Maintenance and Logistics Experience at Loma Linda Proton

Transcription

Maintenance and Logistics Experience at
Loma Linda Proton Treatment Facility
Baldev Patyal, Ph.D., Chief Medical Physicist
Department of Radiation Medicine
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Outline
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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?
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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
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Loma Linda Proton Treatment Facility Layout
FIXED BEAMLINES
SYNCHROTRON
BEAM TRANSPORT SYSTEM
RESEARCH BEAMLINE
TREATMENT GANTRIES:1-3
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JMSPTRC Operational Achievements
» As of April 2010, 14,550 patients treated
» Nearly ½ million treatments and a perfect safety record
» About 140-150 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!
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Machine Performance Requirements in a
Hospital Setting
» Meet patient expectations
¾ Timeliness: Reliability (no delays)
¾ Few interruptions over course of treatment
¾ Overall comfort level
» Integrate into a hospital environment
¾ Efficiency
Patient satisfaction
Patient throughput (revenue generation)
Adaptation of newer technologies (without interruptions)
» Maintain precision & Quality
» Patient & Personnel Safety
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Measuring Machine Performance
»Throughput (Patient Statistics)
»Availability: Uptime
»Precision & Quality (Medical Physics)
»Reproducibility (Medical Physics)
»Effort needed for corrective and preventive
maintenance ( Service Logs)
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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
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Availability
» Availability refers to the time when system can be
used for any of the intended purposes
Availability =
uptime
uptime + downtime
Inherent Availability, Ai =
MTBF
MTBF + MTTR
Operational Availability, Ao =
MTBF
MTBF + MTTR + MLDT
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Proton Maintenance Program Scope @ 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): 263
© 2010 Optivus Proton Therapy
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Proton Maintenance Record: 2009
Total Number of Work Orders (WO) for 2009 at the LLUMC PBTS
7000
6628
6000
5000
Quantity
4131
4000
3000
2183
2000
1000
306
263
Total MMR
Total IWO
0
Total WO
Total PM
Total CM
Work Order Type
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Uptime = 100 – downtime
Downtime = % of tx lost due
to equipment failure
Proton Uptime: 2009
LLUMC Facility Uptime 2009
99.9
99.6
100.0
98.4
99.0
98.0
98.0
98.6
98.5
98.4
98.7
98.7
98.8
98.1
97.5
Percentage
97.1
97.0
96.0
95.0
94.0
93.0
92.0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Annual
Month
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Proton Facility Downtime Snapshot: 2007
Courtesy: Ed Sanders
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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
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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
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Milestones and Major Upgrades (Seamless Integration)
1995:
Completed Calibration /
Research Room
1987:
Ground-breaking
for world’s first hospital-based
proton therapy system
1990:
First Patient Treated with
LLUMC Eye Beam Line
1991:
Developed our own
treatment planning system
1996:
World's First Large Format
Digital Imaging
1997:
NASA Research Room
Upgrade
First Patient Treated with
LLUMC Horizontal Beam Line
1997:
1991:
1997:
First Patients Treated in
LLUMC Gantry 1
Beam Transport Upgrade
1994:
Treated 100 Patients per Day
First Patients Treated in
LLUMC Gantry 2 and 3
1999:
3,000th patient treated
1998:
Accelerator Ion Source
Upgrade
2000:
PBTS Control System
Requirements & Design
2000:
Began Beam Scanning Studies
in Research Room
2001:
Beam Energy/Intensity
Performance Upgrade
2005:
Beam Transport & Treatment
Room Control System
Upgraded for Variable
Energy
2005:
2002:
Treated 150 Patients per Day
2005:
Treated 170 Patients in a Day
2002:
Accelerator Control System
Replacement
2007:
DICOM treatment planning
integrated into PBTS
2003:
Accelerator Control System
Upgraded to Electronic
Variable Energy
2008-2009:
Robotic Precision Patient
Alignment System (PPAS)
installed at LLUMC
2004:
Demonstrated Active Beam
Scanning Capability in
Research Room
April 2010:
All upgrades done by Optivus Proton
Therapy, San Bernardino, CA
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Maintenance: Common Sense Approach
¾Minimize interruptions caused by maintenance
related tasks
¾Develop a thorough preventive maintenance
program
¾Identify “problem” components and develop
strategies
¾Have “backup” components where possible
¾Preventive maintenance should be an “ongoing”
process
¾Determine the criticality of each component
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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
¾ Optivus Proton Therapy, our service provider has 7
FTE in their Field Service Team
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Operations
Typical Proton Facility Weekly Usage
MODE
HOURS
PERCENTAGE
Treatment
85
50.6%
Calibration
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11.9%
Maintenance
8
4.8%
Research
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23.2%
Upgrades
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9.5%
TOTAL
168
100%
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Timeline of a Proton Treatment @LLUMC
Procedure
Time Needed
Time before Tx
Patient orientation & education
1-2 hours
7-10 days
Patient immobilization & imaging
15-30 min
7-10 days
Treatment planning
1- 3 days
5-8 days
Device manufacture & calibration
1 day
1-3 days
Treatment session
Patient setup
Alignment verification & approval
Treatment
Room reset
15-45 min
5-10 min
5-25 min
2-5 min
2-5 min
….
…..
…..
….
….
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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 16-17 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
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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
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Thanks ありがとう
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