RESUMEN
Low-Dose Radiation Therapy (LD-RT) is an emerging treatment option for patients with COVID-19 related pneumonia. Infectivity of the SARS-CoV-2 virus complicates incorporation of LD-RT into existing radiation oncology clinics. The first phase I/II trial of LD-RT for COVID-19-related pneumonia implemented novel operational protocols to address risk of infection and respiratory events. Patients were transported from hospital rooms to linear accelerators and treated with 0.5 Gy or 1.5 Gy using pre-planned, two-dimensional treatments prepared using diagnostic x-rays and caliper measurements. Workflows were revised over time to balance infection risks with implementation burden. Between April 24 and December 7, 2020, fifty-two patients were enrolled and forty were treated. The end-to-end process comprised 16 distinct teams and > 120 cooperating staff members (> 50 core radiation oncology staff). The trial was operationalized at two hospitals at the onset of the COVID-19 pandemic, prior to vaccine availability. Teams included trial leadership/screening (n > 4), inpatient floor staff (n > 10), clinical trials staff and coordinators (n = 8), transport (n = 2), radiation therapists (n > 20), respiratory therapists (n = 5), radiation nursing (n > 7), ICU nursing (n = 4), rapid response teams (n = 4), medical physics (n > 4), dosimetry (n > 3), infection prevention (n > 3), environmental services (n > 6), security (n = 7), lab personnel (n = 1), and physicians from radiation oncology (n = 7), infectious diseases (n = 2), pulmonary/critical care medicine (n = 2), anesthesia (n = 2), and internal medicine (n > 20) [total > 120]. All non-intubated patients were transported by a multi-disciplinary team, consisting of a physician, nurse, transporter, infection prevention specialist, and (when needed) a respiratory therapist. Treatments occurred after normal clinic hours, were initiated by team huddles, check lists, and included personal protective equipment supervision at multiple time points. Transport routes were 880 to 1760 feet (0.33 miles) one-way, with 1 to 3 elevator banks and required 20-35 minutes for round-trip transport and treatment. Oxygen supplementation in non-intubated patients ranged from 2 to 15 L/min. One intubated patient was transported with a portable ventilator and accompanying ICU staff. There were no code-level events during transport. No patient-facing staff contracted COVID-19 from trial activities. Workflow burden was successfully reduced and protocols relaxed over time with increased staff experience. Whole-lung low-dose radiation therapy (LD-RT) for COVID-19-related pneumonia was successfully incorporated into existing workflows at a major academic university. Forty patients were treated with no code-level events, and no staff contracted the virus during eight months of trial accrual. Instructional materials and implementation check lists are provided. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
RESUMEN
Surface disinfecting has become a necessity in the global effort to control the COVID-19 pandemic, and the application of disinfectant liquid to completely and uniformly cover target objects is a common goal. Spraying of these materials offers a clearly beneficial solution where the liquid is atomized into droplets that are distributed on the target surface. However, while surfaces in the direct line-of-sight may receive adequate coverage, hidden surfaces on the sides and back of an object may be shielded and receive limited or no coating. Electrostatically charged sprays have received added attention and use because, in concept, a charged droplet may be more likely to not only land on a surface through direct impingement, but also be drawn further toward hidden surfaces due to attractive charge forces. Therefore, electrostatically charged sprayers provide a uniquely beneficial method to distribute disinfectant materials, although the actual effects have received limited scientific analysis. In the present study, a commercially available electrostatic sprayer has been investigated with electrostatic spray charge off and on in order to evaluate the resulting coating completeness, uniformity, and efficiency. Detailed measurements of the spray characteristics, such as drop size, velocity, and concentration, both upstream and downstream of the target object, offer explanations for differences in the resulting coverage. While this investigation is not comprehensive, it serves to offer insight into the potential benefits of electrostatically charged disinfecting sprays as well as explanations into how those improvements are achieved. Using the present sprayer, disinfectant material, and target object, coverage was improved by 40% using charged droplets, primarily due to increased coverage on the downstream (back) side of the target cylinder, which saw zero coverage without charged droplets. Through detailed analysis, this improvement is attributed to alterations in the velocity field of the droplets just downstream of the cylinder where the charged droplets are more susceptible to following the recirculating turbulence of the entrained air flow.