The P-CURE Solution: More Flexible Image-Guided Patient Positioning for Proton Therapy Increases Treatment Accuracy, Reduces Costs

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The P-CURE solution significantly reduces the cost of proton therapy centers and increases patient positioning accuracy. Construction and equipment costs for new centers can be reduced by 60 percent. A prototype installation has been installed in the United States using P-CURE’s FDA approved 3-D image guided positioning system.

We have developed a patient image-guided positioning system that provides greater flexibility for the physician

A primary goal for all forms of radiation therapy for cancer treatment is to position the patient so that the treatment dose can be precisely delivered to the tumor site. Treatment with proton therapy, an advanced form of radiation that has the potential to deliver higher doses of irradiation with significantly reduced treatment-related side effects as compared to all forms of conventional x-ray, benefits most from achieving the highest level of positioning accuracy.

Proton centers currently use 100(+) ton, three story gantries, to rotate the delivery cone prior to treatment. Or, for head and neck treatments, a fixed beam, non-gantry system is used to deliver the beam to the patient in a seated position. The result is that most proton centers use a multiple room design with two-to-four gantries for treating most cancers of the body, and a single fixed beam room for tumors of the head and neck. Consequently, the construction and equipment cost of a multi-room proton center with multiple three-story high gantries today is approximately $200 million, or more.

P-CURE has developed a treatment room patient setup that has unlimited flexibility to accurately determine and implement a treatment plan for any delivery system. The P-CURE solution is an integrated 3D image guided robotic system that positions the patient from treatment planning to treatment delivery. The resulting treatment accuracy is enhanced to sub-millimeter accuracy. This is particularly important for proton therapy, where a very small deviation from the targeted tumor site may lead to unwanted clinical outcomes.

"We have developed a patient image-guided positioning system that provides greater flexibility for the physician,” says Michael Marash, PhD and CEO of P-CURE Ltd. "Using the integrated P-CURE solution, an entire arsenal of imaging options are available. The P-CURE system optimally determines the imaging resolution on the target, the radiation dose the patient will be exposed to during imaging, and the time allocated for treatment. Now, these parameters can be fully tailored to the patient’s condition, age, and disease progress. The P-CURE installation is completely flexible to set various imaging components not only within the treatment room, but also splitting various imaging components between the patient preparation and treatment rooms. This flexibility optimally supports all possible treatment scenarios and can be tailored to the vision and clinical policy of all treatment centers and vendors."

For those who would decide to use the P-CURE system in front of a fixed beam delivery system, eliminating the need for gantries, the result will be greater accuracy, the elimination of multi-gantry systems and reduced multi-story construction costs, and a financial savings of approximately 60 percent for a new proton center.

To enhance the precision of the more versatile patient positioning system, P-CURE uses a real-time volumetric – three dimensional – imaging of the treatment site. The volumetric imaging of the target cancer site is integrated with a CT scanner producing three-dimensional images used for extremely accurate patient registration in front of any proton delivery system. The final patient positioning uses P-ART™, the P-CURE FDA approved proprietary state of the art 3-D image guided positioning system that takes into account treatment-related anatomical changes that have occurred in the patient’s tumor site. In order to reduce the radiation exposure during the imaging and enhance the treatment workflow, alternative 2D/2D negligible radiation and quickly performing module is incorporated. The integrated design of the P-CURE patient position system allows for total three-dimensional flexibility of the patient, including forward/back, left/right, up/down, yaw, pitch and roll, what is called six degrees of freedom (6DoF). This flexibility, controlled by sophisticated image-guidance and treatment adaptation, shifts the paradigm from needing a three story gantry for beam delivery to a single fixed beam with flexible patient positioning.

Marash says, “Prior to each irradiation treatment, we must first understand where the target is and if its’ position has changed. Then we must determine if the treatment plan generated days or weeks before is suitable for the current treatment. The P-CURE integrated system can, if needed, re-focus the beam on the target either by adjustment of the patient position or by instructing the beam delivery system.”

Each treatment room in the P-CURE patient-centered system includes a multi-slice CT, either ceiling mounted for seated patient positioning or floor mounted for horizontal positioning; the robotic positioner; optical position verification 3-D cameras with submillimeter accuracy; the P-ART™ integrated patient positioning software; and chair, couch and work station for precise patient positioning.

Marash says, “The P-CURE integrated system expands the capabilities of a fixed beam so as to treat virtually all tumor sites. Further, using the P-ART patient positing software, combined with optical positioning 3-D cameras, the treatment delivery is completely automated resulting in higher throughput for the centers, while providing the patient with a higher level of treatment accuracy. And, the reduced costs of a multi-treatment room will permit proton therapy to be more available and more affordable.”

With the incidence of cancer cases expected to increase, driven by rising life expectancy rates and an aging global population, the demand for radiation therapy is expected to further increase. This increased demand will require more patient treatment centers, and proton therapy, the most advanced radiation treatment available to patients, will be more in demand, if costs can be reduced.

Today, treatment at proton therapy centers is expensive so as to offset the high start-up cost of over $200 million for the equipment and construction of multi-room treatment centers. In the future, the cost of delivering proton is expected to be reduced through a treatment modality that allows for the delivery of higher doses and fewer treatments, called hyper-fractionation. Reduced treatment costs, combined with P-CURE’s existing innovative solution will reduce both the high start-up cost of equipment and construction by as much as two-thirds, further contributing to reduced treatment costs in the future.

P-CURE, a medical device company developing advanced solutions for proton and other radiation therapies. Currently, the first clinical installation of the imaging prototype system of the P-CURE technology has been installed at a world-renowned proton center in the United States.

Marash says, “We feel that P-CURE has shifted the paradigm for proton therapy for the 21st century by redesigning how the proton beam can be precisely delivered to the patient’s tumor site. P-CURE system improves treatment accuracy potentially expanding the number of new indications and shortening the length of treatment procedures. The system is completely compatible with existing accelerators, beam lines and treatment protocols.”

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Stephen Jacobs
P-CURELtd
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