic Group, providing solid ground and leadership on academia side for successful cooperation: ● in Estonia: Tallinn University of Technology, National Institute of Chemical Physics and Biophysics, and University of Tartu. ● in Latvia: Riga Technical University, University of Latvia, Riga Stradins University, Ventspils University of Applied Sciences, and Daugavpils University. ● in Lithuania: Vilnius University, Kaunas University of Technology, Vytautas Magnus University, Lithuanian Energy Institute, Lithuanian University of Health Sciences, and National Cancer Institute. Recognizing the multi-disciplinarity, high complexity and investments associated with such infrastructure, the next essential step in the development of the APTCB initiative is the launch of a comprehensive Feasibility Study. To support sustained involvement of researchers from the Baltic States, national co-funding of approximately 300,000 EUR to 400,000 EUR per country (Lithuania, Latvia, and Estonia) over a period of two to three years is estimated, based on recommendation by the Baltic Assembly (see below). The Feasibility Study for the APTCB initiative at large would act as catalyst for development of high-impact research and regional innovation ecosystem, contribute to long-term healthcare improvement and development of highly skilled professionals, while attracting regional and international talent. Feasibility Study will be conducted within the framework of CERN Baltic Group and performed by personnel of involved scientific institutions in the Baltic States, while ensuring strong collaboration on technology development with CERN NIMMS group throughout the duration. The aim of the Feasibility Study is to provide a comprehensive, scientifically and factually driven Feasibility Study Report, that would be used as the basis for informed decision-making on further development of APTCB initiative. For a more detailed plan of the Feasibility Study, please, consult the enclosed brochure. As indicated in the brochure, the initiative has been presented and discussed at various national and regional stakeholder levels. It should be noted that since 2022, the initiative has received strong formal support from the Baltic Assembly, underscoring the strategic importance of APTCB for strengthening scientific research excellence and regional collaboration in the Baltic States: ● Resolution of the 41st Session of Baltic Assembly (2022); ● Resolution of the 42nd Session of Baltic Assembly (2023); ● Resolution of the 43rd Session of Baltic Assembly (2024); ● Resolution of the 44th Session of Baltic Assembly (2025) (in progress). Baltic Assembly calls on the parliaments and governments of the Republic of Estonia, the Republic of Latvia, and the Republic of Lithuania, as well as the Baltic Council of Ministers to: ● Secure the necessary funding for the implementation of a full-scale Feasibility Study of the joint initiative of the CERN Baltic Group and CERN on the APTCB; ● Engage the corresponding ministries, national agencies and relevant stakeholders and jointly apply for co-financing from the European Union for implementing the joint initiative of the CERN Baltic Group and CERN on the APTCB; ● Recommendation of national co-funding of approximately 300,000 EUR to 400,000 EUR per country (Lithuania, Latvia, and Estonia) over a period of two to three years. The Feasibility Study Strategy Group (FSS) of the CERN Baltic Group would welcome the opportunity to present the APTCB initiative and the planned Feasibility Study in more detail - please use the contact data below for further arrangements. We are confident that the initiative aligns with Ministry’s of Social Affairs of the Republic of Estonia strategic priorities in science, healthcare, and innovation. In this context, we kindly ask for your involvement, providing political and financial support for the implementation of the Feasibility Study. Thank you for your consideration. Chair of the CERN Baltic Group Dr. Brigita Abakevičienė E-mail: [email protected] Phone: +370 686 07546 Saatja: "Brigita Abakevičienė" <[email protected]> Saaja: "Info - SOM" <[email protected]> Teema: Support Request for the Feasibility Study of Advanced Particle Therapy Centre for the Baltic States (APTCB) Kuupäev: 2025-09-16 07:20 Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga. Tundmatu saatja korral palume linke ja faile mitte avada. Dear Ministry of Social Affairs of the Republic of Estonia, On behalf of the CERN Baltic Group <https://indico.cern.ch/category/10023/> , we hereby send the Support Request for the Feasibility Study of Advanced Particle Therapy Centre for the Baltic States (APTCB). Enclosed: * Support request letter for the Feasibility Study of Advanced Particle Therapy Centre for the Baltic States (APTCB). * Full text of recent expert publication, outlining key aspects and highlighting the strategic significance of APTCB: Paļskis, K., Korobeinikova, E. et al. <https://doi.org/10.1007/s12553-024-00875-2> <https://doi.org/10.1007/s12553-024-00875-2> “Particle therapy - future for the Baltic states?” – synthesis of the expert workshop report, Health and Technology, 2024 <https://doi.org/10.1007/s12553-024-00875-2> – outlining key aspects of the initiative. * Brochures on APTCB initiative and Feasibility Study in Estonian and English. * Executive summary of the Feasibility Study Proposal. Sincerely Dr. Brigita Abakevičienė | Chair of the CERN Baltic Group Kaunas University of Technology Institute of Materials Science | <https://materials.ktu.edu/> https://materials.ktu.edu K. Barsausko st. 59, Room A-216, 51423 Kaunas, Lithuania +370 686 07546 | <mailto:[email protected]> [email protected] |