The newly constructed New York
Proton Center on 126th St. in Harlem.

Proton therapy comes to New York City: behind the scenes at the NYPC

October 08, 2018
by John R. Fischer, Senior Reporter
At 10 p.m. on Halloween night in 2017, a 150 foot-long truck inched its way through the dark congested streets of midtown Manhattan. Most of the trick-or-treaters had already gone to bed, but a construction crew was waiting outside 126th St. between 2nd Ave. and 3rd Ave. for a treat of their own: a ProBeam proton therapy system from Varian Medical Systems.

The following morning, the crew pried the large blue cargo box open to reveal a cyclotron, fresh off the boat from Germany. The team fastened the particle accelerator to a crane, which lifted it high into the air before bringing it down through an opening in the roof of an unfinished building.

Fast forward to almost one year later and the cyclotron is fully installed in the now complete, three-story building in Harlem that in the coming months will make its debut as the New York Proton Center, the first proton therapy facility in New York State.

“Our goal is to really serve the greater New York marketplace,” Jonathan Weinbach, chief financial officer of New York Proton Center, told HCB News. “We envision that the majority will come from the New York metro area. We’re going to treat the patients who need proton therapy the most and who get the most from it.”

The opening is planned for sometime in February or March of 2019. Meanwhile, Weinbach and his team continue to work through the last few hurdles in what amounts to a nearly decade-long endeavor.

The idea for the NYPC goes back to 2009. Within a year the Department of Health put out a request for proposal in New York, catching the attention of Mount Sinai Health System, Montefiore Medical Center, and Memorial Sloan Kettering Cancer Center. The three subsequently signed on as partners, bringing with them the financial support, clinical expertise and patient populations that are necessary for a successful proton facility.

But how do you find space for a proton therapy facility in Manhattan?

“You essentially need half a city block,” said Weinbach. “The center is 256 feet long but we only needed three stories. Trying to find a piece of real estate where you don’t have to use all of the air rights, which is a key factor for a lot of the real estate decisions in New York, was extremely challenging. We looked at a number of options for building residential units on top of parts of the building.”

After four or five years of looking around, they acquired the 126th Street site from the New York City Economic Development Corporation. In 2015, construction began on the four treatment room facility, comprising three gantries and a fixed beam room.

Entering the building, patients will find themselves in a large waiting room with lots of natural light and simple ornamental decor hanging from the ceiling. Conjoined is another waiting room for pediatric patients and a set of consultation rooms for patient-physician discussions.

Upon being called, the patient can take an elevator to the second floor and head into one of the changing rooms. Personal belongings are stored in lockers across from the changing area and patients continue to either a diagnostic room or one of the center’s four treatment rooms.

In the treatment rooms, patients are laid out on a table under a dome-like sphere, facing upward at the proton beam. What the patient doesn’t see is the three-story delivery system behind the gantry, the installation of which took 18 months to complete. Within it lies the beam line, from which the protons are transferred, with a 70,000 pound magnet curving the beam as it rotates, enabling treatment to be delivered from the bottom of the patient to the sides.

“It’s all done by magnets,” said Allan W. Freeman, the senior vice president of project development for the New York Proton Center. “We have four different treatment rooms. The majority of time is spent positioning the patient and making sure they’re in the right place. Then the actual delivery of protons for the patient is only a couple of minutes.”

Accelerating these protons to two-thirds the speed of light is the cyclotron. Functionality is monitored 24/7 in a control room using software that is also provided by Varian. It also monitors and offers users the ability to make adjustments to a number of cabinets and equipment on the third floor that supply electrical power.

In addition, a mechanical room provides air conditioning and chilled water for the equipment. Systems are equipped with a number of redundancies as backup in case one goes down.

Comprising the third floor is a series of work stations, a staff training room, a lounge area, and a conference room with a view of the entire street outside the front of the center, where everyday life can be seen down below and a medley of restaurants, shops and hardware stores can be found just around the corner.

Being located in the heart of the city is a benefit for physicians from Montefiore, Sloan Kettering and Mount Sinai.

“The building is as centrally located as it could be because their physicians would be going back and forth on a daily basis from the different hospitals, so it actually works out very well for all three partners,” said Freeman. “It’s actually very convenient for patients as well to get to, because you have the highway a block away and a bridge right there.”

In addition to the three provider partners, the project has accumulated a number of banks as investors including JPMorgan Chase & Co., Deutsche Bank AG and the Goldman Sachs Group Inc., along with Long Island-based multi-specialty physician practice, ProHEALTH Care Associates LLP, which serves as the manager of the project.

The regulatory climate for proton therapy in New York
presents challenges because the technology is so new.
Also lending expertise and resources is Dr. Thomas Petrone, who runs Petrone Associates LLC, a medical consulting practice with expertise in all areas of medical physics including diagnostics, nuclear medicine, MR and radiation oncology. The firm carries extensive experience on the regulatory requirements that govern the specific use of radiation, particularly within New York.

“They need to know how to write the regulations, how to enforce the regulations, what the technical aspects of the program are,” said Petrone. “We’re trying our best in making some inroads at creating a bridge between the regulators because this is the first of its kind in New York State, so my role is to bring these parties together.”

Petrone said the main objective at the moment is obtaining a permit for the particle accelerator.

“Because of the newness of this, the New York City Department of Health and Mental Hygiene (DOHMH) Office of Radiological Health (ORH) has established a very detailed scope of what they want accomplished for them to feel comfortable issuing a registration permit to operate the accelerator,” he explained.“That’s the biggest job we have to work on and we are well on our way to doing so, having brought in numerous third-party consultants to help.”

Other less monumental approvals to be completed include radioactive materials licenses for PET/CT scanners and X-ray registration for CT systems, many of which were provided to the center by Siemens Healthineers.

The NYPC is also in the midst of acquiring a permit to occupy the building, which is expected to come through next month. Once completed, it can then apply to the Department of Health for its actual license. In addition, a nationwide search is underway to recruit experts in the field and build up an entire staff of 115-120 individuals to help in the running of the facility.

The center is in line to become the 27th or 28th proton therapy facility in the U.S., and while the aim is to serve the greater New York area, referrals from any hospital will be evaluated and accepted on a medical needs basis.

“It’s the preferred therapy for certain tumors,” said Freeman. “The main objective is to kill the tumor by all means but minimize the damage that you do to tissues in the surrounding areas or other clinical organs that are nearby. Protons have that specific ability to be very focused and not cause damage outside of the area that you are trying to treat.”

He’s quick to add that it isn’t right for all cancer cases – but for certain indications it can mean the difference between life and death. For New Yorkers, who are already accustomed to having everything at their fingertips, proton therapy should be a welcome addition to the neighborhood.