EFOMP MP CoVID-19 Forum
In order to increase exchange of CoVID-19 information between medical physicists in Europe, EFOMP has set up a special MP CoVID-19 Forum. This is a moderated forum to be used by all medical physicists in Europe. Every contributor to the forum has his or her own responsibility for what is written. The following rules apply for use of the forum:
- All contributions to the forum must have to do with practical CoVID-19 situations in the hospital.
- Be brief.
- Be careful in what you write and use your scientific background.
- Share your own experience, especially positive experience.
- Practical advice is welcome.
- Advertisements for products or services are not permitted.
- Posts based on fake or falsified information are not permitted.
- Do not contradict others or governmental guidelines. In case of a possible misunderstanding, contact one of EFOMP’s officers.
- Do not scaremonger or engender chaos.
- An EFOMP moderator will examine the content of submitted posts and will thereafter approve or deny publication in the forum; it may take some hours before a post is published.
- The EFOMP moderator’s decision is final; EFOMP will not enter into any communication regarding posts for which publication has been denied.
- EFOMP reserves the right to edit submitted posts, to deny publication of a post, to remove a post after publication, or to close the forum as it sees fit.
Words of appreciation for the contribution of medical physicists are spoken in Scottish Parliament by Scottish First Minister Nicola Sturgeon [see https://www.youtube.com/
watch?v=hNYzTakw9yw4’48”]. The following words (translated in English) can be found in a recently (30 March 2020) published formal document by the Dutch Ministry of Health: “I very much appreciate the involvement of these parties. Experts (intensivists, medical physicists and medical technologists) assess whether the equipment offered is (or can be made) suitable for use in the IC beds.” In both countries the number of beds in the Intensive Care Units for COVID19 patients has been tripled with the help of medical physicists who have worked non stop to make this happen.
IAEA webinar on COVID-19 and chest CT (protocol & dose optimization)
by Efi Koutsouveli, on 2020-04-02 20:27:55People affected by COVID-19 may need to undergo multiple chest CT scans. In the webinar best practices for chest CT, including scan parameters and related radiation doses will be presented on April 9, 2020.
IPEM have published a special page on their web site, containing a wide range of information:https://www.ipem.ac.uk/ScientificJournalsPublications/IPEMStatementsandNotices.aspx?f24_pid=4cd42711-5182-4596-8486-427a05fc6afe&utm_campaign=All%20Member%20email&utm_source=force24&utm_medium=email&utm_content=textlink
Dear Bart we have looked at a few facemasks.
The 3M FFP3 1863 , Kolmi FFP2 and FFP3 masks showed torque and artefacts. The Kolmi FFP2 and FFP3 and were associated with considerable artefact on GRE images. Like yourselves the Halyard FFP2 mask did not exhibit evidence of ferromagnetism and produced
only minimal artefact on GRE imaging. The standard disposable Dalhousie surgical mask, which has some aluminum showed no signs of ferromagnetism with minimal local artefact. A number of physicists in other departments have looked at these too (particularly in the U.K. on the MRI physics disucssion group ) and may add to the list.RegardsPaddy Gilligan
Hello,Is there any information about MRI compatible masks (IIR/FFP2/FFP3), concerning artifacts, forces, and heating?In our deparntment we tested 2 two types ourselves and concluded:
Kind regards,Bart VermolenHospital Gelderse Vallei, The Netherlands
- Halyard PFR P2, 62408 (FFP2)
- No artifacts detected, no noticeable forces and no noticeable warming
- Halyard Fluidshield 2, 62115 (IIR)
- Artifacts are detected
Fast track individual patient ventilation for protection of medical workers in a Covid-19 crisis scenario
by Jim Patel, on 2020-03-29 18:58:36Strategy to protect medical workers from airborne virus. Individual ventilated hoods for hospital beds. Extracted air purified by passage through a HEPA filter. Details here.
Hi All,These documents are information I have found through the IPEM communities (UK) which may be useful to other hospitals.BNMS guidancehttps://cdn.ymaws.com/www.bnms.org.uk/resource/resmgr/news_&_press_office/news/26-03-2020_nuclear_medicine_.pdfNM preparations article:https://journals.lww.com/nuclearmedicinecomm/Fulltext/2020/04000/COVID19__Nuclear_Medicine_Departments,_be.1.aspxLetter Re: Techngeashttps://higherlogicdownload.s3-external-1.amazonaws.com/IPEM/Technegas%20and%20COVID-19%20letter%20(NM).pdf?AWSAccessKeyId=AKIAVRDO7IEREB57R7MT&Expires=1585237433&Signature=EsvP73p%2BHvcffUg9LwcRjyPImug%3Dand this post Re: RAI18/03/2020
Thyroid Cancer: Radioactive Iodine Treatment during COVID19 pandemic
In these unprecedented times we have been considering how to optimally manage our patients with differentiated thyroid cancer. We have put together the following guidance taking in to account both the risk patients face from cancer and from infection.
We recommend that all radioactive iodine treatments be halted during the COVID 19 pandemic based on the following rationale:
Low risk patients: (adjuvant setting)
- A delay in RAI is not expected to alter prognosis from DTC.
- This cohort of patients are expected to be cured and should they fall ill with severe COVID19 infection whilst radioactive their care and subsequent prognosis may be compromised.
- Once the COVID19 situation resolves, some of the patients who have had their treatment delayed may be suitable for 1.1GBq as an outpatient, thereby taking some demand off inpatient isotope facilities.
High risk patients (metastatic disease):
- The risk/benefit scenario in these clinical situations are harder to determine.
- This cohort are likely to have longer radiation protection restrictions following RAI and are also at higher risk for COVID19 infection. If a patient in this situation was to fall ill with COVID19 whilst radioactive their immediate care may be detrimentally affected.
We must also take in to account the service delivery aspects of patient care.
Resources (Staffing, room availability, supply chain):
- Most centres have limited numbers of clinical scientists able to administer, monitor, scan and calculate radiation protection restrictions. With likely imminent reduced staff levels it may not be safe to administer radioactive substances.
- With widespread travel restrictions and the potential for staff shortages affecting drug manufacture, it is uncertain if our RAI supply chain will be affected.
The recommendations have taken in to account discussions amongst UK thyroid cancer clinicians as well as general COVID19 oncological advice at local and national levels.
Recommendations will be kept under review.
Professor Jon Wadsley, Consultant Clinical Oncologist, Weston Park, Sheffield. Chair NCRI Thyroid Cancer Subgroup
Dr Laura Moss, Consultant Clinical Oncologist, Velindre Cancer Centre, Cardiff. Thyroid Cancer Forum-UK Director
Strategy for handling treatment gaps during COVID-19 - Herlev Hospital (DK)
by Eva Samsøe & Jens Edmund, on 2020-03-26 12:37:30Thank you for sharing your strategy for treatment gaps, Colin Kelly. Our local strategy for handling long treatment gaps during COVID-19 very much resemples yours with the addition of Table 3 in Gay et al. Practial Radiation Oncology (2019) 9, 305-321. This paper - also referenced by ESTRO - descripes the handling of the crisis during the hurricane Maria in Puerto Rico 2007. Currently, we are collecting a document describing the use of hypofractionated regimes, where it makes sense, categorized according to level of crisis (percentage of staff left). Here are our references in the document concerning long treatment interruptions (I will link if/when the document is online - it will, however, be in Danish):
 Gay et al. Practical Radiation Oncology (2019) 9, 305-321
 Higgins et al. “The timely delivery of radical radiotherapy: guidelines for the management of unscheduled treatment interruptions”, 4th edition, The Royal College of Radiologists (2019)
 Dale et al. Clinical Oncology (2002) 14, 382-393
 “Basic Clinical Radiobiology”, 4th edition (2009), M. Joiner and A. van der Kogel (editors).
 Marks et al., IJROBP (2010) 76(3), S10-S19 (QUANTEC)
 Ray et al. Clin. Oncol. (R Coll Radiol) (2015) 27(7), 420-6
 Whelan et al Semin Radiat Oncol (2008) 257-64
 Brenner et al. IJROBP (2002) 52(1), 6-13
 DAHANCA radiotherapy guidelines (2019) https://www.dahanca.oncology.dk/assets/files/GUID_DAHANCA%20Radiotherapy%20Guidelines%202019.pdf/ES, JME 20-03-2020
Clinical guide for the management of cancer patients during the coronavirus pandemic
by Chryssa Paraskevopoulou, on 2020-03-25 16:37:41
Other useful (pre proof) publications on covid-19 and radiotherapy
by Albert Lisbona, on 2020-03-25 15:28:58
The impact of Coronavirus (COVID-19) on head and neck cancer patients’ care
by Albert Lisbona, on 2020-03-25 14:19:09
See there part of the response from ESTRO
Dear ForumI am just wondering is there any consensus emerging concerning COVID 19 patients returning for radiotherapy after gaps of 1-3 weeks for either testing or treatment.Here we are using the UK RCR guidelines form 2008 with some amendments as follows:
1a1b2a2b3SCC Head&NeckHead&Neck (non SCC)BrainProstatePalliativesCervixGravesStereoPaediatricsMedulla blastomaLungTBIPNETBreastPre-op OesOes post opCBURectumPre-Op RectumBladderSCC’sExtremitiesRepop Factor K0.90.70.70.058Repopul Time28252534I would appreciate any comments either on or off the list.
- Use the conventional formula to calculate BED i.e. )
- Discuss with RO whether they want to match normal tissue toxicity for a particular OAR or original treatment prescribed dose
- Determine salvage course which will probably involve bi-dailies and/or weekend treatments
- We have decided not to change the dose per fraction but to stick with that of the original treatment intent
- For the time facto K and the repopulation time we are using the values set out below.
RE: For your information: Fast volume chest CT protocol used in HUS Finland
by Mika Kortesniemi, on 2020-03-25 09:41:43Due to some further questions which I have received on the fast volume chest CT protocol, here are some remarks which might be useful:
- Overall context: There are various CT scan protocols and imaging options which can be used for this patient group (=poorly or non-co-operative intensive care patients in chest CT scan) but this is what we chose to use primarily in this case. Other indications and co-operative patients are typically examined with other protocols and imaging methods.
- Patient orientation: Feet first was used to facilitate the patient access and scan preparations with intensive care patients with related instruments and tubings, and also to facilitate possible further contrast enhanced scan if that is needed for overall clinical status and indications.
- Radiation exposure: We have seen CTDIvol typically within a range of 3 to 9 mGy (depending on patient size & attenuation, we also tested the protocol with anthropomorphic phantom). The scan length is typically about 30 cm (again, varying a lot depending of the patient anatomy) which indicates a DLP ranging from about 100 to 300 mGycm. In terms of effective dose, this indicates that the exposure should be well below 5 mSv, typically 2-4 mSv.
- Scan parameters: It is important to notice that optimal scan parameters may (and will) vary between different vendors and scanner models. Furthermore, in each imaging organisation, the clinical image quality must be adjusted to satisfy radiologists preferences and requirements on each site. Thus, optimal scan parameters may involve:
- different reconstruction options (including anatomical DFOV options, selection of kernels and levels of iterative reconstruction - or more recently, deep-learning based reconstruction)
- application of organ-dose-modulation
- spectral optimisation (e.g. use of tin-filtration if applicable)
- ultra-fast scanning with dual-source or wider detector scanner models
- different number of localiser radiographs (1 or 2 scouts/topograms) and their order and projection angle (effecting ATCM and helping patient centering)
- ...and other scanner specific technical optimisation tools.
Italian experience of a running radiation oncology during the Coronavirus pandemic
by David Lurie, on 2020-03-23 12:22:06The following article has just been published in Advances in Radiation Oncology by Krengli, Ferrara, Mastroleo, Brambilla and Ricardi:"Running a Radiation Oncology Department at the time of coronavirus: an Italian experience"The article, which is Open Access, can be found at: https://doi.org/10.1016/j.adro.2020.03.003
For your information: Fast volume chest CT protocol used in HUS Finland
by Mika Kortesniemi, on 2020-03-23 10:38:41For your information, we prepared the following modification of the volume HRCT protocol to enable fast lung scan for non-co-operative patients, primarily now thinking of covid intensive care cases (mainly for our Siemens Definition Edge/Flash/AS scanners, but also GE is referenced):
Please, note that this only for information of our local protocol. I will gladly receive comments or suggestions for improvements on this.Best regards, stay healthy,Mika
- no IV contrast used in this scan.
- Patient in feet first supine position.
- Two topograms: 1st craniocaudal lat, 2nd caudocranial top, followed by craniocaudal spiral scan.
- DFOV limited tightly to bony chest.
- Rotation time: 0.28-0.33 s or based on scanner model; as fast rotation as feasible considering tube limits.
- Tube-voltage: 120 kV (140 kV only with very obese patients) to keep it simple
- ATCM (mA-modulation): Siemens QRefmAs 110-140 depending on model (QRefmAs 110 with new Stellar detector scanners. With GE scanners: NI 30 HU (set for 0.625 mm primary recon).
- Pitch: Siemens 1.2; GE 1.0. Aiming to fast scan but considering tube limits.
- In this scan, we are quite conservative with iterative recon, but of course that's according to radiologists preferences.
- Archived images:
- Lung window images: Siemens kernel = B50f medium sharp; GE kernel = Bone Plus: axial, sagittal, coronal images with 1 mm thickness (or thinner) with same interval.
- Mediastinum window images: Siemens kernel = B30f medium smooth; GE kernel = Standard: 3 mm thick axial images with same interval
Global challenge for the fast development of ventilators to treat COVID-19
by ennomotive, on 2020-03-20 12:32:51Ennomotive has launched a non-profit online competition for the ideation of low-cost, easy-to-build solutions. The goal is to speed up the availability of ventilators in hospitals everywhere to help patients with coronavirus.The number of people affected by the pandemic doubles every three days in many countries. Since 20% of patients are hospitalized and 5% need to be admitted to an ICU, the demand for ventilators is sky-high.Ennomotive has joined other international initiatives for the development of easy-to-build ventilators and makes its global community of 20,000 engineers available to face the challenge.Based on its experience, ennomotive has chosen to focus on solutions that can adapt or reuse widely used standard industrial components or that use other easy-to-access and universal everyday-life elements.This online challenge is open worldwide to any engineering professional, company, tech center, maker or scholar from different industries and technical backgrounds that want to propose a solution for this challenge. The final goal is to make a key contribution to the fight against the COVID-19 pandemic.The solutions resulting from this challenge will be open to the public and ennomotive will fund the development of the best prototypes in the next round. Given the urgency, the first deadline for submissions is the 25th of March.
Red journal preview article from Italy concerning radiotherapy
by Albert Lisbona, on 2020-03-20 10:27:55
To consider the Belgian therapeutic treatment for the new CKV virus that causes Covid 19, which was published yesterday on 16-3-2020, containing recommendations from Italy, Sweden and the Netherlands. This reference is the most important:
ACR published recommendations concerning the use of CT to screen or diagnose COVID-19 infection: https://www.acr.org/Advocacy-a
nd-Economics/ACR-Position-Stat ements/Recommendations-for- Chest-Radiography-and-CT-for- Suspected-COVID19-Infection
Webinar concerning COVID-19 related infrastructural problems in Dutch hospitals
by Ad J.J. Maas, on 2020-03-17 17:50:19Tuesday 17 March, a webinar was held among 100 MPEs working in hospitals in the Netherlands. Dutch MPEs have a responsibility concerning the availability and quality of medical equipment. The influx of seriously ill COVID-19 patients causes problems for the capacity of IC wards. This capacity is mainly limited by the availability of ventilators and hemodialysis or CVVH equipment. Several solutions were given how to increase the availability of these apparatus in order to increase IC capacity.The main warning was: be prepared and take your measures now!
Recommendations published by the French Society of Radiation Oncology (SFRO), the National Union of Radiation Oncologists (SNRO) and the French Society of Medical Physics (SFPM) for use by professionals working in the Radiation Oncology field.You can find the guidelines (in French) at the website of SFPM:
Read the message of the President of EFOMP, Dr. Marco Brambilla, about the COVID-19 virus.
EFOMP has set up this forum in order to facilitate information exchange between medical physicists concerning the CoVID-19 crisis. In view of the speed of communication exchange, EFOMP refrains from directly checking the published information. None of the information shared in the forum is the responsibility of EFOMP, nor does it reflect the views of EFOMP or its Officers. EFOMP reserves the right to remove posts that do not follow the posting rules or which may be considered as aggressive, racist or insulting to an individual or to a group of people.