Mobile Applications: Sometimes it is both Appropriate and Necessary To Move a TELESYNERGY® System to a New Location rather than Move Personnel to the System Location
For radiation oncology program applications involving the use of a videoconferencing system (e.g. a TELESYNERGY® ) many uses immediately come to mind including remote clinical consultations, videoconferencing for quality assurance, dosimetry issues, and distance learning programs for physicians. Multi-site professional seminars and symposiums, mentor, and professional education efforts with CME and CE credits can be facilitated. Community-based educational efforts, protocol-associated activities and patient navigator topics are also emphasized in the Cancer Disparities Research Program (CDRP) in clinical cancer research. The ability to safely and conveniently relocate the system to several locations may be extremely advantageous, particularly true for programs such as our Radiation Oncology Community Outreach Group (ROCOG) community outreach program. Unique to this ROCOG CDRP is a structure with five cooperating member facilities that are widely distributed over a large geographic area in western Pennsylvania. We present some selection and design considerations for a trailer-based mobility solution and summarize our initial results.
Methods and Materials
The UPMC McKeesport Hospital’s CDRP grant was designed and funded as a multi-site program; initial considerations included provisions for assuring use of the TELESYNERGY® at each of our partner locations. Safety, maneuverability, and cost were primary considerations for determining optimal methods for mobilization. Because the system was already cart-mounted (two or three equipment carts depending on TS version), we wanted to use this to our advantage to minimize equipment “break down” and “set up” effort which we targeted as less than 90 minutes total for each move. We discovered that there were many manufacturers of “TOY HAULERS” in the recreational vehicle industry that commonly had rear walls that doubled as fold down ramps for heavy snowmobile, motorcycle, quad runner, and other off-road vehicles used by outdoor enthusiasts. This general design proved to be an ideal choice for mobilizing our videoconferencing facilities. Additional selection criteria included open space within the unit for both personnel and equipment; high levels of floor, wall, and ceiling insulation; adequate heating and cooling capabilities to protect the equipment and personnel during extremes of weather; sufficient windows and ceiling vents to provide light and ventilation; a 12 volt lighting system for backup use during darkness for operations, loading and unloading; sturdy construction of floors, walls and cabinetry; and finally trailer ground clearance, suspension system, size and mobility (we suggest torsion suspension for smooth ride and a box length of 17-21 feet as maximum). Most important, equipment must be adequately protected during transit. Some more fragile components should be placed in cushioned cases (especially the system’s microscope, the plasma screen, and all other monitors). Other components should be strapped down in their location using heavy duty locking ratchet straps, a cargo mesh, and wide heavy duty velcro screwed down to cart tops, etc. Finally, all equipment carts and cases should be firmly secured to installed “D-rings” that are through bolted to beams within the cargo bed area. Crash test calculations to compute forces on 100, 200 and 300 pound masses ( carts, cases) can provide guidelines for strap and component strength requirements. These calculations are available from the Georgia State University Hyperphysics site at http://hyperphysics.phy-astr.gsu.edu/hbase/carcr.html . Hint: Use a 5 foot crush zone and 15 mph minimum speed to model a frontal collision! These calculation results, coupled with published industry and government strength recommendations, provided guidelines for selection and installation of appropriate tie-down components to assure equipment safety.
We were able to select and appropriately modify a trailer system designed to provide mobility and security for TELESYNERGY® and other video conferencing systems using a TOY HAULER trailer design with added equipment cases and strap down systems as illustrated in the two following figures:
On the left is the selected trailer, loaded and ready to relocate. The rear wall easily folds down to provide a ramp to move equipment carts and cases. The tow vehicle can be any ½ or ¾ ton pickup truck with a 2” receiver and required electrical pigtails. The cost for this basic trailer was $11,000, well under budgeted levels. As shown on the right, a view toward the front of the interior reveals the workbench with enclosed heating and electrical system where system screen cases can be strapped down for transit. On the floor are detention plates, D-rings and strapping at positions for the system carts. The microscope case is strapped down under the cart positioned at the upper right in the photo. The large plasma screen case is strapped down at the area of the photographer’s feet.
Finally all of the modifications we added including a 220v baseboard heating system, intrusion alarms/locking systems, equipment cases, as well as the tie down components totaled less than $2,500. Total costs for the mobility option thus were less than $13,500, a value that we consider extremely cost effective. We have moved the equipment over 400 miles without damage or loose wiring to report. Tear down and loading requires about one hour; unloading and set up require about 30-45 minutes. We consider these time effective activities.
Our first foray into the arena of mobile TELESYNERGY® systems was a programmed relocation of the system from UPMC McKeesport (southeast of Pittsburgh) to Jameson Health System in New Castle, PA (far northwest of Pittsburgh) for a twelve week period. During that time we held nine interdisciplinary Tumor Boards, six radiation oncology chart rounds, four major multi- site CDRP conferences and symposia (IMRT, Gamma Knife, vicryl mesh brachytherapy for lung), three St. Louis mentor conferences (physics and patient management), three educational and navigator conferences for the Lawrence County Cancer Coalition, two management, and fund raising events for hospital administration and two CE teleconferences for nursing. Our only technical problem was associated with ISDN PRI line service provider initiated startup delays, and a mid- term service interruption. Otherwise the relocation was favorable to all involved.
This mobility method for TELESYNERGY® relocation proved efficient, cost effective, and convenient for medical staff use. This approach may also be appropriate when considering other medical activities that would benefit from a mobile application capable of efficiently relocating a system or facility to a remote site.
Larry L. Schenken, PhD
Program Director for Professional Development & Education, TELESYNERGY® and Web-based Communication/Education
ROCOG Grant Offices
Third Floor Shaw Building
UPMC McKeesport Hospital
1500 Fifth Avenue
McKeesport PA 15132
Voice Office: 412.664.2944
Voice (cell) 412.999.6270