Radiation Oncology v1 Slide # 1

1. 2005 DICOM ConferenceRadiation Therapy in Oncology in Singapore Dwight A. Simon, Medical Standards Director and Senior Integration Specialist Merge eFilmwww.merge-efilm.com * * * * * * Co-Chair DICOM Standards Committee DICOM Conference - Singapore April 1, 2005 Radiation Oncology v1 Slide # 1

2. 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

3. 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.)

4. 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

5. 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

6. General Purpose Worklist

7. PerformingApplication ControllingDevice Workflow Archive Manager Transmit SOP Instances for Input Receive GP-SPS Query GP-SPS and Relevant Information Update GP-SPS (IN PROGRESS) Create GP-PPS (IN PROGRESS) Set GP-PPS (COMPLETED) Update GP-SPS (COMPLETED) Store Results General Purpose Worklist (RT) Store SOP Instances Initiate creation of GPSPS(N-CREATE) Notify GP-SPS(N-EVENT-REPORT) Get Progress(N-GET) Notify Progress(N-EVENT-REPORT) Cancel GP-SPS (N-SET)

8. Scenarios • Controlling Device requests... • Segmentation • Treatment planning • Dose calculation • Treatment plan evaluation • Treatment • Port film

9. 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

10. Scenarios – Object References

11. Scenarios – Segmentation Request Segmentation SS exists N Y CT CT, SS Create SS Create SS ‘ C-STORE

12. New segmentation Existing segmentation Continue segmentation Modify segmentation Parameters List of organs List of colors Margins Scenarios – Segmentation

13. Scenarios – Treatment Planning Request Treatm. Plang. Plan exists N Y CT, SS, PRE New Version N Y CT, SS, PRE, RTP CT, SS, RI, PRE, RTP Create RTP, RI Create RTP 2, RI Create RTP ‘, RI C-STORE PRE – RT Prescription IOD** not defined yet

14. New treatment plan Existing treatment plan New version Competing plan Parameters Technique Number of beams Treatment unit Scenarios – Treatment Planning

15. Scenarios – Dose Calculation Request Dose Calc. Dose exists N Y CT, SS, CAL, RTP CT, SS, DOS CAL, RTP Create DOS Create DOS ‘ C-STORE CAL – RT Calculation IOD** not defined yet

16. New dose calculation Existing dose calculation Correct for treatment errors Accumulate previous dose Parameters Algorithm Dose grid Inhomogeneity correction Physical constraints Biological constraints Scenarios – Dose Calculation

17. Scenarios – Plan Evalutation Request Plan Eval. CT, RI, SS, DOS, RTP Create RTP ‘ C-STORE

18. Approve treatment plan Parameters Scenarios – Plan Evalutation

19. Scenarios – Treatment Request Treatment Interrupt before N Y RTP, RI, BM, BR, SU Comp. N Y RTP, RI, BM, BR, SU RTP, RI, BM, BR, SU Create BM, BR, SU Create BM, BR, SU Create BM, BR, SU C-STORE

20. Normal treatment Treatment interrupt before Compensate Patient setup correction Parameters Scenarios – Treatment

21. Scenarios – Port Film Request Port Film RTP, RI, BM, BR Create RI C-STORE

22. Take port film Parameters Beam related With dose accumulation Before / after treatment Single / double exposure Scenarios – Port Film

23. 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 Required Parameters

24. 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

25. 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

26. 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

27. Traditional Accessories • Range Compensators • Bolus • Apertures

28. 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

29. 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.

30. 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.

31. Thank You!