Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 5 - Health Planning
Chapter 115 - Health Resource requirements
Subchapter B - Facility or Service-Specific Criteria and Standards
Section I-11515 - Radiation Therapy

1. Radiation therapy is a clinical medical specialty in which ionizing radiation is used to treat patients with cancer (and other tumors or neoplasms). The objective is to deliver a lethal dose of radiation to cancer cells, with minimal damage to surrounding healthy tissues. The therapy can selectively treat malignant tissues because cancer cells are more susceptible than other cells to the damaging effects of radiation.

2. Radiation therapy is increasingly referred to as "oncology" (the study of tumors), stressing the relationship of the specialty to the field of cancer management. There are three forms of treatment for cancer patients, all of which are used individually or in combination with one another: radiation therapy, chemotherapy, and surgery. Because of differences in degrees of responsiveness to radiation, some tumors can be equally well treated by surgery or by radiation, while others cannot be effectively treated by radiation and must be treated with surgery or chemotherapy. Because of its dual curative and palliative role, therapeutic radiation is sometimes used prior to surgery or after surgery.

3. Approximately 60 percent of all cancer patients require radiation therapy at some time during the course of their disease. Radiation therapy, alone or in combination with other forms of treatment, will be used by only 50 percent of the cancer patients because of limited access. Radiation therapy was not recognized as a medical specialty, apart from general radiology, until the late 1960's, when the American Medical Association recognized separate training programs for radiation therapists and radiologists. The trend of separating therapeutic and diagnostic radiology has continued.

4. The techniques used in clinical radiation therapy are external irradiation, local irradiation, and internal or systemic irradiation, ranging from low energy to megavoltage equipment. Megavoltage machines are more expensive than other types of equipment, because of their high initial cost and protective requirements for the treatment room. However, they offer significant clinical advantages in terms of patient comfort and long term survival and they have higher utilization capacity.

5. There are three types of facilities for radiation therapy. The least comprehensive provides basic services and may provide selected specialized services, using superficial and/or orthovoltage and cobalt equipment. Facilities equipped for major clinical radiation therapy, provide clinical research and training programs using superficial, orthovoltage, cobalt and small linear accelerator equipment. The most comprehensive type provides services of the other two types and, in addition, provides major training and clinical radiation therapy, with linear accelerators, computerized treatment planning, a treatment simulator, and access to a CT Scanner.

6. Over the years a vernacular has developed in the field of radiation therapy. Several definitions unique to the field are important to an understanding of utilization, need and resource goals. The more commonly needed terms are defined as follows:

1. Louisiana's age-adjusted death rate for cancer consistently runs higher than the national rate. In 1970, it exceeded the national rate by 7 percent and by 10 percent in 1975. Utilizing 1984 projected populations for Louisiana and the nation, total reported deaths for Louisiana and a random 10 percent sample of deaths for the nation, and the direct method of computation, the age-adjusted cancer death rates for Louisiana and the nation for that year stood at 144.55 and 133.10 per 100,000 population respectively. Thus, in 1984, the age-adjusted death rate for cancer in Louisiana exceeded that in the nation as a whole by 7.92 percent. Because cancer claims the lives of thousands of persons each year, with no known absolute prevention or cure, radiation therapy will continue to make a substantial contribution to the care of cancer patients. Recent advances in cancer management and in radiation therapy have evidenced a potential for higher cure rates for certain types of cancer.

2. Radiation therapy is part of a multi-disciplinary approach to cancer management, requiring skills of a variety of specialists and services, prior to, during and following treatment. Although it is not feasible for every facility providing radiation therapy to have a total complement of cancer management services in-house, each institution should provide a broad range of services which are basic to cancer management and should establish a referral mechanism with agreements to provide a comprehensive, integrated range of cancer management services, from diagnosis through treatment and follow up.

3. Regionalization of radiation therapy services is a primary issue in terms of promoting efficient use of equipment and providing a coordinated comprehensive system of services which are accessible, of high quality, and at reasonable cost. Planning and delivery of radiation therapy services on a regional basis should reduce unnecessary duplication of equipment and assure sufficient utilization and revenues to meet expenses for each facility providing the service.

4. Accessibility is of particular concern for radiation therapy services because of costs and inconvenience associated with daily treatment over a period of several weeks. Without reasonable access to the services, patients can be forced temporarily to relocate, creating additional stress. Unless there is some clear therapeutic advantage, it is inadvisable to remove cancer patients from the support of their families and friends.

1. Even more than in most fields of medicine, radiation therapy performed with curative intent involves a balance of risks: the risk of not controlling the disease versus the risk of damaging healthy tissue. The treatment is made more difficult in that the disease is complex and variable. Results are not shown immediately, but often require many years to be demonstrated. Highly trained personnel are thus needed in this field, and they need sufficient patient loads to maintain their skills.

2. Volume figures also serve as indicators of need for a new service or expansion of an existing program. A certain volume is advised to ensure quality of care and to contain costs: a megavoltage radiation therapy unit should treat a minimum of 300-500 patients per year; each megavoltage therapy machine should perform at least 6000 treatments per year before another unit is added in the service area. This range of volume allows for differences among patients in terms of treatment required, and among facilities in terms of organization, staff, and equipment.

3. Radiation therapy patients usually receive daily treatment (five per week) over a period of three to eight weeks.

4. Studies have shown that underutilization of services can result in high operating costs for equipment, which are passed on to the patients, and that unrestricted proliferation of radiation therapy facilities can result in disadvantageous benefit/cost to the health care system. Benefits can only be maximized when optimum radiation therapy capacity is available. Therefore, a service should be initiated or expanded only if there is a need for additional capacity within the area and/or if there are special need considerations (e.g. accessibility) which justify the service or expansion.

1. The following standards are necessary for effective and efficient planning of radiation therapy services.