While you are sleeping…


At 9:45 pm, when only the guard keeps watch over the empty lobby and a few therapists tie up loose ends at the end of a long day, they arrive—mostly young, jeans-clad, ready to do the behind-the-scenes, after-hours work that keeps Provision treating cancer patients.

Tonight’s four-man night crew is among 12 total IBA employees responsible for the treatment gantries, cyclotron, and larger proton therapy system—manufactured by Belgium-based IBA—that make proton therapy possible. They work in three shifts, starting at 5:30 a.m. and 1:30 and 10:00 p.m., rotating crews every three weeks. They are little seen behind the closed doors of their control room and in the bowels of the facility’s equipment rooms, but the team is crucial to ensuring patients receive treatment on time and at the correct dose.

Tonight’s night shift is made up of Jake Storey, operator technician; Micah Veilleux, software systems engineer; Jeremy Cheatham, beam physicist; and Troy Brown, systems engineer specializing in robotics.

On this particular evening, Veilleux has preparations for a software system upgrade on his to-do list, while Storey reviews scheduled maintenance tasks such as blowing dust out of the control units, greasing hinges and checking or recalibrating various pieces of equipment.

The big job at hand, though, is dealing with recent challenges presented by IBA’s decision to change out the deflector in the cyclotron. The component, which helps channel protons to the patient target, was acting up at some other IBA sites, so the company chose to upgrade the part in all of its machines. That has resulted in a shutdown and a significant problem to solve in the coming hours.

“The cyclotron’s a huge machine—it’s really a complex thing,” says Veilleux.

At most other proton therapy centers, systems are not as sensitive to cyclotron performance. Here in Knoxville, pencil beam scanning—in which a tumor is divided into tiny cubes which are irradiated individually—is used exclusively.  This is the most precise treatment option but adds a complicating factor because of the accuracy required.

“It’s really sensitive, because we calibrate it to be accurate within half a millimeter,” Cheatman says, adding that even simple weather changes result in pressure and temperature shifts can alter the precision.

A collection of cameras and sensors help inform the crew about trouble spots that need to be addressed, and it’s when the system is quiet and everyone has gone home that workers are able to do needed hands-on work and maintenance to the system without interfering with patient treatment. At the end of each night shift, the crew re-starts the system and conducts a mock treatment every morning before actual patients arrive.

“I don’t mind nights, it’s more interesting work in some sense,” says Veilleux. “There’s always work to do on night shift.”

Each of the IBA employees took a different path to Provision. Veilleux and Cheatham worked at research labs. After a career in sales, Storey went back to school in his 50s to get a B.S. in electrical engineering. He met the site technical manager for IBA at his grandson’s birthday party, and “just fell in love with the idea of all this technology in one place.”

And while the IBA night shift’s relationships are primarily with equipment, they say they enjoy working in a setting where their expertise is practically applied to patient care.

“We don’t interact with patients very often, except maybe during day shift if the robotic couch breaks,” Veilleux says. “But we are certainly aware of the point of all this.”

blog-image-nightcrewMicah Veilleux, top, and Jeremy Cheatham, below, are among those on the 12-employee onsite IBA crew that keeps Provision’s proton therapy machines up and running.