Operating a proton therapy facility

Operating a proton therapy facility

IBA - Your partner in proton therapy

With proton therapy, a cancer center can continue to stay on the leading edge — offering the most advanced treatment to cancer patients.

Choosing the right partner turns a complex adventure into a simple, well mastered project.

5 important things you should know about your future proton therapy center

Yearly operational expenditures

This number varies slightly depending on your choice of system - see the illustrative charts for Proteus®ONE and Proteus®PLUS.

Typical medical staff

The center will require highly trained staff covering the
following specialties:
Oncology
Medical physics
Internal medicine
Nursing
Radiation technology
Administration

Comprehensive training should cover academic, practical
and operational aspects of proton therapy. Hands-on
training is an integral part of staff preparation. Training may be
carried out on-site once the center is up and running or it may take
place at another established facility before the center is opened in order
to expedite the inauguraton of the center.

See the typical medical staff needed for Proteus®ONE and Proteus®PLUS solutions. 

Total number of patient treated

In order to be economically feasible, your proton therapy
center will have to treat a certain number of patients
each year. To minimize the risk of income loss, you may
ask hospitals to commit to referring a certain number of
patients per annum. You could also utilize internal hospital data to assess what
percentage of patients treated with traditional radiotherapy
today could benefit from proton therapy. A typical center treats around 300 patients per room per year.

The number treated depends on your choice of system.

Proteus®ONE 
PATIENTS TREATED* AT CAPACITY BETWEEN 300 AND 350 PER YEAR
NUMBER OF FRACTIONS* DELIVERED BETWEEN 35 AND 50 PER DAY

Proteus®PLUS 
PATIENTS TREATED* AT CAPACITY BETWEEN 1000 - 1500 PER YEAR
NUMBER OF FRACTIONS* DELIVERED BETWEEN 125 - 180 PER DAY

Typical patient mix

The physical properties of proton beams lead to an advantageous dose distribution which results in improved therapeutic gains.
The clinical benefit lies in the comparative impact of proton beam therapy, when used with either a curative intent or as a salvage treatment for cancerous and noncancerous conditions and when compared with alternative treatments such as photon beam therapy. This distinction can effect survival, disease progression, safety, health-related quality of life and other patient outcomes.
An increasing emphasis on evidence-based medicine means it is imperative to assess the current evidence supporting the use of proton therapy over other treatment techniques, so to better guide the physician and patient toward the most appropriate option.

The present policy developed by the American Society for Radiation Oncology (ASTRO) recommends basing patient selection on the added clinical benefit that proton therapy offers. This comes down to considering proton therapy for cases in which sparing the surrounding normal tissue is crucial and when this cannot be adequately achieved with photon based therapy. The policy provides several non-specific examples:

• The target volume is in close proximity to one or more critical structures, and a steep dose gradient outside the target must be achieved in order to avoid exceeding the tolerance dose to those structures.
• A decrease in the amount of dose inhomogeneity in a large treatment volume is required to avoid an excessive dose “hotspot” within the treated volume, in order to lessen the risk of excessively early or late normal tissue toxicity.
• A photon-based technique would increase the probability of clinically meaningful normal tissue toxicity, by exceeding an integral dose-based metric associated with toxicity.
• The same or an immediately adjacent area has been previously irradiated, and the dose distribution within the patient must be sculpted to avoid exceeding the cumulative tolerance dose of nearby normal tissue.
Fully leveraging proton therapy’s dosimetric advantages adds complexity to the treatment when compared to other kinds of radiation therapy. A thorough comprehension of the benefits and consequences by oncology professionals is therefore indispensable.

A typical example of the current patient mix is illustrated in the picture.

Typical operations schedule

This number varies slightly depending on your choice of system, but is approximately 250 days per year and 15 hours a day.

Typically, starting upon Final Acceptance, customers will have primary access to the proton system for patient treatment (clinical or research) and quality assurance operations. Many IBA sites today follow a schedule such as the one listed below:

• on week days: 2 shifts a day (16 hours)
• on Saturday: 1 shift a day (8 hours)

For example, daily schedule could be as follows:
 6:00 AM – 7:00 AM, Monday – Friday: quality assurance
 7:00 AM – 9:00 PM, Monday – Friday: patient treatments
 9:00 PM – 10:00 PM, Monday – Friday: field calibrations
 6:00 AM – 7:00 AM, Saturday: quality assurance
 7:00 AM – 1:00 PM, Saturday: patient treatments
 1:00 PM – 2:00 PM, Saturday: field calibrations 

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