Successful VMAT Commissioning in Low- and Middle-Income Country (LMIC) in the Era of COVID-19 Using Remote Connectivity
S Wadi-Ramahi1*, F Waqqad2,3, A Alsharif3, (1) University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, (2) Radiation Oncology Center, King Abdullah University Hospital, Irbid, Jo,(3) Radiation Oncology Dept, Afia Nuclear Medicine And Radiation Oncology Center, Amman, Jo
Presentations
WE-E-TRACK 1-2 (Wednesday, 7/28/2021) 3:30 PM - 4:30 PM [Eastern Time (GMT-4)]
Purpose: Outlining a systematic process to successfully commission VMAT in Jordan in a time of restricted travel and increased virtual connectivity.
Methods: Process started on 9/2019 with a 2-days physical visit to initiate trust and discuss scope of work. Observing clinical workflow was intended for a week-long visit to follow. After COVID19, VPN access to both center’s Mosaiq and TPS to evaluate treatment setup, reproducibility and reviewing IMRT cases was given. Due to time difference, there was no interruption in clinical workflow when the systems were accesses. Extensive conference calling and email communication to discuss findings. Confidential communication with administration is important. Remote commissioning began with agreeing on a detailed time-table with clear assigned responsibilities. Remote supervision through VPN, videoconferencing, group chats and emails.
Results: Workflow baseline unveiled opportunities for improvements that were accepted and implemented. TPS re-acceptance (TG119 and TecDoc1583) was done by local physicists. Various QAs were implemented using TG142. Linac VMAT acceptance testing was done followed by virtual training by vendor. Lastly, 20 different disease site VMAT plans were done, using actual patient scans for different disease sites, for QA purposes resulting in recommending 3%/3mm for gamma analysis. Clinical protocols written for dose objectives and QA methodology. All work was remotely followed and supervised.
Conclusion: COVID-19 has taught us a very important lesson: Professionals from high-income countries can effectively help clinics in LMICs through virtual connectivity. This process can be adapted to after-COVID to reduce cost. Other lessons learned: 1. A short visit is a must to meet the team, 2. Written communication should be clear. Lapses in communication may greatly hinder the project, 3. Always start with measuring the clinical-workflow baseline. Implementing change to improve and assessing local staff’s effective participation is critical, 4. Agree on a clear timetable with assigned responsibilities.
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