The University of Pennsylvania/Walter Reed Army Medical Center proton therapy program

The design of the proton therapy center being constructed at the University of Pennsylvania is based on several principles that distinguish it from other proton facilities. Among these principles is the recognition that advances in imaging, and particularly in functional imaging, will have a large impact on radiotherapy in the near future and that the conformation of proton dose distributions can utilize that information to a larger degree than other treatment techniques. The facility will contain four-dimensional CT-simulators, an MR-simulator capable of spectroscopy, and a PET-CT scanner. A second principle applied to the facility design is to incorporate into proton radiotherapy the recent progress in conventional radiotherapy; including imaging and monitoring of patients during treatment, imaging of soft tissue, accounting for respiratory motion, and expanding the use of intensity-modulated treatments. A third principle is to understand that the facility must be operated efficiently. To that end the specifications for the equipment have included requirements for high beam intensity, fast switching times between treatment rooms, a multileaf collimator to permit multiple fields to be treated quickly, and plans for an intelligent beam scheduler to determine where the beam can be best used at any given time. We expect to use "universal" nozzles, which can switch rapidly from scattering mode to scanning mode, and there will be a set-up room used for the first day of treatment to verify alignment rather than spend valuable time in a gantry room. Many of these ideas require development, including the applications of existing radiotherapy techniques to proton gantries, so a series of research and development projects have started to address these issues. Walter Reed Army Medical Center, which will provide a portal through which military personnel and their dependants can receive proton radiotherapy, is involved in several of these development projects as well as the creation of process to remotely perform treatment planning for the military patients under treatment at the proton facility.