Precision Without Compromise

Capital Expansion > Precision Without Compromise

Precision Without Compromise

By Carolyn Beans Photography by Paul Flessland

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In the mid-2000s, Nadia Laack, M.D., a pediatric radiation oncologist at Mayo Clinic, saw an opportunity for patients. Mayo Clinic in Rochester was in the midst of designing a new facility for proton beam therapy — a powerful form of radiation that uses streams of protons to destroy tumor cells.

Dr. Laack knew that many patients would benefit the most from pencil beam scanning, the newest form of proton beam therapy. With this precise tool, she could direct protons at the exact contours of a tumor without injuring nearby organs.

But there was a catch. With pencil beam scanning, patients must remain perfectly still. For cancers in the lungs or abdomen, even the subtle movement of breathing could throw the beam off target.

And to prevent young children from wiggling, any form of proton therapy requires anesthesia, which greatly lengthens time in the treatment room.

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As a result, existing proton beam facilities only offered pencil beam scanning for cases where movement could be more controlled. These facilities also strictly limited the number of children they would treat each day so that, from a financial perspective, they could reserve more space for adults who could be moved in and out quickly.

Dr. Laack found these compromises unacceptable. Her colleagues agreed. Mayo Clinic would build the first proton beam facility in the United States that would exclusively offer the more advanced pencil beam scanning approach without limiting access for children.

To do so would come with significantly more work for Dr. Laack and her team, who partnered with engineers and physicists to design new tools to adapt to patients’ movements. And she brought on anesthesiologists to help engineer new ways to move kids in and out of treatment more quickly.

The Mayo Clinic Richard O. Jacobson Building housing the state-of-the-art proton beam facility opened in 2015. And Dr. Laack’s team has never had to turn away a child.

“We didn’t want anything to stand in the way of our being able to treat kids who needed our care,” she says.

Promise in Pencil Beam

Dr. Laack was committed to building a pencil beam scanning facility because she saw how much potential the treatment had to reduce the long-term side effects of radiation for many patients.

Traditionally, patients received radiation with photons, X-rays that pass into the body, through the tumor and out the other side of the body.

Photon radiation is an effective treatment for many cancers and is still commonly used today. But its path through the body requires radiation oncologists to limit the dose or risk damaging healthy tissue.

Proton beam therapy works by using a particle accelerator to whip protons up to a super high velocity — nearly the speed of light. A technician then directs these highly energized protons at a tumor. As protons pass into the body, they release most of their energy within the tumor, minimizing the radiation hitting healthy tissue around the cancer.

Pencil beam scanning is an even more targeted form that delivers protons packed into balls the size of pencil erasers, rather than a scattering of protons covering a wider area.

That precision is critical for children who could develop long-term side effects — such as growth, fertility or vision issues — if healthy tissue is damaged along with the tumor. Adults too can benefit from pencil beam scanning when tumors are situated in sensitive areas such as the brain, spinal cord, heart, lungs, liver and other abdominal organs.

Making Pencil Beam Possible

Dr. Laack and her team from the Division of Medical Physics collaborated with colleagues in the Department of Engineering to design tools to follow tumors in real time and only deliver protons when the tumors are on target. The team developed a respiration tracking tool, for example, that they place on a patient’s abdomen to capture the movement of breathing. They can then automatically trigger the proton beam to pause each time a tumor moves above or below the beam’s reach with each breath in and out.

To open access for more children, the team worked with Mayo Clinic anesthesiologists to figure out how to shorten treatment time. Their solution: prepare children for treatment outside of the pencil beam scanning room.

In the pretreatment area, a young patient lies on a specialized mobile table and begins receiving anesthesia from a compact delivery system. Once asleep, the child is then wheeled on the table into the pencil beam treatment room without interruption to anesthesia. Then a robotic arm docks onto the treatment table and moves it into the beam position. The robotic arm also has a compact anesthesia system built into the base, so the transfer of anesthesia tubes and lines is quick and seamless.

When designing this solution, the team was inspired by how anesthesia is delivered on the Mayo Clinic’s medical helicopters, says Dr. Laack. “You have a tight space in a helicopter too, and you don't want anesthesia lines in the way.”

In the proton beam treatment rooms, technicians use advanced imaging techniques to quickly pinpoint the precise location of the tumor. The robotic table adjusts and aligns the child perfectly so that the pencil beam directly hits the tumor.  

Commitment to Research and Care

Dr. Laack’s passion for designing the best possible cancer care began when her grandfather was diagnosed with leukemia. At the time, she was a college student at Colorado State University. She knew she couldn’t learn enough fast enough to help him. But she committed then to studying cancer so that she could help others.

As a medical student at Loma Linda University in California, Dr. Laack conducted research alongside her coursework, earning a master’s in physiology with a focus on breast cancer research.

She envisioned herself as a full-time cancer researcher. But then she began clinical rotations and discovered how much she values working with patients. “I was still passionate about studying cancer biology,” she says, “But the patient interaction was what brought me the most meaning and joy.”

It is so important to have all the tools in our toolbox so we can continue offering these patients the very best care.

— Nadia Laack, M.D.

As a radiation oncology resident at Mayo Clinic, she discovered that she was especially drawn to helping one patient group in particular: children. Working with kids facing difficult diagnoses was emotionally challenging, she says. “But I felt this was where I was needed the most.”

Today, Dr. Laack cares for patients of all ages, with a special focus on children. She also continues her research.

Before launching the proton beam facility, for example, Dr. Laack and her team spent a decade studying proton therapy and developing computer models that could project how effective and safe their new pencil beam facility would be for treating a wide range of cancers, including brain, breast, prostate and lung. After opening, they led more than 70 clinical trials to confirm that their proton therapy treatment resulted in the best outcomes. 

“The safety of our patients is the highest priority,” she says.

Accelerating Radiation Therapy Innovation for Patients

Today, Mayo Clinic’s proton beam therapy program has treated more than 10,000 patients, and soon, Mayo Clinic and Dr. Laack will have yet another radiation tool available for patients.

Within a few years, the recently constructed Duan Family Building at Mayo Clinic in Florida will be the first clinic in North America to offer a new technology: carbon ion therapy.

Carbon ion therapy is precise, much like proton therapy. But because carbon ions are more massive than protons, their impact is even more damaging to a tumor — making this form of radiation especially effective for patients with large or resistant tumors.

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Dr. Laack was an early proponent of bringing carbon ion therapy to Mayo Clinic. She recognized that Mayo Clinic staff were uniquely positioned to develop the new technology because of the knowledge they had already gained in proton therapy.

“We believed strongly that if anybody in North America was going to offer carbon ion therapy to patients, it needed to be Mayo Clinic,” she says. “We have the physics, the engineering and the physician expertise to be able to do it well and safely.”

Few of Dr. Laack’s pediatric patients require carbon ion therapy because pediatric tumors typically respond well to photon or proton therapy. But for some adult patients, and for children with treatment-resistant tumors, the technology could fight off cancer better and faster than existing therapies. Dr. Laack wanted to ensure that carbon ion therapy would be available for these patients.  

“Patients with some of the most difficult cancers — the hardest of the hard — come to us for hope and healing,” Dr. Laack says. “It is so important to have all the tools in our toolbox so we can continue offering these patients the very best care.”