RT Treatment Delivery Workflow-II

Treatment Delivery Workflow-II (TDW-II) radiation oncology treatment delivery workflow

Summary

The Treatment Delivery Workflow - II Integration Profile Integration Profile describes the necessary workflow between a Treatment Management System (TMS) and Treatment Delivery Device (TDD) for treatment delivery. This profile grew out of the Technical Committee’s work on the Integrated Positioning and Delivery Workflow (IPDW) Integration Profile, which was found to specify too many required elements for some Treatment Delivery Devices. A number of commercially available delivery machines either do not handle positioning interactions at all or they are not externalized in significant or easily modifiable ways. This profile describes the workflow between the TMS and TDD and when the TDDTDD is largely only concerned with delivery scheduling. This profile is a workflow profile.

Benefits

Provides Standards-based interaction between a TMS and a TDD for patient treatment selection

Details

Pre-conditions: The Treatment Delivery Workflow - II Integration Profile requires that the TMS has previously received all information required (generated externally or internally) to effectively respond to queries issued by the TDD. In particular, the TMS must know the SOP Instance UID of the specific RT Plan to be delivered by the TDD. The TMS is required to be in possession of the plan and the records in order to be able to fulfill its function. The TDD shall retrieve that plan from the OST to ensure that the plan treated is consistent with the plan having been scheduled in the TMS. The acquisition of such information by the TMS is out of band for this profile.

Main Flow: The user at the TDD invokes a Worklist Query to request that the TMS sends a scheduled treatment delivery worklist. The TDD gets a list of patients to be treated, which may have zero or more entries. If the patient to be treated is found, the user selects the patient to be treated.

The TDD delivers the treatment.

Once the treatment delivery is finished (completely or partially), the TDD reports the results of the treatment delivery session to the TMS.

Treatment Cancellation Prior to Radiation: Cancellation of a treatment delivery during radiation is fully described by Figure 9.4.2.1-1, taking into account the different final state requirements of RO-64 and the CANCELED status in RO-65. However, when a cancellation occurs prior to radiation delivery, the process flow in this case is shown in Figure 9.4.2.1-1. Note from the Figure 9.4.2.2-1 that:

Any Treatment Delivery Progress Updates RO-62, if present, issued prior to cancellation will have a reported Procedure Step Progress (0074,1004) of 0% in this scenario.
The Treatment Delivery Final Update (RO-64) transaction will not be required to be performed if the Final State conditions (described in Table 7-1 in RO-64) have already been met by previous RO-62 transaction(s).

Treatment Completion: An important use case associated with treatment delivery is that of treatment completion following a delivery interruption.

If the delivery interruption is of a transient nature (e.g. a temporary issue with the delivery machine or a patient position issue caused temporary interruption of the delivery), then the TDD may choose to manage the completion internally and notify the TMS that the UPS has finally completed normally.
If the delivery interruption leads to the UPS being moved to the ‘CANCELED’ state, this requires that a new UPS be scheduled (e.g. if the completion requires re-planning or needs to be performed in a different time slot). The TMS shall then manage the new UPS, specify a Text Value of ‘CONTINUATION’ in the Scheduled Processing Parameters Sequence when returning a query result, and supply the Start Meterset of the continuation treatment in the Delivery Instruction.

Post-conditions: After completion of the treatment delivery, the Treatment Delivery Result objects are stored in the TMS and the UPS is updated with the state COMPLETED.