Electronic Integration of Radiation Oncology Clinics via Remote Proton Radiotherapy Telemedicine Solution

Abstract

Proton radiotherapy is an exciting new modality in radiation oncology, but only a limited number of facilities currently exist in the United States. The costs involved in opening new facilities are significant and the most beneficial uses of proton radiotherapy have yet to be fully determined in clinical trials. Since 2006, the Radiation Oncology Services of the University of Pennsylvania (Penn) and the Walter Reed Army Medical Center have been developing a remote planning system with the goals of 1) improving access to proton radiation therapy for Department of Defense (DoD) patients, 2) minimizing treatment delays and time spent away from home/work (net time savings estimated at one to three weeks per patient), and 3) eliminating the need to duplicate activities at both sites, such as re-staging. This telemedicine solution will facilitate the evaluation of eligibility for and enrollment in protocols at the local level. Initially developed over Internet2, our prototype was migrated to the hospitals' Local Area Networks so as to integrate seamlessly into our existing clinical infrastructure and to meet the stringent security restrictions imposed by the DoD. After evaluating multiple products, we designed a hybrid system merging a CITRIX client with a desktop videoconferencing unit. Although several web-based solutions were initially considered, none were HIPAA-certified. For audio-video interaction, the three principle variables considered were cost, image quality (resolution and frame rates) and assimilation into our existing infrastructure. The CITRIX approach allows us to 1) access remotely a proton therapy calculation engine for treatment planning, 2) transfer patient plans securely to the Penn patient database, and 3) collaborate dynamically to optimize and validate treatment plans. The evaluation of a Tandberg 1700-based prototype system evolved over a period of 12 months, during which the capabilities to conduct ad-hoc and scheduled multi-site video conferences were validated. We believe that this system is a robust, secure, and cost-effective solution that allows greater power and flexibility in the integration of satellite clinics into regional proton therapy centers. Through this integration, proton radiotherapy can be made more widely available and more patients can be enrolled in clinical trials so as to best take advantage of its potential benefits.