Beaumont to get Proton Center

[Ursus Martimus]

Beaumont has recently been approved for a proton center to open in 2010:

http://www.mlive.com/businessreview/oakland/index.ssf/2008/07/beaumont_gets_final_approval_f_1.html

as well they are starting the first private medical school in Michigan in 2010:

http://www4.oakland.edu/?id=1102&sid=148

Finally, they have gotten approval for a 3rd residency spot per year. It is a place worth checking out if you are looking to rotate as a medical student.

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[stephew]

issues of hoping to match at a place after an audition rotation aside, faculty is by far better reason for a student to choose a center for rotation than technology.

 

[RTGuy]

Beaumont got approved for 3 residents per year ?

Are they looking for residents to add to the existing classes or will this only be applied to future classes?

On another note, what kind of technology does beaumont have and who are some of the bigger name attendings there?

 

[xraydude]

What an extreme #$%&! waste of resources. Procure will want it's return on investment, and you'll see lots of prostates treated for absolutely minimal if any benefit over IMRT. This is going to put a big target on reimbursement for rad onc - our greed for money making technologies, and look for us to get huge cuts in reimbursement over the next 10 years due to overuse of expensive but not better technology.

 

[Ursus Martimus]

On another note, what kind of technology does beaumont have and who are some of the bigger name attendings there?

Beaumont has a history of pressing the envelope with numerous technologies. For one, much of the image guided treatments has been driven by the physics groups development of on board cone beam imaging. The department is heavily involved in developments with Eleckta who licences such technology for their linacs.

The brachytherapy is mostly HDR and the Chair, Alvaro Martinez, has been the principle advocate for the technology. Pateints with prostate are treated with HDR in as few as 2 treatments for low risk disease. University of Michigan and Wayne State residents often rotate here for such experience.

Frank Vicini is a driving force for the develpment of partial breast irradiation and is the chair of the B39 trial.

Of course there are other established faculty including Larry Kestin (lung/sarcoma/prostate), John Robertson (GI), Mihai Ghilezon (brachy), Inga Grills (breast/cns/gamma knife), Peter Chen (CNS, peds, gamma knife), and others.

The radio-biology is up and coming with excellent lab space, micro-arrays, proteomics, micro-PET. Beaumont (the primary hospital has over 1000 beds)has a wealth of clinical samples ripe for such analysis

Much criticism surrounds protons, for which data is lacking. This is an argument beyond the scope of this post. However, given beaumont's history of image guidance, what will likely emerge is a form of image guided protons allowing for dose escalation and normal tissue sparing.

 

[xraydude]

IMPT and IGPT are still years away....and have many technical hurldles....you would have to make a separate subgantry to do cone beam quality imaging w/ xrays.

They have good technology and have been innovators - vicini, martinez, kestin.....but their residents have been less than impressive clinically. They are very book smart (see the beaumont notes), but are not as good in actually doing RT as they don't have as much volume as the surrounding programs.

But....the reality is protons is an overutilization of technology that is really only necessary and truly beneficial in certain applications - ie peds, chordomas, NPX or paranasal sinus tumors, etc.

 

[flattire]

bump

 

[Ursus Martimus]

but are not as good in actually doing RT as they don't have as much volume as the surrounding programs.

I am not sure what is ment by "not as good in actually doing RT" means, however these are the treatment numbers (per our business manager) for 2006 for the 4 programs in the metro Detroit area:



William Beaumont Hospitals: 1916 pts (44341 treatments)

Henry Ford Hospital: 999 pts (16,500 treatments)

Karmanos (Wayne State): 1586 pts (29,672 treatments)

University of Michigan: 1586 pts (26,437 treatments)

 

[deleted4401]

Rotated through there. Very busy clinic, especially on certain services. Hardly a moment to eat or piss (Kestin, Martinez). Volume can't be an issue. If you are metro Detroiter, even not in the medical business, you know that Beaumont is the busiest medical center in the area.

That's a weird statement to say they aren't good clinically. I don't how that can be said about any one program. Training is so resident dependent. If you read and see patients, you'll do fine.

And as far as wasting money, that is really hard to predict correctly. Capital costs are high in our field, but Beaumont has a strong infrastructure, heavy volume (the Royal Oak location may treat as many patients as any single site in MI, OH, PA, IN), and are extremely profitable. If they shift all prostate patients from IMRT to proton, it won't take too long to re-coup, if reimbursements don't bottom out. They are facing a threat from another hospital (a Ford affiliate) and this is probably a strategic initiative to keep cancer patients from one of the richest counties in the US from leaving Beaumont. It's an arms race, and they aren't doing anything that a hospital with their resources wouldn't do. It's more silly for Tufts to build one with Harvard's around the corner, or the one being built in Broward when Jacksonville has one 3.5 hours away.

And come on- look at the DVH for an early stage prostate CA 3D (6 field) plan on a medium sized man and compare it to an IMRT plan. Talk about incremental benefits ... sheesh. Who knows if it matters clinically?

S

S

 

[xraydude]

I don't disagree with your comments on IMRT for prostate cancer....being little incremental benefit. The reality is that brachytherapy is really the best treatment for low risk patients from a cost benefit standpoint - it only costs the payors 5-10K. 3DCRT ranges from 5-~12K IMRT ranges from 10-~20K. And protons for 50K.

What IMRT has allowed is dose escalation, relatively safely with little rectal bleeding rates. My rectal bleeding rates for 78Gy (plus) are under 5%, and less than that. Compare that with 3D data where those numbers are clearly in the double digits. While IMRT dosimetry is better, I agree it's not that much of a leap, but it does have significant reduction in complications...and that you can go to a payor to argue a benefit for not a lot of cost.

Do you honestly think payors will want to pay more than double the cost for protons? You have Zietman himself who says it's probably not worth it. And the MGH experience only used protons for a boost. Procure wants to treat the full dose on protons at >1K a day.

Interestingly, these free standing proton centers can't even submit for the recently reduced (2008 CMS rates) that hospital based centers like MGH or Loma Linda bill at - it's at the discretion of the regional medicare director. And I bet when they see their numbers go through the roof, we will all pay dearly in cuts in all of our services. The greed of a few to make a buck will hurt all of us.

Only we can control our destiny. Like urorads, protons are a slippery slope, and we will all stand to lose as they have to make up budget shortfall by cutting IMRT.

Just because it's more sophisticated, does not mean it's better.

And regarding my comments on Beaumont, that was based on my experiences years ago knowing some of the residents. It sounds like the program has picked up and I respect that. I didn't imply these people were not top notch - they certainly were quite bright when I interacted with them....though I felt they were more book smart at the time - they could recite very textbook answers on fields, etc. That certainly has changed since IMRT is no longer a textbook answer when planning. And as I said, there are certainly great people there.

 

[Sunfire]

This is probably old news around here, but just in case...

http://www.touro.edu/general/news/particletherapy/

 

[Adawaal]

Pretty fancy for a DO school. Doesn't that fly in the face of osteopathic principles?

 

[stephew]

no one sticks with classic DO philosophy. like allopathic med its evolved.

 

[Adawaal]

I dunno. Back when I was applying to med school, I had initially flirted with the DO path. Every faculty member pulled back in distaste when I mentioned research and icily retorted that clinical research is absolutely contrary to the DO philosophy. That wasn't all THAT long ago....

 

[qwert]

I'm pretty sure there are combined DO/PhD programs now out West.

I dunno. Back when I was applying to med school, I had initially flirted with the DO path. Every faculty member pulled back in distaste when I mentioned research and icily retorted that clinical research is absolutely contrary to the DO philosophy. That wasn't all THAT long ago....

 

[stephew]

I dunno. Back when I was applying to med school, I had initially flirted with the DO path. Every faculty member pulled back in distaste when I mentioned research and icily retorted that clinical research is absolutely contrary to the DO philosophy. That wasn't all THAT long ago....

that's a surprise to me. I think most do's do it because they want to practice medicine. Many do it because either there's a school near their region or dont get into an md program. and before anyone goes flame on, that's not a comment about the students or the training. Anyway there's always a few. Including a medoncs who are vocal know-nothings about radonc. Most people are reasonable though.