DICOM Virtues and Deficiencies for Oncology Information Management

DICOM Virtues and Deficiencies for Oncology Information Management plus some implementor’s remarks Michael Neumann, Helax AB

Radiation Oncology Scenario Simulator Virtual Sim. TPS Review St. Treatment Lite. Box

Data Transfer CT MR Archive HIS / RIS Portal Imaging Lite. Box Simulator Virtual Sim. Lite. Box TPS Review St. Treatment

Sharing Data Lite. Box CT MR Archive HIS / RIS Portal Imaging Lite. Box Simulator Virtual Sim. TPS Review St. Treatment

Workflow Management CT MR Archive HIS / RIS Portal Imaging Lite. Box Simulator Virtual Sim. Lite. Box TPS Review St. Treatment

‘Blue’ and ‘Green’ Oncology Information Management ACTIVITY MANAGEMENT – Workflow processing – Scheduling – Charge Administration DATA MANAGEMENT – DICOM and non-DICOM Data (e. PF) – Centralized Database / Archive – Connectivity Oncology Applications Target definition, Treatment planning, Dose calculation, Chemo care, Verification, . . .

Current Situation • Limited data transfer between applications • Limited linking between applications • Proprietary databases • Lack of information management • More paper flow than electronic workflow • CLOSED environments

Data • Radiotherapy Treatment Planning – Non-coplanar techniques – Blocks – Dynamic (MLC) field shaping – Compensators – Segmented / Dynamic Multi-Leaf Modulation • Radiotherapy Treatment Verification – Treatment Records, In vivo Dosimetry, EPID, Image Matching • Chemotherapy

Data (Contd. ) • Patient’s ‘Disease History’ – Diagnoses, Reports, Lab-results, Treatment outcome • Scheduling – Time planning for Patients, Equipment, Staff • Charge Capture – Documentation, Billing • Administration – Hospital Information System

Data Formats • Images – DICOM, ACR-NEMA 2. 0 • Treatment Data – DICOM – TMS Export Format – RTP Link – VARi. S Link – ‘Link’ to Afterloader – RTOG

Data Formats (Contd. ) • Block / Compensator – HEK, PAR Scientific • Portal Images – TIFF, JPEG, DICOM • Water Phantom Data – Scanditronix, Wellhöfer, PTW, Multidata, AAPM TG 11 Initiative • Administration – HL 7, SAP-HCM, XML

RTOG Specifications for Tape/Network Format for Exchange of Treatment Planning Information • Based on AAPM Report #10 (1982) • Description of RT related data – CT data – Structures – Treatment data – Dose distributions

Desirable Situation Sim Viewing Station Virtual Sim R&V TPS Portal Imaging Doctor’s Console CT/ MR

Local Working Databases Sim Viewing Station Virtual Sim R&V TPS Portal Imaging Doctor’s Console CT/ MR

DICOM Can you help us ?

DICOM (RT Extension) Patient Visit Study Image Sup. 29 Sup. 11 RT Image RT Dose RT Structure Set RT Plan RT Treatment Record

The Role of DICOM • DICOM – Describes most of the data needed in Radiotherapy – Major vendors currently adopting the standard for their applications • DICOM is well suited to communicate radiotherapy information • DICOM a step towards interface standards

The Role of DICOM • DICOM as basis for a data model ? – DICOM defines a hierarchical data structure – DICOM defines information objects and services on objects – DICOM based archives already available • DICOM as basis for a database ? • DICOM archives a step towards an open environment ?

DICOM Restrictions • DICOM does not handle all data, e. g. – Administrative data – Scheduling data (Patients, Equipment, Staff) – Annotations, Doctor’s notes – Chemotherapy, Regimes, Pharmacy ordering – Charge capture – QA related data (Dosimetric data)

DICOM Archive or Database ?

DICOM Archives • Minimal object identification information • Image-level information stored in ‘BLOBs’ • Retrieval of complete objects necessary • Small and simple database • Mainly unstructured information

DICOM Databases • More than object identification information • Other information stored in ‘BLOBs’ • Object Query sufficient (e. g. References) • Large and more complex database • Mainly structured information

Logical Data Structure Patient Study Series RT-PLAN RT-IMAGE Plan and reference image Study Series RT-IMAGE RT-TREATM. RECORD RT-IMAGE Portal images

Logical Data Structure: Coercion EPID PLAN STRUCT Study RT IMAGE Study Series ? PLAN Series Study Series DOSE TREATRC Study Series

Logical Data Structure: UID Mapping PATIENT Study Ser IM Ser ST Study Ser PL Ser DS IM ST IMAGE Study Series STRUCT Study Series DOSE Study Series Study Ser Ser ST PL ST DS STRUCT PLAN Study Series

Access Control Store RT-PLAN Virtual simulator Store RT-PLAN Simulator Load RT-PLAN TPS Store RT-PLAN

Radiotherapy Data is dynamic Doctor’s Console R&V Prescription Patient Setup Fractionation Treatment Technique Virtual Simulator TPS

Making an Archive a Database • More than object identifying information • Logical Data Structure – Tools for Linking/Re-Linking, Coercion, UID Mapping • Access Control – Object Locking • Considering dynamic character – Handling of ‘modified’ objects, Application behavior

Managed DICOM Archive • Archive Management – Handles DICOM communication – Extended item storage – Object Linking / Re. Linking – Object Locking – non-DICOM access • DICOM Database

DICOM What about Management ?

Full DICOM Support Patient IOD Study IOD Series RT Series Image IOD Plan IOD Str. St IOD Dose IOD RT Series Plan IOD Str. St IOD Dose IOD

Full DICOM Support Patient IOD Visit IOD Study Comp. IOD Series RT Series Image IOD Plan IOD Str. St IOD Dose IOD RT Series Plan IOD Str. St IOD Dose IOD

Patient / Visit / Study Management • Handling ‘Normalized Objects’ • Manage Patient IOD – Create, Admit, Transfer, Discharge • Manage Visit IOD – Create, Schedule, Update • Manage Study IOD – Create, Schedule, Start, Complete, Verify, Read, Update

Patient / Visit / Study Management Patient Management Schedule Visit Admit Patient Create Patient Discharge Patient Transfer Patient Study Management Create Study Schedule Study Prepare for Study Read Study Verify Study Perform Study

Workflow Management • Patient / Visit / Study Management – Create Patient, Create and schedule Visit and Study • Modality Worklist Management – Management of scheduled ‘Procedure Steps’ for a modality • Modality Performed Procedure Step – Management of performed ‘Procedure Steps’ for a modality • Results Management – Create, Record, Transcribe, Approve

HIS Integration • HL 7 -DICOM Protocol Translation – Developed by HL 7 Image Management Group (IMSIG) • HL 7 -DICOM Gateway – Commercially available – Provides access to HL 7 HIS/RIS information via DICOM – DICOM AEs can receive HL 7 HIS/RIS originated messages – Implements the DICOM Worklist Management Service Class

DICOM Virtues and Deficiencies • Describes most of the data needed in Radiotherapy • Major vendors currently implementing the standard • DICOM is well suited for communication • DICOM includes information management capabilities • DICOM may be used as data model • DICOM does not handle all data needed in oncology • DICOM archives are not to be used as databases

DICOM Some Notes on Implementation

DICOM Implementation Notes The ‘Communication’ part works, but the ‘Interoperation’ part may be difficult. • Label and ID Mapping • Interpretation Issues • Required Optional Elements • Unsupported DICOM Elements

Label and ID Mapping • Treatment Units, Wedges, Electron Applicators Treatment Unit: Linac 1 Treatment Unit: Li 1 ? Linac 1 TPS Linac 1 Li 1 R&V

Interpretation Issues + = Four Control Points Three Control Points

Required Optional Elements • Patient Position – Important for 3 D modeling – May be entered by the operator • Manufacturer’s Model Name for CT Images – Adapt to different ‘interpretation issues’ • Structure Set Reference for RT Plan – Reference to underlying coordinate system (Frame of Reference)

Unsupported DICOM Elements Doctor’s Console R&V Prescription Patient Setup Fractionation Treatment Technique Virtual Simulator TPS

Thank you for your attention. Questions ?