Radiotherapy during COVID-19 pandemic. How to create a No fly zone: a Northern Italy experience.

BACKGROUND: SARS-CoV-2 pandemic represents a troubling health emergency but also a main challenge for the clinical governance of the system. Discontinuation of radiation treatments is not desirable and potentially life-threatening. On the other hand, accesses to hospital expose cancer patients to an increased risk of COVID-19 infection. We report our extended protocol, draft to manage clinical activities in our radiotherapy department, by minimizing contagion risks. METHODS: We used telephonic screening to assess the need for patient admission. A telephonic triage was performed to identify the presence of COVID-19 infection risk factors or symptoms. New treatments were stratified according to priority codes. A reserved entrance to radiotherapy department was assured for patients and staff. Surgical disposable mask was required for patients and caregivers. The activities were distributed during the whole workday, avoiding overlap to reduce aggregation. RESULTS: From 1st February 2020 to 31 March 2020, we reported an increase in the number of first medical examinations and treatments, compared to the same period of the previous year. Outpatients first medical examinations have been spread over the 12 working hours. No COVID-19 cases were detected. CONCLUSION: During COVID-19 pandemic, we introduced procedures that allowed us to ensure the continuity in oncological cares, with limited risks of infection for patients and staff.

A new methodological approach for PET implementation in radiotherapy treatment planning.

In this paper, a new methodological approach to using PET information in radiotherapy treatment planning has been discussed. Computed tomography (CT) represents the primary modality to plan personalized radiation treatment, because it provides the basic electron density map for correct dose calculation. If PET scanning is also performed it is typically coregistered with the CT study. This operation can be executed automatically by a hybrid PET/CT scanner or, if the PET and CT imaging sets have been acquired through different equipment, by a dedicated module of the radiotherapy treatment planning system. Both approaches have some disadvantages: in the first case, the bore of a PET/CT system generally used in clinical practice often does not allow the use of certain bulky devices for patient immobilization in radiotherapy, whereas in the second case the result could be affected by limitations in window/level visualization of two different image modalities, and the displayed PET volumes can appear not to be related to the actual uptake into the patient. To overcome these problems, at our centre a specific procedure has been studied and tested in 30 patients, allowing good results of precision in the target contouring to be obtained. The process consists of segmentation of the biological target volume by a dedicated PET/CT console and its export to a dedicated radiotherapy system, where an image registration between the CT images acquired by the PET/CT scanner and a large-bore CT is performed. The planning target volume is contoured only on the large-bore CT and is used for virtual simulation, to individuate permanent skin markers on the patient.