Virtual Tour

Welcome to the Proton Treatment Center Virtual Tour where you can view snapshots of typical steps in the proton therapy, process. The following pages offer a glimpse of what you can expect to experience during proton radiation treatment at Loma Linda University Medical Center (LLUMC).

If you are considering proton treatment at LLUMC, you or your physician should contact our patient referral office. This office collects patient information for review by our team. Following this review, you will be contacted by one of our registered nurse (RN) coordinators about making further arrangements. Your RN coordinator will help coordinate your care before, during and after treatment. Your RN coordinator will also be your primary contact.

Contact us today!
Phone: (800) PROTONS (USA only) or (909) 558-4107
E-mail: protoninfo@llu.edu
Address:
Proton Treatment Center
Department of Radiation Medicine
LLU Medical Center
11234 Anderson Street, Room A875
Loma Linda, CA 92354

The main entrance to LLUMC is on Anderson Street. If you are unable to find parking in the lot near the Proton Treatment Center entrance, overflow parking is available in lot J. Lot J is located across the street from LLUMC at the intersection of Barton Road and Anderson Street. A shuttle transports patients and family members between the front door of the Medical Center and lot J every 10 minutes. The entrance to the Proton Treatment Center is located near the atrium or about 50 yards to the left of the main hospital entrance. The elevator to the proton facility is located to the right of the dark circle on the floor after you pass through the automatic double doors. Once inside the elevator, press A-level if it is your first visit to the Center (you will go down to B-level when undergoing treatment).

A-level contains our clinic facilities where you will meet the physicians, nurses and other medical personnel responsible for you care during treatment. On this floor, you will also find the nutritionist, social service workers and the referral and business offices.

In the clinic, you will meet your clinic nurse and case manager. The nurse will assess your clinical needs. The case manager will guide you through the overall treatment process by:


• arranging consultations with the nutritionist and social service personnel
• providing patient education
• helping patients meet other non-clinical requirements.

You will meet your physician during your first visit. The doctor will examine you and discuss your condition and potential proton treatment side effects with you. Depending on your case, your treatment may involve conventional (x-ray) radiation therapy, surgery, chemotherapy or other modalities in addition to proton treatment. At the end of the consultation, your doctor or nurse will guide you through the steps that must be taken to prepare for treatment.

Before proton treatment, you will meet with a nutritionist and social worker. The nutritionist will help you understand the importance of making proper dietary choices and will also give you advice about cancer fighting foods as well as foods that help you maintain your physical strength during treatment.

Our social workers attend to your psychosocial needs and also help your families through individual or group counseling. They also help you and your family members deal with fear and anger and practical issues such as housing, transportation and recreation.

Once final clearance has been obtained from your insurance company, you will be scheduled for proton therapy. Pre-treatment procedures such as CT scans and immobilization device fittings will take place on B-level. You will also undergo proton treatment on B-level when the preparatory work has been completed. The B-level waiting room has a television, refreshment area and a lending library stocked with books and magazines.

For radiation therapy to be successful, the patient must be in the same exact position with respect to the radiation beam during every treatment session. Precise patient positioning is achieved by carefully comparing x-ray images of the patient in the treatment position. To prevent the patient from moving during imaging and treatment, the patient is immobilized in a customized pod.

Patients who require head or neck area treatment are immobilized using customized masks. The masks are made from a lightweight plastic, which mold to the patient’s face, head or neck upon heating. The mask is placed over the patient each day prior to treatment. The area around the eyes is cut away so the patient can see clearly. For some patients who are treated in a sitting position, further immobilization is required. In these cases, a custom bite block is created to further mobilize the head during proton treatment.

CT scans are performed for all patients receiving proton therapy and for some patients undergoing conventional radiation therapy. The CT scan creates several high-resolution images that are a cross-section of the scanned portion of the body. Together, these images provide accurate information about the patient's anatomy and tissue density. CT images of the tumor and surrounding areas are used to design the radiation therapy plan and to align the patient during each treatment.

At this point, the behind-the-scenes work really begins. You do not have to be in the hospital during this period. Treatment typically starts approximately one week after your first visit.

Before treatment begins, radiation oncologists and medical physicists thoroughly review the proton treatment plan during a treatment conference. They discuss various aspects of the plan including the field arrangements and the total dose. The conference also allows your doctor to gain insights from other experts to make sure you are receiving the right care.

During the planning process, digital files of three-dimensional (3-D) images of the tumor are generated. Technicians use the digitized 3-D images and specialized machinery to mill customized boluses from high-grade wax and customized apertures from a material called cerrobend. The aperture and bolus are placed in the proton beam line to help bend the beam to the shape of the tumor.

Before and during each treatment, precautions are taken to assure accuracy and safety. The proton therapy equipment is calibrated every night to ensure accurate dose delivery. In addition, the facility is equipped with a multiple-redundant, fully-integrated control system that ensures safe operation. Barcode readers scan patient-specific devices, such as the aperture and bolus, to be sure that the device ID matches the device ID prescribed in the patient's unique electronic treatment plan.

Prior to your first proton treatment, your radiation therapists will perform a simulation. You will be placed in your immobilization device and positioned on the treatment table or in the treatment chair. The therapists will then take X-rays and compare them to the images created from the CT scans taken during the pre-treatment preparation process.

The therapists will examine the results and adjust your position until the images match. At that point they will record the alignment coordinates for use on subsequent treatment days and proceed with your first treatment. Because the initial alignment is so important, your first treatment will take much longer than your subsequent daily treatments.

Three of the four treatment rooms use gantries to deliver the proton beam. The 90-ton, three-story gantries can be rotated 360 degrees to deliver the beam at the precise angle prescribed by the physician. Most of the gantry is concealed by the walls and floor of the treatment room, and the patient, lying within the gantry, only sees the front of the proton nozzle rotating prior to treatment. Each treatment takes about 15 minutes for alignment and treatment time, and the patient feels nothing.

The horizontal beam line (HBL) is located in a room near the three gantry treatment rooms. In the HBL room, the patient is adjusted relative to the fixed beam to achieve proper delivery angle unlike in the gantry room where the beam is rotated relative to the patient. The HBL is used primarily to treat tumors of the head and neck.

The second fixed beam in the HBL room is the eye beam. The eye beam is used to treat diseases of the eye and orbit such as choroidal melanoma. Patients are treated in the seated position and are immobilized with a custom-made mask and a bite block.

Protons are commonly used in combination with photons or electrons. Combining the two forms of radiation therapy allows the radiation oncologist to treat the primary disease with a high dose of protons and the potentially cancerous regional area with a sufficient dose of photons to destroy micro-metastases. Photons or electrons can be given either prior to or following proton therapy. Radiation is produced by a linear accelerator that can produce X-rays to treat areas deep within the body or electrons to treat tumors close to the skin surface.

During the course of your treatment, you will make weekly visits to see your doctor or nurse in the clinic. At these meetings, the doctor or nurse will assess the progress of your treatment. They can also address any questions or concerns you may have regarding treatment.

When you have completed treatment, your family physician and/or your local radiation oncologist will follow up with you. You will also be contacted occasionally by our proton therapy case managers for follow-up.

Once you have completed therapy, your condition will be monitored for the rest of your life. Our office will periodically contact you and your physician to ensure that the chart containing all follow-up data is up-to-date. This monitoring enables our proton treatment team to be aware of your progress and ensure quality of care.

If you are a patient who has completed proton treatment at Loma Linda University Medical Center and have questions regarding your follow-up, please feel free to contact us:

Phone: (800) PROTONS or (909) 558-4107
Email: protoninfo@llu.edu
Address:
Proton Treatment Center
Department of Radiation Medicine
LLU Medical Center
11234 Anderson Street, Room A875
Loma Linda, CA 92354

Thank you for taking the Proton Treatment Center Virtual Tour. Please continue to explore our website for additional information and proton treatment resources.