Clinician Experience with TomoMobile TM #1 Doug Kelly, MD Artesian Cancer Muskogee Norman Kahler MS, Van Woo MD, Matt West PhD, Samuel Rhoades PhD, Darren Crabtree RT

Going Mobile

History Physician owned Muskogee Community Hospital. MCH ribbon cutting Feb. 25, Wanted to rapidly and economically start a cancer program Partnership with Artesian Moved trailer onto pad on Sept. 28 Treated first patient Oct. 29 Permanent facility is planned

“We saw an immediate need for high quality radiation therapy services in Muskogee, but knew we would have to delay offering TomoTherapy for almost a year until our new cancer center was built,” said Derek Prentice, president and CEO of DMP Imaging, developer of Artesian Cancer Center of Muskogee. “TomoMobile allows us to accelerate the process significantly. In addition, it will allow us to confirm viability of these services in the market and speed our ability to generate revenue, perhaps to the point where we can utilize cash flow from the mobile unit to fund the purchase of our permanent TomoTherapy system.” Derek Prentice

Uses for a Mobile Linear Accelerator A bridge during the development of a permanent facility Serve patient population earlier Build market share Test a market before committing resources ? An indefinite alternative to building a permanent facility. Expansion of an existing center Use while upgrading / replacing a permanent unit.

The Facility Located behind hospital Tomotherapy trailer Portable clinic Stairs, ramp, walkways, roof External shielding and fencing

Inside the TomoTherapy Trailer

Inside the Clinic Module

Challenges with a Mobile Unit Technical capability is not a challenge Same machine Same planning software Same reliability

Weather Neither snow nor rain nor sleet nor hail …

Space 1 exam room 1 office 1 reception/nursing area Limited changing area

Shielding and Distance

Uptime = 98% Down 0.6 days in Jan, and 1.6 days in March.

# Patients under Treatment

Tumor Sites of Treated Patients over first 3 months N= 40pts first 3 months

Patient Opinion Survey Appreciate having a second radiation oncology center in Muskogee? 100% Yes Appreciate having TomoTherapy technology available in Muskogee? 100% Yes Does “ mobile ” concern you? 90% No Attractiveness of interior 9.4 / 10 Attractiveness of exterior 7.2 / 10 Anonymous questionnaire given to 10 patients undergoing therapy

Location is extremely accessible Great place It’s the best center that Muskogee could ever have Thank God for it! Thank you for bringing first quality treatment

Conclusions Well accepted by patients, community, and referring doctors Quickly and economically provide state- of-the-art therapy TomoMobile has the same quality, capabilities, and uptime as with a permanent structure