3688 - A Robust Radiotherapy Continuity System that Enables Patient Treatments during a Cybersecurity Event

Purpose/Objective(s): Modern radiotherapy departments are susceptible to both Cybersecurity attacks and hospital network outages. These outages can result in radiotherapy treatments being delayed or canceled. We have developed a system that enables the continuity of radiotherapy delivery for patients already under treatment during a significant Information Technology (IT) network outage when the hospital oncology information system (OIS) is inaccessible.

Materials/Methods: An electronic patient information management system is the OIS used in our clinic with a FAT client installed on a dedicated treatment computer (TXPC) at each linear accelerator. When a patient is treated, all the information needed, such as plans, images, and structures, are all cached locally on the TXPC prior to being sent to the technology company medical linear accelerator. The DICOM cache on the TXPC cannot be used conveniently as a backup since it is not human-readable and not in a directly accessible location by the treatment machine. We developed a custom script that reads the DICOM cache on each TXPC, relocates, reorganizes, and renames the cache files. The directory structure of the modified cache is human readable, organized by treatment machine and patient medical record number which allows a therapist to easily select a patient. The organized cache files can be opened in file mode on the linac and treatment can be delivered including scheduled imaging procedures, all without the OIS. A separate effort caches copies of the treatment plan printouts on OneDrive (Microsoft, Richmond, WA) that can be used to verify all beam parameters prior to treatment delivery. Upon completion of each patient’s treatment, the DICOM treatment records are saved into the same location used to load the initial files. Finally, at the conclusion of the downtime, these records can be used to populate the patient’s treatment record in the OIS.

Results: The DICOM cache archive system was deployed on 26 TXPCs and runs nightly. This system enables the continuity of patient treatments for nearly 80% of our treatment population (does not work with Proton Gantries from some precision radiation medicine companies). The cache is stored and updated in redundancy locally on the TXPC, on a network share mapped to each linac, and uploaded to OneDrive. Dry runs have been successfully completed at multiple locations to demonstrate the ability to find and use the cached data. A process was also validated that demonstrating the ability to swap cache locations between the standard technology company file-share and one located on the local sequencer PC without requiring vendor support, which may not be available in a crisis situation.

Conclusion: As part of our internal cybersecurity resilience program, a system was successfully developed and implemented that ensures patients who have begun the course of radiotherapy treatment on linacs can complete their course of radiation without disruption, even during a significant IT outage.