Feature | October 11, 2007 | Rick Dana Barlow and Cristen C. Bolan

Five IMRT/IGRT Centers to Watch

Influential RT centers succeed through innovation, efficiency, customer service and teamwork.

Fighting cancer is a tough-enough ordeal for patients and clinicians alike. But waging war against an eminently deadly organic mass with the right tools that pinpoint the delivery of radiation therapy without harming healthy surrounding tissue in a reimbursement-challenged healthcare environment ultimately fuses art with science.
As a result, Imaging Technology News and its sister magazine Outpatient Care Technology worked together to recognize forward-thinking cancer treatment centers that use advanced techniques and technology, such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), to help their patients and make a difference.
We asked readers to submit nominations of worthy facilities to recognize based on their achievements in innovation, operational efficiency, customer service and teamwork. From there the editors chose five to recognize as facilities to watch in 2007, classifying them as influential market leaders. In alphabetical order, here they are.
1) Bloomington Hospital Regional Cancer Institute Radiation Oncology Centers, Bloomington, IN - Innovation: The radiation oncology department uses a four-slice large-bore simulation CT equipped with respiratory gating; matched 21iX OBI accelerators, two at the main site and one at the satellite site; an integrated ARiA treatment planning, record-and-verify and patient outcomes assessment database with HL7 interface to the hospital billing and patient registration demographics.
Operational Efficiency: Many patient treatment plans, including fused adjuvant diagnostic imaging, PET for head and neck and rectum, MRI for brain lesions and diagnostic CT for sarcoma, allow for all to be imaged in the treatment position. Cone beam CT is useful in evaluating soft tissue changes during head and neck and lung treatments as a verification of prostate tissue location relative to gold seed position and as pretreatment verification of chest wall and heart position for gated breath hold for left-sided breast treatments.
Customer Service: Introducing the new technology at the satellite created the ability to complete all the patients’ treatments at that site and eliminated the need for them to travel.
Teamwork: Upgrades to a platform for simulation, planning and treatment delivery facilitate staff rotation between sites as necessary. This has fostered teamwork amongst the staff as they are now aware of the issues that are unique to each site as well as those that are essential for work.
2) Central Arkansas Radiation Therapy Institute, Little Rock - Innovation: The ExacTrac X-Ray 6D image-guided radiation therapy (IGRT) system enables doctors to pinpoint tumors with increased accuracy and treat a wider variety of indications.
Operational Efficiency: Implementing the new system offered a high level treatment accuracy, resulting in fewer complications and better treatment outcomes, as well as improved workflow to maximize patient output.
Customer Service: The office staff at CARTI assists with housing, transportation, financial concerns, cancer education materials and a plethora of other services for the patients’ and families’ mental and emotional well-being.
Teamwork: With the arrival of the ExacTrac X-Ray 6D system, greater accuracy means that oncologists can now treat a wider range of indications, including prostate, lung, liver and spine.
3) Edward Cancer Center, Naperville, IL - Innovation: The medical oncology practice at Edward Cancer Center and its satellite facility offer physician and nurse visits, chemotherapy, infusion, transfusion services, psycho-social counseling, a resource library, breast rehabilitation services and numerous cancer screening and educational programs. The radiation oncology practice provides external beam radiation therapy (EBRT), including 3D conformal, intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT), as well as high dose rate (HDR) radiation treatments, including gynecological brachytherapy, MammoSite and other HDR procedures. It recently started offering stereotactic radiosurgery.
In early 2007, Edward Cancer Center began using a fixed-site PET/CT, which improves accuracy in identifying cancer and helps physicians determine the most beneficial therapies. The center also offers MammoSite, a brachytherapy treatment for breast cancer. Nearly six percent of Edward patients are enrolled in an oncology clinical trial, double the national average.
Operational Efficiency: Edward physicians use an electronic medical record system that allows physicians to input patient information and order tests/treatment via computer. Consequently, patients and their families no longer have to worry about holding on to or relaying patient records, test orders and test results. All Edward Cancer Center billing is done online.
Customer Service: The 40,000-square-foot Edward Cancer Center features a home like interior with a brick fireplace and maple woodwork. Kitchenettes provide a place for patients and their families to relax and eat meals during long treatment days. Group, semi-private and private chemotherapy treatment rooms are available. The facility provides two licensed clinical social workers, a full-time breast care coordinator, a full-time pharmacist and a dedicated team of oncology nurses. It offers a wide variety of support groups, mindful yoga classes and Reiki classes and holds special events and retreats throughout the year, focusing on health, education, networking, stress management and nutrition. Patients stay in touch with family and friends online through CarePages.
Teamwork: The lines of communication are always open between administrators and clinicians. They meet on a regular basis to discuss workflow, clinical processes and all issues that impact patients and their treatment. This collaborative approach has led to the Edward Cancer Center to achieve the highest level designation for a community hospital — Comprehensive Community status.
4) MIMA Cancer Center, Melbourne, FL - Innovation: The first radiation oncology department to install image-guided radiation therapy (IGRT) technology on all of its machines in 2004, MCC has since transitioned
to Varian OBI/CBCT technology. Last year, routine use of Varian’s respiratory gating technology was brought online for the treatment of lung and upper abdominal tumors.
Operational Efficiency: MIMA has an EMR system and PACS. MCC’s chief physicist, Joseph Ting, PhD, establishes synergistic and strategic partnerships with major vendors, particularly Varian, to keep MCC at the forefront of technology. The center houses approximately 45 staff members, three linear accelerators (with a fourth in construction), dedicated CT and PET/CT technology and treats upwards of 1,000 patients per year.
Customer Service: For purposes of assessing and improving patient satisfaction, patient satisfaction questionnaires at MCC are completed at the end of patients’ treatments.
Teamwork: Administration support is key to MCC’s success with a strong commitment to being at the forefront of technology, operating efficiently and profitably, and providing world-class cancer care since MCC’s opening.
5) University of Maryland Medical Center, Department of Radiation Oncology, Baltimore - Innovation: Throughout the years, the faculty members in the Department of Radiation Oncology have developed several unique IMRT methods, such as intensity-modulated arc therapy (IMAT), which uses overlapping rotational beams, delivered with continuous rotation and reducing the total treatment time. Another innovation is Direct Aperture Optimization (DAO), which optimizes the treatment beam apertures and their weightings. The center uses IGRT using cone beam CT and has implemented gated radiation delivery. Faculty members are developing a real-time tumor tracking technology and are regarded as pioneers in 4D CT and tumor tracking.
Operational Efficiency: The department meets regularly to examine all treatment procedures and migrated to Varis to integrate workflow with the new equipment.
Customer Service: To act as an aid in educating patients about radiation therapy, the department developed a video and handbook and instituted a patient
navigator to guide patients through a potentially complex system.
Teamwork: Patient care meetings are attended by physician leadership, administration leadership and representatives from the clinic (front desk, therapy and nursing) to solicit input on ways to make the clinic run more efficiently.

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