Instituto Oncologico Nacional
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| Location: | former Gorgas Hospital Gorgas Hospital Gorgas Hospital was a U.S. Army hospital in Panama City, Panama named for Army Surgeon General William C. Gorgas .Built on the site of an earlier French hospital called L'Hospital Notre Dame de Canal, it was originally christened Ancon Hospital by the Americans. It was originally built of wood,... , Gorgas Street, Ancon, Building 254 Panama City Panama City Panama is the capital and largest city of the Republic of Panama. It has a population of 880,691, with a total metro population of 1,272,672, and it is located at the Pacific entrance of the Panama Canal, in the province of the same name. The city is the political and administrative center of the... , Panama Panama Panama , officially the Republic of Panama , is the southernmost country of Central America. Situated on the isthmus connecting North and South America, it is bordered by Costa Rica to the northwest, Colombia to the southeast, the Caribbean Sea to the north and the Pacific Ocean to the south. The... |
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| Foundation: | 1936 |
| Type: | Public Hospital Public hospital A public hospital or government hospital is a hospital which is owned by a government and receives government funding. This type of hospital provides medical care free of charge, the cost of which is covered by the funding the hospital receives.... |
| Beds: | 143 |
The National Oncologic Institute or ION (Spanish: Instituto Oncologico Nacional) is a specialized hospital for cancer treatment, located in Panama City
Panama City
Panama is the capital and largest city of the Republic of Panama. It has a population of 880,691, with a total metro population of 1,272,672, and it is located at the Pacific entrance of the Panama Canal, in the province of the same name. The city is the political and administrative center of the...
, Panama
Panama
Panama , officially the Republic of Panama , is the southernmost country of Central America. Situated on the isthmus connecting North and South America, it is bordered by Costa Rica to the northwest, Colombia to the southeast, the Caribbean Sea to the north and the Pacific Ocean to the south. The...
.
History
On 1936, President Juan Demóstenes ArosemenaJuan Demóstenes Arosemena
Juan Demóstenes Arosemena Barreati was President of Panama from October 1, 1936 to December 16, 1939. He belonged to the National Liberal Party...
(a physician), conceived the creation of the National Radiologic Institute, an institution dedicated to treat cancer. The treatments were given on the Santo Tomas Hospital
Hospital Santo Tomas
Hospital Santo Tomás , is the largest Public hospital that the Panamanian Health Ministry has. Its long history goes as far as 1703.-History:...
and on the former 'Panama Hospital'.
On September 18, 1940, during the administration of President Augusto Boyd
Augusto Samuel Boyd
Augusto Samuel Boyd Briceño was First Vice President of Panama and in that capacity also acting President of Panama from December 18, 1939 to October 1, 1940...
, the new facilities of the National Radiologic Institute were inaugurated, giving it its own building. The Institute was part of the Santo Tomas Hospital
Hospital Santo Tomas
Hospital Santo Tomás , is the largest Public hospital that the Panamanian Health Ministry has. Its long history goes as far as 1703.-History:...
. This institute had 4 doctors, 3 nurses, and 40 beds. The treatments they had were radiotherapy, implantation of Radium
Radium
Radium is a chemical element with atomic number 88, represented by the symbol Ra. Radium is an almost pure-white alkaline earth metal, but it readily oxidizes on exposure to air, becoming black in color. All isotopes of radium are highly radioactive, with the most stable isotope being radium-226,...
needles, injections of hydrogenated mustard and surgery.
The institute had a passive handling of cancer, because the treatment of cancer given at the time was to ease pain in patients.
On 1965, a more active role in the battle against cancer is started, when the latest advancements of the time are applied in the detection and treatment of this illness.
Later that year the National Radiologic Institute was renamed "Juan Demóstenes Arosemena
Juan Demóstenes Arosemena
Juan Demóstenes Arosemena Barreati was President of Panama from October 1, 1936 to December 16, 1939. He belonged to the National Liberal Party...
" Cancerologic Center, as a recognition of the work of this physician and creator of the institution. A Cobalt-60
Cobalt-60
Cobalt-60, , is a synthetic radioactive isotope of cobalt. Due to its half-life of 5.27 years, is not found in nature. It is produced artificially by neutron activation of . decays by beta decay to the stable isotope nickel-60...
pump was acquired.
On 1980, the institution begins relations with the government of Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, that was interested on the treatment of cancer in Panama
Panama
Panama , officially the Republic of Panama , is the southernmost country of Central America. Situated on the isthmus connecting North and South America, it is bordered by Costa Rica to the northwest, Colombia to the southeast, the Caribbean Sea to the north and the Pacific Ocean to the south. The...
, and by which a donation of medical and surgical equipment, including ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
, X-rays, and others are acquired.
On 1984, by law 11, the National Oncologic Institute (Instituto Oncologico Nacional) "Juan Demóstenes Arosemena
Juan Demóstenes Arosemena
Juan Demóstenes Arosemena Barreati was President of Panama from October 1, 1936 to December 16, 1939. He belonged to the National Liberal Party...
" is created.
On June 3, 1999, the Panamanian Government, on President Ernesto Perez Balladares
Ernesto Pérez Balladares
Ernesto Pérez Balladares González-Revilla was the President of Panama between 1994 and 1999. Nicknamed "El Toro" , Ernesto Pérez Balladares is married to Dora Boyd Preciado, with 3 daughters.-Studies :...
administration, gives buildings 242 and 254 of the former Gorgas Hospital
Gorgas Hospital
Gorgas Hospital was a U.S. Army hospital in Panama City, Panama named for Army Surgeon General William C. Gorgas .Built on the site of an earlier French hospital called L'Hospital Notre Dame de Canal, it was originally christened Ancon Hospital by the Americans. It was originally built of wood,...
to the Institute, and on July 23 the Institute moves to this location from the building on Justo Arosemena Avenue.
The Hospital has continued its growth and acquired new equipments, like a linear accelerator, a new CT and opened its ICU
Critical Care Medicine
Critical Care Medicine is a peer-reviewed medical journal in the field of intensive care medicine. It is the official publication of the Society of Critical Care Medicine, and is published by Lippincott Williams & Wilkins. The editor-in-chief is Joseph E. Parrillo....
Accident
As in most radiotherapy departments, the one at ION uses a treatment planning system (TPS) tocalculate the resulting dose distributions and determine treatment times. The data for each shielding block should be entered into the TPS separately. The TPS allows a maximum of four shielding blocks per field to be taken into account when calculating treatment times and dose distributions. Shielding blocks are used to protect healthy tissue of patients undergoing radiotherapy at the Institute, as is the normal practice.
In order to satisfy the request of a radiation oncologist to include five blocks in the field, in August 2000 the method of digitizing shielding blocks was changed. It was found that it was possible to enter data into the TPS for multiple shielding blocks together as if they were a single block, thereby apparently overcoming the limitation of four blocks per field. As was found later, although the TPS accepted entry of the data for multiple shielding blocks as if they were a single block, at least one of the ways in which the data were entered the computer output indicated a treatment time substantially longer than it should have been. The result was that patients received a proportionately higher dose than that prescribed. The modified treatment protocol was used for 28 patients, who were treated between August 2000 and March 2001 for prostate cancer
Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
and cancer of the cervix. There were 17 deaths and 11 injuries.
The modified protocol was used without a verification test, i.e. a manual calculation of the treatment time for comparison with the computer calculated treatment time, or a simulation of treatment by irradiating a water phantom and measuring the dose delivered. In spite of the treatment times being about twice those required for correct treatment, the error went unnoticed. Some early symptoms of excessive exposure were noted in some of the irradiated patients. The seriousness, however, was not realized, with the consequence that the accidental exposure went unnoticed for a number of months. The continued emergence of these symptoms, however, eventually led to the accidental exposure being detected. This was in March
2001.
In May 2001, the Government of Panama requested assistance under the terms of the Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency. In its response, the International Atomic Energy Agency (International Atomic Energy Agency
International Atomic Energy Agency
The International Atomic Energy Agency is an international organization that seeks to promote the peaceful use of nuclear energy, and to inhibit its use for any military purpose, including nuclear weapons. The IAEA was established as an autonomous organization on 29 July 1957...
) sent a team of five medical doctors and two physicists to Panama to perform a dosimetric and medical assessment of the accidental exposure and a medical evaluation of the affected patients’ prognosis and treatment. The team was complemented by a physicist from the Pan American Health Organization (PAHO), also at the request of the Government of Panama.
The accidental exposures at the ION in Panama were very serious. Many patients have suffered severe radiation effects due to excessive dose. Both morbidity and mortality have increased significantly. This series of accidental exposures is unique. Previous radiation therapy accidental exposures that resulted in mortality had involved excessive doses of 30–50% more than prescribed. There are no reported previous accidental expoures in which the doses delivered were 50–100% above prescribed radiotherapy doses, with all affected patients being treated in the pelvic region.
The International Atomic Energy Agency
International Atomic Energy Agency
The International Atomic Energy Agency is an international organization that seeks to promote the peaceful use of nuclear energy, and to inhibit its use for any military purpose, including nuclear weapons. The IAEA was established as an autonomous organization on 29 July 1957...
report was consistent with the report made by local investigators. It was found that the radiotherapy equipment was properly calibrated and worked properly. The error was on the data entry, using a protocol not validated to enter more shielding blocks, that resulted in increased dose in the treatment. Most of the exposed patients have died, some radiation related, others by means of their advanced cancer. The Government of Panama
Panama
Panama , officially the Republic of Panama , is the southernmost country of Central America. Situated on the isthmus connecting North and South America, it is bordered by Costa Rica to the northwest, Colombia to the southeast, the Caribbean Sea to the north and the Pacific Ocean to the south. The...
agreed to share urgently the conclusions of the report to help prevent similar accidents. The physicists of ION involved were taken to trial by the patients families.