Medical Physicist, Radiation Oncology Department, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Radiation Oncology Resident PGY4, Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA.
J Appl Clin Med Phys. 2023 Mar;24(3):e13914. doi: 10.1002/acm2.13914. Epub 2023 Jan 31.
The COVID-19 pandemic has disrupted traditional onsite support for radiotherapy clinics in low- and middle-income countries (LMIC). Clinics there have struggled to commission new techniques and receive onsite training for their staff. We sought to evaluate whether an offsite approach could fill this gap at a clinic in Jordan by requesting a clinical audit and attempting to commission volumetric modulated arc therapy (VMAT). Over 13 months, a consultant provided remote support for a radiotherapy center that had already obtained treatment equipment and licenses. The consultant began by conducting a virtual audit, using a remote login to the center's R&V and TPS, to identify any gaps in the clinical workflow. Suggestions for improving the clinical workflow were proposed, and change implementation was tracked through emails, social media apps, and video conferencing. An extensive table outlined the commissioning process, including all measurements to be done. Social media apps and shared documents were used to track measurements and analysis. The lack of person-to-person interaction in this new remote-support ecosystem created conflicts; we have highlighted some of these, as well as their resolution and the lessons learned from them. The virtual audit identified gaps categorized as machine QA, treatment plan review, and treatment delivery processes. Following the implementation of the proposals, motion management was added, and machine QA became more comprehensive. VMAT was commissioned using the reports of the AAPM and the IAEA. The main challenges for remote support were time difference, establishing an appropriate form and frequency of communication, tone of voice used in messages, and buy-in from local staff. This evolving practice will enable medical physicists to use modern, multimodal remote communication pathways to effectively transfer knowledge to centers in LMICs. The audit-proposal-improvement pathway for remote support can be incorporated to help others while avoiding the pitfalls we faced.
新冠疫情打乱了中低收入国家（LMIC）放射治疗诊所的传统现场支持。这些诊所难以委托新技术，并为其工作人员提供现场培训。我们试图评估远程支持是否可以填补约旦一家诊所的这一空白，方法是请求临床审计并尝试委托容积旋转调强弧形治疗（VMAT）。在 13 个月的时间里，一位顾问为一家已经获得治疗设备和许可证的放射治疗中心提供远程支持。顾问首先通过远程登录中心的 R&V 和 TPS 进行虚拟审计，以确定临床工作流程中的任何差距。提出了改进临床工作流程的建议，并通过电子邮件、社交媒体应用程序和视频会议跟踪变更实施情况。一份详细的表格列出了委托过程，包括要进行的所有测量。使用社交媒体应用程序和共享文档来跟踪测量和分析。这种新的远程支持生态系统中缺乏面对面的互动会产生冲突；我们已经强调了其中一些冲突，以及它们的解决方案和从中吸取的教训。虚拟审计确定了机器 QA、治疗计划审查和治疗交付流程方面的差距。在实施建议后，添加了运动管理，并且机器 QA 变得更加全面。使用 AAPM 和 IAEA 的报告委托了 VMAT。远程支持的主要挑战是时差、建立适当的沟通形式和频率、消息中使用的语气以及当地员工的认可。这种不断发展的实践将使医学物理学家能够使用现代、多模式的远程沟通途径，有效地向 LMIC 中心传授知识。可以采用远程支持的审计-建议-改进途径来帮助他人，同时避免我们所面临的陷阱。
