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A Standardized Approach to Patient Positioning for Radiation Therapy Treatments using DICOM

A Standardized Approach to Patient Positioning for Radiation Therapy Treatments using DICOM. Christof Schadt Brainlab AG Senior Software Specialist Vice-Chair DICOM WG-07 “Radiotherapy”. Introduction. Basic problem in radiotherapy:

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A Standardized Approach to Patient Positioning for Radiation Therapy Treatments using DICOM

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  1. A Standardized Approach toPatient Positioning for Radiation Therapy Treatments using DICOM Christof Schadt Brainlab AG Senior Software Specialist Vice-Chair DICOM WG-07 “Radiotherapy”

  2. Introduction • Basic problem in radiotherapy: Where is the patient with respect to the treatment delivery device? • Basic solution: Use some kind of patient landmark and align this with a reference from the planning data Patient Positioning for Radiation Therapy Treatments

  3. Required Steps • Get planning data • Acquire current patient reference • Register against ideal reference • Apply difference to current position • If required, repeat to verify • Perform post-treatment review Patient Positioning for Radiation Therapy Treatments

  4. Real-World Set-Up • Peer-to-peer Communication • Proprietary Protocols • Weak references to DICOM RT Plans • No way to report correction • Lots of error-prone user interaction • Assigning patients to procedures • Selecting treatment locations for verification Patient Positioning for Radiation Therapy Treatments

  5. Ideal Set-Up Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) Patient Positioning for Radiation Therapy Treatments

  6. Approach • Definition of DICOM IODs based on • Supplement 96 „Unified Worklist and Procedure Step“ • Supplement 147 „Second Generation Radiotherapy“ • → Supplement 160 „Positioning and Workflow“ Patient Positioning for Radiation Therapy Treatments

  7. Challenges • Not only a multi-vendor environment, but also multi-technique: • kV/MV imaging (planar, volumetric) • Ultrasound imaging • Surface scanning (visible light, laser) • Marker tracking (visible light, infra-red, radio-frequency, radioactive) Patient Positioning for Radiation Therapy Treatments

  8. Reference Acquisition Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) • Patient Position Acquisition Geometry IOD • Patient Position Acquisition Instruction IOD • Result: • image objects (CT, US, ...) • Surface Segmentation IOD • Optical Surface Scanner IOD • Fiducials IOD Patient Positioning for Radiation Therapy Treatments

  9. Registration Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) • Registration Instruction IOD • Result: • Registration IOD Patient Positioning for Radiation Therapy Treatments

  10. Position Modification Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) • Patient Position Correction Instruction IOD • Patient Position Modification Instruction IOD • Result: • Patient Position Modification Result IOD Patient Positioning for Radiation Therapy Treatments

  11. Monitoring Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) • Patient Position Monitoring Instruction IOD • Result: • Patient Position Monitoring Result IOD • Waveform IOD Patient Positioning for Radiation Therapy Treatments

  12. Cooperation • Joint Enterprise by: • DICOM Working Group 07 „Radiotherapy“ – Sub-Group „Positioning and Workflow“ • IHE Radiation Oncology Technical Committee – Sub-Group „Discrete Positioning and Delivery Workflow“ Patient Positioning for Radiation Therapy Treatments

  13. References http://dicom.nema.org/ http://www.IHE.net/ • DICOM Supplement 96 “Unified Worklist and Procedure Step” • DICOM Supplement 147 “2nd Generation Radiation Therapy” • DICOM Supplement 160 “Positioning & Workflow” • IHE-RO Supplement “Discrete Positioning and Delivery Workflow” Patient Positioning for Radiation Therapy Treatments

  14. Author Contact Thank you for your attention ! • Christof Schadt • christof.schadt@brainlab.com • Brainlab AGKapellenstrasse 1285622 FeldkirchenGermany Patient Positioning for Radiation Therapy Treatments

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