Heritage Snapshot: Part 98

Over the past 25 years I have conducted tours of the Loma Linda University Medical Center Proton Treatment Center. Since it opened in 1990, patients and their families are the only ones who have regularly scheduled tours where they learn how such a unique facility was built in Loma Linda. During his residency in Los Angeles, after graduating from Loma Linda University School of Medicine in 1963, James M. Slater, MD, became extremely upset at the damage that was being done to his cancer patients by x-rays that were designed to help them and the lack of cure in too many cases. So, during his residency, he started developing beam-shaping devices and patient-immobilization systems to reduce the amount of damage being done to surrounding tissues. In addition to these unique improvements, he thought of two additional ways to improve outcomes. He said we need to develop a way to visualize the dose distribution within the body, and we need to determine which would be the best sub-atomic particle to use instead of x-rays. When Dr. Slater returned to Loma Linda in 1970, he had a reputation, and was charged with starting a world-class department of radiation medicine. In the early 1970s, Dr. Slater and his team won international awards and recognition for computer-assisted radiation therapy treatment planning. He made his first scientific presentation at the 1973 annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) in New Orleans, the major radiation medicine meeting in America. One woman from London spoke up from the back of the room and declared, “This has been the missing link for radiation medicine.” From New Orleans it went world-wide overnight. When computerized tomography (CT) became available, Melvin P. Judkins, MD, chair of the Department of Radiology, asked Slater if he would go to London and evaluate the first CT scanners. What Slater saw was so crude, the men decided to wait. In the late 1970s, when General Electric produced the first acceptable CT scanner, LLUMC bought the second one GE built. When Slater’s team wanted to interface their treatment planning equipment with the new CT scanner, GE said, “Fine. But if you damage the machine in any way, you’ll have to pay to fix it.” Dr. Judkins agreed. “We’ll do it,” he said. “Dr. Judkins was a visionary,” according to Dr. Slater. “He didn’t hesitate. He could see where we were headed, and wanted to do everything to help.” Slater’s team removed their treatment-planning equipment from the diagnostic ultrasound machine, hard-wired it into the new CT scanner, and created the world’s first digital images for radiation treatment planning with X-rays. After Dr. Slater published black and white ultrasound images versus the color CT scans in the scientific literature, he was flooded with requests for lectures from around the world. His exhibit won the 1st Place Gold Award for Scientific Exhibit Achievement at the annual ASTRO meeting in Louisiana, in November 1978. In the meantime, international recognition came to Loma Linda University for Dr. Slater’s breakthroughs in cancer treatment imaging. He spoke to the Atomic Energy Commission at a huge United Nations facility in Vienna, which translated his presentation into every language of all the member nations. That led to an interest by NATO and a presentation in Italy. He spoke at universities and physics research laboratories around the world, including two in Russia. To build a facility was Dr. Slater’s next challenge. The accelerator, a proton synchrotron, was built by the United States Department of Energy at Fermi National Accelerator Laboratory, in Batavia, Illinois. Up to 120 scientists from high-energy-physics-research-laboratories around the world participated in its design. They volunteered their time and paid their own transportation costs to participate in what they felt would be a major advancement for mankind. It was one of the most internationally peer-reviewed research projects on the planet, and their participation cost LLUMC nothing. Dr. Slater feels that implementation of the project was providential. Medical Center’s patients are today’s beneficiaries. Although I have taken an estimated 300 groups through the 250-million-dollar facility, I am still dazzled when I take them behind the scenes. The equipment weighs more than 400 tons, stands three stories tall in three places, and produces up to 250-million-electron-volts of ionizing radiation; the same kind of radiation produced by X-rays. However, because they are charged particles, protons can be controlled with sub-millimeter precision. That means there is very little impact on surrounding tissues. That means less negative side-effects and greater quality of life. For more than 10 years it was the only hospital-based facility of its kind in the world. Now there are 10 more in this country and more under construction or in the planning stages. It has served little cancer patients in the Loma Linda University Children’s’ Hospital, the first children’s hospital in the world to have access to this advanced form of radiation therapy. Significant patients have included NASA flight engineers, Ambassador Joseph Reed (the Under Secretary General of the United Nations), and Dr. Georges Charpak (winner of the 1992 Nobel Prize in Physics). (Proton therapy is all about physics). Dr. Charpak came to Loma Linda for proton therapy from CERN, which is now the world’s most powerful proton accelerator. Although staff is capable of treating cancer in more than 50 sites in the body, up to 70 percent of the patients are men with prostate cancer, trying to avoid impotence and incontinence, the morbidity often reported from other forms of treatment. Today, into its 24th year, and after serving 18,000 patients, up to 160 patients a day have benefited from the James M. Slater, MD, Proton Treatment and Research Center. But most importantly, on one of the tours, a gentleman from Texas spoke up, wanting everyone to know that he acknowledged Loma Linda’s reputation. He stated that he could have undergone proton therapy closer to home. “But I came to Loma Linda,” he said, “because of the whole-person care.”