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. 2022 Dec 29;14(12):e33100.
doi: 10.7759/cureus.33100. eCollection 2022 Dec.

Practical Implementation of Emergent After-Hours Radiation Treatment Process Using Remote Treatment Planning on Optimized Diagnostic CT Scans

Kareem R Fakhoury  1 , Leah K Schubert  1 , Mychaela D Coyne  1 , Wes Aldridge  1 , Sabrina Zeiler  1 , Kelly Stuhr  1 , Timothy V Waxweiler  1 , Tyler P Robin  1 , Tracey E Schefter  1 , Brian D Kavanagh  1 , Sameer K Nath  1
Affiliations

Practical Implementation of Emergent After-Hours Radiation Treatment Process Using Remote Treatment Planning on Optimized Diagnostic CT Scans

Kareem R Fakhoury et al. Cureus. .

Abstract

The purpose of this report is to present the implementation of a process for after-hours radiation treatment (RT) utilizing remote treatment planning based on optimized diagnostic computed tomography (CT) scans for the urgent palliative treatment of inpatients. A standardized operating procedure was developed by an interprofessional panel to improve the quality of after-hours RT and minimize the risk of treatment errors. A new diagnostic CT protocol was created that could be performed after-hours on hospital scanners and would ensure a reproducible patient position and adequate field of view. An on-call structure for dosimetry staff was created utilizing remote treatment planning. The optimized CT protocol was developed in collaboration with the radiology department, and a novel order set was created in the electronic health system. The clinical workflow begins with the radiation oncologist notifying the on-call team (therapist, dosimetrist, and physicist) and obtaining an optimized diagnostic CT scan on a hospital-based scanner. The dosimetrist remotely creates a plan; the physicist checks the plan; and the patient is treated. Plans are intentionally simple (parallel opposed fields, symmetric jaws) to expedite care and reduce the risk of error. Education on the new process was provided for all relevant staff. Our process was successfully implemented with the use of an optimized CT protocol and remote treatment planning. This approach has the potential to improve the quality and safety of emergent after-hours RT by better approximating the normal process of care.

Keywords: after hours; diagnostic ct; emergency planning; palliative radiation; process improvement; radiation oncology.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. (A) Diagnostic CT scan of the chest showing a curved tabletop (red arrow) limiting reproducibility of patient position and narrow FOV cropping the body (green arrow) limiting the ability to use fields that pass through this area. (B) Diagnostic CT scan of the cervical spine showing a narrow FOV which crops the body (blue arrows) and prevents the ability to use parallel opposed fields.
FOV: field of view
Figure 2
Figure 2. Workflow for emergent after-hours treatments.
Figure 3
Figure 3. A visual guide included in our treatment process to indicate appropriate treatment techniques, as well as circumstances under which DSBP should not be used.
AP/PA: anteroposterior/posteroanterior; DSBP: diagnostic scan-based planning; IMRT: intensity-modulated radiation therapy; MLC: multileaf collimator; SSD: source-to-skin distance; sup/inf: superior/inferior; VMAT: volumetric modulated arc therapy
Figure 4
Figure 4. Optimized CT order names based on presence or absence of IV contrast and formal radiology interpretation.
RAD ONC: radiation oncology; URG TRTMNT: urgent treatment; W: with; WO: without
See this image and copyright information in PMC

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