Implementing a Novel Remote Physician Treatment Coverage Practice for Adaptive Radiotherapy during the Coronavirus Pandemic

Price, Alex; Kim, Hyun; Henke, Lauren E.; Knutson, Nels C.; Spraker, Matthew B.; Michalski, Jeff; Hugo, Geoffrey D.; Robinson, Clifford G.; Green, Olga

BACKGROUND: and Purposes: The COVID-19 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 hypo-fractionated treatment schedules where MR-guided online adaptive radiotherapy (ART) can aid in dose escalation. This specialized technique requires increased staffing in close proximity, thus requiring novel coverage practices to increase physical distancing while still providing specialty care. MATERIALS AND METHODS: 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 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 computer screen and the remote physician screen. RESULTS: For the 14 fractions after implementation, the average time from image registration to the beginning of treatment was 24.9±6.1min. In comparison, the 20 fractions analyzed without remote coverage had an average time of 29.2±9.8min. The correlation between the console screen and the remote physician screen was R = 0.95. CONCLUSION: Our novel remote physician ART coverage practice is secure, interactive, timely, and of high visual quality. When utilizing remote physicians for ART, our department was able to increase physical distancing to lower the risk of virus transmission while providing specialty care to our patients in need.