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Proton International

Our Qualifications

The Proton International team has collectively been involved with the development of more proton centers than any staff in the business. Our services includes design, construction, equipment installation, commissioning, training, clinical protocols, ongoing equipment service and maintenance and operational support.

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Services Offered

We specialize in one & two room centers

  • Business Planning and Feasibility
  • Financing
  • Organizational Structure
  • Building Design & Construction
  • Installation
  • Commissioning & Training

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Proton International

Making Protons Accessible

Access to Proton Therapy is complicated by the restricted number of centers, the timing issues of cancer as a demanding disease, and the costs. PI has addressed these by starting a Proton Access Program to provide patients and physicians with the tools to make this treatment available.

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Services Summary

Proton International will assure your proton facility is achieved on time, under budget, and within the scope and needs of your Institution. Based on our previous experience developing multiple centers our turnkey offering will, together with your team, oversee and implement all phases of the project including:

  • Business planning & feasibility w/ complete proforma
  • Organizational Structure
  • Financing
  • Real Estate, Building Design and Construction
  • Equipment selection and purchase
  • Ongoing Support Services
  • Equipment Maintenance and Support
  • Installation and Commissioning:
  • Equipment
  • Information Technology
  • Medical Physics and Commissioning
  • Training
  • Clinical Startup
  • Clinical Operations

Services to Ensure Efficent Proton Centers

Business Planning and Feasability

Business Planning and Feasability

PI will work with you to develop a business plan and proforma,specific to your clinical program, business assumptions, and unique program needs.This plan will be used to support the financing for the center. The plan will include:

  • Income Statement
  • Cash Flows
  • Payer Mix
  • Clinical Review
  • Sources and Uses of Funds
  • All Required Revenue, Cost and Related Assumptions and Plans
Business Planning and Feasability


We have developed a financing solution that provides an effective low cost solution, that simultaneously limits healthcare entity balance sheet impact. By leveraging a debt service reserve fund guarantee provided by the healthcare entity, we are able to access tax-exempt / taxable bond market rates that are historically low. The debt service reserve fund guarantee would only be tapped if project revenues are not sufficient to cover principal and interest. At current market levels, the breakeven to cover debt service is approximately 20 patients/day. Given an average patient load the likelihood that the debt service reserve fund is tapped is low.

The finance structure enables the project to be funded at levels close to where the healthcare entity would borrow on its own, without incurring the same balance sheet impact. The impact to the healthcare entity’s financials would be limited to the amount of the debt service reserve fund and not the total amount of debt issued.

Business Planning and Feasability

Organizational Structure

PI will work with your team to identify and define the organizational structure needed to fulfill the project goals and objectives. An ownership structure that will support the finance strategy, the development services and the ongoing operational strategy assuring the clinical partner maintains control, and meets it’s financial obligations.

  • Ownership
  • Board
  • Development agreements
  • Operational Agreements
  • Training Services
Business Planning and Feasability

Building Design & Construction

Proton centers are complex undertakings. Adopt a Proton International designed building to save time in design and cost in design fees. Savings and risk reduction are embedded in innumerable design and engineering cost efficiencies derived from learned lessons. The equipment vendor will move into the building sooner which leads to earlier center opening. Even where a non-Proton International design is favored, there are still substantial savings derived through the knowledge we bring to the process of design, construction and proton equipment set up.

The Tasks in Design and Construction
    Facility Design
  • Oversight and coordination of architects, engineers and all other design consultants to ensure adherence to schedules, budgets and timeframes.
  • Drawing analysis / proactive coordination with architect, engineers and other consultants to study methods and materials
  • For projects not using a Proton International design, review and oversight of design process to incorporate efficiencies as realized on a Proton International design.
    Facility Construction
  • Development and oversight of the bidding, purchasing and contracting strategies
  • On site management of the construction process from pre-construction through post-construction and move-in periods
  • Budget and schedule development and oversight including detailed reporting and payment management.
  • Coordination of interfaces between building infrastructure and proton equipment and medical equipment installation
    Facility Maintenance Management
  • Ensure procedures and policies are set and in-place to take advantage of economies-of-scale, and lessons’ learned from one facility to another.


Equipment and Information Technology
  • Oversee the equipment installation assuring the vendor meets and exceeds all contractual commitments and standards.
  • Management of key milestones based on experience from other centers.
Information Technology

IT & Systems Integration

Purchasing, coordination and implementation of the multiple IT systems must be integrated as one synchronized design and connected to a patient’s passage throughout their continuum of care.

The Tasks in IT and Systems Integration
    IT Project Management
  • Develop a project plan for all the IT related tasks for the center
  • Coordination of tasks/timeline with other disciplines (physics, facilities, clinical operations, etc.)
  • Management of project plan and oversight of IT implementation tasks throughout project.
    IT Infrastructure Build-Out
  • Identify IT infrastructure requirements (voice/data/wireless/servers/storage/PCs)
  • Create configuration documents for bidding,
  • Manage vendor selection,
  • Infrastructure implementation and audit/validation of infrastructure installation
    Clinical Systems Acquisition/Implementation
  • Identify clinical system requirements
  • Obtain/review/validate proposal(s) for clinical systems,
  • Work with appropriate clinical and other staff to implement and configure clinical systems,
  • Coordinate training as needed
    Ancillary Systems Acquisition/Implementation
  • Identify ancillary system requirements (billing, administrative, etc.)
  • Obtain/review/validate proposal(s) for ancillary systems
  • Work with appropriate staff to implement and configure ancillary systems
  • Coordinate training as needed
    External Interfaces/Connectivity
  • Identify requirements for external system connectivity
  • Determine interface system requirements
  • Manage acquisition/implementation of interface engine if needed
  • Coordinate configuration and implementation of external interfaces with internal and external parties
    Start-up Support
  • Develop/manage/lead/document end-to-end testing of center systems workflow, provide technical support for initial center start-up/patient treatment
Medical Physics and Commissioning

Medical Physics Training & Commissioning

It takes the experience of a full building cycle to gain the knowledge of how to efficiently commission a proton center. Through our experienced Proton International team, having commissioned multiple centers, we bring significant efficiencies in this area. When others commission their center with their new physics team, it has taken months per room to finish their QA acceptance. Proton International’s team has completed commissioning tasks in record time resulting in first patient treatment and faster revenue substantially faster than any other solution.

The Tasks in Medical Physics Planning and Commissioning
  • Project Planning:weekly vendor meetings and updates to develop comprehensive timeline for the following work plan:

Equipment purchasing; IT Support; Physics specific applications installation; Multivendor system integration; OIS-Treatment machine integration testing; Treatment room/treatment control room build out; TPS installation, acceptance, and network integration; CT installation, acceptance, and network integration; patient positioned testing; Beam data collection; Room delivery

    Equipment Purchasing
  • Commissioning Equipment; TRS 398 output calibration; Daily, Monthly, Annual QA Equipment;
  • Acceptance Testing
  • Perform acceptance testing with Vendor
  • Assess Proton Therapy System performance as specified in contract
  • Mechanical: Complete evaluation of all mechanical components of treatment room:
X-ray system; Treatment couch; Gantry; Snout; Laser system
  • Proton specific CT calibration; CT transmission measurements; Calculation of CT number to stopping power rations (required by TPS)
    Treatment Planning System:
  • Collection of all data required for TPS beam modeling
  • Comprehensive data collection for validation of TPS beam mode and source characterization for percentage depth dose; lateral profiles; output factors.
    X-ray Patient Alignment System:
  • Complete end to end test of data transfer and integrity
  • Performance testing of all modes of patient alignment with high precision anthropomorphic phantom:

Manual Registration

Fiducial Registration

Automatic Registration

    Patient Positioning System (Treatment Couch) motion accuracy testing with analysis of PPS precision for:
  • translational, rotational, and small corrections
    OIS – Imaging System and treatment machine integration for:
  • network configuration; network traffic testing, and application configuration.
    End to end data transfer test:
  • OIS-Imaging System-Treatment Machine-OIS
    TRS-398 Output calibration Concurrent Daily QA configuration and calibration Patient specific devices: configuration and testing for in house milling as well as third party suppliers.


Proton International will provide all required training for MDs, Physics, Dosimetry and Therapy. It includes comprehensive curriculum on all aspects of proton treatment, clinic work flow and the technology/equipment in the center. There are individualized curriculums for physicians, physicists, dosimetrists, nurses, and radiation therapists. Proton International’s training is one of the key factors in Proton International’s ability to open and ramp up operations faster; personnel are already proficient and experienced on work flow and systems.

Clinical Launch

Clinical Launch & Ongoing Support


A highly effective proton center must open ready to treat patients with the following: the highest quality standards, a competent and well-recruited physician staff, a comprehensive medical program in place, treatment protocols and guidelines for prospective disease sites, and a research platform for clinical trial participation. Proton International is comprehensive in providing all these services.

The Tasks in Clinical Leadership:
  • Support of the Medical Director in reviewing and evaluating competency and training needs
  • Development of a recruitment plan for additional physician and recruitment assistance
  • Early evaluation of diagnosis to be treated based on existing practice patterns and anticipated regional draw
  • Development of clinical protocols for expected disease sites
  • On going medical consulting and oversight
  • Integration of existing programs into clinical research program with PCG and NCI initiatives
  • Proton International Help Desk: on-going access to physics and Dosimetry expertise

Clinic Infrastructure, Operations and Clinic Launch

The Tasks in Clinic Infrastructure, Operations and Clinic Launch
    Patient workflow
  • Define and implement end-to-end patient flow process from first point of contact through patient under beam. Workflow includes clinical and financial contact, clnical nursing, dosimetry, medical physics, RTT.
  • Ensure systems/staff are ready to receive first referral.
  • Assist with the development and implementation of clinical trial and research capabilities through integration with other proton centers and available cooperative proton research programs.
    Clinical Systems
  • Identify ancillary services needs (labs, nutritionists, PT, social services, etc), and work with local providers to determine logistics.
  • Assist with implementation of, and provide training for system applications (OIS, billing, treatment delivery, etc)
  • Evaluate current work flow processes of partners and incorporate into new centers where applicable (OIS, billing, treatment delivery, etc)
  • Outsourced Contracts – Secure service provider contracts (anesthesiology, housekeeping, snow removal, medical waste, etc)
    Quality Assurance
  • Provide infrastructure for populating center Policy and Procedure Manual
  • Help establish a system for Quality Management Review, including key quality metrics
  • Tools for compliance risk assessment and program effectiveness measures, including compliance awareness survey
  • Auditing and monitoring tools
  • Support / assist with accreditation/licensing processes (ACR, ACRO, COG, State and local health departments). Provide technical support for MD, Nursing, RTT, Intake, Billing, Insurance, etc).
    Business Operations and Organizational Set Up
  • Oversee or support in the selection of key Director level staff, and provide guidance on the hiring qualifications and certifications of all other center staff
  • Reporting / Metrics: setup a system of metrics and reporting to enable management of the business.

Ongoing Operational Support Services: Site Manager

Proton International will provide dedicated site support from first patient treatment forward. We will provide a full time Site Manager on your location to manage the various activities covered in our ongoing support agreement. This individual is dedicated to serve the needs of your center and be a key asset to the organizational learning required for world class proton therapy.

    The Tasks of the Site Manager:
  • Oversight and coordination of all proton equipment service contracts .
  • Oversight and responsibility for all proton system issues and performance improvements.
  • Primary point of contact with proton equipment supplier.
  • Site specific project management support as needed (intake, re-imbursement, process improvement, technology, etc)
  • Site reporting on any significant downtime events and corrective action.
  • Oversight and coordination of research protocols conducted in partnership with other proton centers.
  • Coordination and access to other resources in the network to determine and share best practice.
  • KPI reporting on all critical system performance metrics as determined by your center.
  • Coordination of on-going physics quality and commissioning services and oversight of all quality equipment calibration and maintenance.
  • Oversight and coordination of any third party contracted services related to the operation of the proton center.

Proton Equipment Service Contract Coverage

    The Service Contract Includes:
  • Costs for all personnel needed to operate and maintain the proton system .
  • Costs for all spare parts utilized in the proton system.
  • Travel expenses, hotel and living allowance for any required personnel.
  • All tools and equipment required for monitoring, operation, and maintenance of the proton system.
  • All consumables and supplies required for monitoring, operation and maintenance of the proton system .
  • We will provide an onsite system operation team responsible for non-clinical operation of the proton system as needed for patient treatments.
  • On site personnel will perform all system start up, daily operation and shut down.
  • On site personnel will identify and log all component failures and corrective actions.
  • Assure that the proton system meets all applicable safety and regulatory requirements.
  • Responsible for communicating with the necessary regulatory authorities as the manufacturer and service provider of the proton system.
  • Spare parts most critical to daily operations will be maintained on site or near by the facility for rapid repair if needed.
  • All system software and hardware upgrades required for the purchased treatment configuration are included in the maintenance agreement.
  • Assurance that system maintains guaranteed uptime as contracted.

Experienced Team

handshake squareTurnkey offering from a team that has collectively been involved with the development of more proton centers than any team in the business.

Our services includes design, construction, equipment installation, commissioning, training, clinical protocols, ongoing equipment service and maintenance and operational support.

Non-Recourse Off Balance Sheet Proton Center Financing     Read More