Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.
William E. Kahlert Regional Cancer Center, Westminster, MD, 21157, USA.
J Appl Clin Med Phys. 2020 Jul;21(7):187-195. doi: 10.1002/acm2.12896. Epub 2020 May 20.
The COVID-19 pandemic has led to disorder in work and livelihood of a majority of the modern world. In this work, we review its major impacts on procedures and workflow of clinical physics tasks, and suggest alternate pathways to avoid major disruption or discontinuity of physics tasks in the context of small, medium, and large radiation oncology clinics. We also evaluate scalability of medical physics under the stress of "social distancing".
Three models of facilities characterized by the number of clinical physicists, daily patient throughput, and equipment were identified for this purpose. For identical objectives of continuity of clinical operations, with constraints such as social distancing and unavailability of staff due to system strain, however with the possibility of remote operations, the performance of these models was investigated. General clinical tasks requiring on-site personnel presence or otherwise were evaluated to determine the scalability of the three models at this point in the course of disease spread within their surroundings.
The clinical physics tasks within three models could be divided into two categories. The former, which requires individual presence, include safety-sensitive radiation delivery, high dose per fraction treatments, brachytherapy procedures, fulfilling state and nuclear regulatory commission's requirements, etc. The latter, which can be handled through remote means, include dose planning, physics plan review and supervision of quality assurance, general troubleshooting, etc. CONCLUSION: At the current level of disease in the United States, all three models have sustained major system stress in continuing reduced operation. However, the small clinic model may not perform if either the current level of infections is maintained for long or staff becomes unavailable due to health issues. With abundance, and diversity of innovative resources, medium and large clinic models can sustain further for physics-related radiotherapy services.
COVID-19 大流行导致现代世界大部分地区的工作和生计陷入混乱。在这项工作中，我们回顾了其对临床物理任务程序和工作流程的主要影响，并为小型、中型和大型放射肿瘤学诊所中的物理任务避免重大中断或不连续提出了替代途径。我们还评估了“社交距离”下医学物理的可扩展性。
为此目的，确定了三种设施模型，其特征是临床物理学家的数量、每日患者吞吐量和设备。对于具有连续性临床操作相同目标，由于系统紧张而存在社交距离和人员无法使用等限制，但具有远程操作的可能性，研究了这些模型的性能。评估了需要现场人员存在或其他情况的一般临床任务，以确定在疾病在其周围传播的过程中，这三种模型的可扩展性。
三个模型中的临床物理任务可分为两类。前者需要个人存在，包括安全敏感的放射治疗、高剂量分次治疗、近距离放射治疗程序、满足州和核监管委员会的要求等。后者可以通过远程方式处理，包括剂量规划、物理计划审查和质量保证监督、一般故障排除等。
在美国目前疾病水平下，所有三种模型都在持续减少运营的情况下承受了重大系统压力。然而，如果当前的感染水平持续很长时间或由于健康问题人员无法使用，小型诊所模式可能无法运行。具有丰富多样的创新资源，中型和大型诊所模式可以维持进一步的物理相关放射治疗服务。
