Proton Therapy Essentials
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- Aleesha Cunningham
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1 Proton Therapy Essentials An Architect s Perspective Presented By: Tsoi/Kobus & Associates Architects: Erik Mollo-Christensen, AIA Principal Jonathan Cohen, AIA Associate Principal
2 Proton Therapy Essentials An Architect s Perspective Objectives: 1. Overview What is Proton Therapy? Advantages Demand/Availability Opportunities/Challenges 2. Anatomy of a PT Facility Physical requirements Design flexibility A Healing Environment Planning considerations
3 Introduction Tsoi/Kobus & Associates (TK&A) offers nearly 20 years of experience in proton therapy facility planning and design Experience with: Cancer Centers Operating proton therapy facilities Planned proton therapy facilities Proton equipment manufacturers Academic and private proton therapy facilities Erik Mollo-Christensen, Principal Building long-term relationships 3-D modeling and design Jonathan Cohen, Associate Principal
4 1. Overview What is Proton Therapy? Advantages Demand/Availability Opportunities/Challenges
5 What is Proton Therapy? Form of radiation treatment using protons Large and specialized equipment Multi-room facilities 50-90,000 FT 2 $ MM project cost Complex and integrated processes Finance Design/construction Physics Medicine
6 What is Proton Therapy? Form of radiation treatment using protons Large and specialized equipment Multi-room facilities 50-90,000 FT 2 $ MM project cost Complex and integrated processes Finance Design/construction Physics Medicine Cyclotron accelerator Synchrotron accelerator
7 Clinical Advantages Higher dose with greater precision (tissue sparing) Reduced morbidity / side-effects Demonstrated effectiveness on cancer of the eye, head, neck, CNS, prostate, pediatric cancers Protons release their energy in a narrowly defined range Procure Treatment Center, Oklahoma City
8 Perceived Demand for Proton Therapy Significant and unmet need for Protons Especially for children Clinical role for PT remains controversial
9 Perceived Demand for Proton Therapy Significant and unmet need for Protons Especially for children Clinical role for PT remains controversial
10 Current Availability for Proton Therapy 1991 Loma Linda (U.S.) operating centers 4 under/construction +/- 25 centers worldwide Access remains limited (+/- 50,000 patients treated world-wide) Many centers announced/few built
11 Challenges to Adoption Financial/Regulatory High first cost/operating cost Financing CMS/Reimbursement coverage rate Political environment/healthcare reform
12 Challenges to Adoption Technical Limited Vendors/FDA and CE approval Equipment/Software not mature End user responsible for integration
13 Challenges to Adoption Clinical Slow facility ramp-up (not meeting business plan targets) Reliance on low-risk prostate cases Limited evidencephysician skepticism Lack of trained staff Clinicians Physicists Dosimetrists Radiation therapists
14 Opportunities Lowering costs/ Reducing uncertainty Clinical expansion of reimbursable treatment sites (breast, lung, pancreas) Evolving Technologies adapting on the fly Increased Vendor Competition Smaller scale/single room systems Third party development Design and construction schedule
15 Opportunities Lowering costs/ Reducing uncertainty Clinical expansion of reimbursable treatment sites (breast, lung, pancreas) Evolving Technologies adapting on the fly Increased Vendor Competition Smaller scale/single room systems Third party development Design and construction schedule
16 Opportunities Lowering costs/ Reducing uncertainty Clinical expansion of reimbursable treatment sites (breast, lung, pancreas) Evolving Technologies adapting on the fly Increased Vendor Competition Smaller scale/single room systems Third party development Design and construction schedule Still River Systems Monarch 250
17 Opportunities Lowering costs/ Reducing uncertainty Clinical expansion of reimbursable treatment sites (breast, lung, pancreas) Evolving Technologies adapting on the fly Increased Vendor Competition Smaller scale/single room systems Third party development Design and construction schedule IBA Proteus Nano
18 Opportunities Lowering costs/ Reducing uncertainty Clinical expansion of reimbursable treatment sites (breast, lung, pancreas) Evolving Technologies adapting on the fly Increased Vendor Competition Smaller scale/single room systems Third party development Design and construction schedule Compact Synchrotron, ProTom International
19 Opportunities Lowering costs/ Reducing uncertainty Clinical expansion of reimbursable treatment sites (breast, lung, pancreas) - 39 months Evolving Technologies adapting on the fly Increased Vendor Competition Smaller scale/single room systems Third party development Design and construction schedule
20 Opportunities Lowering costs/ Reducing uncertainty Clinical expansion of reimbursable treatment sites (breast, lung, pancreas) - 30 months Evolving Technologies adapting on the fly Increased Vendor Competition Smaller scale/single room systems Third party development Design and construction schedule
21 2. Anatomy of a PT Facility Physical Requirements Design Flexibility A Healing Environment Planning Considerations
22 What are the Physical Requirements? Basic facility Diagram Large scale not a Linac Radiation Shielding & Geometry Building/equipment interface Stringent Design Requirements Loads Tolerances M/E Utilities CT Exam
23 What are the Physical Requirements? Basic facility Diagram Large scale not a Linac Radiation Shielding & Geometry Building/equipment interface Stringent Design Requirements Loads Tolerances M/E Utilities
24 What are the Physical Requirements? Basic facility Diagram Large scale not a Linac Radiation Shielding & Geometry Building/equipment interface Stringent Design Requirements Loads Tolerances M/E Utilities Gantry ~ tons
25 What are the Physical requirements? Basic facility Diagram Large scale not a Linac Radiation Shielding & Geometry Building/equipment interface Stringent Design Requirements Loads Tolerances M/E Utilities
26 What are the Physical Requirements? Basic facility Diagram Large scale not a Linac Radiation Shielding & Geometry Building/equipment interface Stringent Design Requirements Loads Tolerances M/E Utilities
27 Designing for Flexibility Facility Scale Integrated vs. free-standing facilities Expansion & Phasing Installation Access & Removal
28 Designing for Flexibility Facility Scale Integrated vs. free-standing facilities Expansion & Phasing Installation Access & Removal Integrated Facility
29 Designing for Flexibility Facility Scale Integrated vs. free-standing facilities Expansion & Phasing Installation Access & Removal Free standing facility
30 Designing for Flexibility Designing for Flexibility Facility Scale Integrated vs. free-standing facilities Expansion & Phasing Installation Access & Removal Proton Perelman Center for Advanced Medicine
31 Designing for Flexibility Designing for Flexibility Facility Scale Integrated vs. free-standing facilities Expansion & Phasing Installation Access & Removal Cyclotron installation Gantry cage removal
32 A Healing Environment Self-referred patient base Outpatient treatment Efficiency/Throughout Two recent examples: - ProCure Treatment Center Oklahoma City, OK - Roberts Proton Therapy Center Philadelphia, PA
33 A Healing Environment Procure Treatment Center, Oklahoma City, OK
34 A Healing Environment
35 A Healing Environment
36 A Healing Environment
37 A Healing Environment
38 A Healing Environment Roberts Proton Therapy Center, Philadelphia, PA Raphael Vińoly Architects Perkins Eastman Tsoi/Kobus & Associates
39 A Healing Environment
40 A Healing Environment
41 A Healing Environment
42 A Healing Environment
43 Planning Considerations Clinical model/program Business model Site selection Team selection Equipment vendor Radiation physicist A/E team Builder Experience counts!
In 1946 Harvard physicist Robert Wilson (1914-2000) suggested:
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