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Wang X, Lamberti G, Di Federico A, Alessi J, Ferrara R, Sholl ML, Awad MM, Vokes N, Ricciuti B. Tumor mutational burden for the prediction of PD-(L)1 blockade efficacy in cancer: challenges and opportunities. Ann Oncol 2024:S0923-7534(24)00084-X. [PMID: 38537779 DOI: 10.1016/j.annonc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/19/2024] [Accepted: 03/19/2024] [Indexed: 05/16/2024] Open
Abstract
Tumor mutational burden (TMB) is a biomarker that measures the number of somatic mutations in a tumor's genome. TMB has emerged as a predictor of response to immune checkpoint inhibitors (ICIs) in various cancer types, and several studies have shown that patients with high TMB have better outcomes when treated with programmed death-ligand 1-based therapies. Recently, the Food and Drug Administration has approved TMB as a companion diagnostic for the use of pembrolizumab in solid tumors. However, despite its potential, the use of TMB as a biomarker for immunotherapy efficacy is limited by several factors. Here we review the limitations of TMB in predicting immunotherapy outcomes in patients with cancer and discuss potential strategies to optimize its use in the clinic.
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Affiliation(s)
- X Wang
- Harvard T.H. Chan School of Public Health, Boston
| | - G Lamberti
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Di Federico
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - J Alessi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - R Ferrara
- University Vita-Salute San Raffaele, Milan; Department of Medical Oncology, IRCCS San Raffaele, Milan, Italy
| | - M L Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - M M Awad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - N Vokes
- Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, USA
| | - B Ricciuti
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA.
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Chaunzwa TL, Qian JM, Li Q, Ricciuti B, Zhang Z, Weiss J, Mackay J, Kagiampakis I, Bikiel D, Federico AD, Alessi J, Mak RH, Jacob E, Awad MM, Aerts H. AI-Derived CT Body Composition in Advanced Non-Small Cell Lung Cancer: A Multicohort Study. Int J Radiat Oncol Biol Phys 2023; 117:e10-e11. [PMID: 37784624 DOI: 10.1016/j.ijrobp.2023.06.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The relationship between body composition (BC) and cancer outcomes is complex and incompletely understood. Previous research in non-small cell lung cancer (NSCLC) has been limited to small single-institution studies, which have yielded inconsistent results. MATERIALS/METHODS We conducted a comprehensive multicohort analysis to evaluate the impact of BC on overall survival (OS) in advanced NSCLC treated with systemic therapy. The analysis included data from the phase I/II CP1108 study (NSCLC Durvalumab cohort) and the chemotherapy arm of the phase III MYSTIC trial. We also analyzed data from Dana-Farber Cancer Institute (DFCI) cohorts receiving immunotherapy alone or in combination with chemotherapy. Baseline and follow-up (FU) CT scans were collected and analyzed using deep neural networks for automatic L3 slice selection and body compartment segmentation (skeletal muscle [SM], subcutaneous adipose tissue [SAT], and visceral adipose tissue [VAT]). We compared OS based on baseline BC measures or their change at the first FU scan. The impact of sarcopenia at baseline was evaluated in association with the delta metrics. RESULTS A total of 1865 NSCLC patients were analyzed, of which 222 were treated on CP1108, 257 were treated on MYSTIC, 870 received IO monotherapy at DFCI (DFCI-IO), and 516 received chemoimmunotherapy at DFCI (DFCI-CIO). The median ages were 65, 63, 66, and 65, respectively. A loss in SM mass >5%, as indicated by a change in L3 SM area, was significantly associated with poorer OS across all patient groups (median [months]: 5 vs. 19; p<0.001 for CP1108, 11 vs. 14; p = 0.03 for MYSTIC, 11 vs. 17; p<0.001 for DFCI-IO, and 12 vs. 22; p<0.001 for DFCI-CIO). This effect was driven by male patients, with a non-significant association (p>0.5) among female patients in the MYSTIC and DFCI-CIO cohorts. An increase in SAT density >5%, as quantified by the average CT attenuation in HU of the SAT compartment, was significantly linked to poorer OS in three patient groups (median [months]: 4 vs. 19; p<0.001 for CP1108, 10 vs. 17; p<0.001 for DFCI-IO, and 12 vs. 20; p = 0.003 for DFCI-CIO). This was primarily observed among female patients, with a non-significant association (p>0.5) among male patients in the DFCI-CIO cohort. On subgroup analysis, loss in SM mass had an impact on OS in patients with baseline sarcopenia (median [months] 5 vs. 22; p<0.001 for CP1108, 5 vs. 12; p = 0.03 for MYSTIC, 11 vs. 17; p<0.001 for DFCI IO, and 9 vs. 17; p = 0.003 for DFCI-CIO). Conversely, no association was observed between change in SM mass and OS in patients without sarcopenia at baseline in the MYSTIC and DFCI-IO cohorts. CONCLUSION Sarcopenia and loss in SM mass during systemic therapy for NSCLC are markers of poor outcome, especially in male patients. SAT density changes are also strongly associated with prognosis, particularly in female patients. Automated CT-derived BC measurements should be considered along with other risk factors in determining lung cancer prognosis and ability to tolerate oncologic treatments.
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Affiliation(s)
- T L Chaunzwa
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - J M Qian
- Brigham and Women's Hospital and Dana-Farber Cancer Institute/ Harvard, Boston, MA, Boston, MA
| | | | - B Ricciuti
- Dana-Farber Cancer Institute, Boston, MA
| | - Z Zhang
- Dana-Farber Cancer Institute, Boston, MA
| | - J Weiss
- Artificial Intelligence in Medicine (AIM) Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | - J Alessi
- Dana-Farber Cancer Institute, Boston, MA
| | - R H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | | | - M M Awad
- Brigham and Women's Hospital and Dana-Farber/Harvard Cancer Center, Boston, MA
| | - H Aerts
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
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Alessi J, Elkrief A, Ricciuti B, Cortellini A, Wang X, Vaz V, Barrichello A, Lamberti G, Fulgenzi C, Pecci F, Pinato D, Schoenfeld A, Awad M. EP08.01-043 Clinicopathologic and Genomic Factors Impacting Efficacy of First-Line Chemoimmunotherapy in Advanced Non-small Cell Lung Cancer (NSCLC). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pecci F, Ricciuti B, Alden S, Alessi J, Vaz V, Barrichiello A, Lamberti G, Awad M. P1.15-03 Clinical Outcomes Among Patients with Non-small Cell Lung Cancer Who Discontinued Immune Checkpoint Inhibitors Due to Toxicity. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ricciuti B, Alessi J, Alden S, Recondo G, Nishino M, Sholl L, Awad M. FP03.03 ECOG PS of 0-1 and Very High PD-L1 Expression ≥90% Are Associated With Clinical Benefit From First-Line Chemo-Immunotherapy in Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Raparia D, Alessi J, Atoian G, Zelenski A. Charge neutralized low energy beam transport at Brookhaven 200 MeV linac. Rev Sci Instrum 2016; 87:02B935. [PMID: 26932107 DOI: 10.1063/1.4937766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The H(-) magnetron source provides about 100 mA H(-) beam to be match into the radio-frequency quadrupole accelerator. As H(-) beam traverses through low energy transport, it ionizes the residual gas and electrons are repelled and positive ions are trapped in the beam, due to negative potential of the beam, providing charge neutralization for the H(-) beam. The neutralization time for the critical density depends upon the background gas and its pressure. Critical density for xenon gas at 35 keV is about 43 times smaller than that of hydrogen and stripping cross section is only 5 times than that of hydrogen gas. We are using xenon gas to reduce neutralization time and to improve transmission through the 200 MeV linac. We are also using pulse nitrogen gas to improve transmission and stability of polarized H(-) beam from optically pumped polarized ion source.
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Affiliation(s)
- D Raparia
- Brookhaven National Laboratory, Upton, New York 11786, USA
| | - J Alessi
- Brookhaven National Laboratory, Upton, New York 11786, USA
| | - G Atoian
- Brookhaven National Laboratory, Upton, New York 11786, USA
| | - A Zelenski
- Brookhaven National Laboratory, Upton, New York 11786, USA
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Lettry J, Aguglia D, Alessi J, Andersson P, Bertolo S, Briefi S, Butterworth A, Coutron Y, Dallocchio A, David N, Chaudet E, Faircloth D, Fantz U, Fink DA, Garlasche M, Grudiev A, Guida R, Hansen J, Haase M, Hatayama A, Jones A, Koszar I, Lallement JB, Lombardi AM, Machado C, Mastrostefano C, Mathot S, Mattei S, Moyret P, Nisbet D, Nishida K, O'Neil M, Paoluzzi M, Scrivens R, Shibata T, Steyaert D, Thaus N, Voulgarakis G. Linac4 H⁻ ion sources. Rev Sci Instrum 2016; 87:02B139. [PMID: 26932021 DOI: 10.1063/1.4936120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
CERN's 160 MeV H(-) linear accelerator (Linac4) is a key constituent of the injector chain upgrade of the Large Hadron Collider that is being installed and commissioned. A cesiated surface ion source prototype is being tested and has delivered a beam intensity of 45 mA within an emittance of 0.3 π ⋅ mm ⋅ mrad. The optimum ratio of the co-extracted electron- to ion-current is below 1 and the best production efficiency, defined as the ratio of the beam current to the 2 MHz RF-power transmitted to the plasma, reached 1.1 mA/kW. The H(-) source prototype and the first tests of the new ion source optics, electron-dump, and front end developed to minimize the beam emittance are presented. A temperature regulated magnetron H(-) source developed by the Brookhaven National Laboratory was built at CERN. The first tests of the magnetron operated at 0.8 Hz repetition rate are described.
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Affiliation(s)
- J Lettry
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - D Aguglia
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - J Alessi
- Brookhaven National Laboratory, BNL-CA, Upton, New York 11973, USA
| | | | - S Bertolo
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - S Briefi
- AG Experimentelle Plasmaphysik, Universität Augsburg, 86135 Augsburg, Germany
| | | | - Y Coutron
- CERN-ABP, 1211 Geneva 23, Switzerland
| | | | - N David
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - E Chaudet
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - D Faircloth
- RAL, Harwell Oxford, Didcot OX11 0QX, United Kingdom
| | - U Fantz
- AG Experimentelle Plasmaphysik, Universität Augsburg, 86135 Augsburg, Germany
| | - D A Fink
- CERN-ABP, 1211 Geneva 23, Switzerland
| | | | - A Grudiev
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - R Guida
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - J Hansen
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - M Haase
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - A Hatayama
- Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan
| | - A Jones
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - I Koszar
- CERN-ABP, 1211 Geneva 23, Switzerland
| | | | | | - C Machado
- CERN-ABP, 1211 Geneva 23, Switzerland
| | | | - S Mathot
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - S Mattei
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - P Moyret
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - D Nisbet
- CERN-ABP, 1211 Geneva 23, Switzerland
| | - K Nishida
- Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan
| | - M O'Neil
- CERN-ABP, 1211 Geneva 23, Switzerland
| | | | | | - T Shibata
- Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan
| | | | - N Thaus
- CERN-ABP, 1211 Geneva 23, Switzerland
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Lettry J, Alessi J, Faircloth D, Gerardin A, Kalvas T, Pereira H, Sgobba S. Investigation of ISIS and Brookhaven National Laboratory ion source electrodes after extended operation. Rev Sci Instrum 2012; 83:02A728. [PMID: 22380237 DOI: 10.1063/1.3680078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Linac4 accelerator of Centre Européen de Recherches Nucléaires is under construction and a RF-driven H(-) ion source is being developed. The beam current requirement for Linac4 is very challenging: 80 mA must be provided. Cesiated plasma discharge ion sources such as Penning or magnetron sources are also potential candidates. Accelerator ion sources must achieve typical reliability figures of 95% and above. Investigating and understanding the underlying mechanisms involved with source failure or ageing is critical when selecting the ion source technology. Plasma discharge driven surface ion sources rely on molybdenum cathodes. Deformation of the cathode surfaces is visible after extended operation periods. A metallurgical investigation of an ISIS ion source is presented. The origin of the deformation is twofold: Molybdenum sputtering by cesium ions digs few tenths of mm cavities while a growth of molybdenum is observed in the immediate vicinity. The molybdenum growth under hydrogen atmosphere is hard and loosely bound to the bulk. It is, therefore, likely to peel off and be transported within the plasma volume. The observation of the cathode, anode, and extraction electrodes of the magnetron source operated at BNL for two years are presented. A beam simulation of H(-), electrons, and Cs(-) ions was performed with the IBSimu code package to qualitatively explain the observations. This paper describes the operation conditions of the ion sources and discusses the metallurgical analysis and beam simulation results.
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Affiliation(s)
- J Lettry
- CERN, 1211 Geneva 23, Switzerland.
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Pikin A, Alessi J, Beebe E, Kponou A, Okamura M, Raparia D, Ritter J, Tan Y, Kuznetsov G. Ion optics of RHIC electron beam ion source. Rev Sci Instrum 2012; 83:02A504. [PMID: 22380200 DOI: 10.1063/1.3666915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
RHIC electron beam ion source has been commissioned to operate as a versatile ion source on RHIC injection facility supplying ion species from He to Au for Booster. Except for light gaseous elements RHIC EBIS employs ion injection from several external primary ion sources. With electrostatic optics fast switching from one ion species to another can be done on a pulse to pulse mode. The design of an ion optical structure and the results of simulations for different ion species are presented. In the choice of optical elements special attention was paid to spherical aberrations for high-current space charge dominated ion beams. The combination of a gridded lens and a magnet lens in LEBT provides flexibility of optical control for a wide range of ion species to satisfy acceptance parameters of RFQ. The results of ion transmission measurements are presented.
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Affiliation(s)
- A Pikin
- Brookhaven National Laboratory, Upton, New York 11973, USA.
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Kondrashev S, Dickerson C, Levand A, Ostroumov PN, Pardo RC, Savard G, Vondrasek R, Alessi J, Beebe E, Pikin A, Kuznetsov GI, Batazova MA. Development of electron beam ion source charge breeder for rare isotopes at Californium Rare Isotope Breeder Upgrade. Rev Sci Instrum 2012; 83:02A902. [PMID: 22380243 DOI: 10.1063/1.3660823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Recently, the Californium Rare Isotope Breeder Upgrade (CARIBU) to the Argonne Tandem Linac Accelerator System (ATLAS) was commissioned and became available for production of rare isotopes. Currently, an electron cyclotron resonance ion source is used as a charge breeder for CARIBU beams. To further increase the intensity and improve the purity of neutron-rich ion beams accelerated by ATLAS, we are developing a high-efficiency charge breeder for CARIBU based on an electron beam ion source (EBIS). The CARIBU EBIS charge breeder will utilize the state-of-the-art EBIS technology recently developed at Brookhaven National Laboratory (BNL). The electron beam current density in the CARIBU EBIS trap will be significantly higher than that in existing operational charge-state breeders based on the EBIS concept. The design of the CARIBU EBIS charge breeder is nearly complete. Long-lead components of the EBIS such as a 6-T superconducting solenoid and an electron gun have been ordered with the delivery schedule in the fall of 2011. Measurements of expected breeding efficiency using the BNL Test EBIS have been performed using a Cs(+) surface ionization ion source for external injection in pulsed mode. In these experiments we have achieved ∼70% injection∕extraction efficiency and breeding efficiency into the most abundant charge state of ∼17%.
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Affiliation(s)
- S Kondrashev
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA.
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Bai M, Roser T, Ahrens L, Alekseev IG, Alessi J, Beebe-Wang J, Blaskiewicz M, Bravar A, Brennan JM, Bruno D, Bunce G, Courant E, Drees A, Fischer W, Gardner C, Gill R, Glenn J, Haeberli W, Huang H, Jinnouchi O, Kewisch J, Luccio A, Luo Y, Nakagawa I, Okada H, Pilat F, Mackay WW, Makdisi Y, Montag C, Ptitsyn V, Satogata T, Stephenson E, Svirida D, Tepikian S, Trbojevic D, Tsoupas N, Wise T, Zelenski A, Zeno K, Zhang SY. Polarized proton collisions at 205 GeV at RHIC. Phys Rev Lett 2006; 96:174801. [PMID: 16712305 DOI: 10.1103/physrevlett.96.174801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Indexed: 05/09/2023]
Abstract
The Brookhaven Relativistic Heavy Ion Collider (RHIC) has been providing collisions of polarized protons at a beam energy of 100 GeV since 2001. Equipped with two full Siberian snakes in each ring, polarization is preserved during acceleration from injection to 100 GeV. However, the intrinsic spin resonances beyond 100 GeV are about a factor of 2 stronger than those below 100 GeV making it important to examine the impact of these strong intrinsic spin resonances on polarization survival and the tolerance for vertical orbit distortions. Polarized protons were first accelerated to the record energy of 205 GeV in RHIC with a significant polarization measured at top energy in 2005. This Letter presents the results and discusses the sensitivity of the polarization survival to orbit distortions.
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Affiliation(s)
- M Bai
- Brookhaven National Laboratory, Upton, New York 11973, USA
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Bai M, Allgower C, Ahrens L, Alessi J, Brown K, Bunce G, Cameron P, Chu CM, Courant ED, Glenn JW, Huang H, Jeon D, Kponou AE, Krueger K, Luccio A, Makdisi YI, Lee SY, Ratner L, Reece K, Roser T, Spinka H, Syphers MJ, Tsoupas N, Underwood DG, Williams N. Observation of a hybrid spin resonance. Phys Rev Lett 2000; 84:1184-1187. [PMID: 11017474 DOI: 10.1103/physrevlett.84.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/1999] [Indexed: 05/23/2023]
Abstract
A new type of spin depolarization resonance has been observed at the Brookhaven Alternating Gradient Synchrotron (AGS). This spin resonance is identified as a strong closed-orbit sideband around the dominant intrinsic spin resonance. The strength of the resonance was proportional to the 9th harmonic component of the horizontal closed orbit and proportional to the vertical betatron oscillation amplitude. This "hybrid" spin resonance cannot be overcome by the partial snake at the AGS, but it can be corrected by the harmonic orbit correctors.
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Affiliation(s)
- M Bai
- Department of Physics, Indiana University, Bloomington, Indiana 47405 and Brookhaven National Laboratory, Upton, New York 11973 and Argonne National Laboratory, 9700 Cass Avenue, Argonne, Illinois 60439, USA
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