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Radiation Oncology v1 Slide # 1
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 2
DICOM Conference - Singapore April 1, 2005
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 Oncology v1 Slide # 3
DICOM Conference - Singapore April 1, 2005
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 Oncology v1 Slide # 4
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 5
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 7
DICOM Conference - Singapore April 1, 2005
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)
Radiation Oncology v1 Slide # 8
DICOM Conference - Singapore April 1, 2005
Scenarios
Controlling Device requests...
Segmentation Treatment planning Dose calculation Treatment plan evaluation Treatment Port film
Radiation Oncology v1 Slide # 9
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 10
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 11
DICOM Conference - Singapore April 1, 2005
Scenarios – Segmentation
YN
RequestSegmentation
SSexists
CT
C-STORE
Create SS
CT, SS
Create SS ‘
Radiation Oncology v1 Slide # 12
DICOM Conference - Singapore April 1, 2005
Scenarios – Segmentation
New segmentation
Existing segmentation Continue
segmentation Modify
segmentation
Parameters List of organs List of colors Margins
Radiation Oncology v1 Slide # 13
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 14
DICOM Conference - Singapore April 1, 2005
Scenarios – Treatment Planning
New treatment plan
Existing treatment plan New version Competing plan
Parameters Technique Number of beams Treatment unit
Radiation Oncology v1 Slide # 15
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 16
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 17
DICOM Conference - Singapore April 1, 2005
Scenarios – Plan Evalutation
RequestPlan Eval.
CT, RI, SS,DOS, RTP
C-STORE
Create RTP ‘
Radiation Oncology v1 Slide # 18
DICOM Conference - Singapore April 1, 2005
Scenarios – Plan Evalutation
Approve treatment plan
Parameters
Radiation Oncology v1 Slide # 19
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 20
DICOM Conference - Singapore April 1, 2005
Scenarios – Treatment
Normal treatment
Treatment interrupt before Compensate
Patient setup correction
Parameters
Radiation Oncology v1 Slide # 21
DICOM Conference - Singapore April 1, 2005
Scenarios – Port Film
RequestPort Film
RTP, RI,BM, BR
C-STORE
Create RI
Radiation Oncology v1 Slide # 22
DICOM Conference - Singapore April 1, 2005
Scenarios – Port Film
Take port film Parameters Beam related With dose
accumulation Before / after
treatment Single / double
exposure
Radiation Oncology v1 Slide # 23
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 24
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 25
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 26
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 27
DICOM Conference - Singapore April 1, 2005
Traditional Accessories
Range Compensators Bolus Apertures
Radiation Oncology v1 Slide # 28
DICOM Conference - Singapore April 1, 2005
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
Radiation Oncology v1 Slide # 29
DICOM Conference - Singapore April 1, 2005
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.
Radiation Oncology v1 Slide # 30
DICOM Conference - Singapore April 1, 2005
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.
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