Maintenance and Logistics Experience at Loma Linda Proton Treatment Facility

Transcription

1 Maintenance and Logistics Experience at Loma Linda Proton Treatment Facility Baldev Patyal, Ph.D., Chief Medical Physicist Department of Radiation Medicine

2

3 Outline Loma Linda Proton Treatment Facility Machine Performance Requirements Measuring Performance Proton Maintenance Program Scope Downtime Contributors Milestones and Upgrades (Seamless Integration) Maintenance: Service & Support Operations LLUMC PTRC: An Impressive Record Summary: Words of Wisdom?

4 James M. Slater, MD, Proton Therapy & Research Center (JMSPTRC), LLUMC World s first hospital based proton treatment facility (1990) Accelerator: a synchrotron Treatment Machines three isocentric gantries one with robotic patient positioner one horizontal beam line one fixed eye beam line One research room (3 fixed beams) Variable energy capability with energies up to 250 MeV

5 Loma Linda Proton Treatment Facility Layout FIXED BEAMLINES RESEARCH BEAMLINE SYNCHROTRON BEAM TRANSPORT SYSTEM TREATMENT GANTRIES:1-3

6

7 JMSPTRC Operational Achievements» As of April 2010, 14,550 patients treated» Nearly ½ million treatments and a perfect safety record» About patients treated daily» As many as 190 patient treatments in one day» Accelerator runs 24 hrs a day, 6 days a week, all year» One day per week reserved for routine/preventive maintenance» 95-98% uptime over 20 years! 7

8 Machine Performance Requirements in a Hospital Setting» Meet patient expectations Timeliness: Reliability (no delays) Few interruptions over course of treatment Overall comfort level» Integrate into a hospital environment Efficiency Patient satisfaction Patient throughput (revenue generation) Adaptation of newer technologies (without interruptions)» Maintain precision & Quality» Patient & Personnel Safety

9 Measuring Machine Performance»Throughput (Patient Statistics)»Availability: Uptime»Precision & Quality (Medical Physics)»Reproducibility (Medical Physics)»Effort needed for corrective and preventive maintenance ( Service Logs)

10 Reliability» Reliability is the probability that a device or component will perform its intended function over a stated period of time under stated working conditions» A measure of Reliability is a failure free interval» Mean Time Between Failures (MTBF): system s reliability» Mean Time to Repair (MTTR): System s maintainability» Mean Logistic Delay Time (MLDT): System s supportability

11 Availability»Availability refers to the time when system can be used for any of the intended purposes uptime Availability = uptime+ downtime MTBF Inherent Availability, Ai = MTBF+ MTTR Operational Availability, A o MTBF = MTBF + MTTR+ MLDT

12 Proton Maintenance Program LLU Analysis 2009 Work Order» Equipment List: 1,023» Total Work Orders (WO): 6,628» Total Planned Maintenance Tasks (PM): 4,131» Total Unplanned Maintenance (Corrective Maintenance: CM) Tasks: 2,183» Total Material Maintenance Records (MMR): 306» Total Incomplete Work orders (IWO): Optivus Proton Therapy

13 Proton Maintenance Record: 2009 Total Number of Work Orders (WO) for 2009 at the LLUMC PBTS Quantity Total WO Total PM Total CM Total MMR Total IWO Work Order Type Optivus Proton Therapy

14 Proton Uptime: 2009 Uptime = 100 downtime Downtime = % of tx lost due to equipment failure LLUMC Facility Uptime 2009 Percentage Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Annual Month Optivus Proton Therapy

15 Proton Facility Downtime Snapshot: 2007 Courtesy: Ed Sanders

16 Facility Downtime Contributors (2009)»53% of the total downtime attributed to power supplies»47% of the downtime attributed to electronics, computer and software related components

17 Major Downtime Contributors»Radio Frequency Quadruplole (RFQ) Amplifier (injection line)»ion Source (injection line)»high Voltage kicker (injection line)»synchrotron ring power supplies»legacy accelerator control system electronics»radiographic imaging equipment»embedded electronics controllers/computers»vacuum system equipment

18 Milestones and Major Upgrades (Seamless Integration) 1987: Ground-breaking for world s first hospital-based proton therapy system 1990: First Patient Treated with LLUMC Eye Beam Line 1991: First Patient Treated with LLUMC Horizontal Beam Line 1995: Completed Calibration / Research Room Developed our own treatment planning system 1996: World's First Large Format Digital Imaging 1997: NASA Research Room Upgrade 1997: 3,000th patient treated 2000: PBTS Control System Requirements & Design 2000: Began Beam Scanning Studies in Research Room 2001: Beam Energy/Intensity Performance Upgrade 2002: Treated 150 Patients per Day 2002: Accelerator Control System Replacement 2005: Beam Transport & Treatment Room Control System Upgraded for Variable Energy 2005: 10,000th patient treated 2005: Treated 170 Patients in a Day 2007: DICOM treatment planning integrated into PBTS 1991: First Patients Treated in LLUMC Gantry : First Patients Treated in LLUMC Gantry 2 and : Beam Transport Upgrade 1998: Treated 100 Patients per Day 1999: Accelerator Ion Source Upgrade 2003: Accelerator Control System Upgraded to Electronic Variable Energy 2004: Demonstrated Active Beam Scanning Capability in Research Room : Robotic Precision Patient Alignment System (PPAS) installed at LLUMC April 2010: 14,500th patient treated All upgrades done by Optivus Proton Therapy, San Bernardino, CA

19 Maintenance: Common Sense Approach Minimize interruptions caused by maintenance related tasks Develop a thorough preventive maintenance program Identify problem components and develop strategies Have backup components where possible Preventive maintenance should be an ongoing process Determine the criticality of each component

20 Service & Support»Availability of continuous coverage: 24/7/365»Highly trained service personnel People make things happen Reduce repair time»quick response: clear communication pathways Reduce logistic delay time»maximize the use of the regularly scheduled maintenance time»enough Manpower Optivus Proton Therapy, our service provider has 7 FTE in their Field Service Team

21 Operations Typical Proton Facility Weekly Usage MODE HOURS PERCENTAGE Treatment % Calibration % Maintenance 8 4.8% Research % Upgrades % TOTAL % 2010 Optivus Proton Therapy

22 Timeline of a Proton Procedure Patient orientation & education Time Needed 1-2 hours Time before Tx 7-10 days Patient immobilization & imaging min 7-10 days Treatment planning Device manufacture & calibration 1-3 days 1 day 5-8 days 1-3 days Treatment session Patient setup Alignment verification & approval Treatment Room reset min 5-10 min 5-25 min 2-5 min 2-5 min

23 LLUPTC: Slow (cautious) start, but an Impressive Record Started with one patient a day (eye patient) in 1990 It took 4 years to go from one patient a day to 40 patients a day. It took three years to treat first 1000 patients To expedite treatment planning, developed our own treatment planning system (Daniel Miller,1995) To further improve throughput and accuracy, developed our own digital alignment system (Optivus Proton Therapy, 1996) To meet increasing patient demand, started a second shift of treatments (2001). A treatment day is hours long! Over the last 10 years, we have maintained 98% uptime All upgrades have been accomplished without missing a single patient treatment Initiated and completed several treatment protocols. Our initial clinical results helped pave the way for other centers

24 Summary: Words of Wisdom?» Make all processes patient-centric Minimize treatment interruptions High reliability»establish clear communication pathways between different teams» Have the right manpower Hire, train and retain the best people Have adequate staffing level» Keep up with newer technologies Precision, accuracy, reliability (Patient satisfaction) Throughput (revenue generation)» Last, but not the least, maintain good relations with the administration

25 Thanks