2005 DICOM Conference Radiation Therapy in Oncology in

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

Acknowledgement This presentation is given on behalf of DICOM WG 7: Radiation Therapy It has been prepared in conjunction with material from: - Dr. Michael Neumann, Institute of Clinical Biochemistry and Pathobiochemistry - Scot Hogan, Chair - WG 7 Ion Subcommittee - David Murray, Chair – DICOM WG 7 Vital Edge Limited Tomo. Therapy, Incorporated DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 2

Radiation Therapy in DICOM n n 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. ) DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 3

Radiation Therapy Objects (SOP Classes) n n n n (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 DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 4

Use of General Purpose Worklist in Radiation Therapy n A need to manage the various “phases” of radiation therapy, such as transition from: n n n simulation to planning to delivery to adaptive therapy A need to schedule these services Also a need for new functionality: n n 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 DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 5

General Purpose Worklist DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 6

General Purpose Worklist (RT) Controlling Device Archive Workflow Manager Performing Application Store SOP Instances Initiate creation of GPSPS (N-CREATE) Notify GP-SPS (N-EVENT-REPORT) Transmit SOP Instances for Input and Relevant Information Query GP-SPS Receive GP-SPS Update GP-SPS (IN PROGRESS) Create GP-PPS (IN PROGRESS) Get Progress (N-GET) Notify Progress (N-EVENT-REPORT) Cancel GP-SPS (N-SET) Set GP-PPS (COMPLETED) Update GP-SPS (COMPLETED) Store Results DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 7

Scenarios n Controlling Device requests. . . n n n Segmentation Treatment planning Dose calculation Treatment plan evaluation Treatment Port film DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 8

Scenarios – Referenced Objects n n n n 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 DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 9

Scenarios – Object References IM SS Segmentation X X Treatment Planning X X Dose Calculation X X Plan Evaluation X X RI RD RP X X X X BM BR Treatment X X Port film X X DICOM Conference - Singapore April 1, 2005 SU X Radiation Oncology v 1 Slide # 10

Scenarios – Segmentation Request Segmentation N SS exists Y CT CT, SS Create SS ‘ C-STORE DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 11

Scenarios – Segmentation n n New segmentation Existing segmentation n Parameters Continue segmentation Modify segmentation DICOM Conference - Singapore April 1, 2005 n n n List of organs List of colors Margins Radiation Oncology v 1 Slide # 12

Scenarios – Treatment Planning Request Treatm. Plang. N CT, SS, PRE Create RTP, RI Y Plan exists N New Version Y CT, SS, PRE, RTP CT, SS, RI, PRE, RTP Create RTP 2, RI Create RTP ‘, RI C-STORE DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 PRE – RT Prescription IOD* * not defined Slide # yet 13

Scenarios – Treatment Planning n n New treatment plan Existing treatment plan n Parameters New version Competing plan DICOM Conference - Singapore April 1, 2005 n n n Technique Number of beams Treatment unit Radiation Oncology v 1 Slide # 14

Scenarios – Dose Calculation Request Dose Calc. N Dose exists Y CT, SS, CAL, RTP CT, SS, DOS CAL, RTP Create DOS ‘ C-STORE DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 CAL – RT Calculation IOD* * not defined Slide # yet 15

Scenarios – Dose Calculation n n New dose calculation Existing dose calculation n Parameters Correct for treatment errors Accumulate previous dose DICOM Conference - Singapore April 1, 2005 n n n Algorithm Dose grid Inhomogeneity correction Physical constraints Biological constraints Radiation Oncology v 1 Slide # 16

Scenarios – Plan Evalutation Request Plan Eval. CT, RI, SS, DOS, RTP Create RTP ‘ C-STORE DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 17

Scenarios – Plan Evalutation n Approve treatment plan n Parameters DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 18

Scenarios – Treatment Request Treatment N RTP, RI, BM, BR, SU Create BM, BR, SU Interrupt before N Y Comp. Y RTP, RI, BM, BR, SU Create BM, BR, SU C-STORE DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 19

Scenarios – Treatment n n Normal treatment Parameters Treatment interrupt before n n n Compensate Patient setup correction DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 20

Scenarios – Port Film Request Port Film RTP, RI, BM, BR Create RI C-STORE DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 21

Scenarios – Port Film n Take port film n Parameters n n DICOM Conference - Singapore April 1, 2005 Beam related With dose accumulation Before / after treatment Single / double exposure Radiation Oncology v 1 Slide # 22

Required Parameters n Segmentation n n Dose calculation List of organs List of colors Margins n n n Treatment planning n n n Technique Number of beams Treatment unit n n n Algorithm Dose grid Inhomogeneity correction Physical constraints Biological constraints Port film n n DICOM Conference - Singapore April 1, 2005 Beam related With dose accumulation Before / after treatment Single / double exposure Radiation Oncology v 1 Slide # 23

Ion Therapy n 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 DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 24

Two New IODs Created n n n RT Ion Plan contains pretreatment definition RT Ion Treatment Record contains post treatment records New IODs created because: n n 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 DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 25

Beam Line Modifiers n All Ion Therapy beam line modifiers have been categorized into: n n Range Shifting Devices Lateral Spreading Devices Range Modulation Devices Snout n Some machines have interchangeable Snouts DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 26

Traditional Accessories n n n Range Compensators Bolus Apertures DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 27

Other Differences n No Source-to-Axis distance n n n 6 Degrees of freedom couch n n n All measurements taken from isocenter X/Y dependant Virtual SAD added for device manufacturing Pitch and Roll angles defined All imaging performed by x-ray sources Passive and Scanning beams DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 28

Status of On-Going Work n n Has undergone final review by WG 7 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. DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 29

IHE in Radiation Oncology n A stage 1 demonstration scenario was developed: n involves a “normal flow” use case for a patient in a radiotherapy department n n (IHE-RO) 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. DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 30

Thank You! DICOM Conference - Singapore April 1, 2005 Radiation Oncology v 1 Slide # 31