Radiotherapy workflow and protection procedures during the Coronavirus Disease 2019 (COVID-19) outbreak: Experience of the Hubei Cancer Hospital in Wuhan, China

Abstract

The epidemic of Coronavirus Disease 2019 (COVID-19) first broke out in Wuhan in December 2019, and reached its peak in Wuhan in February 2020. It became a major public health challenge for China, and evolved into a global pandemic in March 2020. For radiation oncology departments, the COVID-19 pandemic presents a unique challenge for disease protection and prevention for both patients and staff, owing to the weakened immune systems of cancer patients and the need to deliver timely and uninterrupted radiotherapy. At the Hubei Cancer Hospital, the only hospital in Wuhan that specializes in oncology, we organized an emergency infection control team to lead special efforts to combat COVID-19 during this challenging time. Under its lead, the following measures were implemented in the radiation oncology department: the radiotherapy clinic was divided into different infection control zones with varying levels of protection; special staff and patient infection control training sessions were conducted and appropriate measures deployed; daily symptom testing criteria were implemented for patients undergoing treatment; special rotating schedules and infection control methods were implemented for various staff members such as medical physicists/dosimetrists and radiation therapists; modified radiotherapy workflow and specialized treatment area cleaning and disinfection policies and procedures were designed and executed; and special medical waste disposal methods were implemented. We began treating patients using this new COVID-19 radiotherapy treatment workflow and infection control measures on January 30, 2020. During more than one and a half months of uninterrupted radiation oncology clinical operation through the worst of the Wuhan outbreak, no known COVID-19 infection occurred at our radiotherapy center to our patients or employees. This report may provide valuable information for other radiation oncology departments during this unprecedented public health crisis.

Keywords: COVID-19; Infection control; Radiotherapy; Treatment workflow.

Fig. 1

Radiotherapy center layout and infection control zoning.

Fig. 2

Wearing of a surgical mask in addition to regular immobilization devices. (A) A head-and-neck patient wearing a surgical mask underneath a regular thermoplastic immobilization mask. (B) A cranial patient wearing a surgical mask underneath a semi-open thermoplastic immobilization mask. (C) A thoracic patient wearing a surgical mask on an immobilization Vac-Lok bag. (D) A head-and-neck patient with a laryngeal tube wearing a surgical mask underneath a regular thermoplastic immobilization mask with the laryngeal tube covered by another surgical mask.

Fig. 3

Personnel PPE requirements for (A) Clean Zones, (B) Semi-Contaminated Zones, and (C) Contaminated Zones.

Fig. 4

Example of specific area disinfection procedures. (A) A Vac-Lok bag was wiped down with ethanol. (B) A treatment table extension was cleaned with ethanol spray. (C) A LINAC was disinfected with UV lights. (D) Air disinfection was performed with an air sanitizer.