Remote Remote DosimetryDosimetryBy Mission SearchBy Mission Search

Presented by Tom Morris, CMD

Why Remote Dosimetry Now?Why Remote Dosimetry Now?

The Remote Planning idea is not newThe Remote Planning idea is not new Radiation Therapy is a high revenue Radiation Therapy is a high revenue

specialtyspecialty• Estimated oncology spending for 2009 over Estimated oncology spending for 2009 over

$55 billion$55 billion• Small centers can generate revenue of over $5 Small centers can generate revenue of over $5

millionmillion Changing landscapeChanging landscape

• Improved technologies such as IMRT, IGRT and Improved technologies such as IMRT, IGRT and SRS will require more involved planningSRS will require more involved planning

Remote Dosimetry TopicsRemote Dosimetry TopicsThe wave of the futureThe wave of the futureMethods of Remote PlanningMethods of Remote PlanningWorkflow variationsWorkflow variationsConsistent planning with VPNConsistent planning with VPNHighly qualified dosimetrists Highly qualified dosimetrists HIPAA compliant HIPAA compliant Cost effectiveCost effectiveBe “Perpetually Prepared”Be “Perpetually Prepared”

The Wave Of The FutureThe Wave Of The Future 1.4 million cancer cases diagnosed1.4 million cancer cases diagnosed

• 900,000 will receive radiation treatments900,000 will receive radiation treatments• By 2030 these numbers will almost doubleBy 2030 these numbers will almost double

Shortage of experienced dosimetrists and Shortage of experienced dosimetrists and other healthcare workersother healthcare workers

Projected expansion of new treatment sitesProjected expansion of new treatment sites• Currently 3,000 sitesCurrently 3,000 sites• By 2012 6,000 sites estimatedBy 2012 6,000 sites estimated

Current number of dosimetrists 3,000+Current number of dosimetrists 3,000+ Remote Dosimetry will fill the needRemote Dosimetry will fill the need

The Wave Of The FutureThe Wave Of The Future

More government involvement through More government involvement through healthcare reformshealthcare reforms

Declining reimbursementsDeclining reimbursements• Rates for reimbursement have been falling in Rates for reimbursement have been falling in

recent yearsrecent years• In 2010 CMS projects payment reductions of In 2010 CMS projects payment reductions of

19%19%• Rates for certain cancer services could be Rates for certain cancer services could be

reduced by up to 40%reduced by up to 40%

Typical Radiation Therapy Typical Radiation Therapy Department WorkflowDepartment Workflow

ConsultationConsultation CT SimulationCT Simulation PlanningPlanning Importation of CT dataImportation of CT data Merging of MRI or PET scans if requiredMerging of MRI or PET scans if required Contouring by dosimetrist and PhysicianContouring by dosimetrist and Physician Creating the planCreating the plan Plan review and approval by PhysicianPlan review and approval by Physician Record and verify systemRecord and verify system TreatmentTreatment

Methods of Remote PlanningMethods of Remote Planning

Offsite PlanningOffsite Planning• All planning tasks are performed at another All planning tasks are performed at another

facility on their treatment planning systemfacility on their treatment planning system

VPN Onsite PlanningVPN Onsite Planning• Accomplished through Virtual Private NetworkAccomplished through Virtual Private Network• All treatment plans are performed on the All treatment plans are performed on the

client’s treatment planning systemclient’s treatment planning system

Offsite PlanningOffsite Planning

Requires sending beam data to offsite Requires sending beam data to offsite treatment planning systemtreatment planning system

Transfer of patient informationTransfer of patient information Exporting images through FTP or diskExporting images through FTP or disk Responsibilities for duties Responsibilities for duties

• i.e. contouringi.e. contouring Quality AssuranceQuality Assurance Making plan adjustmentsMaking plan adjustments

VPN Onsite PlanningVPN Onsite Planning

No transfer of machine beam dataNo transfer of machine beam data All patient data including images remains All patient data including images remains

on client’s planning systemon client’s planning system Responsibilities are same as normal Responsibilities are same as normal

clinical settingclinical setting Quality Assurance, same as in the clinicQuality Assurance, same as in the clinic Plan adjustments can be done on client’s Plan adjustments can be done on client’s

planning system planning system

Consistent Planning with VPNConsistent Planning with VPN

The assigned primary dosimetrist is The assigned primary dosimetrist is selected by the clientselected by the client• Physician knows who is doing the planningPhysician knows who is doing the planning• Develops comfort level with the dosimetristDevelops comfort level with the dosimetrist• Physicist knows who to contactPhysicist knows who to contact• Dedicated customer support lineDedicated customer support line

Planning process same as in the clinicPlanning process same as in the clinic A backup dosimetrist always assignedA backup dosimetrist always assigned

Highly Qualified Highly Qualified Dosimetrists Dosimetrists

Only CMD skilled dosimetrists do the Only CMD skilled dosimetrists do the planningplanning

Average over five years of experienceAverage over five years of experience Experienced and knowledgeable in all Experienced and knowledgeable in all

types of treatment planning systems types of treatment planning systems • EclipseEclipse• ADACADAC• CMSCMS• ProwessProwess• TomoTomo• CyberKnife CyberKnife

Rapid Turnaround TimeRapid Turnaround Time

As fast as normal clinic timesAs fast as normal clinic times Often faster through efficient Often faster through efficient

utilization of planning systemutilization of planning system Structured to fit needs of clientStructured to fit needs of client

HIPAA ComplianceHIPAA Compliance

Use point to point Virtual Private NetworkUse point to point Virtual Private Network

All patient information remains with clientAll patient information remains with client

Encrypted softwareEncrypted software

Cost EffectiveCost Effective

No set up costNo set up cost No need to purchase additional work No need to purchase additional work

stationstation Use only as neededUse only as needed

• Pay on per plan basisPay on per plan basis Efficient utilization of planning systemEfficient utilization of planning system

• Less down timeLess down time• Fewer delays in starting patients due to Fewer delays in starting patients due to

heavy work loadheavy work load

Cost EffectiveCost Effective

Reduction in FTE costsReduction in FTE costs• Up to 50% savings!Up to 50% savings!

Cost of recruiting dosimetristsCost of recruiting dosimetrists• Average salary over $130K with benefits Average salary over $130K with benefits • Average cost per permanent hire $25KAverage cost per permanent hire $25K

Peaks and valleys in patient volumePeaks and valleys in patient volume• Seasonal variation in patient volumeSeasonal variation in patient volume• No need for overtime or locumsNo need for overtime or locums

Vacation and sick coverageVacation and sick coverage• No longer an issue!No longer an issue!

Cost ComparisonCost ComparisonFacility BasedFacility Based

vs. Remote Dosimetryvs. Remote Dosimetry

Full Time

.5 FTE

0

25

50

75

100125

150

175

200225

250

Facility Remote

.5 FTE Coverage

Remote Dosimetry

.5 FTE

Full Time

Be “Perpetually Prepared!”Be “Perpetually Prepared!”

Proper utilization and maximized efficiencyProper utilization and maximized efficiency• Always have the right amount of dosimetry for the Always have the right amount of dosimetry for the

patient volumepatient volume Greater usage of planning systemGreater usage of planning system

• After hours planningAfter hours planning• 7 days/week7 days/week• Available on short noticeAvailable on short notice

Creates opportunities for dosimetrists without Creates opportunities for dosimetrists without relocationrelocation

Cost EffectiveCost Effective• No set up chargesNo set up charges• Reduces overall dosimetry cost by up to 50%Reduces overall dosimetry cost by up to 50%

Remote Dosimetry allows you to be “Perpetually Remote Dosimetry allows you to be “Perpetually Prepared”Prepared”

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