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Telemedicine in action

Distant Swedish doctors use telemedicine technology to build expertise in pediatric RT planning

Jack Lindh, MD, sat in the videoconference room at the department of radio-therapy in Umeå, Sweden, comparing radiotherapy plans for a difficult pediatric case with a colleague 357 miles (574 km) away in Uppsala. The five-year-old girl they were discussing had an inoperable sarcoma in her neck that had not responded well to chemotherapy. Radiation therapy was the only definitive treatment option left.

As the two physicians discussed alternative photon and proton treatment plans, they viewed the plans together by videoconference. The system they used to collaborate over long distance is a project of the Swedish Working Group for Paediatric Radiotherapy, which has members from the six university hospitals in Sweden that have pediatric radiation oncology programs.

Accelerated experience

“Pediatric cases are often very tricky to plan,” says Lindh, who chairs the working group. “Radiation affects children differently and often more severely than adults. The late effects include growth disturbances, hormonal side effects, effects on the central nervous system, or other symptoms depending on the irradiated area.” At the same time, pediatric RT cases are relatively uncommon in Sweden. Approximately 100 children receive radiotherapy each year. The larger centers will have about 25 cases per year and a small center like Umeå about 10.

“When you treat only 10 or 20 cases a year, it can take a long time to build up expertise in the specialty,” says Lindh. Telemedicine techniques, including videoconferencing, offer a means for the members to meet more often, share experience on a regular basis, and support one another in difficult decisions. Since 2006, the group has met online every two weeks, and in three years has reviewed 180 cases. In 25 years of practice, Lindh estimates he has seen 300 new pediatric cases having radiotherapy at his center. “Now, through the working group, I will see 60 to 100 new cases per year,” he says. “It will shorten the time to acquire a lot of experience within the field.”

Collaborating with Oncentra

The working group uses Oncentra to view the RT plans during the videoconferences. Though not all members use Oncentra as their treatment planning system, it was chosen as the RT viewer because the Plan Analysis module allows treatment plans to be viewed in full, with images, beams, dose, and dose volume histograms, without recalculating. No beam data is required. Oncentra is installed on a central server, where working group members can access it securely. Plans are exported in DICOM-RT format from the treating center to the server, where they are imported and viewed in the Plan Analysis module. (Read more about the Swedish Working Group’s telemedicine project in the January 2009 issue of Acta Oncologica, http://dx.doi.org/10.1080/02841860802409520.)

“The telemedicine system is an important way to raise the competence in a small group of physicians working with few patients, and where the goal is to cure them with the least side effects possible,” says Lindh. “It is a means of quality assurance in practice.”