Sault hospital gets radiation bunker

A novel partnership between the Sault Area Hospital (SAH) and Sudbury Regional Hospital's Cancer Program will allow Sault Ste. Marie cancer patients to receive radiation treatments closer to home.

A specially-constructed "bunker" in the new hospital will house a radiation treatment machine called a linear accelerator. It is expected to be operational when the hospital opens in April 2011.

Currently, SAH has a team of three medical oncologists, 20 nurses and nine clerks providing chemotherapy services. A surgical oncology unit has also been operating since the late ‘70s. Between 600 and 700 new cancer patients are treated annually, according to Mary Ellen Clark, interim director of the Algoma District Cancer Centre.

The idea to create a satellite cancer radiation treatment service was sparked in 1999 when technological changes opened the door for remote treatment planning, said Clark.

Instead of adding a sixth linear accelerator to Sudbury's arsenal, Sault Ste. Marie was chosen to accommodate a single machine because of the more than 300-kilometre distance patients have to travel between the two cities to receive radiation treatments.

"It's not a pleasant trip to make if you are not feeling well," Clark said.
As interest grew and the feasibility of the project was explored, a proposal was submitted to the Ministry of Health and was approved in 1999. However, the province was in the midst of hospital restructuring, amalgamations and closures, which put the project on hold until the decision to build a new hospital was confirmed in 2003.

Mark Hartman, interim vice president of the Regional Cancer Program in Sudbury, said staff from both organizations have been working collaboratively on the project since that time.

He described the approach as unique because radiation treatment in Canada has been traditionally performed in larger centres.

"You want to make sure the volume of treatment and the ability to retain the expert human resources are centralized and sustainable," he said. "Moving to a decentralized model, where the equipment and staff delivering the treatment are not located centrally, is a new approach. But the intent is to bring care closer to home and provide better access for people who choose to have that treatment."

Clark explained that the SAH is contracting the radiation treatment service from Sudbury Regional Hospital.

"It will function as an extension of the Sudbury program through a contractual arrangement," she said.

"The benefit is that we can use the same approaches, techniques, policies and procedures, and quality assurance - all of those elements that would otherwise have to be developed independently."

As well, both sites will be able to share some of the fixed costs like the implementation of a single treatment planning system, instead of two.

Improved information technology (IT) has also made distance less of an issue. Connections can be created through IT and information shared directly through broadband access. Using Ontario's Telehealth Network, Sudbury Regional performs more than 6,000 telemedicine consultations with cancer patients yearly, one of the highest uses of telemedicine technology in the province. Electronic health records have also allowed radiation oncologists to see patient information, providing seamless treatment plans remotely.

Hartman and Clark anticipate hiring a team of about 15 people.

Sudbury Regional Hospital will serve as the employer, although staff will be permanently located in the Sault. SAH will hire the nursing and clerical support staff to assist in the operation.

Plans to hire a medical physicist for early 2010, followed by an electronic technologist and physics assistant are underway. Other employees will be hired as needed.

"There is a lot of work that needs to be done in advance to prepare the facility, train the staff, set up processes, calibrate the equipment and distribute the treatment planning system," Hartman said.

The systems and equipment required are costly. The linear accelerator costs $2.8 million, the treatment planning and clinical information network systems are $1.3 million and other support equipment is  $750,000, according to Hartman.

Algoma District patients currently account for 18 per cent of Sudbury's radiation treatment activity. Individual visits for treatment total 29,000 annually. 

When the new bunker opens, SAH will absorb one-sixth of Sudbury's capacity. Although there are no future plans to set up similar services in northeastern Ontario, this may be a model considered in other areas of the province or country.

"We are very appreciative of the incredible amount of help we've received from Sudbury," Clark said. "It is exciting for us and will make such a difference in the lives of so many of our patients." 


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