The Tulsa Cancer Institute sprang up in Oklahoma roughly two years ago. It's a simple idea: an integrated cancer center where patients can seek their care in one location. But a lot went into the planning and construction — especially as it concerns equipment. Matthew West, chief medical physicist and radiation safety officer at TCI and Jeanne Bailey, TCI's chief dosimetrist, spoke with DOTmed News about why the TCI decided to upgrade existing equipment.

DMN: How new is the Tulsa Cancer Institute?
MW: As an institution, it's been around 30 years under name Cancer Care Associates. But two years ago, they created the Tulsa Cancer Institute as a sub-clinical entity. The Cancer Care Associates is still the administrative agent for them. Doctors tried to re-brand the clinical part of it if you will — new logos, new building, new name. They were a huge practice of 40 plus medical oncologists spanning the entire state of Oklahoma. There were roughly 15 different cancer centers in the state and what they did was consolidate it into three facilities. TCI is their flagship facility with 20 doctors in the building.

DMN: How is a set-up like this better for patients?
JB: Patients used to have radiology in one facility, radiation therapy in one facility and chemotherapy in all, so patients who needed diagnostic exams had to travel. Instead of driving all over, it's a one-stop shop. They can have diagnostic exams, chemotherapy, medical oncology and radiation all in same building.

DMN: How unique is this model?
MW: Other than the fact that we don't have inpatients, we function largely like a specialty hospital. Individual physician practices have no economy of scale. Bringing doctors under one roof kind of gives you an economy of scale, if you will, where you can offer things that you might have to go to a hospital for — instead they can come as outpatients and [do] almost everything in one stop.

DMN: Our readers will probably be interested in the decision you made about equipment upgrades. Can you tell us about that?
MW: We only had one radiation therapy facility in the Tulsa area so the existing equipment there was just being migrated to our new facility.

While there were lots of costs in constructing the new center, making you think you should just move your existing equipment, it really wasn't cost-effective. Once you look at the costs involved in moving any piece of equipment, you start to look at the business model and think it might be smarter to just buy. With moving equipment you also have to think about the overtime with staff. Also, if you buy a new piece of equipment it's under warranty for the first year and you don't have moving costs. And to be honest, if you are an existing customer, vendors are always willing to work with you.

Take a linear accelerator, for example. We are talking a couple of hundred thousand dollars in vendor costs, plus the service contract on the entire system is between 170-250 thousand dollars a year. So you are already in that 400-500 thousand dollar price range just to get something moved.

DMN: Was there also an appeal factor that new equipment might have for the facility?
MW: We wanted to upgrade and talked about it, but we thought we'd do it after we moved. But because Accuray's TomoTherapy received U.S Food and Drug Administration approval, and coincided with our building opening, it was perfect timing. And staff adopted TomoTherapy quickly. We knew we could pull it off.

DMN: What new modalities did you add?
MW: Radiation therapy equipment stayed in numbers about the same, but the radiology department is easily three times the size it was before. We have CT, nuclear medicine, an interventional suite and MRI.

DMN: Why did radiology increase?
MW: Because we were outsourcing patients — it's a revenue discussion and also convenient for patients. For example, we had a big discussion about MRI — people were skeptical if we could support it. We have 20 docs and 14 are medical oncologists. It doesn't take long to realize you are sending patients out for MRI, and every time they have to make the trip, it's inconvenient for them. The imaging was inevitable, that it grew the way it did.

DMN: What has your patient load been like?
JB: For the TomoTherapy unit, we are at about 43 patients. On the conventional linear accelerator, we are at roughly 23 patients. Since moving into this building, our patient load has almost doubled. It's a significant increase.