But other companies, most notably Still River Systems, founded by some of the original developers of proton therapy at the Harvard Cyclotron Laboratory and Massachusetts General Hospital, also have smaller systems in the works. Still River says it expects to ship its relatively less expensive prototype later this year. The company hopes to have it treating patients as early as 2012.




One of the key features in developing a smaller system is in shrinking development time -- each day you cut off from the building and planning stage makes the project that much more likely to succeed, Morrison said. In general, the time has fallen from 30-36 months to 28-32 months from the start of building to first treatment, he said. However, it's usually another 3-5 months after that before the center is running a full, 6- to 8-hour treatment day.

And condensing the construction time is one of IBA's goals with Proteus One.

"It's not a linac, installed in 15 days. But we're trying to reduce installation times," he said.

"I want protons"

Still, even if built, for a center to be successful, attracting patients is key. This is where marketing comes in, and what Morrison refers to as a "retail" approach.

Part of the reason for the retail approach is that many proton patients are self-referred. In his talk, Morrison estimated at least 70 percent were self-referred (though he said this was a dated figure -- it's higher now). This was somewhat borne out by other presenters. Eric Backes, director of proton operations at the University of Pennsylvania's Roberts Proton Therapy Center, said their self-referred proton mix was about 30 percent.

And Dr. Andrew K. Lee, the director of proton therapy at M.D. Anderson, shared a story from his clinical experience. One young man, an 18-year-old testicular cancer patient who came to the center, asked for proton therapy after reading about it on the Internet. "I hear you're in charge of the protons," he told Lee. "I want protons."

However, the University of Pennsylvania, which first started treating patients early last year, didn't launch its marketing plan until November, when they put up billboards on the local highway and began airing television commercials. The Monday after that started, the center had double the calls that it had the week before, Backes said.

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