Program Information
The Resources and Cost to Operate An Intraoperative Radiation Therapy Program for Accelerated Partial Breast Irradiation Using a Low-Energy X-Ray Source
M Morales-Paliza*, G Ding , Vanderbilt University, Nashville, TN
Presentations
SU-E-T-741 (Sunday, July 12, 2015) 3:00 PM - 6:00 PM Room: Exhibit Hall
Purpose: To report our experience regarding resource requirements and cost to operate an intraoperative-radiation therapy (IORT) since 2011, for accelerated-partial-breast irradiation (APBI) using the Axxent controller (Xoft Inc.).
Methods: To start an IORT program for APBI utilizing the Axxent controller with 50-keV x-ray source, the required resources include acquisition of the Axxent controller and a set of quality assurance (QA) tools, the training of involved professionals -surgeons, oncologists, nurses, and physicists- to use and operate the system, state license, storage room for the equipment, full-time availability of the operating personnel on the procedure day, a survey meter, an ultrasound unit, sparing for x-ray source (at least, two) and cooling-tubing system, shielding equipment, etc. In each treatment day, QA procedures are required to test the controller performance before patient irradiation in the operation room (OR).
Results: During 40 months, 76 procedures were performed. Six surgeons, two oncologists, three nurses and three physicists were trained for the procedure. Irradiation times ranged 7.4-28.6 (mean=11.7) minutes. Eight different x-ray sources were utilized with usage times ranging 33.4-166.8 (mean=108.7) minutes. Sixteen different combinations of spherical-balloon applicators and volumes were employed, with 40-cc (22%) and 30-cc (20%) volumes of the 3-4-cm applicator being the most used. Replacement of the x-ray sources due to arcing during patient irradiation and leak of the cooling-water system in the OR occurred twice and once, respectively. A defective brand-new x-ray source (arcing) happened once.
Conclusion: To start and maintain a successful IORT program, for APBI using a low-energy x-ray source, institutional commitment -in addition to the resource requirements that are specific to the program- is necessary. Based on our over-3-year experience, the cost of the x-ray sources and equipment services along with vendor contract averaged US$1,000-2,000 per treatment, without considering manpower and any other resource expenses.
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