Case Study | September 09, 2011

Overcoming Geographical Challenges to Deliver State-of-the-Art Radiation Therapy

Remote Planning software facilitates treatment for patients in rural Montana

Sponsored by Accuray

Dr. Lyle Harrison is no stranger to the challenges of delivering healthcare to patients in rural markets. Since 1997, he has been living and providing radiation oncology services in the MonDak region of eastern Montana and western North Dakota.

One of his biggest frustrations was not being able to provide radiation services to every patient he saw because of limitations in the technology and expertise available. As a result, many of his patients were forced to travel hundreds of miles to bigger cities where they could get the treatment they needed.

After working in the region for years, Dr. Harrison began focusing on building a radiation oncology practice to serve the Sidney, Mont., area and evaluating the technology that would meet the needs of patients in the region. “We discussed the type of patients we wanted to treat at the Sidney Health Center and quickly came to the decision that we didn’t want to have any patient that we couldn’t treat,” said Dr. Harrison. “Because of that desire, the TomoTherapy radiation therapy platform made the most sense for us.”

The TomoTherapy system gave the center several advantages over conventional radiation therapy systems, said Dr. Harrison. They include: the flexibility to treat a wide range of indications; the knowledge that they could achieve gold-standard treatment quality for their patients; improved clinical confidence via integrated daily image guidance; highly conformal radiation delivery, which helps reduce side effects that commonly occur after conventional treatments, and the ability to deliver hypofractionated treatments to shorten treatment time for patients who have to travel great distances.

While TomoTherapy technology was just what Sidney Health Center needed to support its commitment to being a comprehensive community health facility, there was still another challenge: how to have the complete team in place to support the system. This team would need to include a dosimetrist and physicist, in addition to the radiation oncologists and radiation therapists.

Finding individuals with expertise in dosimetry and physics was a difficult proposition in Sidney, which is a small community of less than 5,000 residents, in a county in eastern Montana with a total population of about 10,000. Further complicating matters is that the region is in the midst of an oil boom, which has resulted in a shortage of housing that would prevent these medical specialists from moving close to the health center to work, should they desire to relocate.

“Being in a rural area and not having the right people onsite is very difficult to overcome,” said Jen Doty, the center’s clinical director. “It was really important for us to have remote planning capabilities. We had this great TomoTherapy technology, but didn’t have the staff to get the planning done for the patients we had lined up.”

The TomoTherapy system’s Remote Planning solution gave Sidney Health Center the ability to work with dosimetrists and physicists in cities more than 900 miles away to create the plans and begin treating patients. With Remote Planning, the dosimetrists, physicists and physicians working at Sidney Health Center are able to access full TomoTherapy treatment planning capabilities from virtually any remote location.

The planning experience is exactly as it would be on TomoTherapy Planning Stations installed within the cancer center’s TomoTherapy network. Furthermore, the performance of these local workstations is not impacted by remote planning instances. The remote users can run the Remote Planning software virtual machines from their location via an encrypted SSL connection, enterprise Citrix connection, VPN or other secure network access connection.

The Remote Planning capabilities have even given the employees located at the Sidney Health Center more flexibility in doing their job. “Our dosimetrists often work outside the standard office hours, so they can call me in the evening when they’re finished with a plan and I can review,” said Dr. Harrison. “It helps us speed up the process for the patients the next day because the plan can be revised and approved before we get in the office the next morning.”

TomoTherapy technology and its Remote Planning capabilities have been instrumental in enabling Sidney Health Center to deliver state-of-the art care to patients in its rural area, rather than forcing those individuals to travel hundreds of miles to larger cities. It is using its TomoTherapy system to treat a wide range of indications, including prostate, breast, lung and metastatic cancers, as well as whole brain, lymphomas and superficial lesions.

“We’ve been able to treat everything that is treated in a larger city’s community center, as well as more complex cases, with the TomoTherapy system,” said Rick Haraldson, CEO of Sidney Health.

“The TomoTherapy platform has met all of our expectations – from installation and training to treatment and the ability to leverage our relationships with experienced dosimetrists and physicists in other cities to develop our treatment plans,” said Dr. Harrison. “I’ve been able to offer treatments that I would have never been able to treat before with conventional radiation therapy machines and would have had to refer out to others.

“It’s very important in a rural environment that no case comes through the door that we wouldn’t be comfortable treating,” he added. “We always felt that we should be able to provide the best care possible – at the same or greater quality as bigger centers – and TomoTherapy technology has helped us meet those expectations in every way.”

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