radiation oncology v1 slide # 1 dicom conference - singapore april 1, 2005 radiation oncology v1...

Radiation Oncology v1 Slide # 1

DICOM Conference - Singapore April 1, 2005



Dwight A. Simon,Medical Standards Director and

Senior Integration Specialist

Merge eFilmwww.merge-efilm.com

* * * * * *

Co-Chair DICOM Standards Committee

2005 DICOM Conference

Radiation Therapy in Oncologyin Singapore



Acknowledgement

This presentation is given on behalf of

DICOM WG7: Radiation Therapy

It has been prepared in conjunction with material from:

- Dr. Michael Neumann, Institute of Clinical Biochemistry and Pathobiochemistry

- Scot Hogan, Chair - WG7 Ion Subcommittee

- David Murray, Chair – DICOM WG7 Vital Edge Limited TomoTherapy, Incorporated



Radiation Therapy in DICOM

What it isn’t – acquisition information for diagnosing a patients condition (CT, MR, Ultrasound, Mammography, Digital X-Ray, etc.)

What it is – a description of how to treat a patient (a Plan of treatment, the Doses of radiation to apply, in what manner and in what quantity, plus the ability to simulate the treatment, etc.)



Radiation Therapy Objects (SOP Classes)

(non-RT – CT, MR, PET & Fused Images) RT Image RT Dose RT Structure Set RT Plan RT Beams Treatment RT Brachy Treatment RT Treatment Summary



Use of General Purpose Worklistin Radiation Therapy

A need to manage the various “phases” of radiation therapy, such as transition from:

simulation to planning to delivery to adaptive therapy

A need to schedule these services Also a need for new functionality:

for referencing persistent objects like RT Plans, CT Images and new objects like Dose Calculation

for having ability to Notify performing application, rather than depending on application to continually check for something new or changed



General Purpose Worklist



General Purpose Worklist (RT) Controlling

Device Archive Workflow Manager

PerformingApplication

Store SOP Instances

Receive GP-SPS

Update GP-SPS (IN PROGRESS)

Create GP-PPS (IN PROGRESS)

Set GP-PPS (COMPLETED)

Update GP-SPS (COMPLETED)

Store Results

Cancel GP-SPS (N-SET)

Initiate creation of GPSPS(N-CREATE)

Query GP-SPS

Notify GP-SPS(N-EVENT-REPORT)

Get Progress(N-GET)

Instances for Input Transmit SOP

and Relevant Information

Notify Progress(N-EVENT-REPORT)



Scenarios

Controlling Device requests...

Segmentation Treatment planning Dose calculation Treatment plan evaluation Treatment Port film



Scenarios – Referenced Objects

IM – Image (CT, MR, …) SS – RT Structure Set RI – RT Image RD – RT Dose RP – RT Plan BM – RT Beams Treatment Record BR – RT Brachy Treatment Record SU – RT Treatment Summary Record



Scenarios – Object References

IM SS RI RD RP BM BR SU

Segmentation

X X

Treatment Planning

X X X X

Dose Calculation

X X X X

Plan Evaluation

X X X X X

Treatment X X X X X

Port film X X X X



Scenarios – Segmentation

YN

RequestSegmentation

SSexists

CT

C-STORE

Create SS

CT, SS

Create SS ‘



Scenarios – Segmentation

New segmentation

Existing segmentation Continue

segmentation Modify

segmentation

Parameters List of organs List of colors Margins



Scenarios – Treatment PlanningRequest

Treatm. Plang.

Planexists

CT, SS, PRE

CT, SS, RI,PRE, RTP

C-STORE

CreateRTP, RI

NewVersion

CT, SS,PRE, RTP

CreateRTP 2, RI

CreateRTP ‘, RI

YN

YN

PRE – RT Prescription IOD** not defined yet



Scenarios – Treatment Planning

New treatment plan

Existing treatment plan New version Competing plan

Parameters Technique Number of beams Treatment unit



Scenarios – Dose Calculation

RequestDose Calc.

Doseexists

CT, SS,CAL, RTP

C-STORE

Create DOS

CT, SS, DOSCAL, RTP

Create DOS ‘

YN

CAL – RT Calculation IOD** not defined yet



Scenarios – Dose Calculation

New dose calculation

Existing dose calculation Correct for

treatment errors Accumulate

previous dose

Parameters Algorithm Dose grid Inhomogeneity

correction Physical

constraints Biological

constraints



Scenarios – Plan Evalutation

RequestPlan Eval.

CT, RI, SS,DOS, RTP

C-STORE

Create RTP ‘



Scenarios – Plan Evalutation

Approve treatment plan

Parameters



Scenarios – Treatment

RequestTreatment

Interruptbefore

RTP, RI,BM, BR, SU

RTP, RI,BM, BR, SU

C-STORE

CreateBM, BR, SU

Comp.

RTP, RI,BM, BR, SU

CreateBM, BR, SU

CreateBM, BR, SU

YN

YN



Scenarios – Treatment

Normal treatment

Treatment interrupt before Compensate

Patient setup correction

Parameters



Scenarios – Port Film

RequestPort Film

RTP, RI,BM, BR

C-STORE

Create RI



Scenarios – Port Film

Take port film Parameters Beam related With dose

accumulation Before / after

treatment Single / double

exposure



Required Parameters

Segmentation List of organs List of colors Margins

Treatment planning Technique Number of beams Treatment unit

Dose calculation Algorithm Dose grid Inhomogeneity

correction Physical constraints Biological constraints

Port film Beam related With dose accumulation Before / after treatment Single / double exposure



Ion Therapy

Manufacturers of Ion Therapy equipment are now actively involved in implementation of Ion Therapy systems, even though all the work on this new DICOM function is not finalized



Two New IODs Created

RT Ion Plan contains pretreatment definition

RT Ion Treatment Record contains post treatment records

New IODs created because: Existing RT Plan has type 1 and 2

(Required) attributes that are not applicable to Ion Therapy

New type 1 and 2 attributes are introduced for Ion Therapy for interoperability



Beam Line Modifiers

All Ion Therapy beam line modifiers have been categorized into: Range Shifting Devices Lateral Spreading Devices Range Modulation Devices

Snout Some machines have interchangeable

Snouts



Traditional Accessories

Range Compensators Bolus Apertures



Other Differences

No Source-to-Axis distance All measurements taken from isocenter X/Y dependant Virtual SAD added for

device manufacturing 6 Degrees of freedom couch

Pitch and Roll angles defined All imaging performed by x-ray

sources Passive and Scanning beams



Status of On-Going Work

Has undergone final review by WG7 Ion Subcommittee and is out for vote.

Subcommittee has T-CON at least once a month.

Two meetings held in conjunction with PT-COG.

Several implementations are undergoing testing – they go live January 2006.



IHE in Radiation Oncology (IHE-RO)

A stage 1 demonstration scenario was developed: involves a “normal flow” use case for a

patient in a radiotherapy department can be achieved using existing DICOM components extended set of query/retrieve attributes specific to

radiation therapy is being defined to enhance interoperability between radiation therapy systems

enhanced General Purpose Worklist for RT may also be used in the demonstrations.

A number of extensions and “non-normal flows” have been identified for implementation in future years.



Thank You!

radiation oncology v1 slide # 1 dicom conference - singapore april 1, 2005 radiation oncology v1...

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