Patient Experience with SGRT (Tattoo-Free Treatments) and Increased Efficiency and Improved Workflows with SGRT

So today I’m going to focus on how AlignRT has impacted our workflow, the workflow of our radiation oncology department, and the overall patient experience. I want to bring to light how AlignRT has changed how we treat with radiation and the opportunities it gives our treatment team and patients. What is the end goal or common goal with the addition of AlignRT in cancer care? Positive patient outcomes. Increased physical and social wellbeing will increase adherence to treatment. Patients will have a higher probability of coming to follow-up treatments and follow-up care. Studies in oncology units have proven a direct correlation between satisfaction and quality of life.

At Texas Oncology Houston Medical Center, we use AlignRT to treat our breast patients. Our site is committed to comprehensive breast cancer care and offers multiple modalities for cancer care. AlignRT has changed our department by giving us not only a faster treatment, but a more accurate treatment. This lets us increase clinical operations. AlignRT also provides tattoo-free treatment with the use and accuracy of SGRT. As a result of using AlignRT, there’s an overall increase in positive patient outcomes that are rooted from patient satisfaction and patient experience. Throughout this, you’ll notice that each advantage of AlignRT will revolve around the patient and its role in positive patient outcomes and how these factors are interconnected, allowing for patients to thrive during and after radiation treatment. In addition, patient satisfaction is sure to increase treatment volumes by word of mouth and reputation.

Once patients are diagnosed, word of mouth and reputation are highly relied on because it’s the first connection a patient thinks of after being blindsided by a diagnosis. What are they going to do, and how are they going to make this work? Who do they know? What have they heard, and what have they seen? Patients are trying to familiarize and make a connection in a foreign situation. Patients rely on the recommendation and experience of others when choosing their care. At times, that’s all they have to rely on.

So with that, I first want to narrow down why AlignRT is related to how you work, whether you’re a physician, a therapist, or somewhere in between. Simply put, AlignRT allows for faster and more accurate radiation treatment. For physicians, this means quicker image evaluation, saving time in clinic schedules that run on time, yielding us positive patient reviews. For therapists, this means faster imaging, faster treatment, and schedules that run on time, if not ahead of schedule. That helps kind of relieve some of the running behind schedule pressures we face. This will also help to avoid therapist burnout and yield to a better work-life balance for us. For the entire radiation team, this means an overall manageable schedule and work environment in the radiation oncology department while prioritizing safety.

AlignRT also makes treatment easier for patients by eliminating therapist uncertainty and enhancing the therapist’s expertise and confidence. So I just want to refer back to when I started out as a therapist. I was at a dedicated breast machine, and typically, when we had a chest wall patient, we would separate the day that we filmed the patient and the day that we treated. So we would film on one day, and then we would treat on another to save time for the patient and the therapist. But every now and then, we would get this one appointment called a film and treat, where we had to film the patient, which was four to six fields for a chest wall, and then treat them as well. And so usually it was about 45 minutes to an hour, and if everything lined up perfectly, you were done within that time, and you could move on with your schedule. But if not, you’re very quickly falling behind schedule, apologizing to all your patients that came afterwards, clocking out late, trying to figure out when you’re going to burn your overtime, and slowly chipping away at your work-life balance. So although AlignRT has not eliminated the need for film and treat, I think it’s probably been replaced by VMAT by now, but at the time, it would’ve made the process a lot faster for both the patient and the therapist.

AlignRT’s impact on clinical operations gives us the opportunity to increase patient volume safely. With its speed and accuracy, volume for a community-based center can increase to 10 patients a day or 50 patients per year. Breast human volumes will make up 35%. From a clinical operations perspective, increased breast human volumes will impact time within the clinic and machine schedules. This can compromise accuracy in daily treatments, leading to interruptions, a near miss, or a mistreat altogether.

Because we are focusing on how AlignRT has impacted how we treat breast cancer at Texas Oncology, I just wanted to share some common breast cancer statistics real quick. I’m going to take us back to school. Breast cancer accounts for 30% of all new cancers in women. One in eight women will develop breast cancer in their lifetime. 27,000 US cases occur in women younger than 45, and 5% to 7% of breast cancer cases occur in women younger than 40, with incidences rising, and these patients often face more aggressive disease and psychosocial challenges such as identity, relationships, lifestyle, family and career planning, and long-term mental health. 50% of these cases will receive radiation, and for a fact, there will be an increased volume of breast cancer treatment in radiation departments.

From a patient perspective, increased breast treatment volumes and radiation mean patients with more stressors and custom needs. We must acknowledge the psychosocial aspects of the cancer. 30% to 60% of patients experience depression, stress, and anxiety that can last after radiation. 30% to 60% of patients reduce work hours or stop working during treatment altogether. Financial strain can lead to depression and lower treatment adherence. And the ability for the patient to maintain their daily routine will be critical because it gives them a sense of control and normalcy at this time. We should preserve their work-life balance as best we can. Working during this time increases emotional well-being, improves return to work rates and quality of life, as well as financial outcomes. Increases in breast treatment volume will force the need for faster and more accurate radiation treatment so patients can continue to have a work, life, and treatment balance. Because we have to keep in mind, cancer has now become a lifestyle, and we want to do our best to accommodate and cater to it, unfortunately.

So just to shed some light on the importance of job security and the ability to work, some assistance is provided, such as protected medical leave, paid sick leave, and sponsored wage replacement. But without these income protections, patients will work with severe symptoms, missed treatments, and risk treatment outcome. Employers are taking new initiatives to cater to employees that are working with cancer. Programs like Working With Cancer make job security and support a priority by ending cancer stigma, opening dialogue with managers and employers, allowing flexibility during treatment, and training managers on how to accommodate these employees.

AlignRT has a positive impact on our workflow and patient care at Texas Oncology. Again, it allows for faster and more accurate treatment. This aids breast cancer patients in conserving their daily life. This means continuing their routines, ability to work, and relieving them of stressors like financial strain, job security, and childcare. By integrating cancer care in their daily life, patients have balance, consistency, security, and a peace of mind.

Texas Oncology prides itself on treating cancer closer to home to minimize interruptions to daily treatment, because in a nutshell, patients are going to thrive in their own environment. And I know a lot of patients are receiving cancer far away from home, and they’re not in their own environment. And so this is when routine comes into play, and it’s really important that patients, wherever they’re at, create that routine, because once they create that routine, the environment will follow.

And so I just want to stress the importance of routine since we’re talking about it. And I want you to think about what is necessary for you to start your day. Is it a coffee? Is it an ice-cold Diet Dr. Pepper? Do you need to send an email before you get into work real quick just to get it out of the way? Are you waiting for a phone call? Are you waiting for your audiobook in the car to your next destination? For me, it’s usually some kind of trashy radio talk show that revolves around whatever celebrity gossip is going on at the time. It’s nothing I’m proud of, but I’m not hurting anybody, and it’s getting me from point A to point B, right? So, I want you to think about what does it take to get you to the next step each day. Although it might be something insignificant, it’s essential to your day.

Sometimes routine is all we have to hold us together when we’re hanging on by a thread. So we want to preserve routine for our breast cancer patients because they’re experiencing physical, emotional, and lifestyle changes that have interrupted their daily routine. We have an opportunity to lessen the impact with AlignRT. It should be as easy as going through the Starbucks drive-thru any time after 10:00 a.m. I also want to mention the impact cancer care has on caregivers, family members as well. They also have to rearrange their life around cancer care. It can be very difficult. Right now, I’m experiencing this for myself, so I’m getting the whole Cancer 360, and I’m seeing it from both perspectives. All the oncology pieces are fitting together right now, and it’s extremely difficult. It is very difficult. And I just want you to think about a lot of caregivers or family members, they’re in their middle ages. And so they’re trying to take care of their kids and their parents. And I want you to just take that a step further, and I want you to think about our breast patients, because a lot of them are in middle age, and they’re also trying to take care of their kids and their parents, and then they’re trying to take care of themselves. So we want to do our best to try to accommodate their routine.

So to test the effectiveness and efficiency of our breast treatment workflow using AlignRT, we compared the amount of time needed for imaging on the patient’s first fraction with our sister site in Sugar Land, Texas, that does not have AlignRT installed. We compared the imaging times of a 3D tangent breast with medial and lateral tangent fields on a free-breathing patient using a Civco board setup and a Varian TrueBeam. At both sites, the same radiation oncologist, patient setup, LINAC, and standard treatment plan was used. The average time for Texas Oncology Sugar Land Imaging on the first fraction for 3D free-breathing tangent breast plans for 20 patients from start to finish without AlignRT was seven minutes. The average time for Texas Oncology Houston Medical Center on the first fraction for 3D free-breathing tangent breast plans for 20 patients from start to finish with AlignRT was five minutes. The difference in treatment time with AlignRT versus without AlignRT was two minutes. As a result, AlignRT can save two minutes at the least on the LINAC when treating 3D free-breathing tangent breast.

And I know what you’re thinking. Two minutes, big deal, right? But if you step back and you think about it, and you have 10 patients like this, this is 20 minutes to check a few plans, call a few patients, schedule a doctor’s appointment because you know we have no time to take care of ourselves or forget. Grab an iced coffee to get you through the second half of your day or possibly fit in a patient that absolutely needs accommodation so they can foster their routine.

So the benefits of using AlignRT include residual errors after image verification. This includes one millimeter shifts in all directions. More than 95% of fractions that are imaged have shifts within five millimeters. 28% of patients imaged were within three millimeters of the planned position, indicating high precision setup, with most others still within acceptable limits. AlignRT provides sub-centimeter accuracy compared to standard set of tolerances, and in a large multi-study, SGRT was tested against the standard tattoo and laser alignment. The average setup for a 3D treatment had a 3.6 millimeter error compared to tattoo and laser alignment alone that had a 4.5 millimeter error. As a result, SGRT provided equal or better accuracy than the standard traditional tattoo laser setup.

So I just want to refer back to when I was on a dedicated breast machine again. When it came to filming a chest wall, filming a supercloud field was quite a challenge for me because everything has to be exactly in the right spot for good reason. And we can end up fighting that, depending on what your first film looks like, right? So eventually, I finessed it and I mastered it, and I was really proud of this. But I noticed after I moved on to other sites or other facilities and I used AlignRT regularly, I don’t remember the last time I had to move an arm or a shoulder or a chin or a neck and risk making the iso or the treatment field look worse than it did to begin with. And this is when I was sold on the system. There’s no better feeling as a therapist, like when you have the first patient or a new patient, not a first patient. When you have a new patient and you take that first image and you’re on. We all know what this means. This is a small win for us, and AlignRT does this for us almost every time.

In addition to faster and more accurate radiation treatment, AlignRT offers the ability to eliminate the need for tattoos. This works by placing temporary marks during CT simulation and capturing the patient’s surface using a reference 3D image, and AlignRT cameras track the patient’s surface during beam on at the time of treatment. Clinical advantages of tattoo-free treatment include providing accuracy that is comparable, if not superior, to tattoo alignment when treating breast. The use of thousands of surface points to provide a 3D match rather than basic laser alignment alone. Motion detection and beam pause when needed. And AlignRT is proven to increase reproducibility in setup, especially when treating breast.

Patient advantages of tattoo-free treatment include taking away the unwanted reminders of their diagnosis, removing one more emotional trigger. It creates a patient-centered experience that is less threatening and increases autonomy, which will have an impact on how the patient trusts us and the satisfaction they’re receiving with their care. And it gives the patient control or empowerment over their diagnosis. It also supports emotional recovery and decreases anxiety and fear during this time. Again, all these advantages lead to increased patient satisfaction, increased patient experience, and increased positive outcomes.

So I want you guys to think so far in your career as a therapist, what’s the maximum amount of tattoos you’ve ever placed on a patient? Mine is six. Does anybody have more than that? How many? Nine. And what site were you treating? It was shoulder, chest. Okay. I see, like multiple sites. Yeah. At one time? At one time. Okay. Wow, that’s a lot. Okay, you win.

Mine was six tattoos and on a very young patient, and this was not just like a single instance. This was the protocol at the facility that I worked at. And although I had a lot of hesitation doing this, I had a lot of hesitation doing this because I know that for these women, it’s more than just a tattoo that’s the size of a freckle. Regardless if you’re into extreme body art or not, the body is a canvas, and we should treat it as so. Our breast patients are getting younger. We not only want to preserve their lifestyle, but their body as well. Our modality radiation has the opportunity to do that with AlignRT. Now, I have my own tattoo from an accidental needle stick, and I hate it. Not only is it ugly, but I can remember exactly how and where and when I got it, and that’s without the negative connection of cancer behind it. So just keep in mind, the 18 gauge tattoo kit, they’re very expensive and then it doesn’t age well on the skin. So just keep that in mind.

In conclusion, at the end of the day to bring everything home, AlignRT is going to offer us faster and more accurate treatment, and it’s going to offer us tattoo-free treatment. It’s like a cheat code to your favorite video game from back in the day. These factors are game changers in radiation oncology because AlignRT offers an opportunity to increase the effectiveness and efficiency of our day-to-day clinical operations through image evaluation and manageable schedules. It also gives us the room to increase patient volume when needed because remember, breast cancer cases are increasing, and we want to be proactive about it. AlignRT also allows us to increase patient experience and satisfaction during this phase of their care. Speed and precision of the system lets patients integrate cancer care into their daily life, giving them a better quality of life during and after treatment. Tattoo-free treatment lets patients maintain their confidence while at a critical time. This option limits long-term psychological burden by taking away permanent visual reminders of cancer, preserving body image, and supporting emotional recovery. These factors give patients their control back. I love when patients getting radiation tell me, “This was the easiest part of my treatment,” or, “This wasn’t that bad.” With AlignRT, we can combine these factors to accomplish our unified goal as pioneers in cancer care to reach for increases in positive patient outcomes. And that’s it. Here’s my works cited.