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Saito M, Tamamoto T, Kawashiro S, Umezawa R, Matsuda M, Tohyama N, Katsuta Y, Kanai T, Nemoto H, Onishi H. Current status of remote radiotherapy treatment planning in Japan: findings from a national survey†. JOURNAL OF RADIATION RESEARCH 2024; 65:127-135. [PMID: 37996096 PMCID: PMC10803164 DOI: 10.1093/jrr/rrad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 10/14/2023] [Indexed: 11/25/2023]
Abstract
The purpose of this study was to investigate the status of remote-radiotherapy treatment planning (RRTP) in Japan through a nationwide questionnaire survey. The survey was conducted between 29 June and 4 August 2022, at 834 facilities in Japan that were equipped with linear accelerators. The survey utilized a Google form that comprised 96 questions on facility information, information about the respondent, utilization of RRTP between facilities, usage for telework and the inclination to implement RRTPs in the respondent's facility. The survey analyzed the utilization of the RRTP system in four distinct implementation types: (i) utilization as a supportive facility, (ii) utilization as a treatment facility, (iii) utilization as a teleworker outside of the facility and (iv) utilization as a teleworker within the facility. The survey response rate was 58.4% (487 facilities responded). Among the facilities that responded, 10% (51 facilities) were implementing RRTP. 13 served as supportive facilities, 23 as treatment facilities, 17 as teleworkers outside of the facility and 5 as teleworkers within the facility. In terms of system usage between supportive and treatment facilities, 70-80% of the participants utilized the system for emergencies or as overtime work for external workers. A substantial number of facilities (38.8%) reported that they were unfamiliar with RRTP implementation. The survey showed that RRTP utilization in Japan is still limited, with a significant number of facilities unfamiliar with the technology. The study highlights the need for greater understanding and education about RRTP and financial funds of economical compensation.
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Affiliation(s)
- Masahide Saito
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Tetsuro Tamamoto
- Department of Medical Informatics, Nara Medical University Hospital, 840 Shijyo-cho, Kashihara, Nara 634-8521, Japan
| | - Shohei Kawashiro
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, Yamagata 990-9585, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Masaki Matsuda
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Naoki Tohyama
- Division of Medical Physics, Tokyo Bay Makuhari Clinic for Advanced Imaging, Cancer Screening, and High-Precision Radiotherapy, 1-17 Toyosuna, Mihama-ku, Chiba, Chiba 261-0024, Japan
| | - Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Takayuki Kanai
- Department of Radiation Oncology, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo 162-8666, Japan
| | - Hikaru Nemoto
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
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Casà C, Corvari B, Cellini F, Cornacchione P, D'Aviero A, Reina S, Di Franco S, Salvati A, Colloca GF, Cesario A, Patarnello S, Balducci M, Morganti AG, Valentini V, Gambacorta MA, Tagliaferri L. KIT 1 (Keep in Touch) Project-Televisits for Cancer Patients during Italian Lockdown for COVID-19 Pandemic: The Real-World Experience of Establishing a Telemedicine System. Healthcare (Basel) 2023; 11:1950. [PMID: 37444784 DOI: 10.3390/healthcare11131950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
To evaluate the adoption of an integrated eHealth platform for televisit/monitoring/consultation during the COVID-19 pandemic. METHODS During the lockdown imposed by the Italian government during the COVID19 pandemic spread, a dedicated multi-professional working group was set up in the Radiation Oncology Department with the primary aim of reducing patients' exposure to COVID-19 by adopting de-centralized/remote consultation methodologies. Each patient's clinical history was screened before the visit to assess if a traditional clinical visit would be recommended or if a remote evaluation was to be preferred. Real world data (RWD) in the form of patient-reported outcomes (PROMs) and patient reported experiences (PREMs) were collected from patients who underwent televisit/teleconsultation through the eHealth platform. RESULTS During the lockdown period (from 8 March to 4 May 2020) a total of 1956 visits were managed. A total of 983 (50.26%) of these visits were performed via email (to apply for and to upload of documents) and phone call management; 31 visits (1.58%) were performed using the eHealth system. Substantially, all patients found the eHealth platform useful and user-friendly, consistently indicating that this type of service would also be useful after the pandemic. CONCLUSIONS The rapid implementation of an eHealth system was feasible and well-accepted by the patients during the pandemic. However, we believe that further evidence is to be generated to further support large-scale adoption.
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Affiliation(s)
- Calogero Casà
- Fatebenefratelli Isola Tiberina-Gemelli Isola, Via di Ponte Quattro Capi 39, 00186 Rome, Italy
| | - Barbara Corvari
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Francesco Cellini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Patrizia Cornacchione
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Andrea D'Aviero
- Mater Olbia Hospital, SS 125 Orientale Sarda, 07026 Olbia, Italy
| | - Sara Reina
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Silvia Di Franco
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Alfredo Cesario
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Stefano Patarnello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Mario Balducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126 Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Jensen K, Dalby RB, Bouchelouche K, Pedersen EM, Kalmar S. Telehealth in Multidisciplinary Target Delineation for Radiotherapy During the COVID-19 Pandemic. A Review and a Case. Semin Nucl Med 2022; 52:79-85. [PMID: 34217435 PMCID: PMC8206582 DOI: 10.1053/j.semnuclmed.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Like all other medical specialties, radiotherapy has been deeply influenced by the COVID-19 pandemic. The pandemic has had severe influence on the entire patient trajectory in oncology, from diagnosis to treatment and follow-up. Many examples of how to deal with patient and staff safety, shortness of staff and other resources and the quest to continue high-quality, evidence-based treatment have been presented. The use of telemedicine and telehealth is frequently presented as a part of the solution to overcome these challenges. Some of the available presented solutions will only apply in an acute, local setting, whereas others might inspire the community to improve quality and cost-effectiveness of radiotherapy as well as knowledge sharing in the future. Some of the unresolved issues in many of the available technical solutions are related to data security and public regulation, for example, GDPR (General Data Protection Regulation) in the EU and HIPAA compliance (Health Insurance Portability and Accountability Act) in the USA. Using a solution that involves a supplier's server in a non-EU country is problematic within the EU. In this paper we shortly review the influence of COVID-19 on radiotherapy. We describe some of the possible solutions for telehealth in target delineation - a crucial part of high-quality radiotherapy, which often requires multidisciplinary effort, hands-on corporation, and high-quality multimodal imaging. Hereafter, our own technical solution will be presented as a case.
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Affiliation(s)
- Kenneth Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark,Address reprint requests to: Kenneth Jensen MD, PhD, Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | | | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Denmark
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Hasson SP, Waissengrin B, Shachar E, Hodruj M, Fayngor R, Brezis M, Nikolaevski-Berlin A, Pelles S, Safra T, Geva R, Wolf I. Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer. Oncologist 2021; 26:e679-e685. [PMID: 33453121 PMCID: PMC8013179 DOI: 10.1002/onco.13676] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction The use of telemedicine in oncology practice is rapidly expanding and is considered safe and cost effective. However, the implications of telemedicine on patient‐physician interaction, patient satisfaction, and absence of the personal touch have not been studied to date. Following the spread of COVID‐19, telemedicine services were rapidly incorporated at the Oncology Division of Tel Aviv Medical Center. We aimed to evaluate patients' perspectives and preferences regarding telemedicine and to assess whether this virtual communication platform affects the patient‐physician relationship. Methods Between March 2020 and May 2020, adult cancer patients who conducted at least one successful telemedicine meeting were interviewed by trained medical personnel. The interview was based on validated patient satisfaction questionnaires and focused on patient‐physician interaction in relation to the last in‐patient visit. Results Of 236 patients, 172 (74%) patients agreed to participate. The study population comprised mainly patients with gastrointestinal malignancies (n = 79, 46%) with a median age of 63 years (range 21–88). The majority of patients were male (n = 93, 54%). Eighty‐nine (51.7%) patients were receiving active oncologic treatment, and 58 (33.7%) were under routine surveillance following completion of active therapy. Almost all had a sense of secured privacy (n = 171, 96%), the majority of patients affirmed that their concerns were met (n = 166, 93%) and perceived that eye contact with the treating physician was perceived (n = 156, 87%). Only a minority felt that the absence of physical clinic visits harmed their treatment (n = 36, 20%). Most patients (n = 146, 84.9%) wished to continue telemedicine services. A multivariate analysis revealed that higher satisfaction and visits for routine surveillance were both predictors of willingness to continue future telemedicine meetings over physical encounters (odds ratio [OR] = 2.41, p = .01; OR = 3.34, p = .03, respectively). Conclusion Telemedicine is perceived as safe and effective, and patients did not feel that it compromised medical care or the patient‐physician relationship. Integration of telemedicine is ideal for patients under surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform. Implications for Practice During the COVID‐19 pandemic, telemedicine was rapidly implemented worldwide to facilitate continuity of quality care and treatment. Despite many potential setbacks, telemedicine has become a useful and safe tool for oncology practitioners to care for their patients. The use of telemedicine regarding patients' perspectives, emotions, and patient‐physician communication in daily oncology practice has not been studied to date. This study demonstrated telemedicine is perceived as safe and effective and does not compromise medical care or the patient‐physician relationship. Its use is ideal for surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform. The use of telemedicine in oncology practice is rapidly expanding; however, the implications for patient‐physician interaction and patient satisfaction have not been well studied. This article evaluates patients' perspectives and preferences regarding telemedicine and whether a virtual communication platform affects the patient‐physician relationship.
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Affiliation(s)
- Shira Peleg Hasson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Barliz Waissengrin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eliya Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Marah Hodruj
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rochelle Fayngor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mirika Brezis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Sharon Pelles
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Safra
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ravit Geva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Finazzi T, Papachristofilou A, Zimmermann F. "Connection Failed": A Word of Caution on Telemedicine in Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 108:435-437. [PMID: 32890527 PMCID: PMC7462966 DOI: 10.1016/j.ijrobp.2020.06.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Tobias Finazzi
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | | | - Frank Zimmermann
- Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland
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Abdel-Wahab M, Rosenblatt E, Prajogi B, Zubizarretta E, Mikhail M. Opportunities in Telemedicine, Lessons Learned After COVID-19 and the Way Into the Future. Int J Radiat Oncol Biol Phys 2020; 108:438-443. [PMID: 32890528 PMCID: PMC7462967 DOI: 10.1016/j.ijrobp.2020.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Affiliation(s)
- May Abdel-Wahab
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria.
| | - Eduardo Rosenblatt
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Ben Prajogi
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Zubizarretta
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
| | - Miriam Mikhail
- Telemedicine, Radiation Oncology, International Atomic Energy Agency, Vienna, Austria
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Pannullo SC, Julie DAR, Chidambaram S, Balogun OD, Formenti SC, Apuzzo MLJ, Knisely JPS. Worldwide Access to Stereotactic Radiosurgery. World Neurosurg 2020; 130:608-614. [PMID: 31581410 DOI: 10.1016/j.wneu.2019.04.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 12/31/2022]
Abstract
Stereotactic radiosurgery is a safe and effective technology that can address a variety of neurosurgical conditions, but in many parts of the world, access remains an issue. Although the technology is increasingly available in the United States, Canada, Europe, and parts of Asia, poor access to central nervous system (CNS) imaging and inadequate treatment equipment in other parts of the world limit the availability of radiosurgery as a treatment option. In addition, epidemiologic data about cancer and CNS metastases in low-income countries are sparse and much less complete than in more developed countries, and the need for radiosurgery may be underestimated as a result. Current radiosurgical platforms can be expensive to install and require a substantial amount of personnel training for safe operation. Socioeconomic and political forces are relevant to limitations to and opportunities for improving access to care. Here we examine the current barriers to access and propose areas for future efforts to improve global availability of radiosurgery for neurosurgical conditions.
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Affiliation(s)
- Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Diana A R Julie
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Swathi Chidambaram
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | | | - Michael L J Apuzzo
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
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Zou L, Chen X, Xu C, Xing L, Xie Y. Design and Preliminary Experience of a Tele-Radiotherapy System for a Medical Alliance in China. Telemed J E Health 2019; 26:235-243. [PMID: 30892144 DOI: 10.1089/tmj.2018.0323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The medical alliance and telemedicine are considered to be important means to solve the imbalance between regions and shortage of professionals and promote the homogenization of medical services. Sichuan Provincial People's Hospital Group (SPPHG) is a network of hospitals with different levels of expertise, and all the members with radiotherapy form a radiotherapy network (RTN). Addressing the inadequacy and imbalance of radiotherapy services of Sichuan Province, China, a tele-radiotherapy system for RTN-SPPHG is designed, which includes the business model and corresponding technical implementation of an information system. Materials and Methods: In the RTN-SPPHG, a distributed remote collaboration business model is explored and a tele-radiotherapy information system is customized for this telemedicine model. Both the business model and tailored information system were evaluated in actual use. Results: Based on the tele-radiotherapy system of RTN-SPPHG, multitype hospitals are linked together and serve as a whole. Through the internet, the experience of experts of Sichuan Provincial People's Hospital is effectively deployed to member hospitals at the grassroot level. Conclusions: A close-knit medical alliance based on a tele-radiotherapy system should be a way to rapidly improve radiotherapy services and promote the homogenization of service in a region.
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Affiliation(s)
- Lian Zou
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Institute of Biomedical and Health Engineering, Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China.,Department of Radiation Oncology, Cancer Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Chen
- Department of Laboratory Medicine, The Third People's Hospital of Chengdu/Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Chuan Xu
- Department of Radiation Oncology, Cancer Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Xing
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Yaoqin Xie
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Department of Radiation Oncology, Cancer Center, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Telehealth in radiation oncology at the Townsville Cancer Centre: Service evaluation and patient satisfaction. Clin Transl Radiat Oncol 2018; 15:20-25. [PMID: 30582017 PMCID: PMC6293044 DOI: 10.1016/j.ctro.2018.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 12/14/2022] Open
Abstract
Telehealth serviced a range of ages, cancer diagnoses and treatment intents. Tele-radiation oncology consultations reduced travel and time burden for patients. Patients reported an overall high level of satisfaction with telehealth consultation.
Purpose Telehealth (TH) in Radiation Oncology at Townsville Cancer Centre (TCC) was implemented in July 2011 to provide cancer care closer to home to the regional and rural population. The aim of this study was to describe the service use and patient satisfaction. Materials and methods A retrospective audit of records was conducted for patients treated at TCC between July 2011 and December 2015. Data included patient demographics, diagnosis and treatment. Results of a patient satisfaction survey were summarised through descriptive statistics. Results A total of 1530 TH consultations were provided to 833 patients. 311 patient charts were audited (615 TH, 650 in-person, 151 phone consultations). Median distance from TCC to satellites was 327.3 km (21.6 to 1130.1). 71% were male and median age was 65 (23–94 years). Cancer diagnoses included prostate (32%), breast (12%) and head and neck (10%). 60% of patients underwent radiation therapy for curative intent, 22% palliative and 18% did not undergo treatment. 106 patients participated in the satisfaction survey (231 patients invited, response rate of 46%), with the overall positive response mainly attributed to advantages in travel and time savings. 54.7% of patients selected TH as their preference for future consultations, 34.9% indicated a mix of TH and in-person consultations, and only 1 patient (0.9%) indicating in-person only. Conclusion TH enables the delivery of radiation oncology consultations to rural and regional patients, with an overall high level of patient satisfaction. Patients welcomed the model for benefits of travel and time savings. Future directions include engaging with specialist, rural medical staff and patients to maximize access.
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10
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Shalowitz DI, Smith AG, Bell MC, Gibb RK. Teleoncology for gynecologic cancers. Gynecol Oncol 2015; 139:172-7. [PMID: 26151077 DOI: 10.1016/j.ygyno.2015.06.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 01/10/2023]
Abstract
Teleoncology describes cancer care provided remotely to improve access to care in rural or underserved areas. In the United States, 14.8 million women live more than 50 miles away from the closest gynecologic oncologist; 4.3 million women live more than 100 miles distant. Teleoncology may therefore partially relieve the geographic barriers to high-quality gynecologic cancer care these women experience. Little has been published on the feasibility of remote provision of high-quality care for gynecologic cancers, perhaps owing to the particular difficulties inherent in remote management of patients who may require both medical and surgical intervention. In this article, we review the data supporting the use of telemedicine in the treatment of cancer patients with a specific focus on applicability to management of gynecologic malignancies. We further add our group's experience with the treatment of rural, underserved gynecologic cancer patients. We believe that development of teleoncologic systems is critical to ensure that all women have access to high-quality gynecologic cancer care, regardless of where they reside.
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Affiliation(s)
- David I Shalowitz
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, United States.
| | - Allison G Smith
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Maria C Bell
- Department of Obstetrics and Gynecology, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | - Randall K Gibb
- Division of Gynecologic Oncology, Billings Clinic, Billings, MT, United States
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11
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Remote access to treatment planning software for pre-registration radiation therapy education: a single-case feasibility study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAimThis single-case feasibility study presents an undergraduate radiotherapy student’s experiences of remote access to University treatment planning software in place of on-site practical learning. With clinical sites increasingly utilising telemedicine there is interest in educational applications of this technology.Materials and methodsThis was an unplanned study with the student initiating remote access; additional tutor support was provided as requested. Subsequent discussion between the tutor and student formed the basis for the presented findings.ResultsA second-year student planned five assessment cases from home, supported by regular on-campus tutorials. The student saved a 2-hour journey per practical and gained additional planning practice time. Unit performance was 10% less than a previous Unit, but student satisfaction with the format was high.FindingsEducational remote access to treatment planning software is logistically feasible, although strict guidelines and formal tutor support is vital. Remote access can alleviate pressure on facilities and improve student time efficiency. Controlled and supported provision of remote access to planning software could enhance on-site practical teaching sessions for more mature independent learners. Further cohort-wide studies could clarify advantages, disadvantages and possible role of remote access for radiotherapy planning education.
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Datta NR, Heuser M, Samiei M, Shah R, Lutters G, Bodis S. Teleradiotherapy Network: Applications and Feasibility for Providing Cost-Effective Comprehensive Radiotherapy Care in Low- and Middle-Income Group Countries for Cancer Patients. Telemed J E Health 2015; 21:523-32. [PMID: 25763906 PMCID: PMC4507307 DOI: 10.1089/tmj.2014.0154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Globally, new cancer cases will rise by 57% within the next two decades, with the majority in the low- and middle-income countries (LMICs). Consequently, a steep increase of about 40% in cancer deaths is expected there, mainly because of lack of treatment facilities, especially radiotherapy. Radiotherapy is required for more than 50% of patients, but the capital cost for equipment often deters establishment of such facilities in LMICs. Presently, of the 139 LMICs, 55 do not even have a radiotherapy facility, whereas the remaining 84 have a deficit of 61.4% of their required radiotherapy units. Networking between centers could enhance the effectiveness and reach of existing radiotherapy in LMICs. A teleradiotherapy network could enable centers to share and optimally utilize their resources, both infrastructure and staffing. This could be in the form of a three-tier radiotherapy service consisting of primary, secondary, and tertiary radiotherapy centers interlinked through a network. The concept has been adopted in some LMICs and could also be used as a “service provider model,” thereby reducing the investments to set up such a network. Teleradiotherapy networks could be a part of the multipronged approach to address the enormous gap in radiotherapy services in a cost-effective manner and to support better accessibility to radiotherapy facilities, especially for LMICs.
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Affiliation(s)
- Niloy Ranjan Datta
- 1 Centre for Radiation Oncology, KSA-KSB, Kantonsspital Aarau , Aarau, Switzerland
| | - Michael Heuser
- 1 Centre for Radiation Oncology, KSA-KSB, Kantonsspital Aarau , Aarau, Switzerland
| | - Massoud Samiei
- 2 Formerly, PACT Section, International Atomic Energy Agency , Vienna, Austria
| | - Ragesh Shah
- 3 Online Telemedicine Research Institute , Ahmedabad, India
| | - Gerd Lutters
- 1 Centre for Radiation Oncology, KSA-KSB, Kantonsspital Aarau , Aarau, Switzerland
| | - Stephan Bodis
- 1 Centre for Radiation Oncology, KSA-KSB, Kantonsspital Aarau , Aarau, Switzerland .,4 Department of Radiation Oncology, University Hospital Zurich , Zurich, Switzerland
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Arenas M, Gomez D, Sabater S, Rovirosa A, Biete A, Colomer J. Decentralisation of radiation therapy. Is it possible and beneficial to patients? Experience of the first 5 years of a satellite radiotherapy unit in the province of Tarragona, Spain. Rep Pract Oncol Radiother 2014; 20:141-4. [PMID: 25859402 DOI: 10.1016/j.rpor.2014.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/06/2014] [Accepted: 10/15/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The concept of satellite radiotherapy originates in countries whose populations are largely dispersed in order to treat homogenously the population by a unique fixed team. AIM This report describes the creation and management of a satellite radiotherapy unit in Spain (RUTE-Radiotherapy Unit, Terres de l'Ebre). It is managed by the Radiation Oncology Department at Hospital Universitari Sant Joan de Reus. We report the benefit gained in the comfort of patients and the economic benefit gained by reducing the expense of transport for the health care system. MATERIALS AND METHODS RUTE is equipped with a linear accelerator. A team of 10 physicians, specialised in different oncology pathologies, travel to RUTE on a rotational basis from the main Radiation Oncology Department. Simulation and planning of treatment is managed at the Radiation Oncology Department in Reus. Patients from RUTE only have to visit the centre in Reus once throughout the treatment process. RESULTS Since August 2008, 1500 patients have completed treatment in the satellite unit. The implementation of RUTE has greatly improved the comfort of patients and along with that, there have been important savings in transport costs to the regional health care system. CONCLUSIONS Despite the high technological requirements of our speciality, decentralising radiotherapy is feasible. We can guarantee the highest standards of treatment with no differences from attending the main centre. It implies a clear benefit for the comfort of the patients and an economic benefit by decreasing transport costs.
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Affiliation(s)
- Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - David Gomez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, IISPV, Tarragona, Spain
| | - Sebastià Sabater
- Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete, Spain
| | - Angeles Rovirosa
- Department of Radiation Oncology, Hospital Universitari Clínic de Barcelona, Spain
| | - Albert Biete
- Department of Radiation Oncology, Hospital Universitari Clínic de Barcelona, Spain
| | - Jordi Colomer
- Hospital Universitari Sant Joan de Reus and Group SAGESSA (Assistència Sanitària i Social), Tarragona, Spain
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Radiotherapy infrastructure and human resources in Europe - present status and its implications for 2020. Eur J Cancer 2014; 50:2735-43. [PMID: 25085229 DOI: 10.1016/j.ejca.2014.06.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/06/2014] [Accepted: 06/13/2014] [Indexed: 11/22/2022]
Abstract
Radiotherapy (RT) is required for nearly half of the newly diagnosed cancer patients. To optimise the quality and availability of RT, guidelines have been proposed by European Society for Radiotherapy and Oncology-QUAntification of Radiation Therapy Infrastructure And Staffing Needs (ESTRO-QUARTS) and the International Atomic Energy Agency (IAEA). This study evaluates the present status of RT capacity in Europe and the projected needs by 2020 as per these recommendations. Thirty-nine of the 53 countries, listed in Europe by the UN Statistical Division, whose cancer incidences, teletherapy and human resources were available in the Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN), International Agency for Research on Cancer (IARC) and DIrectory of RAdiotherapy Centres (DIRAC) (IAEA) databases were evaluated. A total of 3550 teletherapy units (TRT), 7017 radiation oncologists (RO), 3685 medical physicists (MP) and 12,788 radiotherapy technologists (RTT) are presently available for the 3.44 million new cancer cases reported annually in these countries. The present infrastructure and human resources in RT are estimated to provide RT access to 74.3% of the patients requiring RT. The current capacity in TRT, RO, MP and RTT when compared with recommended guidelines has a deficit of 25.6%, 18.3%, 22.7% and 10.6%, respectively. Thus, to respond to requirements by 2020, the existing capacity needs to be augmented by an additional 1698 TRTs, 2429 ROs, 1563 MPs and 2956 RTTs. With an imminent rise in cancer incidence, multifaceted strategic planning at national and international levels within a coordinated comprehensive cancer control programme is highly desirable to give adequate access to all patients who require radiotherapy across Europe. Specific steps to address this issue at national and continental levels involving all major stakeholders are proposed.
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15
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Kawashiro S, Hagiwara Y, Ota I, Ichikawa M, Miwa M, Kuroda Y, Nemoto K. Experience of a Videoconference System with Medical Information Desktop Sharing for Radiation Therapy and Evaluation of Its Usefulness. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijmpcero.2014.31004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kamal R, Hong CS, Lee SG. A telemedicine application to schedule temperature in an in vivo sensor network for cancer treatment. Telemed J E Health 2013; 18:760-71. [PMID: 23234425 DOI: 10.1089/tmj.2011.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Wireless communication has played a significant role in modern healthcare systems. However, the death toll from chronic diseases, such as cancer, continues to increase. Hyperthermia combined with radiotherapy and/or chemotherapy is a promising strategy for cancer treatment, and temperature control is critical for the success of this intervention. In vivo sensors are an emerging technology in healthcare. Thermal awareness has also received attention in in vivo sensor research. In this context, we have been motivated to use in vivo sensors to regulate the temperature changes in cancer cells during combined treatment. Limitations in existing in vivo thermal-aware routing algorithms motivated us to use the in vivo "lightweight rendezvous routing" approach. However, smartphone-driven telemedicine applications are proliferating to provide remote healthcare and collaborative consultation, required in combined therapies. In this context, we have proposed a telemedicine application where a smartphone not only regulates temperature scheduling in in vivo sensors, but also communicates with local or remote clinicians to maintain collaborative efforts for combined therapies against cancer.
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Affiliation(s)
- Rossi Kamal
- Department of Computer Engineering, Kyung Hee University, Yongin, Korea
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17
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Pavliha D, Kos B, Marčan M, Zupanič A, Serša G, Miklavčič D. Planning of electroporation-based treatments using Web-based treatment-planning software. J Membr Biol 2013; 246:833-42. [PMID: 23780414 DOI: 10.1007/s00232-013-9567-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/31/2013] [Indexed: 12/12/2022]
Abstract
Electroporation-based treatment combining high-voltage electric pulses and poorly permanent cytotoxic drugs, i.e., electrochemotherapy (ECT), is currently used for treating superficial tumor nodules by following standard operating procedures. Besides ECT, another electroporation-based treatment, nonthermal irreversible electroporation (N-TIRE), is also efficient at ablating deep-seated tumors. To perform ECT or N-TIRE of deep-seated tumors, following standard operating procedures is not sufficient and patient-specific treatment planning is required for successful treatment. Treatment planning is required because of the use of individual long-needle electrodes and the diverse shape, size and location of deep-seated tumors. Many institutions that already perform ECT of superficial metastases could benefit from treatment-planning software that would enable the preparation of patient-specific treatment plans. To this end, we have developed a Web-based treatment-planning software for planning electroporation-based treatments that does not require prior engineering knowledge from the user (e.g., the clinician). The software includes algorithms for automatic tissue segmentation and, after segmentation, generation of a 3D model of the tissue. The procedure allows the user to define how the electrodes will be inserted. Finally, electric field distribution is computed, the position of electrodes and the voltage to be applied are optimized using the 3D model and a downloadable treatment plan is made available to the user.
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Affiliation(s)
- Denis Pavliha
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška c. 25, SI-1000, Ljubljana, Slovenia,
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Santhanam AP, Min Y, Dou TH, Kupelian P, Low DA. A client-server framework for 3D remote visualization of radiotherapy treatment space. Front Oncol 2013; 3:18. [PMID: 23440605 PMCID: PMC3579192 DOI: 10.3389/fonc.2013.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/23/2013] [Indexed: 11/13/2022] Open
Abstract
Radiotherapy is safely employed for treating wide variety of cancers. The radiotherapy workflow includes a precise positioning of the patient in the intended treatment position. While trained radiation therapists conduct patient positioning, consultation is occasionally required from other experts, including the radiation oncologist, dosimetrist, or medical physicist. In many circumstances, including rural clinics and developing countries, this expertise is not immediately available, so the patient positioning concerns of the treating therapists may not get addressed. In this paper, we present a framework to enable remotely located experts to virtually collaborate and be present inside the 3D treatment room when necessary. A multi-3D camera framework was used for acquiring the 3D treatment space. A client–server framework enabled the acquired 3D treatment room to be visualized in real-time. The computational tasks that would normally occur on the client side were offloaded to the server side to enable hardware flexibility on the client side. On the server side, a client specific real-time stereo rendering of the 3D treatment room was employed using a scalable multi graphics processing units (GPU) system. The rendered 3D images were then encoded using a GPU-based H.264 encoding for streaming. Results showed that for a stereo image size of 1280 × 960 pixels, experts with high-speed gigabit Ethernet connectivity were able to visualize the treatment space at approximately 81 frames per second. For experts remotely located and using a 100 Mbps network, the treatment space visualization occurred at 8–40 frames per second depending upon the network bandwidth. This work demonstrated the feasibility of remote real-time stereoscopic patient setup visualization, enabling expansion of high quality radiation therapy into challenging environments.
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Affiliation(s)
- Anand P Santhanam
- Department of Radiation Oncology, University of California Los Angeles, CA, USA
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Wu VWC, Tang FH, Cheung WK, Chan KC. Development of a prototype of the tele-localisation system in radiotherapy using personal digital assistant via wireless communication. J Med Imaging Radiat Oncol 2013; 57:113-8. [PMID: 23374563 DOI: 10.1111/1754-9485.12016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 08/19/2012] [Indexed: 11/30/2022]
Abstract
In localisation of radiotherapy treatment field, the oncologist is present at the simulator to approve treatment details produced by the therapist. Problems may arise if the oncologist is not available and the patient requires urgent treatment. The development of a tele-localisation system is a potential solution, where the oncologist uses a personal digital assistant (PDA) to localise the treatment field on the image sent from the simulator through wireless communication and returns the information to the therapist after his or her approval. Our team developed the first tele-localisation prototype, which consisted of a server workstation (simulator) for the administration of digital imaging and communication in medicine localisation images including viewing and communication with the PDA via a Wi-Fi network; a PDA (oncologist's site) installed with the custom-built programme that synchronises with the server workstation and performs treatment field editing. Trial tests on accuracy and speed of the prototype system were conducted on 30 subjects with the treatment regions covering the neck, skull, chest and pelvis. The average time required in performing the localisation using the PDA was less than 1.5 min, with the blocked field longer than the open field. The transmission speed of the four treatment regions was similar. The average physical distortion of the images was within 4.4% and the accuracy of field size indication was within 5.3%. Compared with the manual method, the tele-localisation system presented with an average deviation of 5.5%. The prototype system fulfilled the planned objectives of tele-localisation procedure with reasonable speed and accuracy.
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Affiliation(s)
- Vincent Wing-Cheung Wu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong SAR.
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20
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EORTC Radiation Oncology Group quality assurance platform: establishment of a digital central review facility. Radiother Oncol 2012; 103:279-86. [PMID: 22633815 DOI: 10.1016/j.radonc.2012.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 04/10/2012] [Accepted: 04/24/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Quality assurance (QA) in clinical trials is essential to ensure treatment is safely and effectively delivered. As QA requirements have increased in complexity in parallel with evolution of radiation therapy (RT) delivery, a need to facilitate digital data exchange emerged. Our objective is to present the platform developed for the integration and standardization of QART activities across all EORTC trials involving RT. METHODS The following essential requirements were identified: secure and easy access without on-site software installation; integration within the existing EORTC clinical remote data capture system; and the ability to both customize the platform to specific studies and adapt to future needs. After retrospective testing within several clinical trials, the platform was introduced in phases to participating sites and QART study reviewers. RESULTS The resulting QA platform, integrating RT analysis software installed at EORTC Headquarters, permits timely, secure, and fully digital central DICOM-RT based data review. Participating sites submit data through a standard secure upload webpage. Supplemental information is submitted in parallel through web-based forms. An internal quality check by the QART office verifies data consistency, formatting, and anonymization. QART reviewers have remote access through a terminal server. Reviewers evaluate submissions for protocol compliance through an online evaluation matrix. Comments are collected by the coordinating centre and institutions are informed of the results. CONCLUSIONS This web-based central review platform facilitates rapid, extensive, and prospective QART review. This reduces the risk that trial outcomes are compromised through inadequate radiotherapy and facilitates correlation of results with clinical outcomes.
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Training the trainees in radiation oncology with telemedicine as a tool in a developing country: a two-year audit. Int J Telemed Appl 2011; 2011:230670. [PMID: 21603023 PMCID: PMC3095242 DOI: 10.1155/2011/230670] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 02/10/2011] [Indexed: 11/29/2022] Open
Abstract
Purpose. The estimated new cancer patient load in the Indian state of Uttar Pradesh is 0.1–0.12 million per year. Approximately two thirds of these require treatment by a radiation oncologist. Radiation oncologists: cancer patient ratio in this state is 1 : 2000 as compared to the recommended 1 : 250. This problem is compounded by the poor infrastructure of radiation oncology departments in the state which is suboptimal for teaching, training of resident doctors, and treatment in most barring a few departments. To bridge some gap in the sociodemographics stated above and enhancement of training of residents, we submitted a project for establishment of a telemedicine facility in our department to the Department of Science and Technology, Government of India. We present the design, implementation, and a two-year audit of our tele-education activities. Materials and Methods. After the sanction of the project, we established telemedicine linkage with another medical institute in the city located 25 kms away in 2007. After implementation of the project, academic sessions designed for trainee residents in our department were shared with the remote end. A record of these activities and a feedback of the activities were audited at the end of 2 years of implementation of this project. Results. Regular videoconferencing sessions comprising of lectures on clinical oncology, medical physics, and radiobiology were held. Feedback from the users revealed satisfaction with the content of the academic sessions for the purpose of MD training. Conclusions. Distance education in radiation oncology is an important tool for training of the trainee residents.
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Hazin R, Qaddoumi I. Teleoncology: current and future applications for improving cancer care globally. Lancet Oncol 2010; 11:204-10. [PMID: 20152772 DOI: 10.1016/s1470-2045(09)70288-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Access to quality cancer care is often unavailable in low-income and middle-income countries, and also in rural or remote areas of high-income countries. Teleoncology-oncology applications of medical telecommunications, including pathology, radiology, and other related disciplines-has the potential to enhance access to and quality of clinical cancer care, and to improve education and training. Implementation of teleoncology in the developing world requires an approach tailored to priorities, resources, and needs. Teleoncology can best achieve its proposed goals through consistent and long-term application. We review teleoncology initiatives that have the potential to decrease cancer-care inequality between resource-poor and resource-rich institutions and offer guidelines for the development of teleoncology programmes in low-income and middle-income countries.
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Affiliation(s)
- Ribhi Hazin
- Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
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Qaddoumi I, Bouffet E. Supplementation of a Successful Pediatric Neuro-oncology Telemedicine-Based Twinning Program by E-Mails. Telemed J E Health 2009; 15:975-82. [DOI: 10.1089/tmj.2009.0043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ibrahim Qaddoumi
- Department of Paediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Eric Bouffet
- Paediatric Brain Tumour Program, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
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Suzuki K, Hirasawa Y, Yaegashi Y, Miyamoto H, Shirato H. A web-based remote radiation treatment planning system using the remote desktop function of a computer operating system: a preliminary report. J Telemed Telecare 2009; 15:414-8. [DOI: 10.1258/jtt.2009.090409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We developed a web-based, remote radiation treatment planning system which allowed staff at an affiliated hospital to obtain support from a fully staffed central institution. Network security was based on a firewall and a virtual private network (VPN). Client computers were installed at a cancer centre, at a university hospital and at a staff home. We remotely operated the treatment planning computer using the Remote Desktop function built in to the Windows operating system. Except for the initial setup of the VPN router, no special knowledge was needed to operate the remote radiation treatment planning system. There was a time lag that seemed to depend on the volume of data traffic on the Internet, but it did not affect smooth operation. The initial cost and running cost of the system were reasonable.
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Affiliation(s)
- Keishiro Suzuki
- Department of Radiation Oncology, Hokkaido Cancer Centre, Sapporo
| | | | - Yuji Yaegashi
- Department of Radiation Oncology, Kushiro Municipal General Hospital, Shunkodai Kushiro
| | | | - Hiroki Shirato
- Department of Radiation Oncology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Karlsson M, Björk-Eriksson T, Mattsson O, Mattsson S, Montelius A, Nilsson P, Zackrisson B. "Distributed proton radiation therapy"--a new concept for advanced competence support. Acta Oncol 2009; 45:1094-101. [PMID: 17118845 DOI: 10.1080/02841860600897876] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The increased interest in high precision radiation therapy is to a large extent driven by the potential of modern imaging technology. The aim of this project was to analyse how an expensive proton facility best could support a multi-centre health care system. We have developed a model for distributed expert collaboration where all clinical experts will work close to their patients in regional centres. Patients who are candidates for proton therapy will be examined and dose-planned at their regional clinic, discussed in a fully information supported video conference and digitally made available at the proton treatment facility. The proton facility itself will be placed near a communication centre easily reached by all patients where they will be treated under full responsibility of their own physician at the home clinic. This concept has been analysed in detail both with respect to the overall functionality and with respect to possible weaknesses. It was found that the concept of distributed radiation therapy, as proposed here, will offer a stable clinical solution for advanced radiation therapy. It will support the spread of knowledge, serve as a fully developed backup system and the concept will further serve as an efficient base for clinical research.
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Affiliation(s)
- Mikael Karlsson
- Radiation Physics, Department of Radiation Sciences, Umeå University, Umeå, Sweden.
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26
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Kristensen I, Lindh J, Nilsson P, Agrup M, Bergström P, Björk-Eriksson T, Engellau J, Hjelm-Skog AL, Malmer B, Martinsson U, Karlsson M. Telemedicine as a tool for sharing competence in paediatric radiotherapy: implementation and initial experiences from a Swedish project. Acta Oncol 2009; 48:146-52. [PMID: 18846448 DOI: 10.1080/02841860802409520] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kagadis GC, Nagy P, Langer S, Flynn M, Starkschall G. Anniversary Paper: Roles of medical physicists and health care applications of informatics. Med Phys 2007; 35:119-27. [DOI: 10.1118/1.2822875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Qaddoumi I, Mansour A, Musharbash A, Drake J, Swaidan M, Tihan T, Bouffet E. Impact of telemedicine on pediatric neuro-oncology in a developing country: the Jordanian-Canadian experience. Pediatr Blood Cancer 2007; 48:39-43. [PMID: 17066456 DOI: 10.1002/pbc.21085] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Telemedicine is widely used in industrialized countries for educational purposes. Twinning experiences using telemedicine between institutions in industrialized and developing countries (DC) have been limited. Pediatric neuro-oncology is a complex multidisciplinary discipline that is underserved in most of DC and provides a model to test the feasibility of such tool for twinning purposes. METHODS A computer, an EMLO visual presenter HV-7600SX document camera, and a TANDBERG 6000 model videoconference unit were used to present data. For connectivity, we used a six-channel ISDN telephone line. Each channel is 64 megabytes/sec. RESULTS Between December 2004 and May 2006, 20 sessions of videoconference were held between King Hussein Cancer Center and the Hospital for Sick Children to discuss 72 cases of 64 patients with various brain tumors (5 patients were discussed twice and 1 patient four times). In 23 patients (36%), major changes from original plan were recommended on different aspects of the care. In 21 patients (91%), those recommendations were followed, with potentially significant positive impact on patients' care. CONCLUSIONS Videoconferencing is a feasible and practical twinning tool in pediatric neuro-oncology with a potentially major impact on patient care.
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Affiliation(s)
- Ibrahim Qaddoumi
- Department of Pediatrics, King Hussein Cancer Center (KHCC), Amman, Jordan.
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Ntasis E, Gletsos M, Mouravliansky NA, Zacharaki EI, Vasios CE, Golemati S, Maniatis TA, Nikita KS. Telematics enabled virtual simulation system for radiation treatment planning. Comput Biol Med 2005; 35:765-81. [PMID: 16278107 DOI: 10.1016/j.compbiomed.2004.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Revised: 06/25/2004] [Accepted: 06/25/2004] [Indexed: 11/28/2022]
Abstract
In this paper, GALENOS, a Telematics Enabled Virtual Simulation System for Radiation Treatment Planning (RTP) is described. The design architecture of GALENOS is in accordance with the dual aim of virtual simulation of RTP, i.e. to allow (a) delineation of target volume and critical organs, and (b) placement of irradiation fields. An important feature of GALENOS is the possibility for on-line tele-collaboration between health care professionals under a secure framework. The advantages of GALENOS include elimination of patient transfers between departments and health care institutions as well as availability of patient data at sites different than those of his/her physical presence.
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Affiliation(s)
- Efthymios Ntasis
- School of Electrical and Computer Engineering, National Technical University of Athens, 9 Iroon Polytechniou, Zografos 157 80, Athens, Greece
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Datta NR, Rajasekar D. Improvement of radiotherapy facilities in developing countries: a three-tier system with a teleradiotherapy network. Lancet Oncol 2004; 5:695-8. [DOI: 10.1016/s1470-2045(04)01613-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Matsopoulos GK, Kouloulias V, Asvestas P, Mouravliansky N, Delibasis K, Demetriades D. MITIS: a WWW-based medical system for managing and processing gynecological-obstetrical-radiological data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2004; 76:53-71. [PMID: 15313542 DOI: 10.1016/j.cmpb.2004.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 03/09/2004] [Indexed: 05/24/2023]
Abstract
In this paper a World Wide Web (WWW)-based medical system, called MITIS, is designed and developed for the management and processing of obstetrical, gynecological and radiological medical data. The system records all the necessary medical information in terms of patient data, examinations, and operations and provides the user-expert with advanced image processing tools for the manipulation, processing and storage of ultrasound and mammographic images. The system can be installed in a hospital's Local Area Network (LAN) where it can access picture archival and communication systems (PACS) servers (if available), or any other server within the radiology department, for image archiving and retrieval, based on the digital imaging and communication in medicine (DICOM) 3.0 protocol, over TCP/IP and also it is accessible to external physicians via the hospital's Internet connection. MITIS is composed as a set of independent WWW modules (ISAPI server extension dlls) and a Win32 application (COM+ server) for mammography image processing and evaluation.
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Affiliation(s)
- George K Matsopoulos
- Institute of Communication and Computer Systems, National Technical University of Athens, 9, Iroon Polytechneiou Str., Zografos, Athens 157 80, Greece.
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Abstract
In 1999, the European Organisation for Research and Treatment of Cancer (EORTC), being a European pioneer in the field of cancer research as well as in quality assurance (QA), launched an Emmanuel van der Schueren fellowship for QA in radiotherapy. In this paper, the work that has been done during the first E. van der Schueren fellowship is reported, focusing on four phase III EORTC clinical trials: 22921 for rectal cancer, 22961 and 22991 for prostate cancer and 22922 for breast cancer. A historical review of the QA programme of the EORTC Radiotherapy group during the past 20 years is included.
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Affiliation(s)
- V E Kouloulias
- European Organisation for Research and Treatment of Cancer (EORTC), Data Center, Avenue Mounier 83, B-1200, Brussels, Belgium.
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Ntasis E, Maniatis TA, Nikita KS. Real-time collaborative environment for radiation treatment planning virtual simulation. IEEE Trans Biomed Eng 2002; 49:1444-51. [PMID: 12542240 DOI: 10.1109/tbme.2002.805450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A virtual simulation (VS) system is a software system that enables the delineation of anatomical structures, and the placement of irradiation fields for the purpose of radiation treatment planning, making use of patient's tomographic data, instead of the real patient. Since patient's tomographic data can be communicated between distinct radiotherapy departments, collaborative work on VS, connecting remote health care professionals, becomes feasible. In this paper, an environment enabling real-time collaboration on VS is presented. The environment architecture is based on both offline and online communication of data under a secure framework and can be directly integrated into the infrastructure of a radiotherapy department. The online collaboration relies on the simultaneous execution of all actions at both collaborating sites, and prerequisites the offline communication of the data set on which the collaboration will be performed. Analytical description of the custom-made layered service, which supports the offline communication is given, along with a detailed presentation of the secure management of messages, which enables the real-time collaboration. The technical evaluation of the environment highlights the effectiveness of the proposed methodology, since real-time secure collaboration on VS is achieved.
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Affiliation(s)
- Efthymios Ntasis
- National Technical University of Athens, Department of Electrical and Computer Engineering, Zografos 15780, Athens, Greece
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Cross SS, Dennis T, Start RD. Telepathology: current status and future prospects in diagnostic histopathology. Histopathology 2002; 41:91-109. [PMID: 12147086 DOI: 10.1046/j.1365-2559.2002.01423.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Telepathology is the process of diagnostic histopathology performed on digital images viewed on a display screen rather than by conventional glass slide light microscopy. The technology of telepathology has radically improved over the past 5 years so that it is no longer the limiting factor in the diagnostic process. This review looks at the resources needed for dynamic and static telepathology, including image quality, computers and software interfaces, means of transmission and human resources. It critically analyses 32 published trials of telepathology, including some large prospective studies, in all areas of diagnostic histopathology including intraoperative frozen sections, routine and referral cases. New developments, including internet solutions and virtual microscopy, are described and there is analysis of the economics of telepathology within health care systems. The review concludes that all the necessary technology for telepathology is available, there is strong published evidence for a diagnostic accuracy comparable with glass slide diagnosis, in many contexts there is a clear-cut economic argument in favour of telepathology, and that the technique should now be integrated into mainstream diagnostic histopathology.
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Affiliation(s)
- S S Cross
- Digital Pathology Research Group, Academic Unit of Pathology, Section of Oncology and Pathology, Division of Genomic Medicine, School of Medicine and Bioscience, University of Sheffield, South Yorkshire, UK.
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Ntasis E, Maniatis TA, Nikita KS. Fourier volume rendering for real time preview of digital reconstructed radiographs: a web-based implementation. Comput Med Imaging Graph 2002; 26:1-8. [PMID: 11734368 DOI: 10.1016/s0895-6111(01)00022-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Digital reconstructed radiograph (DRR) constitutes an important tool in clinical radio-oncology. In this paper, a Fourier volume rendering (FVR) method is proposed, enabling real time preview of DRR. Important aspects related to re-sampling into the frequency domain are examined, leading to results of high quality. Experiments using phantom and clinical data sets are presented, demonstrating the effectiveness of the method for a real time execution. Furthermore, due to the inherent parallelism of the proposed algorithm, its execution time can be further reduced by distributing the required computations to more than one processors. The computational efficiency of the method highlights its suitability for integration into a web-based radiation treatment planning (RTP) system, using a client-server architecture. Thus, platform independent, real time tele-cooperation in clinical radio-oncology can be achieved.
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Affiliation(s)
- E Ntasis
- Department of Electrical and Computer Engineering, National Technical University of Athens, Iroon Polytechniou 9, Zografos 15780, Athens, Greece
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