Price Alex, Kim Hyun, Henke Lauren E, Knutson Nels C, Spraker Matthew B, Michalski Jeff, Hugo Geoffrey D, Robinson Clifford G, Green Olga
Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri.
Department of Engineering Management and Systems Engineering, Missouri University of Science and Technology, St. Louis, Missouri.
Adv Radiat Oncol. 2020 May 24;5(4):737-742. doi: 10.1016/j.adro.2020.05.007. eCollection 2020 Jul-Aug.
The 2019 coronavirus disease pandemic has placed an increased importance on physical distancing to minimize the risk of transmission in radiation oncology departments. The pandemic has also increased the use of hypofractionated treatment schedules where magnetic resonance-guided online adaptive radiation therapy (ART) can aid in dose escalation. This specialized technique requires increased staffing in close proximity, and thus the need for novel coverage practices to increase physical distancing while still providing specialty care.
A remote-physician ART coverage practice was developed and described using commercially available software products. Our remote-physician coverage practice provided control to the physician to contour and review of the images and plans. The time from completion of image registration to the beginning of treatment was recorded for 20 fractions before remote-physician ART coverage and 14 fractions after implementation of remote-physician ART coverage. Visual quality was calculated using cross-correlation between the treatment delivery and remote-physician computer screens.
For the 14 fractions after implementation, the average time from image registration to the beginning of treatment was 24.9 ± 6.1 minutes. In comparison, the 20 fractions analyzed without remote coverage had an average time of 29.2 ± 9.8 minutes. The correlation between the console and remote-physician screens was = .95.
Our novel remote-physician ART coverage practice is secure, interactive, timely, and of high visual quality. When using remote physicians for ART, our department was able to increase physical distancing to lower the risk of virus transmission while providing specialty care to patients in need.
2019年冠状病毒病大流行使得在放射肿瘤学部门保持身体距离以尽量降低传播风险变得愈发重要。大流行还增加了超分割治疗方案的使用，其中磁共振引导的在线自适应放射治疗（ART）有助于提高剂量。这种专业技术需要增加近距离的人员配备，因此需要新的覆盖模式来增加身体距离，同时仍能提供专科护理。
利用商用软件产品开发并描述了一种远程医生ART覆盖模式。我们的远程医生覆盖模式使医生能够对图像和计划进行轮廓勾勒和审查。记录了在远程医生ART覆盖之前的20次分割治疗以及实施远程医生ART覆盖之后的14次分割治疗从图像配准完成到开始治疗的时间。使用治疗交付与远程医生电脑屏幕之间的互相关计算视觉质量。
在实施后的14次分割治疗中，从图像配准到开始治疗的平均时间为24.9±6.1分钟。相比之下，在没有远程覆盖的情况下分析的20次分割治疗的平均时间为29.2±9.8分钟。控制台与远程医生屏幕之间的相关性为 = 0.95。
我们新颖的远程医生ART覆盖模式安全、交互式、及时且视觉质量高。当使用远程医生进行ART时，我们科室能够增加身体距离以降低病毒传播风险，同时为有需要的患者提供专科护理。
