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Facility delayed from late 2013 to early 2014
By Paul Sisson6:20 p.m. Jan. 28, 2014
Anthony Mascia, a Scripps Health physicist, demonstrates one of the new treatment gantries at the Scripps Proton Therapy Center in Mira Mesa. — Eduardo Contreras
Highly publicized to open last fall, proton beam therapy has not yet arrived in San Diego.
Scripps Health planned to launch the area’s first proton treatment center in late 2013, touting the benefits of using the charged subatomic particles to deliver cancer treatments with greater precision and less collateral damage to surrounding tissue than other types of radiation therapy.
As recently as late August, Scripps said the center would be treating patients in October. But that timetable proved inaccurate.
Not to worry, says Scripps Vice President Tim Collins. “We believe we will be able to start treating patients within the month of February,” he said.
Collins said the original timeline for the $220 million facility was always an educated guess. Installing a particle accelerator is not like building a normal health care facility, he said.
In fact, the building’s equipment has more in common with a physics lab. A 90-ton particle accelerator called a cyclotron produces a steady stream of protons that travel down a 100-meter path controlled by powerful electromagnets to massive three-story 280-ton rotating gantries that can attack tumors from any angle.
It’s impossible, Collins said, to know exactly how long it will take to get such a complicated system installed, tuned and tested.
“We all knew that the timeline was subject to change as the process moved forward. I mean, if you look at the great achievements of mankind, this process is really putting all of that together,” Collins said.
Though there are now more than a dozen proton centers in the United States, the Scripps center is the first in the United States that uses medical equipment made by Palo Alto-based Varian Medical Systems. Because Scripps is the first to use the manufacturer, it had to go through premarket certification by the U.S. Food and Drug Administration.
The FDA signed off on the project Jan. 10, Collins said.
Varian did not respond to a request for an interview, but it did reply to written questions. When asked which part of the installation process has taken longer than expected, the company said: “No part has taken longer than expected. Everything has been within the realm of normal variance.”
Leonard Arzt, executive director of the National Association for Proton Therapy, said that it has not been uncommon for new proton centers to open later than originally planned.
“That’s pretty common at all of the proton centers,” Arzt said. “They have a lot of things they need to get perfect before they start treating patients.”
Starting in early 2014 instead of late 2013 is not completely Scripps’ problem.
Though it bears the Scripps name and it will be Scripps employees who treat patients there, the proton center does not belong to Scripps Health. Rather, the 102,000-square-foot facility, built in a Mira Mesa business park, is owned by Advanced Particle Therapy, a local investment group that is also building centers in Baltimore, Dallas and Atlanta.
Jeffrey Bordok, chief executive of Advanced Particle, said Tuesday that a last-minute software upgrade also played a role in the delay. He said it made sense to hold off on submitting information to the FDA until the software had been installed.
“We elected to update it so that it would be the latest and greatest version,” Bordok said. “We feel that the changes are going to be well worth it over time.”
The government shutdown in the fall also lengthened the government’s approval process, he added.
While delivering and installing the center’s massive equipment was a big part of the job, Anthony Mascia, a physicist with Scripps Health, said that testing and adjustment is also time-consuming. Once the center’s cyclotron makes a stream of protons, those subatomic particles must be guided to each of the facility’s five treatment rooms, a journey that can be more than 100 yards, he said.
The beam of protons, though, does not want to travel in a straight line, requiring regular exposure to strong electromagnetic fields to keep en route to the patient.
“You have to constantly refocus the beam between the cyclotron and here,” Mascia said, standing in one of the proton center’s rooms.
Getting the magnetic fields lined up, he said, requires the attention of many specialists and goes right down to the reliability of the electricity coming off the region’s power grid.
“You’ve got to take all of this work that’s been done by five different companies and make it come together,” he said.
Testing is in its final phase, with technicians using special detectors to make sure that the proton beam arrives in exactly the right spot, and at exactly the dose, that is required for treatment.
Precision is important because the equipment uses a new type of proton technology called pencil beam, which delivers a much narrower field of protons to cancerous tumors than previous generations of proton technology that used a larger scatter pattern. The emitter that directs the beam of protons at the tumor is also able to scan back and forth, following the shape of the malignancy more accurately than was previously possible.
Scripps is the first in the nation built from the ground up to use only pencil-beam technology, though several existing centers have retrofitted their equipment to offer a similarly narrow beam path.
The scanning capabilities, and narrower path, also allow treatment of cancers in inconvenient locations, like the eye or lung, that are very difficult to treat with traditional radiation-emitting technology.
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