Implementation of a Novel Remote Physician SBRT Coverage Process during the Coronavirus Pandemic

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

Remote SBRT coverage is feasible with minimal observed potential failure modes based on our initial implementation data. Of the first 15 remote coverage cases attempted, only 1 case ultimately required physician presence. Specifically, nuances of communication using remote instructions for gating windows for a gated abdominal case led to physician discomfort with remote coverage, and the physician instead opted to be physically present at the console for more direct communication. Other observed failure modes were a distracted physician (multiple phone messages while covering via Teams mobile app call) and a nearly-missed pre-treatment time-out. Both of these were detected and corrected prior to treatment. Formal FMEA analysis is the optimal approach prior to implementation of novel technologies in a medical environment 15 . However, given the urgency of creating a remote coverage process in the pandemic setting, this will instead be formally carried out after remote SBRT implementation.