Insights into SGRT Applications that Streamline Active Motion Management Documentation

So I was excited to be able to share my experience with using the AlignRT OIS Report module to assist with active motion management documentation. I work for Cape Fear Valley Health in Fayetteville, North Carolina. We have three locations, and at each location, we use Varian TrueBeams and then AlignRT for our SGRT patients. When we first started using it, we were predominantly only using it for just a handful of our patients, the deep inspiration breath hold breast patients. But as we have grown and evolved through the years, we’ve expanded that usage to encompass all types of treatments, and so currently we utilize SGRT for the majority of everyone under treatment. Our physicians are not only wanting us to use it for alignment and positioning in the room, but also to ensure that we have and monitor the patient’s position throughout treatment so we can ensure they’re in the correct position through the entire procedure.

So a daily basic run-through of one of our procedures would be to start off by using the AlignRT Patient ID module. This uses facial recognition software to ensure we have the correct patient in the treatment room, and then we’ll verify this with the patient by having them state their name, date of birth, the site that we’re treating. And then once we place them on the table, we will press play in AlignRT so that we can get them in the correct position before we ever even step out of the room. And then once we step out, we proceed with our daily imaging, which is typically cone beam CT for almost everyone, sometimes KV and MV. Then we’ll apply the shifts and capture the position in AlignRT, which essentially zeros out the deltas, so it defines our reference position for the day. The real-time deltas are the deviation between the patient’s current surface position and the reference surface position, which was attained at the time of CT simulation. And then we will toggle beam control on, and with beam control being toggled on, if that patient moves outside of the small parameters that we have set, the beam will be paused until they’re back in that threshold again, and then we’ll continue on with treatment. And then at the end of treatment, while that patient is still in that correct treatment position, we will pause the AlignRT screen so that this correct position is accurately reflected in the SGRT report for our physicians.

So the daily SGRT report is necessary for billing purposes, for documentation purposes. It has to be approved by a physician, typically within 24 hours or before that patient’s next beam-on time. Every department has their own way of documenting and recording their SGRT treatments, and at our site for years, we had a document that was created by our physicians. This is an example of one of our old documents in which we would input that daily treatment information. So it was created in ARIA, and it would appear in a list of documents for the physician to have to go in and approve. So at the completion of treatment, after we would pause that AlignRT screen, one of the therapists would sit down and type all those values into the document. They’d have to make sure that they tagged the correct physician into the document. Then they would have to select from a drop-down menu the type of treatment that we were performing for the day, like 3D, IMRT, VMAT, SRS, SBRT, and then they would type all those values from that pause screen into that document. And although effective, it did give us a form for approval. It was not the most efficient system. It would typically take 10 to 15 seconds, probably per patient, to type all that into the document. And although 15 seconds is not a very long period of time, if you have a busy schedule, 30, 35, which I thought was busy for us until I’m hearing some people have 60 to 80 patients a day, that really can start to add up. And there would always be at least once or twice during the day where one of us would be putting our values into the document, and one of the other therapists would think we were finished and would close that screen out to move on to the next patient. We’d have to stop what we’re doing, go back into the previous patient’s chart before we can bring the next patient in, pull up that document, and finish typing everything in. So sometimes not the smoothest system. The biggest issue, though, would be human error. It’s very easy, especially if you are in a hurry and you’re trying to get everything typed in before that next patient’s set up, to perhaps type in an incorrect value or leave a negative sign off, or leave a number out or put a decimal in the wrong spot. The biggest issue I would typically find would be that the therapists sometimes would forget to tag the physician into the document. So it might not get caught until the next weekly chart check, and we’d realize we had a document sitting there that never had gotten approved, and it was because the physician was never tagged into it and didn’t know it was waiting for their approval.

So around September of this past year, we were given the opportunity to be one of the test sites for the new AlignRT OIS Report module, and we were really excited to give it a try to see if it would help to improve our workflow, and it definitely has. AlignRT has always had the ability, although we were not doing it at the time, to be able to take a screenshot, convert it into a PDF, push it into a folder, and then manually export that into the oncology information system like ARIA or Mosaic. We use ARIA. But it was always a manual process. So now with the AlignRT OIS Report module, it’s a seamless transfer of information. It occurs entirely in the background. It takes that SGRT report and converts it into the DICOM format and then pushes it into the OIS automatically at the completion of treatment. So now when we complete one of our patients’ treatment and we pause and close that AlignRT screen out, this creates a screenshot of that final pause window. It inserts into the timeline in the RT summary in ARIA, and then it creates that AlignRT report. So we’re no longer having to tag a physician into the document. They’re not having to go into a list of documents to sign off on anything. I did ask our physicians if it makes it easier for them, and they did say that, yes, it makes it a bit quicker, more streamlined. They’re not having to go to two different locations to sign off on anything. It appears alongside the images they’re reviewing every day in the offline review. The therapists, of course, love it because it’s saving them a lot of time of having to manually enter in data after every single treatment, and of course, it’s helping to eliminate the risk of human error of typing those in incorrectly.

So the AlignRT report can be tailored and customized for each facility. This is an example of one of our patient’s AlignRT reports. Perhaps there’s something in the customization of our report that another site would not want to include, or perhaps we don’t have something included in ours that another site would want to include. It has all that basic patient information, name, date of birth, medical record number, the site that we’re treating, even though I don’t think you can see that because it’s probably darkened out with patient identifiers, but it is on there. It does include the screenshot of that final pause window, which was sent over from the AlignRT screen, and also it has the total duration of time, which is from when we open that patient up in AlignRT to when we close the patient out of AlignRT. It has a monitoring session time, so it breaks it down a bit further, and that’s from when we press play in AlignRT to when we pause and close out. So for this particular patient, that’s encompassing the alignment in the room, the imaging, and then the treatment itself. It includes the statement that the AlignRT system was used to position the patient immediately prior to treatment and track the patient during treatment in 3D mode. This is the default statement, and it can actually be customized as well, and some sites are now getting the verbiage to state that the patient is being tracked with active motion management. If we capture SSDs for the day, those will be inserted into the report as well, as long as we save them to the report, and that’s one of my favorite features of AlignRT in general. I love the fact that with the click of a mouse, I can capture SSDs from multiple treatment angles. So if we get those SSDs and save them, they will be inserted also.

So this is an example of a patient monitoring graph. We do not currently have this included or configured into the layout of our report at this time. I do think it’s a really neat feature, though. A lot of sites are not including it because it does increase the length of the report considerably from what I understand. As you can see, this is just a small example of one online and it says page one of eight, so it definitely increased the length of the report. But it’s a really neat feature, and it’s actually reflecting that patient’s motion and position throughout the entire treatment. If that patient ends up moving and the beam is held due to deltas being out of tolerance, that’s reflected in the graph. So as you can see on the graph, where the red bar dips below, that represents where the deltas were outside of the tolerance, and then the yellow bar represents where the beam was held due to the deltas being out of tolerance. So it’s another option. It could be included, and it would definitely be able to show evidence of performing active motion management.

If you have a patient with multiple sites, we’ve learned that we can create an AlignRT report with screenshots from each site on a single report. The physicians do seem to like this. It’s a little bit less they’re having to sign off on, and it’s fairly easy to do. So if you have someone with, for example, two sites, at the end of your first site, you can just open up the sidebar menu on the screen, which you can access from a little arrow on the right-hand side of the screen, and just click Report Screenshot, and then you could pause, move to that next treatment site, and then at the end of that second treatment site, you could just pause and close out. And so this is going to create those screenshots and insert those into the timeline in the RT summary in ARIA, and then it’s also going to insert those into the AlignRT report. So you’d have one screenshot from each site on the single report. Now, bear in mind, this is not a full detailed report for each site. It’s just a screenshot. So if you or your physician prefers to have a full detailed report for each site, that’s also fairly easy to do. And in order to do that, if you’re treating someone with, once again, two sites, at the end of that first site, you would just simply pause, close out of AlignRT, move to the next treatment site, and then reopen AlignRT. And I know for us in ARIA, if I move to that second site, it auto-launches the correlating site anyway in AlignRT, so it’s a little bit even less that we’re having to click on. But this is going to give you a full detailed report for each site for the physician to be able to review and approve, and then as well, all that’s going to be inserted in the timeline in the RT summary in ARIA in chronological order with the timestamps. So these are some of the main highlights and the features of the AlignRT reports that I have experienced up to this point.

And in comparison with our previously used system of just simply typing the values into our SGRT document at the completion of treatment from that paused AlignRT screen, the AlignRT report that is generated with the OIS report module is a much more detailed document for our patients’ records, and as well, it provides substantiating documentation to assist with our billing justification. So with the new billing changes that we’ve seen in 2026, and with the elimination of several of our previously used codes, it’s become imperative to show justification if charging that higher treatment level charge, that 77412 charge. So performing active motion management is not only best practice for our patients to ensure that they are in the correct position throughout the entire treatment, but it’s also one of the best ways to be able to provide justification of charging that 77412 charge. Therefore, practices are trying to find the best ways of being able to show supporting documentation that they’re performing active motion management. Especially if undergoing an audit, if they are reviewing and pulling specific charges, it is crucial to be able to show not only the medical necessity of performing active motion management, but also the documentation and evidence that we have been performing active motion management for our patients.

As one way of doing this, some sites are now starting to capture screenshots after they take their imaging every day. So they do their images, apply the shifts, capture the position in AlignRT, which once again zeros those deltas out, shows the patient’s in the right position. Then they could toggle beam control on, and then open up the sidebar menu and click Report Screenshot. So it’s just one additional click. It takes just a couple of seconds, but this is going to insert that screenshot into that AlignRT report. So you’d have two screenshots in that report. You’d have the one showing from the beginning that the patient’s in the correct position at the start of treatment, and then you’d have the one that’s automatically fed through at the end, showing that the patient was in the correct position at the end of treatment as well. And if beam control is toggled on, that’s reflected in that initial screenshot, so you’d be able to see that not only was the patient in the correct position at the start of treatment and at the end of treatment, but that beam control was toggled on, therefore performing active motion management. And so it’s just another option. And then as well, all that would be inserted into the timeline in the RT summary in ARIA. So if you opened up that timeline, you’d actually have a visual layout in chronological order with the timestamps of everything we had done for that patient for the day. You’d be able to look at it and visually see this is where we did our initial imaging, and then we took that screenshot. Patient’s now in the correct position. Beam control is active. Then we did our treatment. The final screenshot, patient’s still in the correct treatment position, and then the AlignRT report.

So it would definitely be another option and helpful tool to show that we’re actively monitoring the patient’s position throughout their entire treatment. With the AlignRT OIS report module, I do feel now that we have the tools, if necessary, to be able to show supporting documentation of performing active motion management. I said in the reports themselves, we have the timestamps of that monitoring session time, which correlates with what is in our RT summary in ARIA. We have the statement that automatically states the patient’s being tracked throughout treatment, but that we can customize to state the patient’s being tracked with active motion management. We have the ability of capturing those screenshots, showing that the patient’s in the correct position at the start and at the end of treatment with beam control active. And then we even have, if we choose, the ability to be able to include in the configuration of our report that patient monitoring graph, which shows that we’re tracking that patient’s treatment throughout the entire procedure, and if that patient happens to move and the deltas are out of tolerance and therefore beam is held, that’s reflected in that as well.

So with all of these, I do feel now that we are able to show the evidence of performing active motion management and therefore the justification of that higher treatment level charge. The AlignRT OIS report module has been a very useful tool for us to help to maintain precise records, eliminate the need for someone to have to manually enter in data after each treatment, eliminated the risk of human error, so now we’re more streamlined, more efficient, more accurate, and we do have, if needed, any necessary documentation and records for reimbursement justification. So once again, thank you for giving me your time and allowing me to share my experience with the AlignRT OIS report module.

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