Jack Yang, Ph'D', Hansen Chen, MS, Scott Murphy, MS, Gin Wu, Ph'D', Smitha Gollamudi, MD, Sang Sim, - PowerPoint PPT Presentation

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Jack Yang, Ph'D', Hansen Chen, MS, Scott Murphy, MS, Gin Wu, Ph'D', Smitha Gollamudi, MD, Sang Sim,

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Jack Yang, Ph'D', Hansen Chen, MS, Scott Murphy, MS, Gin Wu, Ph'D', Smitha Gollamudi, MD, Sang Sim, – PowerPoint PPT presentation

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Title: Jack Yang, Ph'D', Hansen Chen, MS, Scott Murphy, MS, Gin Wu, Ph'D', Smitha Gollamudi, MD, Sang Sim,


1
Siemens 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

2
Clinical workflow at MMC
Information System
3
Information 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 !!!

4
Oncology is an Imaging Rich Field Now
Information rich but how to integrate these
modalities?
5
Work 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

6
How 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)

7
Lantis? (Impac?) Clinical Application with
Physics QA Process at MMC
8
Physics 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

9
Patient Electric Chart Check
  • Lantis electronic chart check for routine physics
    QA

10
Current Physics Machine QA in RV System
  • We have created a group of rtp files in Lantis to
    automate physics QA process (need machine
    interface)

11
Current 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

12
Current 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
13
Billing Code Charges in RV System
  • We charge all the work related to physics or
    planning on the fly no more mistakes or
    confusion !

14
Export Planning Data and Validation
  • We run the CRC check and patch the planning files
    to meet the Lantis import requirement (rtp format)

15
We 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)
16
Integration !Integration !Integration !
17
Information Pipeline !
CT
PET/CT
MR
PACS
NM
Courtesy of Siemens Medical Solutions USA, Inc
18
A Clinical Approach from the Vendor Suggested by
Clinical Users
  • Need more integration from various resources !!


Clinical Applications
3D CRT
IGRT
ART
IMRT
Workspaces
Components
19
COHERENCE? - Oncology Workspaces
Oncology Workflow Solutions
Physician
Dosimetrist
Physicist
Therapist
Courtesy of Siemens Medical Solutions USA, Inc
20
COHERENCE? Workspaces
Courtesy of Siemens Medical Solutions USA, Inc
21
Physicist Workspace as an example !Q What does
a physicist need/want for his/her clinical duty
under one operational workstation?
22
Plan 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
23
Plan 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
24
Independent 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
25
IMRT 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
26
Linear 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
27
Report 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
28
Image-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

29
PETCT - 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
30
Image-Guided Solutions
COHERENCEVolume Targeting
31
Basic A-Si structure for Cone Beam CT
amorphoussilicon
32
More 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
33
3D MV Cone Beam Approach
Courtesy of Siemens Medical Solutions USA, Inc
34
3D MV Cone Beam Approach
Courtesy of Siemens Medical Solutions USA, Inc
35
3D MV Cone Beam Approach
Courtesy of Siemens Medical Solutions USA, Inc
36
Radiation Therapy Clinical Decision Making Process
Simulation
Planning
Daily positioning
Verification
Dose delivery
  • Adaptive Radiation Therapy
  • Correction for Plan
  • Dose Warping
  • Dose Reconstruction

37
Siemens IGRT Workflow
Courtesy of Siemens Medical Solutions USA, Inc
38
What 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)

39
Cancer Treatment Roadmap
Courtesy of Siemens Medical Solutions USA, Inc
40
Conclusion
  • 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 !
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