improving safety in radiation oncology through the development and testing of ihe radiation oncology...

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Results: The average transfer time per image was 1.2±0.5 seconds and the average time to conduct a treatment field localization ranged from 35.0 to 260.5 seconds. Besides, it took an average of 4.8 seconds to open an image file in the PDA. The image accuracy including the field dimension indicators before and after transmission was within ±1.0 mm. Conclusions: Overall, the first prototype of the tele-localization system was able to meet the required objectives with reasonable operation speed and accuracy. Author Disclosure: V. Wu, None; F. Tang, None. 2637 Improving Safety in Radiation Oncology through the Development and Testing of IHE Radiation Oncology Integration Profiles B. H. Curran 1 , 2 , M. Abdel-Wahab 3 , S. J. Swerdloff 4 , C. Field 5 , M. Miettinen 6 , J. Palta 7 , P. Tripuraneni 8 1 Department of Radiation Oncology, Rhode Island Hospital, Providence, RI, 2 Alpert Medical School of Brown University, Providence, RI, 3 Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, 4 Elekta, Sunnyvale, CA, 5 Cross Cancer Institute, Edmonton, AB, Canada, 6 Varian Medical Systems, Palo Alto, CA, 7 Department of Radiation Oncology, University of Florida, Gainesville, FL, 8 Department of Radiation Oncology, Scripps Institute, La Jolla, CA Purpose/Objective(s): The planning and delivery of radiation oncology treatments have increased in complexity at a rapid rate over the past decade. As a consequence, our ability to insure the safety and quality of information flow through the process has diminished, requiring significant increases in personnel, time, and resources in order to achieve a clinically acceptable treatment environment. In response to this challenge, Integrating the Healthcare Enterprise (IHE) efforts in radiation oncology (IHE-RO) have focused on identifying significant issues, developing solutions, and testing them in clinically realistic environ- ments. Materials/Methods: The IHE-RO Planning Committee (PC), consisting of clinicians and industry personnel, each year solicits Use Cases illustrating issues that need to be solved in the radiation oncology process. These Use Cases are discussed and pri- oritized by the PC and then released to the Technical Committee (TC) for development. The medical physicists and engineers of the TC review the selected Use Cases and produce an Integration Profile (IP), a detailed process describing the communication requirements for resolving the issues raised. Test Tools are then constructed to assist manufacturers in producing applications that meet the requirements of the IP. Finally, vendors test their implementations at a Connectathon, where applications that interact along the process defined by the IP must prove that interactions occur reliably and safely in front of a panel of clinical experts. Results: To date, 5 IPs have been developed in areas of basic and advanced treatment planning, multimodality image regis- tration, exchange of dose calculation matrices, and treatment delivery workflow. Three profiles have been tested through the use of Test Tools and Connectathons. During this testing, problems in communication of image orientation, spatial registra- tion, contour and region-of-interest definition, and dose values have been identified and resolved prior to release to the clinical user. Conclusions: The IHE-RO process has resulted in the development of commercial products that have undergone an extensive testing regimen. Manufacturers are able to show conformance to clinically relevant IPs in a vendor-neutral environment that allows cooperative testing by multiple vendors and publication of successful results. This benefits clinicians by providing them with products that have been shown to be interoperable thus improving the efficiency and effectiveness of the radiation oncology process. Author Disclosure: B.H. Curran, None; M. Abdel-Wahab, None; S.J. Swerdloff, Elekta, A. Employment; Tomotherapy, E. Owner- ship Interest; C. Field, None; M. Miettinen, Varian Medical Systems, A. Employment; Varian Medical Systems, E. Ownership Interest; J. Palta, None; P. Tripuraneni, CMO, Viewray Inc, A. Employment; VP, Vantage Oncology, A. Employment; Viewray Inc., E. Ownership Interest. 2638 A Simple Technique for Scoring Radiotherapy Treatment Plans G. Field, H. Warkentin, A. Syme, K. Powell, R. Scrimger, M. Parliament, N. Jha, M. MacKenzie Cross Cancer Institute, Edmonton, AB, Canada Purpose/Objective(s): A system that scores radiotherapy treatment plans in a manner consistent with clinical practice would be extremely useful for developing objective criteria for dosimetry education, knowledge transfer from experienced to novice treat- ment planners, and comparing different treatment planning systems. Materials/Methods: A spreadsheet was developed to score radiotherapy treatment plans based on user-provided metrics. These metrics include dose-volume constraints, treatment delivery time, and time to prepare the plan. Each metric was assigned a relative weight, with incentives for exceeding the specified goal and penalties for failing to achieve the goal. The metrics were normalized such that if all constraints were satisfied, but not exceeded, the plan received a score of 100. If penalties were incurred, they could be offset with bonus points. Participants with a range of treatment planning expertise, and full knowledge of the scoring system, generated plans on multiple copies of a single patient data set. The spreadsheet was populated with dose-volume data, the treatment time, and planning time. The score for each metric, and the total score, was calculated and displayed. Participants were given the opportunity to further optimize the plan to improve their score. Radiation Oncologists (ROs) categorized the plans into one of: exceptional, acceptable, marginal, or unacceptable. The plans were ranked within each category and numerical scores ranging from 83 - 110 were associated with each plan. Each treatment plan was scored five times: twice using different metric weights and once by each of three ROs. A statistical analysis was performed. S488 I. J. Radiation Oncology d Biology d Physics Volume 78, Number 3, Supplement, 2010

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S488 I. J. Radiation Oncology d Biology d Physics Volume 78, Number 3, Supplement, 2010

Results: The average transfer time per image was 1.2±0.5 seconds and the average time to conduct a treatment field localizationranged from 35.0 to 260.5 seconds. Besides, it took an average of 4.8 seconds to open an image file in the PDA. The image accuracyincluding the field dimension indicators before and after transmission was within ±1.0 mm.

Conclusions: Overall, the first prototype of the tele-localization system was able to meet the required objectives with reasonableoperation speed and accuracy.

Author Disclosure: V. Wu, None; F. Tang, None.

2637 Improving Safety in Radiation Oncology through the Development and Testing of IHE Radiation Oncology

Integration Profiles

B. H. Curran1,2, M. Abdel-Wahab3, S. J. Swerdloff4, C. Field5, M. Miettinen6, J. Palta7, P. Tripuraneni8

1Department of Radiation Oncology, Rhode Island Hospital, Providence, RI, 2Alpert Medical School of Brown University,Providence, RI, 3Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, 4Elekta,Sunnyvale, CA, 5Cross Cancer Institute, Edmonton, AB, Canada, 6Varian Medical Systems, Palo Alto, CA, 7Department ofRadiation Oncology, University of Florida, Gainesville, FL, 8Department of Radiation Oncology, Scripps Institute, La Jolla, CA

Purpose/Objective(s): The planning and delivery of radiation oncology treatments have increased in complexity at a rapidrate over the past decade. As a consequence, our ability to insure the safety and quality of information flow through the processhas diminished, requiring significant increases in personnel, time, and resources in order to achieve a clinically acceptabletreatment environment. In response to this challenge, Integrating the Healthcare Enterprise (IHE) efforts in radiation oncology(IHE-RO) have focused on identifying significant issues, developing solutions, and testing them in clinically realistic environ-ments.

Materials/Methods: The IHE-RO Planning Committee (PC), consisting of clinicians and industry personnel, each year solicitsUse Cases illustrating issues that need to be solved in the radiation oncology process. These Use Cases are discussed and pri-oritized by the PC and then released to the Technical Committee (TC) for development. The medical physicists and engineers ofthe TC review the selected Use Cases and produce an Integration Profile (IP), a detailed process describing the communicationrequirements for resolving the issues raised. Test Tools are then constructed to assist manufacturers in producing applicationsthat meet the requirements of the IP. Finally, vendors test their implementations at a Connectathon, where applications thatinteract along the process defined by the IP must prove that interactions occur reliably and safely in front of a panel of clinicalexperts.

Results: To date, 5 IPs have been developed in areas of basic and advanced treatment planning, multimodality image regis-tration, exchange of dose calculation matrices, and treatment delivery workflow. Three profiles have been tested through theuse of Test Tools and Connectathons. During this testing, problems in communication of image orientation, spatial registra-tion, contour and region-of-interest definition, and dose values have been identified and resolved prior to release to the clinicaluser.

Conclusions: The IHE-RO process has resulted in the development of commercial products that have undergone an extensivetesting regimen. Manufacturers are able to show conformance to clinically relevant IPs in a vendor-neutral environment thatallows cooperative testing by multiple vendors and publication of successful results. This benefits clinicians by providingthem with products that have been shown to be interoperable thus improving the efficiency and effectiveness of the radiationoncology process.

Author Disclosure: B.H. Curran, None; M. Abdel-Wahab, None; S.J. Swerdloff, Elekta, A. Employment; Tomotherapy, E. Owner-ship Interest; C. Field, None; M. Miettinen, Varian Medical Systems, A. Employment; Varian Medical Systems, E. OwnershipInterest; J. Palta, None; P. Tripuraneni, CMO, Viewray Inc, A. Employment; VP, Vantage Oncology, A. Employment; ViewrayInc., E. Ownership Interest.

2638 A Simple Technique for Scoring Radiotherapy Treatment Plans

G. Field, H. Warkentin, A. Syme, K. Powell, R. Scrimger, M. Parliament, N. Jha, M. MacKenzie

Cross Cancer Institute, Edmonton, AB, Canada

Purpose/Objective(s): A system that scores radiotherapy treatment plans in a manner consistent with clinical practice would beextremely useful for developing objective criteria for dosimetry education, knowledge transfer from experienced to novice treat-ment planners, and comparing different treatment planning systems.

Materials/Methods: A spreadsheet was developed to score radiotherapy treatment plans based on user-provided metrics.These metrics include dose-volume constraints, treatment delivery time, and time to prepare the plan. Each metric wasassigned a relative weight, with incentives for exceeding the specified goal and penalties for failing to achieve the goal.The metrics were normalized such that if all constraints were satisfied, but not exceeded, the plan received a score of 100.If penalties were incurred, they could be offset with bonus points. Participants with a range of treatment planning expertise,and full knowledge of the scoring system, generated plans on multiple copies of a single patient data set. The spreadsheet waspopulated with dose-volume data, the treatment time, and planning time. The score for each metric, and the total score, wascalculated and displayed. Participants were given the opportunity to further optimize the plan to improve their score. RadiationOncologists (ROs) categorized the plans into one of: exceptional, acceptable, marginal, or unacceptable. The plans wereranked within each category and numerical scores ranging from 83 - 110 were associated with each plan. Each treatmentplan was scored five times: twice using different metric weights and once by each of three ROs. A statistical analysis wasperformed.