FIELD REPORT FIRST MONTH OF CLINICAL OPERATIONS RPTC, APRIL ´09
Facility reliability. Beginning with the treatment of the first patient on 16.03.2009, the facility is scheduled for clinical use five days per week. It was fully operational in the first four weeks of operations on all of these 20 days and the complete radiation programs could be carried out.
Time requirement per treatment. Whilst the very first radiation still required a treatment room occupation time of 55 minutes, the aim for this operating year, a duration of 20 minutes, has already been achieved. After that time the patient can leave the treatment room. Hence we already advance to the planned 15 minutes per patient despite additional safety checks still conducted during every individual treatment.
Precision targeting system. One of the main factors determining the time requirement for each treatment is the novel, improved and so far unique positioning system in the treatment room. It consists of two simultaneously working digital x-ray systems which are installed outside of the proton treatment beam path. They automatically, but visually monitored, compare the actual position radiograms of the patient with those calculated by the targeting-computer- tomography. This method enables an accuracy in positioning within the range of a millimeter. The facility is based on a development and patent of the Rinecker-Group which was placed at exclusive disposal of the PROHEALTH AG. Due to its high importance, the companies Siemens and Accel (!) have appealed against the assignation of patent. However, they lost in first instance.
Governmental license. The „Chirurgische Klinik Dr. Rinecker“ (CKR) which cooperates with the RPTC, was now also included in the governmental hospital master plan of the state of Bavaria for „radiation therapy“ on 16.03.2009. As this was due solely to the proton therapy the CKR is the first hospital in Germany being licensed by the government to treat with protons hospital patients carrying compulsory health insurance.
Status waiting list. In spite of the deliberately limited publicity, 910 individual treatment requests have been received by our call-center in the fist four weeks alone. As a result of the still limited initial treatment capacity only a small fraction of these patients could be treated. We have begun with the radiation of prostatic carcinoma. However, after the first week in May we will be able, with two exceptions, to treat according to the operating permisson, all types of tumor which could be irradiated with x-ray therapy so far. The exceptions are melanoma of the eye and radiation therapy after tumor operations on the female breast. For the latter, PROHEALTH AG is currently optimising a positioning system which incorporates the latest technical developments in the area of body surface modelling. This will permit to fully utilise the precision of proton therapy.
Individual dose planning and standard procedures for different types of tumors. The legislation for radiation therapy in Germany as well as our permission of operations require individually designed treatment plans for each patient. The PROHEALTH AG intends to provide, upon request, every patient with her or his own individual proton scanning plan. This comes together with a conventional x-ray plan for comparison which can be easily understood by the patients themselves due to its straightforward graphical layout. The graphs and comprehensible numbers therefore enable the patient to judge the effectiveness of the two methods – optimisation of the dose within the tumor and the reduction of the dose in the healthy tissue. Such a methodical comparative selection is required by law for every radiation oncologist anyway.
At the same time we are obliged by the legislation to theoretically pre-plan so called standard protocols for common tumortypes and –localisations. The actual layout by the PROHEALTH AG for standard protocols can be accessed for the following tumors below:
- Chordom / Chondrosarkom
- NSCLC Lungenkarzinom Stage I/II
- NSCLC Lungenkarzinom Stage III/IV
- Leber-Tumor klein (Karzinom oder Metastase)
- Leber-Tumor mittelgroß
Those protocolls intended for orientation consist of a description of todays prevalent x-ray techniques, the proposed standard proton plans (which are to be individually modified and optimised) in graphical form and a tabular effectiveness analysis including annotations.