Journal List > Prog Med Phys > v.27(4) > 1098561

Jo, Ahn, Chung, Cho, Shin, Hong, Park, Kim, Lee, Lee, Seo, Jang, Choi, Lim, and Han: Analysis of Treatment and Delay Times by Disease Site and Delivery Technique at Samsung Medical Center - Proton Therapy Center

Abstract

We have treated various disease sites using wobbling and scanning proton therapy techniques since December 2015 at the Samsung Medical Center. In this study, we analyze the treatment time for each disease site in 65 wobbling and 50 scanning treatments. Treatment times are longest for liver and lung cancer cases using the respiratory gating technique in the wobbling treatment and for cranio-spinal irradiation in pediatric patients with anesthesia in the scanning treatment. Moreover, we analyze the number of incidents causing treatment delays and the corresponding treatment delay time. The mal-functioning related to the X-ray imagers was the main reason for delays in the wobbling treatment; the delayed time decreased continually from January to June 2016, due to the attaining of proficiency in handling the mal-functioning. The main reason for delays in the scanning treatment was interlocks during scanning pattern delivery; and the interlocks has been resolved by proton therapy service engineers. Through this work, we hope to provide other institutes with useful information and insight for initial operation of proton therapy system.

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Fig. 1.
Site-specific daily average of proton treatment time for the wobbling mode. Pink: averaged treatment time with standard deviation only for the first fraction of treatment. Blue: averaged treatment time with standard deviation after the second fraction of treatment. The standard deviation of each graph is indicated by upper and lower bars and average values are denoted by solid dots in the middle of the range. Red upward (downward) triangles are minimum (maximum) values of treatment time after the second fraction of treatment. At the bottom of the graph, the number of patients for each treatment site are presented. tx.: Treatment, fx.: fraction.
pmp-27-258f1.tif
Fig. 2.
Site-specific daily average of proton treatment time for the scanning mode. Pink: averaged treatment time with standard deviation only for the first fraction of treatment for each patient. Blue: averaged treatment time with standard deviation after the second fraction of treatment. The standard deviation of each graph is indicated by upper and lower bars and average values are denoted by solid dots in the middle of the range. Red upward (downward) triangles are minimum (maximum) values of treatment time after the second fraction of treatment. At the bottom of the graph, the boxed numbers are the numbers of patients for each treatment site. tx.: Treatment, fx.: fraction.
pmp-27-258f2.tif
Fig. 3.
The number of incidents causing treatment delays and average delay time for the wobbling mode. Left axis/blue dots: daily averaged treatment delay time at that week. Right axis/red line: daily average number of incidents during the given week.
pmp-27-258f3.tif
Fig. 4.
The number of incidents causing treatment delays and average delay time for the line-scanning mode. Left axis/blue dots: daily averaged treatment delay time during the given week. Right axis/red line: daily average number of incidents during the given week.
pmp-27-258f4.tif
Table 1.
Treatment time of each site for the wobbling mode.
(min) Brain Head and neck Chest excluding lung Lung Spine Liver Abdomen Pelvis Other
Avg_1st 51.8 35.0 40.7 66.5 82.3 56.4 41.0 31.3 37.0
Avg_tx 34.0 29.6 32.3 46.6 64.1 48.1 31.5 24.8 31.4
Std_1st 26.8 2.5 7.4 5.5 47.9 14.3 15.3 1.3 1.0
Std_tx 2.8 2.8 5.9 13.6 38.2 4.7 7.4 0.8 3.2
Min 23.0 23.0 20.0 32.0 29.0 33 21.0 20.0 27.0
Max 57.0 38.0 40.0 81.0 140.0 92.0 52.0 28.0 35.0
N 13 3 3 2 3 30 6 3 2

Site-specific daily average proton treatment times for the wobbling mode. Avg_1st: Average value of treatment time for the first fraction, Avg_tx: average value of treatment time after the second fraction, Std_1st: standard deviation of treatment time for the first fraction, Std_tx: standard deviation of treatment time after the second fraction, Min: minimum value of treatment time after the second fraction, Max: maximum value of treatment time after the second fraction, N: number of samples.

Table 2.
Treatment time of each site for the scanning mode.
  Brain Head and neck Chest (without gating) Lung (with gating) Abdomen Pelvis Prostate CSI
Avg_1st 48.6 40.1 37.6 76.2 66.0 38.6 50.0 91.4
Avg_tx 30.2 29.7 29.8 66.9 39.7 24.9 31.6 60.0
Std_1st 5.8 4.9 4.9 18.5 4.9 8.1 10.8 32.9
Std_tx 3.0 3.8 1.1 23.9 10.8 3.0 2.8 17.8
Min 22.00 20 22 33.00 22 20 24 22
Max 60.00 99 51 170.00 69 42 70 114
N 10 15 3 4 2 3 3 10

Site-specific daily average proton treatment times for the scanning mode. CSI: Cranio-Spinal Irradiation, Avg_1st: average value of treatment time for the first fraction, Avg_tx: average value of treatment time after the second fraction, Std_1st: standard deviation of treatment time for the first fraction, Std_tx: standard deviation of treatment time after the second fraction, Min: minimum value of treatment time after the second fraction, Max: maximum value of treatment time after the second fraction, N: number of samples.

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