IHERO UseCase 2011 QA Checker

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1. Proposed Workitem: Integrated Patient QA Checker (part of Patient Safety Use Case)

  • Proposal Editor: Name: Mika Miettinen, mika.miettinen@varian.com, +1 650 799 7665
  • Editor: Colin Field for Mika
  • Date: N/A (Wiki keeps history)
  • Version: N/A (Wiki keeps history)
  • Domain: Radiation Oncology

2. The Problem

Today many effective patient QA solutions rely on stand alone systems. Lack of integration of these important QA systems with TPS and TMS systems greatly hinders the reliability and efficiency of the patient specific QA checks and their verification. The lack of integration causes not only a lot of manual work for clinicians but also an increased risk that patient is treated before the required QA checks on the treatment have been successfully completed. Manpower and the lack of reliability of manual entering QA check results to multiple systems also discourage the adoption of these patient QA systems into everyday operations.

3. Key Use Case

Success Use Cases

Use Case 1

  1. Treatment plan has been created and is sent to Treatment Management System (TMS)
  2. Treatment is prepared by dosimetrist in TMS
  3. Dosimetrist saves the final plan in TMS, and sends request for plan approval
  4. TMS system requests a “QA check verification” from “QA checker” (QA application)
  5. “QA checker” performs verification of the required QA Checks, and returns the results to TMS
  6. If “QA Checker” result is “Ok to proceed”
    • Plan in TMS is ready to be approved by physicist and physician (Not sure if this is the sequence of clinical flow for many, it is not for UNC, where physician approves the plan (before patient-specific QA), and then physicists approves (after patient-specific QA)that the plan can be executed according to the physician approved plan.
    • Physicist and physician approve the plan for treatment
  7. If “QA Checker” result is “Not Ok to proceed”
    • TMS prohibits the delivery of the QA-failed treatment plan
    • TMS informs physicist/dosimetrist about the failure of the check

Use Case 2

  1. Therapist opens the worklist on the Treatment Delivery System (TDS) and selects the patient plan to be treated.
  2. TDS retrieves the patient plan from TMS
  3. TDS system request a “QA check” for the plan from “QA checker” (QA application)
  4. “QA checker” performs the “QA Check”, and returns the results to TDS
  5. If “QA Checker” result is “Ok to proceed”
    • TDS allows therapist to start treatment (after other verification steps are completed)
  6. If “QA Checker” result is “Not Ok to proceed”
    • TDS prohibits the delivery of the treatment plan
    • TDS informs the therapist about the failure of the check and physicists to resolve the situation.


These are just example use cases, and any actor in the radiotherapy or radiosurgery process shall be able to call a “QA check” at any point of time of the process, and this way the clinic is able to define “QA check timeouts” in their process.

4. Standards & Systems

As IHE-RO addresses interoperability, not functionality, the integration profile must be defined along these lines even if there is a temptation to define what kind of QA checks the “QA checkers” should perform. However it is clear that the community needs the “QA checkers” to perform e.g. data integrity checks, data sanity checks, clinical sanity checks, independent MU calculations, data verification, etc. As part of this integration profile, the technical committee must create a list of “checks” that the “QA checkers” can perform (define what, not how), and what are the expected inputs and outputs in the process.
DICOM RT standard (data objects and worklist) should be considered in implementation of the integration profile. One of the main objectives is to get the QA vendors to join the IHE-RO efforts, and get these QA tools to be part of clinical workflow.

5. Discussion

<Include additional discussion or consider a few details which might be useful for the detailed proposal>

<Why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>
<What might the IHE technical approach be? Existing Actors? New Transactions? Additional Profiles?>
<What are some of the risks or open issues to be addressed?>
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