Title:
Impact of proton beam availability on patient treatment schedule in radiation oncology.

Abstract:
Proton beam therapy offers unique physical properties with potential for reduced toxicity and better patient care. There is an increased interest in radiation oncology centers to acquire proton therapy capabilities. The operation of a proton treatment center is quite different than a photon-based clinic because of the more complex technology involved, as well as the single proton beam source serving multiple treatment rooms with no backup source available. There is limited published data which investigates metrics that can be used to determine the performance of a proton facility. The purpose of this study is to evaluate performance metrics of Indiana University Cyclotron Operations (IUCO), including availability, mean time between failures, and mean time to repair, and to determine how changes in these metrics impact patient treatments. We utilized a computerized maintenance management system to log all downtime occurrences and servicing operations for the facility. These data were then used to calculate the availability as well as the mean time between failures and mean time to repair. Impact on patient treatments was determined by analyzing delayed and missed treatments, which were recorded in an electronic medical record and database maintained by the therapists. The availability of the IUCO proton beam has been increasing since beginning of operation in 2003 and averaged 96.9% for 2009 through 2011. The mean time between failures and mean time to repair were also determined and correlated with improvements in the maintenance and operating procedures of the facility, as well as environmental factors. It was found that events less than 15 minutes in duration have minimal impact on treatment delays, while events lasting longer than one hour may result in missed treatments. The availability of the proton beam was more closely correlated with delayed than with missed treatments, demonstrating the utility and limitations of the availability metric. In conclusion, we suggest that the availability metric and other performance parameters, such as the mean time between failures and the mean time to repair, should be used in combination with downtime impact on patient treatments in order to adequately evaluate the operational success of a proton therapy facility.