Ideas for Hospitals, Centers and Practices

Oncology Center Goes TomoMobile
New & Noteworthy: Fast-acting, Simple Dosing Stress Agent

Oncology Center Goes TomoMobile

Artesian Cancer Centers is the first to install TomoTherapy?s TomoMobile unit equipped to provide patients with image guided radiation therapy.

Often when hospitals are building new facilities or updating old modalities with a forklift upgrade, a mobile unit will be leased or purchased to continue—or begin—service while the permanent structure is being completed.

Now, TomoTherapy of Madison, Wis, is literally delivering its unique image guided radiation therapy (IGRT) linear accelerator system to a facility’s doorstep. TomoTherapy’s new TomoMobile? unit can be installed next to a future new facility or at a temporary location and begin to deliver its radiation therapy to patients while construction is being completed.

Inside the TomoMobile’s adapted 18-wheeler is a TomoTherapy system installed in attractive surroundings with skylights and hardwood floors.

Derek M. Prentice, president and CEO of DMP Imaging and developer and managing member of Artesian Cancer Centers, Oklahoma City, was the first to install the TomoMobile unit in its Muskogee, Okla, oncology center location.

“For us, the reason to purchase it was to give us quicker access to the marketplace while we build and eventually put in a permanent site,” he said.

Artesian had already purchased four TomoTherapy units for its permanent oncology centers around Oklahoma and has plans to build more TomoTherapy treatment centers throughout the Mid-South.

It takes Artesian 9 to 12 months to go from finalizing a concept and creating a business plan, to completing the construction process. Rather than lose clients during the development, Prentice saw the mobile unit as an opportunity to begin market penetration sooner.

“At the end of the day, you can get to market in perhaps 60 or 90 days instead of 9 to 12 months. That was the reason we chose this particular mobile linear accelerator.”

Aside from its mobile advantages, Prentice considered the TomoTherapy system as a market differentiator. The system’s unique design has a linear accelerator combined with a CT scanner for more precise IGRT.

“With the TomoTherapy technology, we’re able to take a CT image a millisecond before the radiation penetrates into the tumor or wherever the metastatic disease may be,” he said.

As patients lose weight and the tumor decreases in size, the TomoTherapy system can use its internal CT to more precisely image and target the cancer while avoiding healthy tissue and organs.

Prentice said, “From a technology standpoint, certainly other vendors are very good and can cure prostate cancer, but when it’s all said and done, you have to pick one that you believe is the clinical leader for delivery of radiation, and we believe that TomoTherapy is that provider.”

After the Permanent Site

What happens after the permanent site is built? Prentice plans to use the mobile unit as Artesian Cancer Centers expand throughout the Mid-South region.

“We own it, so it can go to a new site that we’re developing, or it can be used for leasing to another hospital system while they install a new linear accelerator,” Prentice said.

In addition to the TomoMobile unit, Prentice purchased a modular building that is built next door. It houses a lobby, exam rooms, and check-in. They work together for whatever permanent site is being developed.

Despite its name, the TomoMobile is not designed to be moved frequently. While it technically could be moved once a month, the cost of transportation, installation, and deinstallation makes frequent moves cost-prohibitive. Prentice recommends utilizing the mobile unit for at least 6 to 12 months.

In addition, he also recommends having nearby access to a diagnostic quality CT scanner for the treatment planning before the therapy.

Artesian’s business plan calls for continuing to utilize the TomoMobile during the development of its future permanent sites. But Prentice said he could envision a hospital purchasing a TomoMobile for a year and then either leasing it or selling the unit to another facility.

As with most IGRT systems, the TomoMobile system has a 1-year warranty with an optional maintenance and service plan afterwards.

—Tor Valenza

New & Noteworthy: Fast-acting, Simple Dosing Stress Agent

Astellas Pharma US Inc, Deerfield, Ill, introduced Lexiscan (regadenoson) Injection, a fast-acting pharmacologic stress agent for radionuclide myocardial perfusion imaging (MPI) in 2009. In addition to being a fast-acting agent for patients unable to perform traditional exercise treadmill MPI tests, Lexiscan can be administered as a fixed dose, regardless of the patient’s weight.

Cardiologists often diagnose patients with coronary artery disease (CAD) through an exercise treadmill MPI test. However, traditional MPI tests performed on exercise machines are inappropriate for certain patients who are physically unable to exercise or cannot exercise sufficiently to increase blood flow for accurate diagnosis. In lieu of exercise, clinicians administer a pharmacologic stress drug that temporarily increases blood flow through the coronary arteries and mimics the increase in coronary blood flow that normally would have been caused by exercise.

While traditional MPI pharmacologic stress agents are effective for these types of patients, they can take several minutes to take effect, and once the increase in coronary blood flow is achieved, it lasts longer than is needed for the detection of CAD. In addition, the dosing for each patient must be carefully calculated based on the patient’s body weight.

Lexiscan was designed to address both these issues in that it increases blood flow within a minute and the dosage is independent of the patient’s weight.

Manuel D. Cerqueira, MD, FACC, FAHA, FASNC, chairman of nuclear medicine and staff cardiologist at the Cleveland Clinic, is a researcher with Lexiscan. He noted that pharmacological agents such as Adenoscan (adenosine injection) and dipyridamole work by stimulating all types of adenosine receptors but only stimulation of the A2A receptor is needed to increase blood flow to the coronary blood vessels. These agents do not always give a direct, immediate increase in coronary blood flow and can have uncomfortable side effects for the patient.

For example, with Adenoscan, also marketed by Astellas, common side effects include flushing, chest discomfort, and dyspnea. Less frequent side effects reported can include second- and third-degree AV block.

Cerqueira said, “Lexiscan met several needs. It tends to be more selective for this A2A receptor, and it has less effect on the atrioventricular node that causes heart block, which you could see frequently with adenosine.”

Lexiscan’s increased selectivity for the A2A receptor allows for faster examinations. Cerqueira said it may take 8 to 9 minutes using dipyridamole to do the pharmacologic portion of the MPI study; with adenosine, the time can be shortened to 6 minutes. With Lexiscan, the pharmacological portion can be performed in about a minute.

Cerqueira explained, “You give Lexiscan as an intravenous slow injection over about 10 seconds, and then at about 30 seconds, you give the radioisotope. So, in about a minute or so, you’re pretty much done with the stress portion of the study. So it can considerably shorten the time.”

Another advantage to Lexiscan is that clinicians do not need to calculate weighted adjusted doses for each patient. Cerqueira said, “You can give a single dose of 400 micrograms, regardless of whether the patient had a BMI of 20 or BMI of 50. You get the same effect on coronary blood flow.” Since it is given as a 10-second infusion, you do not need a computerized pump as is used with adenosine and dipyridamole.

In its press release for the launch of Lexiscan, the company mentions the results of two identically designed Phase III clinical trials. “Lexiscan met primary endpoints for scan agreement rates by showing with 95% confidence that MPI studies conducted with Lexiscan were similar to MPI studies conducted with Adenoscan?.” More information on these clinical trials can be found on Lexiscan’s Web site under “Clinical Development.”

In terms of side effects of Lexiscan, Cerqueira said, “Heart block is less of a problem as with adenosine. We published a paper on over 2,000 patients who were enrolled in the Phase III trials, and the incidence of heart block was significantly reduced in comparison to adenosine.”

The company reported that most common adverse events reported in clinical trial patients who received Lexiscan were shortness of breath, headache, flushing, chest discomfort, angina or ST-segment depression, dizziness, and nausea.

For more comprehensive prescribing information for Lexiscan, visit the company’s Web site

—Tor Valenza