IHERO UseCase Improved Workflow B

1. Proposed Workitem: Transfer of Anatomy/Aperture Data

• 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 transfer of patient anatomy data or aperture data from the TPS to the localization system or from the Record and Verify system (R&V) to the localization system. This creates problems for establishing the correct patient position, and gating envelope in case of gated treatment.

3. Key Use Case

1. Physician A prescribes daily image guided patient setup using CT/CBCT imaging device in the treatment room. He has outlined the anatomy details, which are needed to position patient correctly at the time of the treatment. Therapist acquires CT/CBCT images, and uses the anatomy information (defined by physician) to position patient correctly before treatment.>
2. Physician A prescribes daily image guided patient setup using radiographic imaging device in the treatment room. He has outlined the anatomy details, which are needed to position patient correctly at the time of the treatment. Therapist acquires radiographic images, and uses the anatomy information (defined by physician) to position patient correctly before treatment.>
3. Physician A prescribes daily gated therapy with localization and the gating envelope to be established while viewing (under flouro using the treatment room imaging system) the relationship between implanted fiducials and an ITV established for these implanted fiducials. To accomplish this, 4-D CTs are taken and the physician decides to treat over certain phases. Individual contours are made of the CTV and fiducials on each phase selected for treatment. An ITV is created for the fiducials and the target and an additional margin is added to the target ITV to establish a PTV. Because the anatomical information is not transferred to the localization system (in this case the fluoro system), there is no way to view under flouro an anatomy outline of the fiducial ITV. >
4. Same scenario as Number 3, except Physician A wants to localize and establish the gating envelope by viewing the tumor under flouro with respect to the treatment aperture for that gantry position. Because the portal information is not transferred to the localization system (in this case the flouro system), there is no way to view, under flouro, the position of the tumor with respect to the treatment portal.

4. Standards & Systems

DICOM RT

5. Discussion

The planning committee acknowledges that DICOM standard provides tools to transfer the anatomy information (both 2D and 3D). However the vendors have not implemented the support consistently, and thus the interoperability is poor. These use cases are challenging, because the data needs to flow though several systems before it is used by localization system.