Infection Control of 2019 Novel Corona Virus Disease (COVID-19) in Cancer Patients undergoing Radiotherapy in Wuhan

BackgroundA pandemic of 2019 novel corona virus disease (COVID-19), which was first reported in Wuhan city, has affected more than 100,000 patients worldwide. Patients with cancer are at a higher risk of COVID-19, but currently, there is no guidance on the management of cancer patients during this outbreak. Here, we report the infection control measures and early outcomes of patients who received radiotherapy (RT) at a tertiary cancer centre in Wuhan. MethodsWe reviewed all patients who were treated at the Zhongnan Hospital of Wuhan University (ZHWU) from Jan 20 to Mar 6, 2020. This preceded the city lock-down date of Jan 23, 2020. Infection control measures were implemented, which included a clinical pathway for managing suspect COVID-19 cases, on-site screening, modifications to the RT facility, and protection of healthcare workers. Primary end-point was infection rate among patients and healthcare staff. Diagnosis of COVID-19 was based on the 5th edition criteria. Findings209 patients completed RT during the study period. Median age was 55 y (IQR = 48-64). Thoracic, head and neck, and lower gastrointestinal and gynaecological cancer patients consisted the majority of patients. Treatment sites included thoracic (38.3%), head and neck (25.4%), and abdomen and pelvis (25.8%); 47.4%, 27.3%, and 25.4% of treatments were for adjuvant, radical, and palliative indications, respectively. 188 treatments/day were performed prior to the lock-down, in contrast to 12.4 treatments/day post-lock-down. Only one (0.48%) patient was diagnosed with COVID-19 during the study period. No healthcare worker was infected. InterpretationHerein, we show that in a susceptible population to COVID-19, strict infection control measures can curb human-to-human transmission, and ensure timely delivery of RT to cancer patients. FundingThis study was funded by Health Commission of Hubei Province Scientific Research Project, WJ2019H002, Health Commission of Hubei Province Medical Leading Talent Project. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSThe 2019 novel coronavirus disease (COVID-19) is now a global pandemic. Cancer patients are at risk of COVID-19 pneumonia, and thus infection control measures are crucial to mitigate their risk of infection. We searched PubMed and Medline for articles published up to Mar 12, 2020, using the following keywords: "COVID-19", "SARS", "SARS-CoV-2", "infection control", and "cancer". No evidence exists that informs on the appropriate infection control measures for COVID-19. Added value of this studyWe report our single centre experience on the detailed infection control measures that were undertaken to minimise cross transmission between cancer patients undergoing radiotherapy, and between patients and healthcare workers. Measures entailing screening of suspect cases, re-organisation of the treatment facility, and protection of healthcare workers were described. With our infection control protocol, we recorded only one COVID-19 case among the 209 patients (0.48%) who were treated at our centre during the period of Jan 20 to Mar 6, 2020. No healthcare worker was affected. Implications of all the available evidenceThe effective infection control measures outlined in this study will help institutions worldwide affected by COVID-19 to formulate guidelines to mitigate nosocomial human-to-human transmission, especially among susceptible patients.

Dosimetry test of domestically-made accelerator intensity-modulated radiation therapy and volumetric-modulated arc therapy / 中华放射肿瘤学杂志

Objective:To create AAPM TG 119 test plans for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in order to evaluate the accuracy of the United Imaging Healthcare′s URT treatment planning system (URT-TPS). The plans were delivered to the phantom using the United Imaging Healthcare′s URT-Linac 506C.Methods:The overall accuracy of IMRT and VMAT planning, measurement, and analysis were evaluated for four test geometries provided by American Association of Physicists in Medicine (AAPM) Task Group Report 119(TG-119) on multi-target, prostate, head and neck and C-shape (easy). The dose distributions were measured in the coronal plane. The point measurements were measured by a Farmer type ion chamber and fluence measurements were completed with film and Delta4 phantom, respectively. Measured planar dose distributions were analyzed using gamma index with criteria 3%/3 mm.Results:For IMRT and VMAT plans, the planning results matched the TG-119 planning results. Measured point doses of IMRT and VMAT were within 2.62% and 3.90% of the planned doses, respectively. Measured film dosimetry gamma values of IMRT and VMAT were> 97.50% and> 93.27%, respectively.Conclusion:Based on these analyses which were performed in line with the TG119 recommendations, it is evident that the URT treatment planning system and URT-Linac 506C have commissioned IMRT and VMAT techniques with adequate accuracy.

Quantitative analysis of setup errors in lung SBRT with R 624-SCF immobilization equipment / 中华放射肿瘤学杂志

Objective KV-CBCT was utilized to evaluate the setup errors in lung SBRT with R624-SCF immobilization equipment,quantitatively analyze the percentage of all types of errors in the cumulative errors and unravel the main sources of setup errors.Methods The CBCT data weekly and QA data monthly from 32 patients diagnosed with lung neoplasms were collected to quantitatively analyze the setup errors.The cumulative errors were calculated by statistical model.The proportion and source of each type of setup error was analyzed.Results All 32 patients received a total of 420 times of CBCT.The setup errors of immobilization equipment in the lateral,supine-inferior,anterior-posterior directions were (0.03±0.72) mm,(0.73± 1.16) mm and (0.21±0.95) mm,respectively.The errors of tumor motion in three directions were (0.71±2.61) mm,(-0.80±2.60) mm and (0.075± 1.77) mm,respectively.According to the calculation formula proposed by Vance Keeling,the proportion of the cumulative error was 54.55％,9.21％ for immobilization equipment,12.97％ for tumor motion,2.55％ for couch sagging,5.70％ for Gantry radiation isocenter,4.73％ for Collimator radiation isocenter,4.61％ for couch radiation isocenter and 5.70％ for Xray field isocenter,respectively.Conclusions The main factors of setup errors during SBRT treatment for lung cancer are setup random,tumor motion,immobilization equipment,couch sagging and machine isocenter.During radiotherapy,targeted control of tumor motion is of significance for minimizing the cumulative errors.

Improved 2D image registration algorithm applied to head and neck tumor / 中华放射医学与防护杂志

Objective To evaluate the effect of setup errors on the 2D image projection and image registration, and then propose an improved registration method based on mutual information. Methods An anthropomorphic head phantom was used to simulate the rotational and translational setup errors. The geometric disparities were reflected by the changes of mutual information. Known setup errors were intentionally introduced to twenty cases divided into two groups demarcated by 3 mm translation error and 3° rotation error: ten cases with larger errors and ten with smaller errors. Then the anterior-posterior and lateral portal images were captured by the electronic portal imaging device ( EPID ) , based on which the setup errors were calculated using two mutual information registration method respectively: the vender provided one, and the improved method as proposed. The calculated errors were compared with the actual setup errors to evaluate robustness of the method. Results For the ten cases with smaller setup errors, the average translational registration disparities using the conventional method were 0. 3, 0. 4, and 0. 3 mm in x, y and z directions respectively. The rotational disagreements were 0. 4° in both x and z directions. The average time consumption was 28. 7 s. The corresponding discrepancies analyzed using the improved method were 0. 3, 0. 4, 0. 3 mm, 0. 5° and 0. 4°, respectively. On average, 31. 1 s was needed for registration. For the ten cases with larger setup errors, the mean disparities of the conventional method were 0. 9, 0. 7, 0. 8 mm, 0. 9° and 0. 8°, 29. 9 s taken on average. The corresponding result of the improved method was 0. 5, 0. 4, 0. 5 mm, 0. 6° and 0. 5°, 33. 2 s taken on average. Conclusions Regarding smaller setup errors, the two methods showed little difference and both had good performance in imageregistration accuracy. For larger setup errors, however, the improved mutual information registration method exhibited significantly higher accuracy than the conventional method, at cost of clinically acceptable registration time.

Improved 2D image registration algorithm applied to head and neck tumor / 中华放射医学与防护杂志

Objective To evaluate the effect of setup errors on the 2D image projection and image registration, and then propose an improved registration method based on mutual information. Methods An anthropomorphic head phantom was used to simulate the rotational and translational setup errors. The geometric disparities were reflected by the changes of mutual information. Known setup errors were intentionally introduced to twenty cases divided into two groups demarcated by 3 mm translation error and 3° rotation error: ten cases with larger errors and ten with smaller errors. Then the anterior-posterior and lateral portal images were captured by the electronic portal imaging device ( EPID ) , based on which the setup errors were calculated using two mutual information registration method respectively: the vender provided one, and the improved method as proposed. The calculated errors were compared with the actual setup errors to evaluate robustness of the method. Results For the ten cases with smaller setup errors, the average translational registration disparities using the conventional method were 0. 3, 0. 4, and 0. 3 mm in x, y and z directions respectively. The rotational disagreements were 0. 4° in both x and z directions. The average time consumption was 28. 7 s. The corresponding discrepancies analyzed using the improved method were 0. 3, 0. 4, 0. 3 mm, 0. 5° and 0. 4°, respectively. On average, 31. 1 s was needed for registration. For the ten cases with larger setup errors, the mean disparities of the conventional method were 0. 9, 0. 7, 0. 8 mm, 0. 9° and 0. 8°, 29. 9 s taken on average. The corresponding result of the improved method was 0. 5, 0. 4, 0. 5 mm, 0. 6° and 0. 5°, 33. 2 s taken on average. Conclusions Regarding smaller setup errors, the two methods showed little difference and both had good performance in imageregistration accuracy. For larger setup errors, however, the improved mutual information registration method exhibited significantly higher accuracy than the conventional method, at cost of clinically acceptable registration time.