Title: Jack Yang, Ph'D', Hansen Chen, MS, Scott Murphy, MS, Gin Wu, Ph'D', Smitha Gollamudi, MD, Sang Sim,
1Siemens Informatics Tools in Radiation Oncology
- Jack Yang, Ph.D., Hansen Chen, MS, Scott Murphy,
MS, Gin Wu, Ph.D., Smitha Gollamudi, MD, Sang
Sim, MD. Mitch Weiss, MD - Institute for Advanced Radiation Oncology
- Monmouth Medical Center
- Long Branch, NJ 07740
2Clinical workflow at MMC
Information System
3Information Explosion !
- We have more diagnostic and therapy imaging
information than ever - We have more needs for information transfer and
verification in the department - We have more database requirement for patients
- We have more complicated procedures which are
information hungry - Integration of information becomes necessary and
is very challenging !!!
4Oncology is an Imaging Rich Field Now
Information rich but how to integrate these
modalities?
5Work Flow !
- Process needs integration from consultation to
follow-up - Procedures need integration from External to
Brachytherapy - Staff need integration from Nurses to
Therapists - Departments need integration Radiology, NM,
medical and radiation oncology - Treatment needs integration Patient
relocalization to repositioning
6How to improve clinical workflow?
- Assess the needs of the radiation therapy
clinical chain - Changing from task driven to staff driven
(concept of staff oriented workspace) - Put all the necessary modules under one
workstation and improve the workflow - Data should be accessed easily from the same
resources, not from different running modules or
programs (resource integration)
7Lantis? (Impac?) Clinical Application with
Physics QA Process at MMC
8Physics Related Tasks
- Physics QA check Patient specific, plan check
and chart review, etc. - Rtp QA files generation Machine specific, LINAC
functionality checks and data analysis for
routine and IMRT machine QA - Planning Verification Data transfer and
verification from planning to delivery - Billing verification and gateway connection
help to capture charges and integrate hospital
HL-7 connection for charge export
9Patient Electric Chart Check
- Lantis electronic chart check for routine physics
QA
10Current Physics Machine QA in RV System
- We have created a group of rtp files in Lantis to
automate physics QA process (need machine
interface)
11Current Physics Machine QA in RV System
- We also created an auto-sequencing file which
includes all the necessary test conditions for
data acquisition in Lantis
12Current Physics Machine QA in RV System
- We executed the Autosequencing files while
measuring and collecting data for analysis
(imported into our program for data analysis)
The delivery sequence can be easily compiled and
imported to the Lantis? system, saved as a
template and delivered with data transferred via
RS-232 interface, and imported to the Excel
worksheet for real-time comparison
13Billing Code Charges in RV System
- We charge all the work related to physics or
planning on the fly no more mistakes or
confusion !
14Export Planning Data and Validation
- We run the CRC check and patch the planning files
to meet the Lantis import requirement (rtp format)
15We have applied lots of application tools,
however, for LINAC and patient QAs there are
still missing links to be addressed and
integrated into an easy executable format
!(i.e.. We have to modify and integrate modules
during the radiation therapy process)
16Integration !Integration !Integration !
17Information Pipeline !
CT
PET/CT
MR
PACS
NM
Courtesy of Siemens Medical Solutions USA, Inc
18A Clinical Approach from the Vendor Suggested by
Clinical Users
- Need more integration from various resources !!
Clinical Applications
3D CRT
IGRT
ART
IMRT
Workspaces
Components
19COHERENCE? - Oncology Workspaces
Oncology Workflow Solutions
Physician
Dosimetrist
Physicist
Therapist
Courtesy of Siemens Medical Solutions USA, Inc
20COHERENCE? Workspaces
Courtesy of Siemens Medical Solutions USA, Inc
21Physicist Workspace as an example !Q What does
a physicist need/want for his/her clinical duty
under one operational workstation?
22Plan Evaluation and Plan Comparison
- Plan Evaluation and Plan Comparison
- 3 main functions in clinical work
- Import one plan and evaluate slice by slice,
organ by organ, using images, isodoses or DVHs. - DVH Evaluation or TCP- NTCP radiobiology
evaluation (WIP) - Compare plans import two plans (even from
different RTP systems) and evaluate them using
the described tools.
Courtesy of Siemens Medical Solutions USA, Inc
23Plan Validation and Editing
- Plan Visualization and Editing
- Import, visualize a plan
- Analyze the plan integrity
- Clean-up functions if necessary, as adding
missing data, tolerances or other mandatory
information. - (Work in Progress)
WIP
Courtesy of Siemens Medical Solutions USA, Inc
24Independent MU verification
- Independent MU verification
- Run a fast 3D conformal or IMRT (not yet) fast
calculation for verification proposed against MU
calculation from RTP. - System compares calculated results against
imported from RTP and shows the differences.
Courtesy of Siemens Medical Solutions USA, Inc
25IMRT phantom QA
- Phantom QA
- Data from Measurement devices (dose measurements)
projected at the phantom measurement point. - Isodoses from RTP showed with the Phantom CT
images - Compare measured doses against calculated,
evaluation tools available. - Open scanned film images ( from integrated
interface to Vidar scanner) as DICOM doses - Open imported plan
- Match, calculate errors
- Overlay on-to DRR or reconstructed images
- Evaluation tools as errors, trends, graphics,
histograms
Courtesy of Siemens Medical Solutions USA, Inc
26Linear Accelerator QA
- Linear Accelerator QA
- Pattern Customizer
- Protocols for periodical QA
- Image Guided QA
- Optical, Geometrical, Mechanical and
Radiation test procedures - Dosimetry evaluation tools
Courtesy of Siemens Medical Solutions USA, Inc
27Report Generator
Reports Every activity can be documented using
DICOM report functionalities, and after used as
XML or other conventional way for reporting.
Courtesy of Siemens Medical Solutions USA, Inc
28Image-Guided RT as we all talk about this !!
- It is a very technical driven project.
- It needs lots of resources and coordination to
make this project smooth and be successful. - Not only the information has to be correct and
stored fast, most importantly, has to be
processed quickly to make clinical decision for
treatment. - It is one of the important steps to extend the
successful implementation of IMRT and hopefully
improve the clinical outcome
29PETCT - based Radiotherapy Planning in patients
with NSCLC How to integrate information
properly?
- Helps to adjust the boost volume
- 20 increase of PTV by 60 of patients
- 20 reduction of PTV by 40
- Dose reduction for organs at risk by lt20
It is still evolving inside the information
integration process !!
M.Schmücking. Nuklearmedizin, 2000 Erdi YE.
Radiotherapy Oncology, 2002
30Image-Guided Solutions
COHERENCEVolume Targeting
31Basic A-Si structure for Cone Beam CT
amorphoussilicon
32More specifically about the definition ..
Image Guided Radiation Therapy - IGRT A
radiotherapy procedure where, during the course
of treatment, any deviations from the target
location are monitored via image-guidance and
corrected for with the goal that the original
prescription is fulfilled Volume Targeting -
VT IGRT with software enablers to monitor and
correct for target location AND shape Adaptive
Radiation Therapy - ART A radiotherapy procedure
where, during the course of treatment,
any deviations from the planned target location
shape or dose distribution are monitored via
image guidance and other techniques and corrected
for with the goal that the original prescription
is fulfilled or further optimized
Courtesy of Siemens Medical Solutions USA, Inc
333D MV Cone Beam Approach
Courtesy of Siemens Medical Solutions USA, Inc
343D MV Cone Beam Approach
Courtesy of Siemens Medical Solutions USA, Inc
353D MV Cone Beam Approach
Courtesy of Siemens Medical Solutions USA, Inc
36Radiation Therapy Clinical Decision Making Process
Simulation
Planning
Daily positioning
Verification
Dose delivery
- Adaptive Radiation Therapy
- Correction for Plan
- Dose Warping
- Dose Reconstruction
37Siemens IGRT Workflow
Courtesy of Siemens Medical Solutions USA, Inc
38What is Volume Targeting?
- Plan isocenter is at a known location relative to
the PTV - LINAC isocenter should be at the same location
relative to the target volume at treatment time - Align target volume on treatment image with PTV
- Shift LINAC isocenter to plan isocenter (by
automatic couch movement and re-verification
process)
39Cancer Treatment Roadmap
Courtesy of Siemens Medical Solutions USA, Inc
40Conclusion
- Information available for radiotherapy process
grows exponentially. - Integration is the key and we have so many tools
in hand but they dont communicate well each
other. - More computer integrated applications will be
performed on a single workstation - Radiation therapy informatics will improve the
clinical workflow and hopefully improve the
outcome. - Real time imaging and treatment validation
process will be the mainstream of patient care
for the next few years. - Vendor support is important and need clinical
physics guidance !