Detailed Proposal Template

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1. Proposed Profile: Structure Template Creation, Import, and Export

• Proposal Editor: Charles M. Able, MS
• Profile Editor: <Name of candidate Lead Editor for the Profile>
• Domain: Radiation Oncology

Summary

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<Summarize in one or two lines the existing problem . E.g. "It is difficult to monitor radiation dose for individual patients and almost impossible to assemble and compare such statistics for a site or a population.">

<Demonstrate in a line or two that the key integration features are available in existing standards. E.g. "DICOM has an SR format for radiation dose events and a protocol for exchanging them.">

<Summarize in a few lines how the problem could be solved. E.g. "A Radiation Dose profile could require compliant radiating devices to produce such reports and could define transactions to actors that collect, analyze and present such information.">

<Summarize in a line or two market interest & available resources. E.g. "Euratom and ACR have published guidelines requiring/encouraging dose tracking. Individuals from SFR are willing to participate in Profile development.">

<Summarize in a line or two why IHE would be a good venue to solve the problem. E.g. "The main challenges are dealing with the chicken-and-egg problem and avoiding inconsistent implementations.">

2. The Problem

1. Different structure templates are needed at various stages of the radiotherapy process (i.e. virtual simulation, treatment planning, image guided therapy). The ability to build, activate, and/or disable structure templates or a subset of structures(sub-template) for use at each stage of the radiotherapy process is needed.

2. Specific structure templates may be developed by cooperative oncology groups for certain protocols. Treatment planning systems need to be able to import the structure templates to allow for consistent identification and evaluation of clinical data for national clinical trials.

3. The use of standard naming conventions(i.e. ATC's Uniform Tissue Names for use in RTOG Advanced Technology Clinical Trials, caBIG naming convention, etc.) has not been adopted to date by the radiation oncology community. Structure Template Import/Export capability will accelerate the standardization of tissue naming.

4. The need to import and export structure templates for patients being treated at multiple institutions using different platforms exists. Patients being transferred or receiving retreatment could benefit from the ability to import and export the structure template.

Lost productivity is at the heart of this problem. The time required to re-create structures used repeatedly for specific body sites can be substantial for therapist and dosimetrist when performing virtual simulation and treatment planning. Additional time is lost during IGRT implementation by the therapist and radiation oncologist eliminating unwanted structures when reconciling the patient position. Further lost productivity results when the radiation oncologist reviews images off line when structures viewed must be customized each time an image is taken during the course of treatment.

The Advanced Technology QA Consortium's Image Guided Therapy QA Center (ITC) has developed software tools to assist in reconciling discrepancies between submitted and protocol-specified structure names. Some cases still require visual inspection of images, contours to identify structures. The ITC states "the effort required to correctly identify all structures can be substantial."

Development of this use case can increase productivity across the field of radiation oncology.

3. Key Use Case

How It Currently Works

Patient X enters on a National Cooperative Group Trial: 1. The planner determines the structure names (spelling and abreviations) used based on the specifics of the protocol. A treatment plan is prepared in which these structures may be expanded for creation of inverse planning or IGRT evaluation structures that have no direct bearing on what is required for the clinical trial. These additional structures may have names that are similar to or abbreviations of the protocol required structures and adds complexity and quantity to the structure set.

2. The plan is reviewed and approved for treatment by the radiation oncologist.

3. The plan needs to be anonymized and transferred to the Cooperative group. The list of contoured clinical structures can be uploaded into a structure template containing the nomenclature and format identified by the cooperative group along with the complete treatment plan DICOM file.

4. The structures contained in the DICOM file are reconciled using software tools. If the software reconciliation is incomplete the file is rejected and a manual review is performed.

5. The file is edited and submitted for further review.

6. The plan can now be reviewed and evaluated for acceptance in the cooperative clinical trial.

How is should work

Patient X enters on a National Cooperative Group Trial: 1. The planner imports the structure template into the planning system from the cooperative group.determines the structure names (spelling and abreviations) used based on the specifics of the protocol. A treatment plan is prepared in which these structures may be expanded for creation of inverse planning or IGRT evaluation structures that have no direct bearing on what is required for the clinical trial. These additional structures may have names that are similar to or abbreviations of the protocol required structures and adds complexity and quantity to the structure set. 2. The plan is reviewed and approved for treatment by the radiation oncologist. 3. The plan needs to be anonymized and transferred to the Cooperative group. The list of contoured clinical structures can be uploaded into a structure template containing the nomenclature and format identified by the cooperative group along with the complete treatment plan DICOM file. 4. The structures contained in the DICOM file are reconciled using software tools. If the software reconciliation is incomplete the file is rejected and a manual review is performed. 5. The file is edited and submitted for further review. 6. The plan can now be reviewed and evaluated for acceptance in the cooperative clinical trial.

a. A DICOM file containing a list of clinical structure names can be created in the treatment planning contouring workspace. Clinical structures can be contoured under each identifying structure name.

b. A DICOM file containing a list of clinical structure names can be imported into the treatment planning contouring workspace. Clinical structures can be contoured under each identifying structure name.

c. Using an existing treatment plan a structure template can be created from the structures defined in the treatment plan. The newly created structure template can be exported as a DICOM file

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<Focus on the end user requirements, and not just the solution mechanism. Give concrete examples to help people trying to understand the problem and the nature of the solution required. Remember that other committee members reviewing the proposal may or may not have a detailed familiarity with this problem. Where appropriate, define terms.>

4. Standards & Systems

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5. Technical Approach

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<Outline how the standards could be used/refined to solve the problems in the Use Cases. The Technical Committee will be responsible for the full design and may choose to take a different approach, but a sample design is a good indication of feasibility.>

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Existing actors

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New actors

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Existing transactions

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New transactions (standards used)

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Impact on existing integration profiles

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New integration profiles needed

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Breakdown of tasks that need to be accomplished

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6. Support & Resources

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7. Risks

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8. Open Issues

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9. Tech Cmte Evaluation

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Effort Evaluation (as a % of Tech Cmte Bandwidth):

• 35% for ...

Responses to Issues:

See italics in Risk and Open Issue sections

Candidate Editor:

TBA

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