A few new proton centers coming

[IonsAreOurFuture]

I noticed that UPENN just announced a 4th proton center to be built in its network:

1. Original 5 room center in Philly, 2010
2. Lancaster, PA - 2022
3. South New Jersey -2023
4. Penn-Presbyterian Medical Center in 2027

Penn Medicine to open new proton therapy center in University City

The facility will be at Penn Presbyterian Medical Center and is slated to open in 2027. It will expand access to the targeted, less-invasive cancer treatment, officials say.

www.phillyvoice.com

Not to be outdone, Thomas Jefferson also has announced a proton center for northeast Philly:

Jefferson Health to develop proton therapy center in Northeast Philadelphia

The plans for a cancer treatment facility at the Torresdale campus would be just the second in the city

www.phillyvoice.com

Morristown Medical center in Morristown, NJ also recently announced a single room install of the Mevion-Fit system that uses the upright Leo chair system.

Atlantic Health System and Mevion Announce Plans to Bring Newest Proton Therapy Technology to Cancer Patients

www.morningstar.com

I think that marks at least the 6th Leo chair system announced in the past couple years:

Mclaren - 2 chairs, 2 gantries
Stanford - 1 chair
Madison, WI - 1 chair, 1 gantry
Baycare in Tampa - 1 chair
Morristown, NJ - 1 chair

There's a lot riding on the hoped-for success of the Leo chair system, I hope it works out.

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[grenz]

I noticed that UPENN just announced a 4th proton center to be built in its network:

1. Original 5 room center in Philly, 2010
2. Lancaster, PA - 2022
3. South New Jersey -2023
4. Penn-Presbyterian Medical Center in 2027

Penn Medicine to open new proton therapy center in University City

The facility will be at Penn Presbyterian Medical Center and is slated to open in 2027. It will expand access to the targeted, less-invasive cancer treatment, officials say.

www.phillyvoice.com

Not to be outdone, Thomas Jefferson also has announced a proton center for northeast Philly:

Jefferson Health to develop proton therapy center in Northeast Philadelphia

The plans for a cancer treatment facility at the Torresdale campus would be just the second in the city

www.phillyvoice.com

Morristown Medical center in Morristown, NJ also recently announced a single room install of the Mevion-Fit system that uses the upright Leo chair system.

Atlantic Health System and Mevion Announce Plans to Bring Newest Proton Therapy Technology to Cancer Patients

www.morningstar.com

I think that marks at least the 6th Leo chair system announced in the past couple years:

Mclaren - 2 chairs, 2 gantries
Stanford - 1 chair
Madison, WI - 1 chair, 1 gantry
Baycare in Tampa - 1 chair
Morristown, NJ - 1 chair

There's a lot riding on the hoped-for success of the Leo chair system, I hope it works out.

When does the first Leo system start treating patients? And how will centers contemplating one find out whether it is “working out” as you say?

 

[RickyScott]

I noticed that UPENN just announced a 4th proton center to be built in its network:

1. Original 5 room center in Philly, 2010
2. Lancaster, PA - 2022
3. South New Jersey -2023
4. Penn-Presbyterian Medical Center in 2027

Penn Medicine to open new proton therapy center in University City

The facility will be at Penn Presbyterian Medical Center and is slated to open in 2027. It will expand access to the targeted, less-invasive cancer treatment, officials say.

www.phillyvoice.com

Not to be outdone, Thomas Jefferson also has announced a proton center for northeast Philly:

Jefferson Health to develop proton therapy center in Northeast Philadelphia

The plans for a cancer treatment facility at the Torresdale campus would be just the second in the city

www.phillyvoice.com

Morristown Medical center in Morristown, NJ also recently announced a single room install of the Mevion-Fit system that uses the upright Leo chair system.

Atlantic Health System and Mevion Announce Plans to Bring Newest Proton Therapy Technology to Cancer Patients

www.morningstar.com

I think that marks at least the 6th Leo chair system announced in the past couple years:

Mclaren - 2 chairs, 2 gantries
Stanford - 1 chair
Madison, WI - 1 chair, 1 gantry
Baycare in Tampa - 1 chair
Morristown, NJ - 1 chair

There's a lot riding on the hoped-for success of the Leo chair system, I hope it works out.

Penn also has a proton center at virtua in south jersey

 

[IonsAreOurFuture]

When does the first Leo system start treating patients? And how will centers contemplating one find out whether it is “working out” as you say?

Great question, it's really hard to say. I've seen pictures online of the McLaren and U of W Madison facilities being built.

Proton hardware is still pretty complex and no two systems seem totally the same, compared to the good old linac that's on its 7th generation or so.

As far as when is it "safe" to jump in the pool, it depends largely on one's tolerance for risk and institutional tendency to get the newest modality. You definitely need a good team of problem solvers who can fix it locally if it breaks, without having to fly people or parts in from overseas.

The question kind of reminds me of the Tomotheray machine. It did some things extremely well and remains a one of a kind system, but some people feel like it never reached the 99.5% uptime of a mature linac platform and couldn't do everything that a linac could or should. Some people feel like the Tomo never met its promise or was always inferior to a Truebeam, or they didn't need a 2nd or 3rd machine, and so never adopted a Tomo.

In my experience, if you had a good engineer on site who kept it running smoothly, or a backup Tomo if one went down, uptime was pretty good. Proton downtime is still a major issue for many centers, and this is even more of an unknown, so it's kind of like buying the fifth Tomo off the line.

There will definitely be an upright learning curve for the whole treatment team; even trying to treat a palliative patient sitting upright on a Truebeam would require a new set of devices, processes and training for everyone involved.

 

[pikachu]

Great question, it's really hard to say. I've seen pictures online of the McLaren and U of W Madison facilities being built.

Proton hardware is still pretty complex and no two systems seem totally the same, compared to the good old linac that's on its 7th generation or so.

As far as when is it "safe" to jump in the pool, it depends largely on one's tolerance for risk and institutional tendency to get the newest modality. You definitely need a good team of problem solvers who can fix it locally if it breaks, without having to fly people or parts in from overseas.

The question kind of reminds me of the Tomotheray machine. It did some things extremely well and remains a one of a kind system, but some people feel like it never reached the 99.5% uptime of a mature linac platform and couldn't do everything that a linac could or should. Some people feel like the Tomo never met its promise or was always inferior to a Truebeam or didnt need a 2nd or 3rd machine, and so never adopted a Tomo.

In my experience, if you had a good engineer on site who kept it running smoothly, or a backup Tomo if one went down, uptime was pretty good. Proton downtime is still a major issue for many centers, and this is even more of an unknown, so it's kind of like buying the fifth Tomo off the line.

There will definitely be an upright learning curve for the whole treatment team; even trying to treat a palliative patient sitting upright on a Truebeam would require a new set of devices, processes and training for everyone involved.

"a backup tomo" lol, it's all good if you have an extra $4mil machine standing idle in your dept. i've never seen an unhappier department than when the heavily loaded Tomo unit would go down indefinitely for the nth time in a month, leaving all patients to be replanned.

 

[IonsAreOurFuture]

"a backup tomo" lol, it's all good if you have an extra $4mil machine standing idle in your dept. i've never seen an unhappier department than when the heavily loaded Tomo unit would go down indefinitely for the nth time in a month, leaving all patients to be replanned.

Yeah, having a $4 million Tomo machine go down for 2-3 days is a real pain. Now imagine it's a $40 Million proton machine, and the patients who traveled to get protons are particularly ticked off, and the admin is breathing down your neck even though you can't fix a bum accelerator. That is a recurring theme at some (not all) proton centers, and the replanning can really take a toll on dosi, physics, doc and therapists who have to stay late to QA, Vsim and treat the former proton patients.

 

[communitydoc13]

Now imagine it's a $40 Million proton machine, and the patients who traveled to get protons are particularly ticked off, and the admin is breathing down your neck even though you can't fix a bum accelerator. That is a recurring theme at some (not all) proton centers, and the replanning can really take a toll on dosi, physics, doc and therapists who have to stay late to QA, Vsim and treat the former proton patients.

Collective madness.

A couple beam matched Truebeams...for everything...sanity.

 

[yesmaster]

Why protons and upright chair, versus linac and upright chair?

 

[Doctorer]

Why protons and upright chair, versus linac and upright chair?

because with an upright chair the patient moves instead, saving $$$ on a gantry that moves, and you can advertise that you have protons without spending as much money.

 

[RickyScott]

because with an upright chair the patient moves instead, saving $$$ on a gantry that moves, and you can advertise that you have protons without spending as much money.

Not sure how cbct would work, but also save on shielding.

 

[temujim]

Not sure how cbct would work, but also save on shielding.

CBCT comes down over the patient on the upright table.

 

[TheWallnerus]

I noticed that UPENN just announced a 4th proton center to be built in its network:

1. Original 5 room center in Philly, 2010
2. Lancaster, PA - 2022
3. South New Jersey -2023
4. Penn-Presbyterian Medical Center in 2027

Penn Medicine to open new proton therapy center in University City

The facility will be at Penn Presbyterian Medical Center and is slated to open in 2027. It will expand access to the targeted, less-invasive cancer treatment, officials say.

www.phillyvoice.com

Not to be outdone, Thomas Jefferson also has announced a proton center for northeast Philly:

Jefferson Health to develop proton therapy center in Northeast Philadelphia

The plans for a cancer treatment facility at the Torresdale campus would be just the second in the city

www.phillyvoice.com

Morristown Medical center in Morristown, NJ also recently announced a single room install of the Mevion-Fit system that uses the upright Leo chair system.

Atlantic Health System and Mevion Announce Plans to Bring Newest Proton Therapy Technology to Cancer Patients

www.morningstar.com

I think that marks at least the 6th Leo chair system announced in the past couple years:

Mclaren - 2 chairs, 2 gantries
Stanford - 1 chair
Madison, WI - 1 chair, 1 gantry
Baycare in Tampa - 1 chair
Morristown, NJ - 1 chair

There's a lot riding on the hoped-for success of the Leo chair system, I hope it works out.

It is interesting re: Penn and Thom Jeff. Why? They are their own health insurance systems, right? A vast majority of their patients would thus get automatically approved for protons. So, protons work economically... in these systems. But arguably unnaturally so.

UAB does not have its own health insurance system.

 

[RickyScott]

CBCT comes down over the patient on the upright table.

View attachment 390522

My guess is that there won’t be any upfront cost savings over stripped down halcyon given economy of scale with varian. Maybe save on shielding and service Contract

 

[pikachu]

because with an upright chair the patient moves instead, saving $$$ on a gantry that moves, and you can advertise that you have protons without spending as much money.

New proton center promotional brochure like

 

[seper]

It is interesting re: Penn and Thom Jeff. Why? They are their own health insurance systems, right? A vast majority of their patients would thus get automatically approved for protons. So, protons work economically... in these systems. But arguably unnaturally so.

UAB does not have its own health insurance system.

Health Partners is a form of Medicaid, with Temple University being the 3d partner. So case for PBT not so straightforward

 

[xrt123]

Is there any clear data on proton reimbursement/cost? Is any Medicare data available, as I am sure institutions would never reveal this?

 

[TheWallnerus]

Is there any clear data on proton reimbursement/cost? Is any Medicare data available, as I am sure institutions would never reveal this?

There’s (there are?) definitely clear data on the First Coast Service Options website. Please do check it out!

 

[IonsAreOurFuture]

Health Partners is a form of Medicaid, with Temple University being the 3d partner. So case for PBT not so straightforward

United Healthcare owns part of a proton center. United Healthcare does not authorize protons. They believe in protons as an investment but not as an expenditure.

The protons they own are standard of care and FDA approved. Everyone else's protons are experimental and "not medically necessary."

I would bet that UPENN and Jefferson's insurance arm and hospital group are similarly conflicted internally.

 

[NotMattSpraker]

United Healthcare owns part of a proton center. United Healthcare does not authorize protons. They believe in protons as an investment but not as an expenditure.

This is amazing. How big of a part?

 

[Chartreuse Wombat]

United Healthcare owns part of a proton center. United Healthcare does not authorize protons. They believe in protons as an investment but not as an expenditure.

The protons they own are standard of care and FDA approved. Everyone else's protons are experimental and "not medically necessary."

I would bet that UPENN and Jefferson's insurance arm and hospital group are similarly conflicted internally.

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/proton-beam-radiation-therapy.pdf

Looks like wiggle room on prostate. This is a change in their stance maybe in response to the below

https://www.americanbar.org/groups/health_law/section-news/2021/03/uni-hea/

Not sure where the class action suit is.

 

[OTN]

United Healthcare owns part of a proton center. United Healthcare does not authorize protons. They believe in protons as an investment but not as an expenditure.

The protons they own are standard of care and FDA approved. Everyone else's protons are experimental and "not medically necessary."

I would bet that UPENN and Jefferson's insurance arm and hospital group are similarly conflicted internally.

Wasn't that the EXACT point of the Matt Damon movie about insurance companies that was the big "gotcha" in the trial?

 

[TheWallnerus]

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/proton-beam-radiation-therapy.pdf

Looks like wiggle room on prostate. This is a change in their stance maybe in response to the below

https://www.americanbar.org/groups/health_law/section-news/2021/03/uni-hea/

Not sure where the class action suit is.

In general UHC no longer denies protons for prostate

 

[medgator]

In general UHC no longer denies protons for prostate

But they push hypo for IMRT. I wonder if that is the case for protons

 

[TheWallnerus]

But they push hypo for IMRT. I wonder if that is the case for protons

it is the case

 

[seper]

United Healthcare owns part of a proton center. United Healthcare does not authorize protons. They believe in protons as an investment but not as an expenditure.

The protons they own are standard of care and FDA approved. Everyone else's protons are experimental and "not medically necessary."

I would bet that UPENN and Jefferson's insurance arm and hospital group are similarly conflicted internally.

which proton center is the one that UHC owns?

 

[IonsAreOurFuture]

which proton center is the one that UHC owns?

I think that UHC owns part of New York Proton Center under a subsidiary called Prohealth Proton Center Mgmt, LLC, a Delaware corporation.

 

[communitydoc13]

I think that UHC owns part of New York Proton Center under a subsidiary called Prohealth Proton Center Mgmt, LLC, a Delaware corporation.

Very interesting.

Huge fraction of corporations are incorporated in DE due to tax policy and chancery court structure. It means nothing regarding the actual location of the corporation.

 

[Chartreuse Wombat]

Very interesting.

Huge fraction of corporations are incorporated in DE due to tax policy and chancery court structure. It means nothing regarding the actual location of the corporation.

Why Does One Tiny State Set the Rules for Everyone? - Freakonomics

Why Does One Tiny State Set the Rules for Everyone? - Freakonomics

freakonomics.com

 

[A_DeMichele]

Prohealth Proton Center Mgmt is UHG? just wow