Implementation of a Novel Remote Physician Stereotactic Body Radiation Therapy Coverage Process during the Coronavirus Pandemic

Alex Price; Lauren E Henke; Borna Maraghechi; Taeho Kim; Matthew B Spraker; Geoffrey D Hugo; Clifford G Robinson; Nels C Knutson

doi:10.1016/j.adro.2020.04.012

Implementation of a Novel Remote Physician Stereotactic Body Radiation Therapy Coverage Process during the Coronavirus Pandemic

Adv Radiat Oncol. 2020 Apr 28;5(4):690-696. doi: 10.1016/j.adro.2020.04.012. eCollection 2020 Jul-Aug.

Authors

Alex Price^{1

2}, Lauren E Henke¹, Borna Maraghechi¹, Taeho Kim¹, Matthew B Spraker¹, Geoffrey D Hugo¹, Clifford G Robinson¹, Nels C Knutson¹

Affiliations

¹ Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri.
² Department of Engineering Management and Systems Engineering, Missouri University of Science and Technology, Rolla, Missouri.

Abstract

Purpose: During the coronavirus 2019 disease (COVID-19) pandemic, alternative methods of care are needed to reduce the relative risk of transmission in departments. Also needed is the ability to provide vital radiation oncological care if radiation oncologists (RO) are reallocated to other departments. We implemented a novel remote RO stereotactic body radiation therapy (SBRT) coverage practice, requiring it to be reliable, of high audio and visual quality, timely, and the same level of specialty care as our current in-person treatment coverage practice.

Methods and materials: All observed failure modes were recorded during implementation over the first 15 sequential fractions. The time from cone beam computed tomography to treatment was calculated before and after implementation to determine timeliness of remote coverage. Image quality metrics were calculated between the imaging console screen and the RO's shared screen. Comfort levels with audio and visual communication as well as overall comfort in comparison to in-person RO coverage was evaluated using Likert scale surveys after treatment.

Results: Remote RO SBRT coverage was successfully implemented in 14 of 15 fractions with 3 observed process failures that were all corrected before treatment. Average times of pretreatment coverage before and after implementation were 8.74 and 8.51 minutes, respectively. The cross correlation between the imaging console screen and RO's shared screen was r = 0.96 and lag was 0.05 seconds. The average value for all survey questions was more than 4.5, approaching in-person RO coverage comfort levels.

Conclusion: Our novel method of remote RO SBRT coverage permits reduced personnel and patient interactions surrounding radiation therapy procedures. This may help to reduce transmission of COVID-19 in our department and provides a means for SBRT coverage if ROs are reallocated to other areas of the hospital for COVID-19 support.