Therapy Facility Research Articles

Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) - Part 2 with Recommendations on Psycho-oncology, Rehabilitation, Follow-up, Recurrence, Palliative Therapy and Healthcare Facilities.

Aim This is an update of the interdisciplinary S3-guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL), published in March 2021. The work on the updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German Society of Gynecology and Obstetrics ( Deutsche Gesellschaft für Gynäkologie und Geburtshilfe , DGGG) and the Working Group on Gynecological Oncology ( Arbeitsgemeinschaft Gynäkologische Onkologie , AGO) of the German Cancer Society ( Deutsche Krebsgesellschaft , DKG). Method The process used to update the 2014 S3-guideline was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing evidence-based national and international guidelines or - if evidence was lacking - on the consensus of the specialists involved in compiling the update. After an initial review of the current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new recommendations or statements which would take account of more recently published literature and the recent appraisal of new evidence. Recommendations The short version of this guideline consists of recommendations and statements on palliative therapy and follow-up of patients with cervical cancer. The most important aspects included in this updated guideline are the new FIGO classification published in 2018, the radical open surgery approach used to treat cervical cancer up to FIGO stage IB1, and the use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.

A 3D printed pure copper drift tube linac prototype.

Radio frequency cavities are among the most challenging and costly components of an accelerator facility. They are usually manufactured in individual parts, which are then joined by complex processes, e.g., several brazing steps. 3D printing has become an alternative to these conventional manufacturing methods due to higher cost efficiency, freedom in design, and recent achievement of high print quality for pure copper. A fully functional 3GHz drift tube linac (DTL) prototype was 3D printed in one piece, made from pure copper by selective laser melting (SLM). To achieve a higher surface quality, the DTL geometry was optimized for the SLM process. The DTL design is related to the design of the DTL part of the side-coupled DTL modules used in linac-based proton therapy facilities. The quality factor (8750) and the shunt impedance per unit length (102mΩm) of the printed prototype are already comparable to traditionally manufactured DTL structures and can be further enhanced by surface treatments.

Implementation of a rapid response system at an isolated radiotherapy facility through simulation training

A rapid response system is required in a radiotherapy department for patients experiencing a critical event when access to an emergency department is poor due to geographic location and the...

Strategic Vision for Business and Marketing in the Physical Therapy Industry

A thorough overview of healthcare, physical treatment, business growth, strategic planning, marketing tactics, and personal development is provided in this document. It covers push technologies, value propositions for patients, and a business model for wellness while addressing key issues in the physical therapy sector. It examines important healthcare hazards and presents a methodology for goodwill compensation. The work presents a strategic vision for business and marketing in the physical therapy sector, highlighting the significance of management, location, competitiveness, and technology adoption. Push technologies and patient value propositions are discussed, with an emphasis on improving patient care and working with referral sources. The business plan for wellness emphasizes the significance of controlling and preventing obesity. The document also explores the fundamental principles of physical therapy organizations and proposes five potential directions for practice growth. Additionally, it discusses important healthcare dangers, patient privacy issues, workplace violence, and infection preparedness, all of which are especially pertinent given the continuing COVID-19 pandemic. The significance of developing one’s own personal capital, including ongoing education and public speaking abilities, is emphasized. The article presents a strategy plan for health and wellbeing in a physical therapy facility with an emphasis on the mission, core values, current situation, goals, structure overview, particular tactics, and management. It discusses the development of human resources and financial resources and proposes a wellness program. The value of partnerships and the necessity of providing patients with helpful information regarding home exercise regimens are both stressed in the presentation of marketing tactics to ensure customer happiness. Indicators for a successful physical therapy practice and conditions for client satisfaction are provided in the document’s conclusion. This content, which focuses on enhancing patient care, expanding services, and fostering success and satisfaction in the industry, provides a thorough manual for healthcare professionals, organizations, and individuals looking to successfully navigate the industry’s constantly evolving landscape.

Commissioning of carbon-ion radiotherapy for moving targets at the Osaka Heavy-Ion Therapy Center.

PurposeHerein, we report the methods and results of the Hitachi carbon‐ion therapy facility commissioning to determine the optimum values of the magnitude of movement and repaint number in respiratory‐gated irradiation.MethodsA virtual‐cylinder target was created using the treatment‐planning system (VQA Plan), and measurements were performed to study the effects of respiratory movements using a two‐dimensional ionization‐chamber array detector and a phantom with movable wedge and stage. For simulations, we selected a 10 × 10 × 10 cm3 cubic irradiation pattern with a uniform physical dose and two actual cases of liver‐cancer treatments, whose prescribed doses were 60 Gy(RBE)/4 fraction (Case 1) and 60 Gy(RBE)/12 fraction (Case 2). We employed two types of repainting methods, one produced by the algorithm of VQA Plan (VQA algorithm) and the other by ideal repainting. The latter completely repeats all spots with set number of repaintings. We performed flatness calculations and gamma analysis to evaluate the effects of each condition.ResultsFrom the measurements, the gamma passing rates for which the criteria were 3%/3 mm exceeded 95% for displacements in the head‐to‐tail direction if the repaint number was greater than 3 and the magnitude of the residual motions was less than 5.0 mm. In simulations with the cubic irradiation pattern, the gamma passing rates (with criteria of 2%/2 mm) exceeded 95% when the magnitude of the residual motions was 3.0 mm and the repaint number was greater than 3. When the repaint number was set to 4 in the VQA with the actual liver cases, the flatness results for Case 2 was minimal. For ideal repainting, the flatness results for all ports fell within ∼3.0% even when the magnitude of the residual motions was 5.0 mm if the repaint number was 6. However, the flatness was less than 3.0% for almost all ports if the magnitude of the residual motions was less than 3.0 mm with a repaint number of 4 in case of both types of repaint methods.ConclusionsAt our facility, carbon‐ion radiotherapy can be provided safely to a moving target with residual motions of 3.0 mm magnitude and with a repaint number of 4.

E-Survey: Current Status of Proton Beam Therapy in USA

The clinical use of Proton Beam Therapy (PBT) in the management of cancer is increasing worldwide. USA has high number of proton therapy centres and this number is growing with new proton therapy centres under development. This study expresses the views of Proton Therapy experts from 12 US cities based in 9 states with respect to the role of proton therapy in cancer treatment. An E-survey was conducted to assess clinical, technical, educational, and organizational resources and strategies in US -based Proton Beam Therapy facilities and to recognize patters of practice. The E-survey attempted to identify tumours which are more likely to benefit from Proton beam Therapy compared to Photon based Therapy. The role of Proton Beam Therapy in Breast, Brain and Lung cancers was also studied. The study also intended to find what improvements are needed to ensure efficient treatment planning, delivery and dosimetry. This is the first study of its kind in USA.

OD174 - Augmented reality supporting innovation and accuracy in advanced radiation therapy facilities

OD174 - Augmented reality supporting innovation and accuracy in advanced radiation therapy facilities

Proton therapy facilities: an overview of the development in recent years

Since its discovery in 1946, Proton therapy has continued to overgrow from the number of units installed in various countries and the technology used. This paper aims to provide an overview of the development of proton therapy facilities to date based on a literature review. The results are discussed in several aspects, including its distribution across the globe, beam delivery techniques, dose verification, room layout, and shielding design considerations.

How Can Adjustable Velcro Wraps Help in the Management of Lymphedema in the Absence of Complex Physical Therapy Facilities.

Background: Lymphedema is a progressive disorder characterized by impairment of lymph flow from tissues to the blood circulation due to damage of lymphatics. Treatment can be surgical or nonsurgical. A great number of operative procedures described in the literature demonstrate no single method exists that could be regarded as a standard. Nonsurgical therapy consists of a set of four physiotherapeutic measures, if properly performed; it treats the cause of lymphedema in a manner free of side effects, this set is called complex physical therapy (CPT). Criteria and facilities of CPT are not available in Iraq now. Methods and Results: Below is a short clinical experience of seven cases (nine diseased lower limbs) presented at our clinic for management of lymphedema who were all managed successfully during the decongestive period using adjustable Velcro wraps (AVW). Conclusions: In the absence of ideal CPT facilities, AVW can be used as a single therapeutic modality for treatment of lymphedema.

Abstract 9442: Acute Coronary Syndrome Treatment Delay in Low to Middle-Income Countries: A Systematic Review

Introduction: Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle-income countries (LMICs), largely due to pre-hospital treatment delays. Purpose: This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical, and health system characteristics that contribute to treatment delays. Methods: A comprehensive review of the English literature was conducted between January 1990 through May 2020 using predefined criteria. Time to treatment was defined from ACS symptom onset to first medical contact and then further dichotomized as less than (early) or greater than 12-hours (late) treatment. Twenty-nine peer-reviewed studies, which comprised 29,731 subjects with ACS symptoms residing in 14 LMICs. Sample sizes in the studies ranged from 50 to 20,937. Age ranged from 28-72 years and the majority were males. The Newcastle-Ottawa Assessment Scale was utilized to measure study quality. Results: The mean time from symptom onset to first medical contact was 12.7 hours, ranging from10-minutes to 96 hours. Being older age, female gender, illiterate, rural residence, having atypical chest pain and lack of ACS symptom knowledge were associated with longer delays. Those directly admitted to an emergency department with the capacity to provide coronary interventions received earlier treatment. Community facilities where ECG machines were available had lower prehospital delay time for referral to reperfusion therapy facilities. Lack of emergency medical systems, poor communication between the community and interventional facilities were also major contributors to ACS treatment delays. Conclusions: Pre-hospital delay time remains an important contributor to poorer clinical outcomes and higher mortality in LMICs. Country-wide referral plans are urgently needed to ensure timely transfer of patients from non-cardiac centers to interventional facilities. Health education through the different media outlets will raise awareness of ACS risk factors, accompanying signs and symptoms as well as the need to seek early treatment to improve clinical outcomes.

A Comparison of Conventional Empirical Formula and MCNPX Code in the Estimations of Photon and Neutron Skyshine Rates for an 18MV Radiotherapy Bunker

Purpose: A physical phenomenon, scattering the radiation by the atmosphere above the room to the points at ground level around the linac treatment room is known as skyshine radiation. This study aimed to estimate photon and neutron skyshine from a linac in a high-energy radiation therapy facility. Materials and Methods: The empirical method of NCRP report 151 and MC simulations were employed to estimate skyshine radiation dose from the 18MV linac photon beam. A linac and its bunker were modeled and skyshine dose equivalent from photons and secondary neutrons were derived and compared in the control room, corridor, sidewalk and, parking. Results: The photon skyshine dose rates calculations by the MC method varied from 0.43 µSv/h at the sidewalk to 6.2 µSv/h at the control room. The ratios of NCRP to MCNP calculations varied from 3.58 for the corridor to 16.14 for the control room. For the neutron skyshine dose rate at distances shorter than 20m, it was found to be 10.4 nSv/h and the ratios of the NCRP to MCNP were 1.26 at the control room and 3.34 at the sidewalk. Conclusion: It was concluded that the empirical method overestimates photon and neutron skyshine dose rates in comparison to the MCNPX code. The refinement of the proposed empirical method of NCRP 151 and application of MC methods are strongly suggested for more reliable calculations of skyshine radiations.

Expert Roundtable: accelerating time to market for CAR-T cell therapies through translatable workflow

<div class="authors authors-lg"><div class="author"><div class="author-img"><img src="https://cdn.insights.bio/uploads/Riviere square.png" data-image="1"></div><div class="author-det"><h3 class="author-name" style="color:#5D538A;">Isabelle Riviére</h3><h5 class="author-title" style="color:#5D538A;">Director, Cell Therapy and Cell Engineering Facility, Memorial Sloan Kettering Cancer Center</h5> Dr Rivière joined the faculty of the Memorial Sloan-Kettering Cancer Center (MSKCC) in 1999. She is currently the Director of the Cell Therapy and Cell Engineering Facility where she investigates novel strategies for cell therapies and immunotherapies to increase or retarget the immune response against tumors and treat hematological disorders. Her laboratory has developed multiple processes for clinical-grade gamma-retroviral and lentiviral vector production as well as hematopoietic and T-cell manufacturing. </div></div></div><div class="authors authors-lg"><div class="author"><div class="author-img"><img src="https://cdn.insights.bio/uploads/Kurtoglu photo copy.jpg" data-image="1"></div><div class="author-det"><h3 class="author-name" style="color:#00A795;">Metin Kurtoglu</h3><h5 class="author-title" style="color:#00A795;">Chief GMP Manufacturing and Chief Medical Officer, Cartesian Therapeutics</h5> Metin Kurtoglu, MD, PhD, is a medical oncologist board certified in internal medicine. Dr Kurtoglu’s clinical and basic science research career spans over 20 years and has focused on developing novel targets for drug-resistant cancer cells and cancer stem cells, including multiple myeloma. He has also been an investigator in various cancer immunotherapy trials. Cartesian Therapeutics is pioneering RNA cell therapies in and beyond oncology, with three assets in clinical trials for autoimmune, oncologic and respiratory disorders. The investigational therapies are manufactured at Cartesian’s cGMP manufacturing facility. </div></div></div><div class="authors authors-lg"><div class="author"><div class="author-img"><img src="https://cdn.insights.bio/uploads/Tariq Haq.JPG" data-image="1"></div><div class="author-det"><h3 class="author-name">Tariq Haq</h3><h5 class="author-title" style="color:#007589;">Head of Cell and Gene Therapy Segment Marketing at Lonza Bioscience Solutions</h5><p data-focus-visible-added="" class="focus-visible">Tariq Haq is the Head of Head of Cell and Gene Therapy Segment Marketing at Lonza Bioscience Solutions. He brings with him extensive bioprocess experience including strategy development, new product launch and commercialization. Previously he has held positions in marketing and product management while working in companies such as Pall, GE Healthcare, Thermo Fisher Scientific and Millipore. He has authored publications in peer-reviewed journals such as Science and Vaccine. Tariq holds degrees in Physics and Biotechnology from Aligarh Muslim University in India and in Biochemistry from Texas A&amp;M University in the US. </div></div></div>

Geographic Access to Radiation Therapy Facilities in the United States

The current distribution of radiation therapy (RT) facilities in the United States is not well established. A comprehensive inventory of U.S. RT facilities was last assessed in 2005, based on data from state regulatory agencies and dosimetric quality assurance bodies. We updated this database to characterize population-level measures of geographic access to RT and analyze changes over the past 15 years. We compiled data from regulatory and accrediting organizations to identify U.S. facilities with linear accelerators used to treat humans in 2018 to 2020. Addresses were geocoded and analyzed with Geographic Information Services software. Geographic access was characterized by assessing the Euclidian distance between ZIP code tabulation areas/county centroids and RT facilities. Populations were assigned to each county to estimate the effect of facility changes at the population level. Logistic regressions were performed to identify features associated with increased distance to RT and associated with regions that gained an RT facility between the 2 time points studied. In 2020, a total of 2313 U.S. RT facilities were reported, compared with 1987 in 2005, representing a 16.4% growth in facilities over nearly 15 years. Based on population attribution to the centroids of ZIP Code Tabulation Areas, 77.9% of the U.S. population lives within 12.5 miles of an RT facility, and 1.8% of the U.S. population lives more than 50 miles from an RT facility. We found that increased distance to RT was associated with nonmetro status, less insurance, older median age, and less populated regions. Between 2005 and 2020, the population living within 12.5 miles from an RT facility increased by 2.1 percentage points, whereas the population living furthest from RT facilities decreased 0.6 percentage points. Regions with improved geographic RT access are more likely to be higher income and better insured. The percentage of the U.S. population with limited geographic access to RT is 1.8%. We found that people benefiting from improved access to RT facilities are more economically advantaged, suggesting disparities in geographic access may not improve without intervention.

Medipix3 for dosimetry and real-time beam monitoring: first tests at a 60 MeV proton therapy facility

Charged particle therapy (CPT) is an advanced modality of radiation therapy which has grown rapidly worldwide, driven by recent developments in technology and methods of delivery. To ensure safe and high quality treatments, various instruments are used for a range of different measurements such as for quality assurance, monitoring and dosimetry purposes. With the emergence of new and enhanced delivery techniques, systems with improved capabilities are needed to exceed existing performance limitations of conventional tools. The Medipix3 is a hybrid pixel detector able to count individual protons with millisecond time resolution at clinical flux with near instant readout and count rate linearity. The system has previously demonstrated use in medical and other applications, showing wide versatility and potential for particle therapy. In this work we present measurements of the Medipix3 detector in the 60 MeV ocular proton therapy beamline at the Clatterbridge Cancer Centre, U.K. The beam current and lateral beam profiles were evaluated at multiple positions in the treatment line and compared with EBT3 Gafchromic film. The recorded count rate linearity and temporal analysis of the beam structure was measured with Medipix3 across the full range of available beam intensities, up to 3.12 × 1010 protons/s. We explore the capacity of Medipix3 to provide non-reference measurements and its applicability as a tool for dosimetry and beam monitoring for CPT. This is the first known time the performance of the Medipix3 detector technology has been tested within a clinical, high proton flux environment.

A new emittance selection system to maximize beam transmission for low-energy beams in cyclotron-based proton therapy facilities with gantry.

PurposeIn proton therapy, the potential of using high‐dose rates in the cancer treatment is being explored. High‐dose rates could improve efficiency and throughput in standard clinical practice, allow efficient utilization of motion mitigation techniques for moving targets, and potentially enhance normal tissue sparing due to the so‐called FLASH effect. However, high‐dose rates are difficult to reach when lower energy beams are applied in cyclotron‐based proton therapy facilities, because they result in large beam sizes and divergences downstream of the degrader, incurring large losses from the cyclotron to the patient position (isocenter). In current facilities, the emittance after the degrader is reduced using circular collimators; however, this does not provide an optimal matching to the acceptance of the following beamline, causing a low transmission for these energies. We, therefore, propose to use a collimation system, asymmetric in both beam size and divergence, resulting in symmetric emittance in both beam transverse planes as required for a gantry system. This new emittance selection, together with a new optics design for the following beamline and gantry, allows a better matching to the beamline acceptance and an improvement of the transmission.MethodsWe implemented a custom method to design the collimator sizes and shape required to select high emittance, to be transported by the following beamline using new beam optics (designed with TRANSPORT) to maximize acceptance matching. For predicting the transmission in the new configuration (new collimators + optics), we used Monte Carlo simulations implemented in BDSIM, implementing a model of PSI Gantry 2 which we benchmarked against measurements taken in the current clinical scenario (circular collimators + clinical optics).ResultsFrom the BDSIM simulations, we found that the new collimator system and matching beam optics results in an overall transmission from the cyclotron to the isocenter for a 70 MeV beam of 0.72%. This is an improvement of almost a factor of 6 over the current clinical performance (0.13% transmission). The new optics satisfies clinical beam requirements at the isocenter.ConclusionsWe developed a new emittance collimation system for PSI's PROSCAN beamline which, by carefully selecting beam size and divergence asymmetrically, increases the beam transmission for low‐energy beams in current state‐of‐the‐art cyclotron‐based proton therapy gantries. With these improvements, we could predict almost 1% transmission for low‐energy beams at PSI's Gantry 2. Such a system could easily be implemented in facilities interested in increasing dose rates for efficient motion mitigation and FLASH experiments alike.

Disparities in Access to Radiation Therapy Facilities Among American Indians/Alaska Natives and Hispanics in Washington State

Racial and ethnic minorities in the state of Washington experience higher cancer mortality relative to whites. We sought to characterize differences in travel distance to radiation therapy (RT) facilities in Washington by race and ethnicity with a special focus on non-Hispanic American Indians and Alaska Natives as a contributor to limited access and cancer disparities. Geocoded mortality data from Washington Department of Health (2011-2018) were used to identify decedents with mortality related to all-causes, all cancers, and cancers likely requiring access to RT. This was determined from optimal RT usage estimates by diagnosis. RT facility locations were ascertained from the Directory of Radiation Therapy Centers and confirmed. Distance from decedents' address listed on death certificates to nearest RT facility was calculated. Generalized mixed models were used for statistical analysis. We identified 418,754 deaths; 109,134 were cancer-related, 60,973 likely required RT. Among decedents with cancers likely requiring RT, non-Hispanic American Indians and Alaska Natives decedents would have had to travel 1.16 times (95% confidence interval [CI], 1.09-1.24) farther from their residences to reach the nearest treatment facility compared with non-Hispanic whites. This association existed in metro counties but was more pronounced in nonmetro counties (1.39 times farther; 95% CI, 1.22-1.58). In addition, Hispanics would have had to travel 1.11 times farther (95% CI, 1.06-1.16) to reach the nearest facility compared with non-Hispanic whites, primarily due to differences in urban counties. Decedents in nonmetro counties lived on average 35 miles (SD=29) from RT centers and non-Hispanic American Indians and Alaska Natives in nonmetro counties 53 miles (SD=38). Compared with non-Hispanic white decedents, those who were non-Hispanic black, non-Hispanic Asian, and non-Hispanic Native Hawaiian decedents lived closer to RT facilities. We observed significant disparities in access to RT facilities in Washington, specifically for non-Hispanic American Indians and Alaska Natives and rural decedents. The findings call for initiatives to improve access to critical cancer treatment services for these underserved populations with known disparities in cancer deaths.

Disparities in Access to Radiation Oncology Facilities Among American Indian/Alaska Natives and Hispanics in Metro and Non-Metro Washington State

Racial and ethnic minorities in Washington State (WA) experience higher cancer mortality relative to whites. We sought to characterize differences in travel distance as a marker for access to radiation therapy (RT) facilities in WA and one possible contributing factor to cancer disparities.Geocoded mortality data from the WA Department of Health (2011-2018) were used to identify decedents with mortality related to all causes, all cancers, and cancers likely requiring access to RT (defined as estimated RT usage rate > 50% by anatomical subsite corresponding to ICD-9 or 10 code). Race was defined per US Office of Management and Budget 1997 standard and ethnicity as Hispanic or non-Hispanic. RT facility locations were identified from the Directory of Radiotherapy Centers and validated by internet search or phone calls. Road network distance from decedent's residence to nearest RT facility was calculated on a geographic information platform. Generalized mixed models were used for statistical analysis.We identified 109,134 cancer-related deaths of which 60,973 likely required RT. Among decedents with cancers likely requiring RT, non-Hispanic (NH) American Indian/Alaskan Native (AI/AN) decedents would have had to travel 1.16 times (95% CI 1.09-1.24) farther to reach the nearest treatment facility compared to NH whites. This association existed in metro counties but was more pronounced in non-metro and rural counties, where NH AI/ANs would have had to travel 1.39 times farther compared to NH whites (95% CI 1.22 - 1.58). This translated to an average of 83 miles (SD = 22) for NH AI/AN in rural areas to travel to RT centers whereas NH Whites in rural areas would have had to travel on average 59 miles (SD = 28). Hispanics would have had to travel 1.11 times farther to reach the nearest facility compared to NH whites (95% CI 1.06 - 1.16), primarily due to differences in urban areas. NH African American, NH Asian, and NH Native Hawaiian decedents lived closer to RT facilities compared to the NH white decedents. Based on our findings, we estimated that expanding the federal "safe harbor" restrictions on health systems providing transportation from 50 to 75 miles could open up needed services for 96% of rural NH AI/ANs.NH AI/ANs and rural decedents experience stark disparities in access to RT facilities in WA state. The findings call for creative initiatives to improve access to critical cancer treatment services to combat racial, ethnic and rural disparities in cancer deaths. In depth analysis of local barriers to access for minority communities is necessary to devising practical solutions such as advocating for policy change for "safe harbor" restrictions.

The Downstream “Halo Effect” of Opening a Single-Vault Proton Therapy Facility at a Cancer Center

There have been limited reports evaluating the effect of a proton center (PC) on a radiation oncology department at a medical center (MC). We hypothesized that the opening of our PC would both directly and indirectly increase the number of patients treated at the MC.The impact of a new single-vault PC on patient volume at the MC was evaluated from fiscal year 2016 (FY16) through FY19, representing the year prior to induction of the PC through the first 2.5 years of operation. Patient starts and fractions were obtained through hospital patient tracking and billing systems for our primary site (MC1), which shares a campus with our PC, and two additional sites (MC2 and MC3) on separate campuses. Resident Accreditation Council for Graduate Medical Education case logs were also analyzed. To determine the effect of the PC on MC1, MC2, and MC3, we reviewed the electronic medical record for all patients seen in in consultation for PC, where consults were initiated in July 2017.Photon-based treatment starts at MC1 increased by a total of 4% (P = 0.49) from FY16-FY19. Combined photon and proton starts at MC1/PC increased by a total of 27% (P < 0.0001). The total combined number of photon starts at MC1, MC2, and MC3 increased by 11% (P = 0.002). Proton starts were 38 in FY17, 174 in FY18, and 191 in FY19. A total of 523 patients were seen in consultation at the PC (185 for prostate cancer), of whom 187 ultimately underwent proton therapy (36%), 36 prostate HDR (7%), 7 Gamma Knife radiosurgery (1%), 45 photon-based treatment (9%), and 248 no treatment within our department (47%). An additional 216 patients received proton therapy following consultations for photon-based treatment at MC1, MC2, or MC3. There was a cumulative 104% increase in HDR prostate implants from FY16-FY19 at MC1 (P = 0.0005), with PC consultations directly resulting in 69 HDR prostate implants in 36 patients. There was a 96% increase (from 25 in FY16 to 49 in FY19) in pediatric yearly case volume at MC1 from FY16-FY19 (P = 0.007).The opening of our single-vault PC, which has been at full capacity since April 2018, has had no deleterious effect on photon-based treatment volume. However, there has been an approximate doubling in HDR prostate implants and pediatric treatment starts. Clinicians and administrators should be cognizant of this "halo" effect when balancing the costs and benefits of opening a particle-based therapy center.

Evaluation of depth-dose profiles in a water phantom at the BNCT facility at BINP

In this study, we present depth-dose profiles measured with a water phantom at the boron neutron-capture therapy (BNCT) facility at Budker Institute of Nuclear Physics (BINP). The presented results demonstrate that the proposed design of radiation detector with an optical fiber readout, which includes three different sensors (the first based on a plastic scintillator enriched with boron, the second based on a simple plastic scintillator, and the third having no scintillator at all), enables measurement of neutron flux, as well as estimations of the dose induced by gamma rays. The results of simulations with the GEANT4 package demonstrated good agreement with the experimental data and can be used for further system improvement.

Low Intensity Beam Extraction Mode on the Protom Synchrotron for Proton Radiography Implementation

Proton radiography is one of the most important and actual areas of research that can significantly improve the quality and accuracy of proton therapy. Currently, the calculation of the proton range in patients receiving proton therapy is based on the conversion of Hounsfield CT units of the patient's tissues into the relative stopping power of protons. Proton radiography is able to reduce these uncertainties by directly measuring proton stopping power. The study demonstrates the possibility of Protom synchrotron-based proton therapy facilities to operate in a special mode which makes it possible to implement proton radiography. This work presents the status of the new low beam intensity extraction mode. The paper describes algorithms of low flux beam control, calibration procedures and experimental measurements. Measurements and calibration procedures were performed with certified Protom Faraday Cup, PTW Bragg Peak Chamber and specially designed experimental external.