title: Improving proton therapy accessibility through seamless electronic integration of remote treatment planning sites.
abstract: OBJECTIVE
  Proton radiotherapy is a relatively scarce treatment modality in radiation oncology, with only nine centers currently operating in the United States. Funded by Public Law 107-248, the University of Pennsylvania and the Walter Reed Army Medical Center have developed a remote proton radiation therapy solution with the goals of improving access to proton radiation therapy for Department of Defense (DoD) beneficiaries while minimizing treatment delays and time spent away from home/work (time savings of up to 3 weeks per patient).
  
  
  METHODS
  To meet both Health Insurance Portability and Accountability Act guidelines and the more stringent security restrictions imposed by the DoD, our program developed a hybrid remote proton radiation therapy solution merging a CITRIX server with a JITIC-certified (Joint Interoperability Test Command) desktop videoconferencing unit. This conduit, thoroughly tested over a period of 6 months, integrates both institutions' radiation oncology treatment planning infrastructures into a single entity for DoD patients' treatment planning and delivery.
  
  
  RESULTS
  This telemedicine solution enables DoD radiation oncologists and medical physicists the ability to (1) remotely access a proton therapy treatment planning platform, (2) transfer patient plans securely to the University of Pennsylvania patient database, and (3) initiate ad-hoc point-to-point and multipoint videoconferences to dynamically optimize and validate treatment plans.
  
  
  CONCLUSIONS
  Our robust and secure remote treatment planning solution grants DoD patients not only access to a state-of-the-art treatment modality, but also participation in the treatment planning process by Walter Reed Army Medical Center radiation oncologists and medical physicists. This telemedicine system has the potential to lead to a greater integration of military treatment facilities and/or satellite clinics into regional proton therapy centers.
authors.affiliation: Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA. arnaud.belard@amedd.army.mil
authors.forename: Arnaud
authors.initials: A
authors.lastname: Belard
authors.forename: Derek
authors.initials: D
authors.lastname: Dolney
authors.forename: Tochner
authors.initials: T
authors.lastname: Zelig
authors.forename: James
authors.initials: J
authors.lastname: McDonough
authors.forename: John
authors.initials: J
authors.lastname: O'Connell
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D004867:Equipment Design / Q000592:standards; D006801:Humans; D020407:Internet / Q000639:trends; D009369:Neoplasms / Q000532:radiotherapy*; D061766:Proton Therapy; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014481:United States; D049269:Videoconferencing; D011522:Protons
chemical_list: D011522:Protons