IHERO UseCase Prescription Automatation
1. Proposed Workitem: Comprehensive/universal radiotherapy treatment prescription format
- Proposal Editor: Sha Chang
- Editor: Sha Chang, May Wahab
- Date: N/A (Wiki keeps history)
- Version: N/A (Wiki keeps history)
- Domain: Radiation Oncology
2. The Problem
The problem: Current radiotherapy software systems do not have a consistent and comprehensive approach to record the treatment prescription, which describes the treatment intended by the patient’s physician. A comprehensive recording of the treatment prescription that is transferable and understandable by different RT software has become increasingly important today as the radiotherapy treatment technology as well as treatment objective becomes more complex and the need to consider previous treatments for today’s patient care increases.
The solution: To create a unified radiotherapy treatment prescription format that can be used by all RT systems (treatment planning systems and record & verify systems) to systematically record and interface treatment prescriptions of different complexity levels. For instance, it should work for the simplest form of treatment prescription – 6MV AP and PA fields, 200 cGy x 20 daily - and for complex treatment prescriptions that are anatomical structure specific and dose-optimized.
What are needed:
- define the content of the comprehensive treatment prescription
- define the format of the prescription.
Content: A comprehensive RT treatment prescription should contain all the information the physician would need in order to reconstruct the same treatment planning again). Suggested items in the comprehensive treatment prescription include: external/brachytherapy, total and fractional dose, fractionation scheme, treatment sites, treatment target volume names, margins to be used (in case of 3DCRT), dose constraints for organs at risk/normal tissue, beam energy, dose optimization and IMRT or not, gated treatment or not, immobilization to be used, image set(s) used for treatment planning, type of image-guided patient setup/treatment delivery (daily cone beam CT, radiographic, fluoro, ultrasound, etc.). Many of the above items can be extracted from the treatment planning system.
3. Key Use Case
- Physician diagnoses the patient based on all information received from referring physician, imaging data, lab results, etc. He prescribes the treatment dose, OAR dose constraints, etc. (see the list of attributes above). The comprehensive prescription will be stored as part of the electronic medical record, and will be available electronically for dosimetry team to plan on. The original prescription will be also available for the rest of the care team, and will be used as a baseline for any changes, which will be done during the treatment course.
- Patient comes in with prostate cancer having received external beam radiation using IMRT at another facility and is here for a brachytherapy boost. We need to integrate previous external beam plans with the brachytherapy plan and streamline the prescription as well. There should be a area in the prescription to reflect the previous dose. This also applies to head & neck re-treatment prescriptions, so the dose to the cord can be assessed in the current plan as well as cumulatively.
4. Standards & Systems
All treatment planning systems and record & verify systems will be involved in the problem and hopefully in the solution as well.
DICOM RT