Loma Linda Proton Facility Named for Dr. James M. Slater
Tuesday, April 22, 2008
On December 9, 2007, ceremonies were held at Loma Linda University Medical Center to formally re-name the Loma Linda proton facility for James M. Slater, MD, FACR. The ceremonies were part of an all-day celebration at the medical center, consisting of tours of the facility, the formal naming event, and an evening dinner.
The naming ceremony was preceded by a video presentation in which many patients who had been treated with protons at Loma Linda spoke of their experiences there and the excellent quality of life they have experienced in the time—spanning many years for most—since they were treated. The video concluded with each patient thanking Dr. Slater for the work he had done and the life and health he had helped them to preserve. “Dr. Slater is my hero,” one patient said.
Following the invocation by Calvin Rock, DMin, PhD., Past General Vice President, General Conference of Seventh-day Adventists and past chair, Loma Linda University Adventist Health Sciences Center (LLUAHSC) Board of Trustees, Dr. Lyn Behrens, president of LLUAHSC, observed that the occasion celebrated Dr. Slater’s history of achievement, his passion for excellence, his dedication to research, and his love for humanity. She noted that the opening of the Loma Linda proton facility in 1990 followed more than a decade of work by Dr. Slater, in which he had assembled an international team of experts in cancer and radiation physics and therapy. Dr. Slater’s scientific credibility, character, compassion, and integrity, she said, led the boards of trustees and administration of LLUMC to support his vision, which in turn led to the successful proton facility at Loma Linda. After noting that the Loma Linda hospital-based facility was a “prototype for the world,” she remarked, “You, Dr. Slater, are our superstar.”
H. Roger Hadley, MD, dean of Loma Linda University School of Medicine, praised Dr. Slater for his contributions to the institution in its role as an academic medical center. He observed that an academic center has three purposes, health care, research, and education, and that Dr. Slater’s work has contributed to all three. Dr. Hadley was followed by Lowell C. Cooper, MDiv, MPH, chair of the Board of Trustees and Advisors, LLUAHSC, and General Vice President of the General Conference of Seventh-day Adventists. Rev. Cooper noted that “Dr. Slater thinks enormous thoughts about small things.” He went on to say that the proton facility is one of Loma Linda University’s marks of recognition, and that the Board of Trustees speaks of it with great pride.
Congressman Jerry Lewis, representing California’s 41st district, was not able to be present but offered a video message. He noted that it was most appropriate that Dr. Slater was being honored, and recalled his first visit, two decades ago, with Dr. Slater and Dr. David Hinshaw, Sr., then Vice President for Medical Affairs at Loma Linda University, who were seeking funds to complete the proton project. Mr. Lewis recalled that Dr. Slater explained the project in simple terms, making the benefits clear so clear to him that he desired to help. From that beginning, the Loma Linda proton center became known in the Congress and was able to secure later funding to help advance a comprehensive program that included basic research, clinical research, and an association with NASA. Congressman Lewis called the proton facility “a miracle, breakthrough idea” that brought international recognition to Loma Linda.
Ken Venturi, the 1964 U.S. Open golf champion, offered a tribute to Dr. Slater in two parts. In a video presentation he recalled meeting Dr. Slater in 1972, when Mr. Venturi’s mother was ill. Dr. Slater cared for his mother, and afterward, Mr. Venturi said that if there was ever any way he could help Dr. Slater, to let him know. That opportunity came almost twenty years later, with the first Proton Charity Invitational golf tournament, which Mr. Venturi made into an ongoing commitment. In the video also, Mr. Venturi recalled his own treatment for prostate cancer, and that he decided immediately for proton therapy, owing to his confidence in Dr. Slater and in the treatment he pioneered. He concluded his video tribute by recalling two old sayings, “We only pass this way but once,” and “Leave the world a better place than you found it.” Dr. Slater, he said, has indeed made the world a better place. In extemporaneous remarks following the video, Mr. Venturi commented that Dr. Slater had achieved great things, yet remained personally humble. “You are the most humble man I’ve ever known,” he said.
Jerry D. Slater, MD, chairman of the department of radiation medicine, spoke next. He recalled how his father had built up the department systematically: from a unit having a single cobalt therapy machine in 1970, Dr. James Slater utilized technology to bring to Loma Linda ever more advanced treatment techniques, including high-energy x-rays, electrons, and hyperthermia. He led the development of the world’s first computer-assisted treatment planning systems based on digital data taken from the patient, first via ultrasound data and later by CT scans; the density information made possible by the latter permitted better dose distributions with conventional radiation and foreshadowed CT-based therapy planning systems that now are used everywhere. Dr. Slater assembled teams of physicians, physicists, and engineers to develop the world’s first hospital-based proton treatment system, doing so in spite of doubters, some of whom later developed proton systems of their own, and some of whom became proton patients. In doing this, Dr. James Slater proceeded on the premise: follow your vision and others will follow in turn.
His father’s vision for protons was only a beginning, Dr. Jerry Slater went on. Dr. James Slater developed research facilities, he noted, that have enabled Loma Linda to always look ahead to ever better ways to exploit proton radiation. He did all this while maintaining a fundamental concern for patient care, directing physicians and staff to make patients feel like guests in the home: “Treat these people like you would like your mother and father to be treated,” Dr. James Slater would say. Dr. Jerry Slater finished with a recollection from his childhood. His father, he recalled, always used to say, “If you’re going to do something, do it right.” Turning to Dr. James Slater, he ended, “Dad, you did it right.”
Ruthita Fike, CEO of the medical center, recalled important dates in the history of the Loma Linda proton facility: 1970, when Dr. Slater started his work; 1985, when intensive development began; 1990, when patient treatments began; the present, when 150 patients or more are being treated every day. “It is only fitting,” she said, “that we today celebrate the unwavering vision of this humble man.” Then she invited Dr. Slater to unveil the sign on the east front of Loma Linda University Medical Center. At Dr. Slater’s signal, volunteers at the roofline released a veil to display the familiar Bragg peak logo and the words, “James M. Slater, MD Proton Treatment and Research Center.”
At the evening dinner the guest list included members of Dr. Slater’s family: his sisters, brother, children, grandchildren, great-grandchildren, and other relatives, as well as members of the department of radiation medicine, the medical center, and the university. A video, “A Convergence of Disciplines,” presented a brief glimpse of Dr. Slater’s life and featured excerpts of interviews with him and with others, including David B. Hinshaw, Sr., MD, FACS, Vice President for Medical Affairs during the development and early years of the Loma Linda proton facility and Past President of Loma Linda University Medical Center; Leon M. Lederman, PhD, Nobel Prize winner and former director of Fermi National Accelerator Laboratory (Fermilab); Daniel S. Goldin, former NASA Administrator of NASA; Dr. Calvin Rock; Ruthita Fike, CEO of the medical center; and Dr. Jerry Slater.
Following the video, Dr. Slater received more tributes. Richard H. Hart, MD, DrPH, chancellor of Loma Linda University, praised Dr. Slater for his emphasis on and commitment to research, including reaching out to other disciplines. Dr. Cooper read a letter from Dr. Jan Paulsen, President of the General Conference of Seventh-day Adventists, who thanked Dr. Slater for his work on behalf of the church and noted the pride the church feels in the work done at Loma Linda as “an outreach to the world.” Dr. Calvin Rock echoed Dr. Paulsen’s words, and added; “God made you an instrument,” he told Dr. Slater, and “the church is thankful.”
Ken Venturi noted that he and Dr. Slater share a common characteristic: a readiness to refute those who say, “you can’t do it.” Success, he said, means giving back to the world and leaving it a better place, respecting others, and loving children. Dr. Slater’s success encompasses these things, he said, and concluded, “I’m glad you passed my way.”
Mrs. Fike concluded the evening’s tribute by quoting from William Jennings Bryan: “Destiny is no matter of chance. It is a matter of choice. It is not a thing to be waited for, it is a thing to be achieved.” Dr. Slater’s achievements, she noted, resulted from a belief and conviction he feels “down to his fingernails.” He achieved his goals “inch by hard-won inch,” thanks to his great energy, an unwaveringly inquisitive nature, his mastery of persuading others to see and follow his vision, his unswerving commitment to his work, and the sense of hope he carries with him. Then, inviting Drs. Behrens, Cooper, Hadley, and Hart to join her, she presented Dr. and Mrs. Slater with flowers and a plaque commemorating the day. Dr. Slater received a standing ovation.
Background
For Dr. James M. Slater, the events of December 9th were, in a sense, the culmination of four decades of work in proton radiation therapy. In another sense, they marked a continuation.
Following graduation from Loma Linda University School of Medicine in 1963, Dr. Slater took residency training at the Latter-day Saints Hospital in Salt Lake City and the White Memorial Medical Center in Los Angeles. In 1968 he went to M.D. Anderson Hospital, in Houston, Texas, on a National Institutes of Health fellowship, where he studied with one of the great radiation oncologists, Dr. Gilbert Fletcher. It was during his years at “the White,” as staff called it, that he became dissatisfied with the side effects that occurred in many patients treated with radiation. He realized that these side effects could be largely prevented if radiation oncologists could increase the precision of radiation treatments and subject patients to less normal-tissue radiation. While he was a resident, therefore, he began to perform his own therapy planning, in the process designing improved set-ups, using smaller treatment portals, making new devices to shield more of the normal tissues. His results proved that normal-tissue injury could be reduced and would lead to improved patient tolerance.
During his residency years also, Dr. Slater, whose undergraduate training was in physics, determined that two conditions had to be met for if more significant reductions in side effects were to occur. One involved a better treatment beam, one that could be focused more precisely on the target volume. The other involved more-precise tumor localization, and a treatment planning system that could take advantage of such localization. During his residency years he devoted much effort to the latter effort, working with a physicist and engineers at Loma Linda to develop a computer-assisted treatment planning system that brought into the planning process digital imaging information taken directly from the patient.
In 1970, Dr. Slater was recruited to develop a dedicated section of radiation oncology at Loma Linda. In addition to continuing the work already started on the computer-assisted treatment planning system, he began investigating the possibility of a hospital-based, heavy-charged-particle treatment delivery system at Loma Linda. Dr. Slater initiated a feasibility study to determine whether such a project would be doable then. The study showed that three areas were not sufficiently mature in 1970 to proceed: 1) digital imaging of patients’ anatomy; 2) computer science; and 3) technology to accurately and precisely focus the invisible beam on an invisible target in the patient.
Dr. Slater and his colleagues at Loma Linda had been developing the world's first computer-assisted treatment planning system, using ultrasound digital images, and this work they continued. In 1971 they began using the system clinically; the system allowed the physician to define the patient's anatomy precisely and to demonstrate the actual distribution of radiation in the patient, both of which would result in significant improvements in treatment with all forms of radiation and would facilitate heavy-charged-particle radiation therapy. In 1973 the same investigators made further improvements in the system by using computed tomography scans, provide tissue density (electron density) information, in turn allowing accurate calculations of radiation absorption. This basic technology became internationally widespread, being produced by many manufacturers and employed by thousands of radiation oncologists within the subsequent decade. Loma Linda investigators received several national and international awards for their achievements in treatment planning.
Despite this focus on treatment planning, Dr. Slater did not reduce his interest in developing a hospital-based, heavy-charged-particle treatment facility at Loma Linda. For the next decade and a half following the 1970 feasibility study he kept informed about, and obtained experience with, heavy-charged-particle therapy. By accumulating experience and keeping in touch with experts in the field, he became convinced that the proton would be the particle of choice for a hospital-based facility because it has the combination of capabilities that make it close to an ideal particle for routine radiation therapy: it is highly localizable and controllable, thanks to its electromagnetic charge and its rapid fall-off in energy deposited as it comes to the end of its range in tissue, yet has a relatively sparse ionization pattern that makes it less harsh than heavy ions to normal cells.
By the 1980s, the deficiencies Dr. Slater had identified in 1970 had been largely overcome. In 1984, then, Dr. Slater began building a team of associates committed to proton therapy. Dr. Slater also began building up support among administration and faculty of Loma Linda University and Medical Center, and played a major part in organizing a meeting of scientists from around the world, at Fermi National Accelerator Laboratory in January 1985. The meeting centered on the requirements for a clinical proton therapy facility and generated so much enthusiasm that it spawned other meetings and led to the formation of an international group, now called the Particle Therapy Co-operative group (PTCOG), that still is active. At an early meeting at Fermilab, Dr. Slater approached laboratory personnel about the possibility of Fermilab working with Loma Linda to develop the world’s first proton accelerator designed for therapy. Fortunately, the U.S. Department of Energy had a “work for others” provision that allowed national laboratories such as Fermilab to collaborate with private entities if the end result was technology transfer and bettering the general good. In 1986, the Loma Linda Boards of Trustees and Fermilab entered into a contract for a conceptual design study, followed later by a formal agreement to build the world's first hospital-based proton treatment system.
The period from early 1986 through late 1990 represents the construction phase of the proton facility. The formal groundbreaking occurred in April 1988; commissioning of the proton synchrotron at Fermilab happened early in 1989; and shipping the proton accelerator and beam-transport system to Loma Linda occurred later in the year; and assembling and commissioning the treatment system at Loma Linda was done in 1990. The first patient was treated in October of that year.
During construction, Dr. Slater orchestrated the efforts of personnel from Fermilab; the NBBJ architectural firm; Science Applications International Corporation (SAIC), which assisted in transferring the accelerator and adapting the technology; Loma Linda University Radiation Research Laboratories, predecessor of Optivus Proton Therapy, Inc., which facilitated technology transfer and served thereafter as engineering support for the facility; the McCarthy construction corporation; and faculty and staff from the department of radiation medicine. He established teams to monitor all aspects of the project and oversaw dynamic development process that included changes that were implemented as more was learned about what would work for best patients. As a result, the facility was designed and built with everything the patient needed in mind. Further, everything was designed and built to adjust to changing needs over time.
In the years since 1990, progress has continued steadily. Many upgrades have occurred but have been seamless because Dr. Slater anticipated the need to change with time and so oversaw the design of a facility that would be able to facilitate such changes. These upgrades have been done by Optivus Proton Therapy, Inc., of San Bernardino, which have kept the Loma Linda facility at the leading edge of proton and heavy-charged-particle facilities worldwide.
At present, Loma Linda radiation oncologists treat about 50 different anatomic sites with protons. The use of robotics will enable them to increase the number of patients treated daily, and another development, active beam delivery, also called intensity-modulated proton therapy, will enable them to treat even more. This system will enable radiation oncologists to treat patients with large and more irregular treatment volumes, such as one often finds in breast cancer and lung cancer.
All of this progress, and future progress, is part of a planned process. In 1990 only a few patients were treated; large numbers of patients did not begin to be treated with protons until the remaining two gantries came into operation in 1994. That was by design: Dr. Slater and his colleagues built up the experience slowly, testing proton treatment against accepted standard radiation treatment to determine comparative results, and only thereafter began to treat more patients, to higher doses, and often with protons alone rather than in combination with photons, as they usually did in the early days. Dr. Slater insisted that proton therapy always build on a foundation of clinical research; beginning in 1994, he supplemented that with a comprehensive program of basic research in radiation biology and molecular biology, as well as physics and engineering.
Perspective
Perhaps Dr. Slater’s main accomplishment is that he showed the way. There were no hospital-based, patient-dedicated proton treatment facilities anywhere in the world when his vision, the Loma Linda facility, opened in 1990, and there wasn’t another in the United States for eleven years. Now there are five facilities in the United States, with another under construction, and several others in other countries. Hospital-based proton therapy has proven itself worldwide, and it started with Loma Linda.
Further Loma Linda provided a model. The Loma Linda center is now in its 18th year of operation but is as modern as facilities that are still on the drawing boards. This happened because the Loma Linda facility was so designed and built that it would be able to advance and modernize with the times.
In the future, the James M. Slater, MD Proton Treatment and Research Center will continue to lead. The fact that there now are other proton facilities in the United States opens up the possibility of cooperative endeavors that will enable physicians to further refine the role of protons for treating cancer and other diseases. The possibilities for protons are almost endless. For example, Dr. Jerry Slater foresees a major role for protons in treating pediatric cancers because the tissue-sparing properties of the proton beam are especially attractive for treating cancers in the growing child, for whom exposure of normal tissues to radiation could affect growth, both physically and mentally. Protons also are expected to assume a larger and larger role in treating other major cancers, such as breast cancer and lung cancer.
The underlying reason that Dr. Slater started this effort, more than 40 years ago, was to deliver needed doses of radiation to diseased sites and avoid normal tissues. Loma Linda scientists are studying ways to improve that, both with investigations of physical dose distributions at the macro and subcellular levels and by studying the effects of adjuncts, such as radiosensitizers or radioprotectors, that may enhance the effectiveness of proton radiation. This work will continue for decades to come.
The main objective, which Dr. Slater identified when he was a resident, will remain the same at Loma Linda in the future as it has been in the past: to do what is best for the patient, and to do it right.
