An Evolving Treatment, Adapting Design

Technological innovations and practical experience are changing the way proton therapy is practiced.

With more than a dozen proton therapy centers in operation in the U.S., the proton community is discovering more applications and techniques for their use. Likewise, new technologies are coming online that make the treatment more effective. This evolution in practice is effecting how we design proton therapy centers.

Georgia Proton Therapy Center

Georgia Proton Therapy Center

As experience accrues in the proton beam community, a better understanding of the application and use of proton therapy has emerged. Clinicians understand when it’s appropriate to use proton treatment versus traditional radiation oncology. Instead of an either/or approach, doctors have found that they can mix or combine treatments to achieve more desirable results. With experience, the treatment team is better able to define the appropriate dosage to target the tumors. And proton’s advantage for treating pediatric patients, or patients with tumors in more sensitive areas, continues to be realized.

The new gold standard in proton beam therapy treatment uses pencil beam scanning. Pencil beam is an advance over current passive scattering proton therapy methods as its beam conforms more closely to the tumor and spares even more surrounding healthy tissue from harm.

Pencil beam technology does not require special fittings (customized for each patient’s unique tumor characteristics) at the end of the nozzle that delivers the radiation. Over the course of the treatment they require recasting to match the shape of the shrinking tumor. Without the need to house these devices in facilities with pencil beam technology, milling machines are eliminated and storage requirements in the facility are decreased.

The Proton Therapy Center at Knoxville, TN

The Proton Therapy Center at Knoxville, TN

Another new standard is emerging with on board or in-room imaging. In-room imaging helps ensure that proton therapy’s greatest benefits are realized.

With imaging technology in the treatment room, proper patient alignment is easier to obtain. Cone beam CTs allow for a greater level of accuracy in proton therapy. With the capability in the room, doctors feel assured that they are hitting the tumor where they are expecting to hit it. With CT scanning capability in the treatment room, clinicians can do real-time, just-in-time imaging to confirm. Not only is this more effective, it increases patient throughput, requires fewer staff and less set-up time.

Better monitoring means more imaging equipment, either adjacent to or in the treatment room, thus increasing size requirements. Clients must weigh the benefits of introducing an in-room CT scanner against the necessity of a larger concrete bunker for the treatment room.

Post range verification imaging also has many benefits to a proton treatment program. It uses PET CT imaging of the patient’s slight radioactivity post-treatment to see how successfully a tumor has been hit. However, because the window of time after treatment when this can be accomplished is narrow, the PET CT equipment must be located close to the treatment rooms.

New York Proton Therapy Center

New York Proton Therapy Center

Previously, American proton treatment centers were envisioned and most closely associated with the treatment of prostate cancer. Prostate cancer has been the most common condition for which a Medicare beneficiary receives proton beam therapy. Prostate cancer treatment, however, usually involves adult patients that are otherwise healthy and mobile. Proton treatment is quick and convenient for those patients.

Now, generally speaking, more types of cancers, more complex cases and more tumor types are being treated with proton therapy than ever before. Proton therapy has been proven beneficial for tumors surrounded by sensitive structures such as the eye, brain, and spinal cord, where the potential for radiation damage is very high. A 2012 study published in the journal Radiotherapy and Oncology, found proton beam therapy to be superior to traditional photon therapy for some childhood cancers of the central nervous system as well as cancers of the eye and tumors at the base of the skull.

Pediatric cancer, head and neck tumors are among these complex disease states that proton is treating today. Pediatrics requires us to adjust our design as it introduces the extra complexity of anesthetizing young patients. Pediatrics has a different set of space requirements. Kids come in with their families, so there is the need for more waiting space, larger exam rooms, more preparation rooms to prepare the patient as well as recovery suites. Sometimes separate induction rooms are required to keep the treatment room available for treatment rather than preparation.

Treating adult patients with complex cases introduces another type of design challenge. These adults are likely to be less mobile, sicker and could be dealing with the effects of chemotherapy or other forms of radiation being delivered in parallel with proton treatment. New proton centers treating these complex cases may find the need for larger nurse stations, as well as sick bays or recovery rooms, rather than just changing and gowned waiting space for the therapist to retrieve the patient.

Treating more complex cancers, including pediatric cases, raises the bar for the clinical requirements for proton centers. Increasingly, these centers will need to measure up to hospitals in their healthcare standards and design features.

Download the complete Design Quarterly Winter 2015 – Trends in Proton Therapy Center Design now.

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