Into the breach.

Top Line: What happens when there is a cyber attack on a radiation oncology department?

The Study: In April 2021, Elekta experienced a cyber attack on its first-generation cloud storage system. The cloud system was taken offline, which interrupted record and verify systems (RVS) in multiple radiation oncology departments across the country. Here is an in-depth analysis of the response at Thomas Jefferson. The loss of RVS cloud backup meant the department couldn’t access who was receiving treatment and where they were in their treatment course. Many RVS interface with hospital electronic medical records to transfer information on a regular basis. So, the hospital EMR was used to determine patients on treatment and their cumulative dose and fraction. From there, back-up treatment plans were generated and transferred via DICOM directly to the linear accelerator with the recording of treatment delivery done on paper charts. Local file folders were created for the linear accelerator to access treatment plans. The rest of the documentation of treatment planning, QA, and delivery were all printed on paper and physically signed. Daily IGRT was captured with screen-shots and reviewed daily by providers. Within a week, 95% of patients were back on treatment. It took over a month for a return of full functionality of the RVS. So, what were the important lessons learned? While cloud systems are increasingly used in radiation oncology, local, frequent backup of RVS data provides essential information that can be used to deliver treatment when remote systems are compromised. Second, consider having a formal paper charting process for emergency operation and make sure staff are familiarized with how the paper charting process works. Last, the authors recommend standardized, common data elements and information across vendor software applications so there are no vendor road-blocks to data transfer in emergency situations.

TBL: Ransomware attacks are a real concern in modern radiation oncology, but there are ways to prepare your department to minimize the impact on patient care. | Harrison, Pract Radiat Oncol 2021