SGRT 101 The Seven Stages of SGRT Adoption

Ryan Hecox,
MS, DABR Lead Medical Physicist, Intermountain Health – Canyons Region

1. Confidential and property of Intermountain Health

2. SGRT 101:
The Seven Stages
of SGRT
Ryan Hecox
Lead Medical Physicist
Intermountain Health - Canyons

3. Intermountain Utah
SGRT Experience
•9 Radiation Oncology locations
•11 Linacs
•~3000 EBRT cases per year
•SGRT on 100% of linacs by 2025
•4 VisionRT AlignRT systems
•2 to be added by 2025
•3 Varian Identify systems
•3 to be added by 2025
•All 5 locations with SGRT are fully SGRT for all patients
•No mark or tattoos
•Every patient, All treatment sites
•Some patterns have emerged…..
Identify
AlignRT

4. SGRT Champion
vs
“They way we have always done it”
Excitement
&
Opposition

5. SGRT
Champion
vs
“They way we
have always
done it”
Excitement
&
Opposition
To Do:
GO SLOW
Basic system function
Education!
Start indexing at sim
Milestones
The system works!
Physics can understand
how to support/admin
Fears, concerns,
hopes, promises are
vocalized
Pitfalls
Don’t give into detractors.
Do the research to
answer any questions or
concerns.
Ready to
Move On
When you are ready to enable
the system clinically for at
least SOME patients

6. To Do:
GO SLOW
Basic system function
Education!
Start indexing at sim
Milestones
The system works!
Physics can understand
how to support/admin
Fears, concerns,
hopes, promises are
vocalized
Pitfalls
Don’t give into detractors
Do the research to
answer any questions or
concerns
Ready to
Move On
When you are ready to enable
the system clinically for at
least SOME patients
Excitement
&
Opposition
SGRT
Champion
vs
“They way we
have always
done it”

7. To Do:
GO SLOW
Basic system function
Education!
Start indexing at sim
Milestones
The system works!
Physics can understand
how to support/admin
Fears, concerns,
hopes, promises are
vocalized
Pitfalls
Don’t give into detractors
Do the research to
answer any questions or
concerns
Ready to
Move On
When you are ready to enable
the system clinically for at
least SOME patients
Excitement
&
Opposition
SGRT
Champion
vs
“They way we
have always
done it”

8. Excitement
&
Opposition
SGRT
Champion
vs
“They way we
have always
done it”
To Do:
GO SLOW
Basic system function
Education!
Start indexing at sim
Milestones
The system works!
Physics can understand
how to support/admin
Fears, concerns,
hopes, promises are
vocalized
Pitfalls
Don’t give into detractors
Do the research to
answer any questions or
concerns
Ready to
Move On
When you are ready to enable
the system clinically for at
least SOME patients

9. Excitement
&
OppositionThe
Pause

10. Let the system become a non-
threatening part of the clinic
The
Pause

11. Let the system
become a non-
threatening
part of the
clinic
The
Pause
Work To
Do
Build comfort
Be Patient
Gain experience with the
behavior, buttons &
interface
Milestones
SGRT is turned on everyday for
some patients
SGRT is on for most patients
during treatment to monitor
stability
SGRT is looked at during setup
on a “casual” basis
Pitfalls
Don’t learn how to
disable/avoid/bypass the SGRT system to “make it go away”.
Get familiar with
seeing it in action.
Any claims of
increased efficiency or ease of use will be strongly pushed
against.
Ready to
Move On
When a therapist
finally
asks, “Well, what
about this
situation……”

12. The
Pause
Work To
Do
Build comfort
Be Patient
Gain experience with the
behavior, buttons &
interface
Milestones
SGRT is turned on everyday for
some patients
SGRT is on for most patients
during treatment to monitor
stability
SGRT is looked at during setup
on a “casual” basis
Pitfalls
Don’t learn how to disable or bypass
the SGRT system to “make it go
away”
Get familiar with
seeing it in action
Any claims of increased
efficiency or ease of use will not be
well received
Ready to
Move On
When a therapist
finally
asks, “Well, what
about this
situation……”
Let the system
become a non-
threatening
part of the
clinic

13. The
Pause
Work To
Do
Build comfort
Be Patient
Gain experience with the
behavior, buttons &
interface
Milestones
SGRT is turned on everyday for
some patients
SGRT is on for most patients
during treatment to monitor
stability
SGRT is looked at during setup
on a “casual” basis
Pitfalls
Don’t learn how to disable or bypass
the SGRT system to “make it go
away”
Get familiar with
seeing it in action
Any claims of increased
efficiency or ease of use will not be
well received
Ready to
Move On
When a therapist
finally
asks,
“Well, what about this
situation?”
Let the system
become a non-
threatening
part of the
clinic

14. The
Pause
Work To
Do
Build comfort
Be Patient
Gain experience with the
behavior, buttons &
interface
Milestones
SGRT is turned on everyday for
some patients
SGRT is on for most patients
during treatment to monitor
stability
SGRT is looked at during setup
on a “casual” basis
Pitfalls
Don’t learn how to disable or bypass
the SGRT system to “make it go
away”
Get familiar with
seeing it in action
Any claims of increased
efficiency or ease of use will not be
well received
Ready to
Move On
When a therapist
finally
asks,
“Well, what about this
situation?”
Let the system
become a non-
threatening
part of the
clinic

15. Baby Steps
Excitement
&
OppositionThe
Pause

16. Questions about how the system
COULD be used come up
Baby Steps

17. Work To
Do
Find path of least
resistance for YOUR clinic
-DIBH
-SBRT
-SGRT before tattoos on certain
patients
-Collect data on shifts using different workflows
-?????
Empower users that “get it” to drive
the conversation
Milestones
SOMETHING now
incorporates SGRT as a core
part of the workflow
SGRT is USED to setup/position
patients
Pitfalls
The spread in comfort will
begin to further spread out.
Don’t let
detractors get in the way!
DO NOT
PUSH efficiency
too soon.
Ready to
Move On
You know
WHEN
and HOW
to use SGRT
Questions
about how the
system
COULD be
used come up
Baby Steps

18. Work To
Do
Find path of least
resistance for YOUR clinic
-DIBH
-SBRT
-SGRT before tattoos on certain
patients
-Collect data on shifts using different workflows
-?????
Empower users that “get it” to drive
the conversation
Milestones
SOMETHING now
incorporates SGRT as a core
part of the workflow
SGRT is USED to setup/position
patients
Pitfalls
The spread
in comfort will increase
DO NOT
PUSH efficiency
too soon
Ready to
Move On
You know
WHEN
and HOW
to use SGRT
Questions
about how the
system
COULD be
used come up
Baby Steps

19. Work To
Do
Find path of least
resistance for YOUR clinic
-DIBH
-SBRT
-SGRT before tattoos on certain
patients
-Collect data on shifts using different workflows
-?????
Empower users that “get it” to drive
the conversation
Milestones
SOMETHING now
incorporates SGRT as a core
part of the workflow
SGRT is USED to setup/position
patients
Pitfalls
The spread
in comfort will increase
DO NOT
PUSH efficiency
too soon
Ready to
Move On
You know
WHEN
and HOW
to use SGRT
Questions
about how the
system
COULD be
used come up
Baby Steps

20. Work To
Do
Find path of least
resistance for YOUR clinic
-DIBH
-SBRT
-SGRT before tattoos on certain
patients
-Collect data on shifts using different workflows
-?????
Empower users that “get it” to drive
the conversation
Milestones
SOMETHING now
incorporates SGRT as a core
part of the workflow
SGRT is USED to setup/position
patients
Pitfalls
The spread
in comfort will increase
DO NOT
PUSH efficiency
too soon
Ready to
Move On
You know
WHEN
and HOW
to use SGRT
Questions
about how the
system
COULD be
used come up
Baby Steps

21. Baby Steps
Excitement
&
Opposition
Organic Growth
The
Pause

22. Growth is occurring without
telling people what to do
Organic
Growth

23. Work To
Do
Stay out of the way!
Do your homework
on how
others use SGRT
Milestones
Therapists use using SGRT for
setup because they want to
SGRT is suggested as
the solution for clinical
problems
All body sites use SGRT for
setup
Pitfalls
The spread
in comfort it at its
maximum.
Fast movers feel
held back
and slow adopters
feel pressured.
Ready to
Move On
When
you hear:
“Why
can’t we just……”
Growth is
occurring
without telling
people what
to do
Organic
Growth

24. Work To
Do
Stay out of the way!
Do your homework
on how
others use SGRT
Milestones
Therapists use using SGRT for
setup because they want to
SGRT is suggested as
the solution for clinical
problems
All body sites use SGRT for
setup
Pitfalls
The spread
in comfort it at its
maximum.
Fast movers feel
held back
and slow adopters
feel pressured.
Ready to
Move On
When
you hear:
“Why
can’t we just……”
Growth is
occurring
without telling
people what
to do
Organic
Growth
.com

25. Work To
Do
Stay out of the way!
Do your homework
on how
others use SGRT
Milestones
Therapists use using SGRT for
setup because they want to
SGRT is suggested as
the solution for clinical
problems
All body sites use SGRT for
setup
Pitfalls
The spread
in comfort is at a
maximum
Fast movers feel
held back
and slow adopters
feel pressured
Ready to
Move On
When
you hear:
“Why
can’t we just……”
Growth is
occurring
without telling
people what
to do
Organic
Growth

26. Work To
Do
Stay out of the way!
Do your homework
on how
others use SGRT
Milestones
Therapists use using SGRT for
setup because they want to
SGRT is suggested as
the solution for clinical
problems
All body sites use SGRT for
setup
Pitfalls
The spread
in comfort is at a
maximum
Fast movers feel
held back
and slow adopters
feel pressured
Ready to
Move On
When
you hear:
“Why
can’t we just……”
Growth is
occurring
without telling
people what
to do
Organic
Growth

27. Work To
Do
Stay out of the way!
Do your homework
on how
others use SGRT
Milestones
Therapists use using SGRT for
setup because they want to
SGRT is suggested as
the solution for clinical
problems
All body sites use SGRT for
setup
Pitfalls
The spread
in comfort is at a
maximum
Fast movers feel
held back
and slow adopters
feel pressured
Ready to
Move On
When
you hear:
“Why
can’t we just……”
Growth is
occurring
without telling
people what
to do
Organic
Growth

28. Baby Steps
Excitement
&
Opposition
Organic Growth
The
Pause
Evolution

29. Workflows are changed to
depend on SGRT
Evolution

30. Work To
Do
Modify policies, on-boarding
standards etc.
Listen to your users and
enable them to get the most out
of the system
Milestones
Super-users are not needed to
make it go smooth
Time gains and efficiency will
appear naturally
Focus is on how to do it right
Tattoos are “secretly” ignored
Pitfalls
COMMUNICATION
Volume of change makes
errors much more likely
Ready to
Move On
SGRT is “normal” and
expected to be used
SGRT workflows
now seem quick and efficient
Workflows are
changed to
depend on
SGRT
Evolution

31. Work To
Do
Modify policies, on-boarding
standards etc.
Listen to your users and
enable them to get the most out
of the system
Milestones
Super-users are not needed to
make it go smooth
Time gains and efficiency will
appear naturally
Focus is on how to do it right
Tattoos are “secretly” ignored
Pitfalls
COMMUNICATION
Volume of change makes
errors much more likely
Ready to
Move On
SGRT is “normal” and
expected to be used
SGRT workflows
now seem quick and efficient
Workflows are
changed to
depend on
SGRT
Evolution

32. Work To
Do
Modify policies, on-boarding
standards etc.
Listen to your users and
enable them to get the most out
of the system
Milestones
Super-users are not needed to
make it go smooth
Time gains and efficiency will
appear naturally
Focus is on how to do it right
Tattoos are “secretly” ignored
Pitfalls
COMMUNICATION
Volume of change makes
errors much more likely
Ready to
Move On
SGRT is “normal” and
expected to be used
SGRT workflows
now seem quick and efficient
Workflows are
changed to
depend on
SGRT
Evolution

33. Work To
Do
Modify policies, on-boarding
standards etc.
Listen to your users and
enable them to get the most out
of the system
Milestones
Super-users are not needed to
make it go smooth
Time gains and efficiency will
appear naturally
Focus is on how to do it right
Tattoos are “secretly” ignored
Pitfalls
COMMUNICATION
Volume of change makes
errors much more likely
Ready to
Move On
SGRT is “normal” and
expected to be used
SGRT workflows are
quick and efficient
Workflows are
changed to
depend on
SGRT
Evolution

34. Work To
Do
Modify policies, on-boarding
standards etc.
Listen to your users and
enable them to get the most out
of the system
Milestones
Super-users are not needed to
make it go smooth
Time gains and efficiency will
appear naturally
Focus is on how to do it right
Tattoos are “secretly” ignored
Pitfalls
COMMUNICATION
Volume of change makes
errors much more likely
Ready to
Move On
SGRT is “normal” and
expected to be used
SGRT workflows are
quick and efficient
Workflows are
changed to
depend on
SGRT
Evolution

35. Baby Steps
Excitement
&
Opposition
Organic Growth
The
Pause
Evolution
Owning
the Tool

36. Therapists don’t hesitate to operate
SGRT and can fully predict its behavior
and how to avoid issues
Owning
the Tool

37. Work To
Do
Wrap up any remaining
usage goals
Officially eliminate
marks & tattoos
Limiting factor is time & effort
not ability to imagine solutions
Milestones
Therapists state they
can’t imagine treating without SGRT
Naturally discussing
how easy and beneficial SGRT is,
even if they were the hold
outs !
Pitfalls
Physicians & physicists that
have avoiding accepting this
will impact their practice need to be nudged.
Eliminate variations and
focus on standardizing
the workflow for all MDs & patients
Ready to
Move On
SGRT is now the
standard
and is RELIED
on
clinically
Therapists
don’t hesitate
to operate
SGRT and can
fully predict
its behavior
and how to
avoid issues
Owning
the Tool

38. Work To
Do
Wrap up any remaining
usage goals
Officially eliminate
marks & tattoos
Limiting factor is time & effort
not ability to imagine solutions
Milestones
Therapists state they
can’t imagine treating without SGRT
Naturally discussing
how easy and beneficial SGRT is,
even if they were the hold
outs !
Pitfalls
Physicians & physicists that
have avoided accepting
SGRT will impact their practice need
to be nudged.
Eliminate variations and
focus on standardizing
the workflow for all MDs & patients
Ready to
Move On
SGRT is now the
standard
and is RELIED
on
clinically
Therapists
don’t hesitate
to operate
SGRT and can
fully predict
its behavior
and how to
avoid issues
Owning
the Tool

39. Work To
Do
Wrap up any remaining
usage goals
Officially eliminate
marks & tattoos
Limiting factor is time & effort
not ability to imagine solutions
Milestones
Therapists state they
can’t imagine treating without SGRT
Naturally discussing
how easy and beneficial SGRT is,
even if they were the hold
outs !
Pitfalls
Physicians & physicists that
have avoided accepting
SGRT will impact their practice need
to be nudged.
Eliminate variations and
focus on standardizing
the workflow for all MDs & patients
Ready to
Move On
SGRT is now the
standard
and is RELIED
on
clinically
Therapists
don’t hesitate
to operate
SGRT and can
fully predict
its behavior
and how to
avoid issues
Owning
the Tool

40. Work To
Do
Wrap up any remaining
usage goals
Officially eliminate
marks & tattoos
Limiting factor is time & effort
not ability to imagine solutions
Milestones
Therapists state they
can’t imagine treating without SGRT
Naturally discussing
how easy and beneficial SGRT is,
even if they were the hold
outs !
Pitfalls
Physicians & physicists that
have avoided accepting
SGRT will impact their practice need
to be nudged.
Eliminate variations and
focus on standardizing
the workflow for all MDs & patients
Ready to
Move On
SGRT is now the
standard
and is RELIED
on
clinically
Therapists
don’t hesitate
to operate
SGRT and can
fully predict
its behavior
and how to
avoid issues
Owning
the Tool

41. Baby Steps
Excitement
&
Opposition
Organic Growth
The
Pause
Evolution
Owning
the Tool
No Going
Back

42. SGRT gives you freedom to
focus on your patients and
eliminate past methods
No Going
Back

43. SGRT gives
you freedom
to focus on
your patients
and eliminate
past methods
Work To
Do
Clean house
Toss tattoo supplies
Decommission CT lasers
Milestones
No double work is occurring, “just in
case”
SGRT is in harmony with
immobilization & imaging
Confidence in the accuracy of
patient setup is at an all time high
Pitfalls
Let go of old ways.
Relax and
embrace the work
you have
done
Ready to
Move On
Be ready
for
whatever
comes next!
No Going
Back
RIP CT Laser Computer

44. SGRT gives
you freedom
to focus on
your patients
and eliminate
past methods
Work To
Do
Clean house
Toss tattoo supplies
Decommission CT lasers
Milestones
No double work is occurring, “just in
case”
SGRT is in harmony with
immobilization & imaging
Confidence in the accuracy of
patient setup is at an all time high
Pitfalls
Let go of old ways.
Relax and
embrace the work
you have
done
Ready to
Move On
Be ready
for
whatever
comes next!
No Going
Back

45. SGRT gives
you freedom
to focus on
your patients
and eliminate
past methods
Work To
Do
Clean house
Toss tattoo supplies
Decommission CT lasers
Milestones
No double work is occurring, “just in
case”
SGRT is in harmony with
immobilization & imaging
Confidence in the accuracy of
patient setup is at an all time high
Pitfalls
Let go of old ways.
Relax and
embrace the work
you have
done
Ready to
Move On
Be ready
for
whatever
comes next!
No Going
Back

46. SGRT gives
you freedom
to focus on
your patients
and eliminate
past methods
Work To
Do
Toss tattoo supplies
Decommission CT lasers
Milestones
No double work is occurring, “just in
case”
SGRT is in harmony with
immobilization & imaging
Confidence in the accuracy of
patient setup is at an all time high
Pitfalls
Let go of old ways.
Relax and
embrace the work
you have
done
Ready to
Move On
Be ready
for
whatever
comes next!
No Going
Back

47. Baby Steps
Excitement
&
Opposition
Organic Growth
The
Pause
Evolution
Owning
the Tool
No Going
Back

48. Thank You

49. Baby Steps
Excitement
&
Opposition
Organic Growth
The
Pause
Evolution
Owning
the Tool
No Going
Back