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

The comfort level amongst all members of the treatment team approached the in-person SBRT coverage comfort levels, demonstrating that our SBRT team felt comfortable proceeding with treatment despite not having a physician physically present. The lowest comfort level reported for any fraction was a 2, due to inconsistencies between the CBCT and fluoroscopic gated images. Despite a low comfort level, we were able to correctly identify that the physician was needed at the machine and had minimal wait time for the physician to be present (approximately a minute or less). In the future, we look to identify cases where remote SBRT coverage may be challenging, such as first fraction abdominal gating cases or for lesions that have high potential for poor detectability even if in person (e.g. peridiaphragmatic lung lesions). Additional time-outs during this process are necessary to ensure physicians have all needed information. Ordinarily, time out is performed before the patient is placed on the table and again when physician arrives for coverage. With in-person coverage, the physician has the opportunity to pull up patient charts and supplementary imaging alongside the treatment console on a separate computer from the Microsoft Teams computer. In the remote setting, especially by mobile app, a second time-out to transmit this information about the case to the physician is critical. Having available resources at the ready, including prior fraction notes, planning scans, etc. to answer whatever questions that the physician has may be helpful. Additional challenges include the greater importance of using direct verbal communication, as common non-verbal cues are lost with remote coverage. Limiting distractions from competing physician tasks is also critical to ensure quality and future steps may include . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.