IHERO UseCase Improved Workflow A

1. Proposed Workitem: Registration Data Tranfer

• Proposal Editor: Virgil Willcut
• Editor: Virgil Willcut, Mika Miettinen
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: Radiation Oncology

2. The Problem

There is currently no consistent network transfer of patient registration information and/or applicable localization data (e.g. cone beam CT images) between the localization systems and either a) the record and verify system (R&V) or b) the treatment planning system (TPS). There is also no record of the imaging in relation to the treatment (pre-tx, pre-shift, post-shift). This means the accuracy and full record of each day’s imaging, localization, and delivery is not being recorded in an automated fashion into the R&V system, and that delivery evaluation and subsequent decision making concerning the need for an adapted or new plan is very manual and, therefore, labour intensive, which limits its availability for routine clinical use.

3. Key Use Case

Physician A prescribes daily localization via pre-treatment CT done in treatment room (CT or CBCT) for the first five fractions of a patient’s treatment. The patient is subsequently imaged, registered, and shifted prior to each treatment for the first five fractions. The physician would like to import these pre-treatment images( to treatment planning system), along with the shift information which is necessary to locate isocenter, and contour on each image set for a patient specific PTV and organ at risk (OAR) evaluation and assessment of the need for re-planning.

Envisioned process: Once the patient treatment has concluded, the images, registration information, and status of the image information (pre- or post-shift/treatment) is sent to the R&V so that a record is established. These images, along with any applicable registration information are then exportable from the imaging workstation or the R&V system to the TPS. In an ideal world, the imaging system and registration information would automatically export to the TPS if the user desires and the TPS would associate the images with the correct baseline plan, locate the isocenter, deform the original structures to the new dataset, re-compute dose, compute user defined metrics, compare these to user established limits and inform the user when tolerances were exceeded.

4. Standards & Systems

DICOM RT

5. Discussion

The planning committee acknowledges that some (or all) aspects of the described use case(s) is covered by 2008 “Treatment Delivery Workflow” profile. However the team decided to submit the use cases, because the use cases are not very clearly described in the profile document, which is under public commenting at the moment. The planning committee asks the technical committee to analyze that the use case(s) described in this document are covered by 2008 profiles, would like to link these “real-life” use case descriptions to 2008 profile document.