What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?

COVID Update 1/30/21

Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patients if they become COVID+ or a PUI unless they are clinically unstable.

PPE precautions:

Per hospital policy, all staff wear surgical masks and eye protection at all times once you enter your the build...

There are many good sources like the CDC for best practices. Nevertheless, I do want to share some thoughts more relevant to our field:

As radiation oncologists, COVID-19 and radiation share the same principles of ALARA: time, distance, and shielding.

Time: we should minimize the time patients spend in the clinic with efficient scheduling, rescheduling non-essential follow-ups (a patient doesn’t need to come in to be told their PSA is stable or lower, ...), minimizing relatives/friends accompan...

I agree with @Dr. First Last and @Dr. First Last: very helpful comments above.

Communication – we have had multiple new protocols rolled out over a very short time period. Clear communication with staff and patients is important to ensure that new infection control protocols are implemented correctly and to also (hopefully) keep everyone comfortable with this rapidly evolving situation.

1. For staff, we have done this through emails, rounding through clinic and hospital-wide virtual town-halls.
2. Fo...

Thanks for the helpful answers above. I recommend that everyone: patients, staff, and physicians wear masks, and explain it’s for their safety. A single asymptomatic infected technologist can infect every patient. Our patient population is elderly and immunocompromised; it is our duty to protect them. The CDC guidelines were based on SARS, they have NOT been updated to conform to the most recent literature on COVID-19. COVID-19 differs from SARS in that high viral concentrations are present in t...

The NJ Department of Health has issued a very helpful flow chart for risk-stratifying Coronavirus exposure for healthcare providers. It supplements preliminary recommendations from the CDC and is useful for practitioners in any state.

The key takeaway from the flowchart is that if a patient later tests positive for Coronavirus, it does not take much for rad onc staff who interacted with that patient to have to go into self-quarantine for 14 days, unless precautions are taken. If healthcare prov...

Update 3/18/20:

Update: 3/16/20

Below is a list of updates occurring today:

1. Faculty/residents are encouraged to telework on their administrative/research day.

2. All those performing direct patient care can choose to wear scrubs as opposed to traditional attire (i.e. dry clean only). We typically only wear scrubs if we have procedures.

3. Staffing:

- All photon/proton dosimetry will become remote except for the main hospital site where we will staff one on-site dosimetrist (due to high volume of emergency c...

Thank you all for this wonderful thread. In NC, all major hospital systems are no longer testing outpatients based on updated state recommendations regarding community spread. In rad onc, therefore, we will only know if someone is + if they are an inpatient. We have taken similar precautions as above i.e., limiting follow-ups, delaying appropriate patients, hypofractionation where appropriate, telehealth visits, etc. How else have your practices/recommendations changed now that there is communit...

Update 3/25/20:

- Clinical Experience: we have had several patients who were deemed PUIs who we have treated using the algorithms above. Thus far (and fortunately!) all have tested negative. Treating even a PUI has caused significant anxiety for staff. One thing that is clearly critical is reviewing procedures with staff on a routine basis. I'm sure our NY/Seattle colleagues can attest to this! We have implemented telehealth for follow-ups but have not initiated this for consults yet. We have de...

Update 3/26/20:

Clinical practice updates:

- Additional plans for treating PUIs/COVID + patients: If we get in a scenario where we have PUIs and COVID+'s, then PUIs will be treated first with a complete wipe down followed by COVID + pts. For therapists, you will have 1-2 'dirty' therapists and 1 'clean' therapist. "Dirty therapists" will attend to patient and touch patient. The "clean therapist" will stay outside of room and use treatment console. During actual treatment/imaging, "dirty therapis...

Excellent thread and very helpful. We have sectioned off our department of three accelerators into distinct units with specific therapists, entry and exit, such that if one patient tests positive, only specific therapists would have been exposed. We have PPE shortage and all therapists are wearing surgical masks and gloves, all devices wiped down pre and post use, patients wash hands before entering accelerator. We are following the cycling re-use of surgical masks as of today due to short suppl...

1. Follow up visits can utilize Telehealth or phone to minimize the risks to patients presenting to busy clinics.

MDs can be allowed to perform the Telehealth or phone visits from home as well to minimize the numbers of personnel and PPE needed.

2. Radiation therapy for small cell lung cancer or for disease control or palliative for cancer pain is not elective and should proceed.

3. Radiation therapy sessions that can be given over shorter duration (less number of days) can be considered.