Brachytherapy and ASCs

The treatment of cancer in ASCs can be a positive experience for patients undergoing certain types of radiation therapy. The calm and personalized setting of an ASC can prove more comforting and less expensive than the typical hospital setting.

One type of treatment that is being done more and more in ASCs is that of brachytherapy. This type of program might be something that you should consider adding to the services offered by your own ASC.

What is Prostate Brachytherapy?

Brachytherapy in ASCsChief Executive Officer of Prologics Healthcare, LLC, Roger Corle, a proponent of having ASCs adopt a brachytherapy program for the treatment of cancer patients, explains that prostate brachytherapy is a practical and economical method of treatment for those suffering from prostate cancer.

The procedure, namely Low Dose Rate (LDR) Brachytherapy, is performed by a urologist and a radiation oncologist together who place tiny “seeds” of radioactive material inside the tumor.

“Brachytherapy seeds are approximately the size of a grain of rice and are generally encapsulated Iodine-125 or Palladium-103,” Corle said. “These radioisotopes have a short half-life and decay over a period of weeks or months, delivering the intended amount of radiation to treat the patient’s cancer. Brachytherapy can be used as a treatment option for breast cancer and ocular cancer as well.”

By choosing this form of treatment over other types of external radiation therapy, patients can return to their daily lives and activities sooner. The procedure itself can be performed in as ASC in just one day and in as short a time as one hour. Furthermore, the risks to the healthy tissues surrounding the tumor are decreased, according to Dr. Jon Prescott, Radiation Oncologist, Administrator, and Owner at Northern Ohio Regional Cancer Center.

“The difference between brachytherapy and putting radiation sources in a tumor versus the external option is that with brachytherapy you typically get a much higher dose that’s concentrated to a much smaller area,” he explained. “The importance of that is by limiting the amount of radiation that goes to the organs around the tumor, not only does it allow us to increase the dose to the tumor, but it allows us to decrease the dose to the normal tissues around it.”

Benefits to an ASC

Implementing a prostate brachytherapy program in an ASC is typically much simpler than most owner operators would assume, especially if the center already has an urologist on site.

“Prostate brachytherapy requires a urologist, radiation oncologist, an anesthesiologist for day of procedure as well as a medical dosimetrist or physicist for treatment planning,” Corle said. “Typically ASCs with urology participation or ownership are ideal candidates for starting a prostate brachytherapy program.”

In terms of licensures, an ASC would need to obtain a Radioactive Materials License. This allows the center to store and handle radioactive seeds. According to Corle, the application is typically about 2-3 pages long and takes 6-8 weeks to process. The cost of the license can be less than $1,500 and is done through the state.

Facility requirements for the ASC are rather minimal as well.

“Sources come in a lead envelope or container commonly known as a ‘pig’ and should be stored in a locked cabinet until used in procedure,” Corle said. “Additional shielding or drainage is not necessary to perform implants and existing electrical and electrical backup should suffice.”

According to Dr. Prescott, the equipment needed to perform LDR brachytherapy procedures might already be at the ASC looking to implement such a program.

“The actual equipment that is necessary is an ultrasound unit and something called a stepper stabilizer,” he said. “It allows us to use the ultrasound to get the needles and tubes in the right place.”

Corle notes that most ASCs already have an ultrasound with bi-planar probe on site. Depending on the technique in which the procedure is done, the center might desire another piece of equipment known as a mick applicator, but for the most part, that is the bulk of the purchasing an ASC needs to do.

“An ultrasound unit and stepper stabilizer can be purchased refurbished with warranty for approximately $15K combined,” he said.

When it comes to how much income this program can potentially generate for an ASC, breaking even on the investment made to get the ball rolling can be done rather quickly.

“On average an ASC will generate approximately $4,000 per implant in income,” Corle said. “In other words it would take an ASC less than 5 implants to breakeven on their initial investment.”

According to Dr. Prescott, the benefits that ASCs can gain from brachytherapy programs stem from the simplicity and low-risk nature of the procedure.

“It usually brings in radiation oncologists and urologists together for a low investment,” he said. “The major costs are just the normal fees of licensures and the equipment fees.”

Corle feels that the most attractive aspect for an ASC involves throughput and facility utilization.

“It’s the fact that if you do have urology participation, there’s a strong chance that this is being done in your area, so why not have it done in your own ASC?” he said. “It’s a pretty profitable procedure, and increases facility utilization. It’s offering more services and it’s a no-brainer if you have urologists doing it somewhere else.”



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