Table 1 Planned actions implemented for radiotherapy activities in lockdown Phase I and in post-lockdown Phase II in the experience of Chieti Radiation Oncology department

1

Full maintenance of Radiotherapy treatments on both Linacs

As per Phase I

2

Linacs disinfection at each workshift

As per Phase I

3

Preference for hypofractionated schemes

As per Phase I

4

Full maintenance of Simul CT and Dosimetry activities

As per Phase I

5

Simul CT disinfection at each workshift

As per Phase I

6

Staff: systematic hand washing before and after each clinical and technical procedure

As per Phase I

7

Maintenance of a single clinic room for the first radiotherapy visits. Interruption of oncological follow-up clinic room with phone contact of patients and viewing of laboratory and instrumental exams via telematics. On urgency, patients are booked in the single clinic room active

Full recovery of the oncological follow-up clinic room clinic with double daily shift 8.00 am–1.00 pm and 2.00 pm–5.00 pm with spacing appointments of 1 patient every 45 min

8

Preparation of 2 dedicated areas outside the waiting rooms for family members and carers. Entry into the Radiation Oncology center reserved for one family member and only for the first radiotherapy visits or on urgent cases

Preparation of a single pre-waiting room area for family members and carers. Entry into the Radiation Oncology center reserved for one family member and only for the first radiotherapy visits or on urgent cases

9

Triage area with nursing staff: (a) entry for 4 patients at a time with a distance of at least 1 m; (b) body temperature detection with Thermo can; (c) finding of respiratory symptoms, ocular disorders (conjunctivitis), dysgeusia and anosmia; (d) contacts with suspected COVID-19 by filling of the dedicated Hospital questionnaire; (e) obligation of surgical mask for patients and carers [18,19,20,21]

As per Phase I

10

Management of suspected case in triage for patients, staff, carers and third parties: if temperature ≥ 37.5° repetition after 10 min and if confirmed, access to the center is not allowed. Evaluation for deferral of planned clinical or technical performance: in the case of deferral, the patient is rescheduled; in the case of non-deferral, the patient accesses the service by adopting all the safety criteria indicated in points 12 and 13 [19]

As per Phase I

11

Double daily shift of all staff in order to prevent potential multiple infections

/

12

Personal protective equipment. (a) Visits: surgical mask and gloves; FFP2 mask with superimposed surgical mask in patients with respiratory symptoms; (b) Simul TC and Linear Accelerators: FFP2 mask with superimposed surgical mask and single-use gloves; systematic hand disinfection; visor or protective glasses for Head and Neck and respiratory tumors and for patients with respiratory symptoms [18,19,20,21]

As per Phase I

13

Symptomatic and asymptomatic positive COVID-19 patient: medical evaluation for treatment interruption based on the clinical disease status, with monitoring of the clinical status and treatment recovery after 2 consecutive negative swabs, symptomatic absence and negative CT scan. In the case of treatment continuation because it cannot be deferred: preparation of separate paths; bunker disinfection before and after treatment; FFP2 masks with superimposed surgical mask; single-use gloves and gowns; visors or protective glasses and overshoes for staff; separate and disinfected room for dressing and undressing [21]

As per Phase I

14

Maintenance of Department meetings for discussion of clinical cases and ongoing scientific work with limited number of professionals and spacing measures

Full recovery of Department Meetings without contingent number of professionals but with maintenance of the safety distance of at least 1 m

15

Maintaining of multidisciplinary Tumor Board meetings only by requesting consultations, e-mail correspondence, phone contacts and telematic platforms

Full recovery of multidisciplinary Tumor Board meetings