DICOM Conference - Singapore April 1, 2005 2005 DICOM Conference Radiation Therapy in Oncology in Singapore Dwight A. Simon, Medical Standards Director and Senior Integration Specialist Merge eFilm www.merge-efilm.com * * * * * * Co-Chair DICOM Standards Committee DICOM Conference - Singapore April 1, 2005 Radiation Oncology v1 Slide # 1

This presentation is given on behalf of DICOM WG7: Radiation Therapy Acknowledgement This presentation is given on behalf of DICOM WG7: Radiation Therapy It has been prepared in conjunction with material from: - Dr. Michael Neumann, Institute of Clinical Biochemistry and Pathobiochemistry - Scot Hogan, Chair - WG7 Ion Subcommittee - David Murray, Chair – DICOM WG7 Vital Edge Limited TomoTherapy, Incorporated

Radiation Therapy in DICOM What it isn’t – acquisition information for diagnosing a patients condition (CT, MR, Ultrasound, Mammography, Digital X-Ray, etc.) What it is – a description of how to treat a patient (a Plan of treatment, the Doses of radiation to apply, in what manner and in what quantity, plus the ability to simulate the treatment, etc.)

Radiation Therapy Objects (SOP Classes) (non-RT – CT, MR, PET & Fused Images) RT Image RT Dose RT Structure Set RT Plan RT Beams Treatment RT Brachy Treatment RT Treatment Summary

Use of General Purpose Worklist in Radiation Therapy A need to manage the various “phases” of radiation therapy, such as transition from: simulation to planning to delivery to adaptive therapy A need to schedule these services Also a need for new functionality: for referencing persistent objects like RT Plans, CT Images and new objects like Dose Calculation for having ability to Notify performing application, rather than depending on application to continually check for something new or changed

General Purpose Worklist

General Purpose Worklist (RT) Controlling Device Archive Workflow Manager Performing Application Store SOP Instances Initiate creation of GPSPS (N-CREATE) Notify GP-SPS (N-EVENT-REPORT) Instances for Input Transmit SOP and Relevant Information Query GP-SPS Receive GP-SPS Update GP-SPS (IN PROGRESS) Create GP-PPS (IN PROGRESS) Get Progress (N-GET) Notify Progress (N-EVENT-REPORT) Set GP-PPS (COMPLETED) Cancel GP-SPS (N-SET) Update GP-SPS (COMPLETED) Store Results

Scenarios Controlling Device requests... Segmentation Treatment planning Dose calculation Treatment plan evaluation Treatment Port film

Scenarios – Referenced Objects IM – Image (CT, MR, …) SS – RT Structure Set RI – RT Image RD – RT Dose RP – RT Plan BM – RT Beams Treatment Record BR – RT Brachy Treatment Record SU – RT Treatment Summary Record

Scenarios – Object References IM SS RI RD RP BM BR SU Segmentation X Treatment Planning Dose Calculation Plan Evaluation Treatment Port film

Scenarios – Segmentation Request Segmentation SS exists N Y CT CT, SS Create SS Create SS ‘ C-STORE

Scenarios – Segmentation New segmentation Existing segmentation Continue segmentation Modify segmentation Parameters List of organs List of colors Margins

Scenarios – Treatment Planning Request Treatm. Plang. Plan exists N Y CT, SS, PRE New Version N Y CT, SS, PRE, RTP CT, SS, RI, PRE, RTP Create RTP, RI Create RTP 2, RI Create RTP ‘, RI C-STORE PRE – RT Prescription IOD* * not defined yet

Scenarios – Treatment Planning New treatment plan Existing treatment plan New version Competing plan Parameters Technique Number of beams Treatment unit

Scenarios – Dose Calculation Request Dose Calc. Dose exists N Y CT, SS, CAL, RTP CT, SS, DOS CAL, RTP Create DOS Create DOS ‘ C-STORE CAL – RT Calculation IOD* * not defined yet

Scenarios – Dose Calculation New dose calculation Existing dose calculation Correct for treatment errors Accumulate previous dose Parameters Algorithm Dose grid Inhomogeneity correction Physical constraints Biological constraints

Scenarios – Plan Evalutation Request Plan Eval. CT, RI, SS, DOS, RTP Create RTP ‘ C-STORE

Scenarios – Plan Evalutation Approve treatment plan Parameters

Scenarios – Treatment N Y N Y Request Treatment Interrupt before RTP, RI, BM, BR, SU Comp. N Y RTP, RI, BM, BR, SU RTP, RI, BM, BR, SU Create BM, BR, SU Create BM, BR, SU Create BM, BR, SU C-STORE

Scenarios – Treatment Normal treatment Treatment interrupt before Compensate Patient setup correction Parameters

Scenarios – Port Film Request Port Film RTP, RI, BM, BR Create RI C-STORE

Scenarios – Port Film Take port film Parameters Beam related With dose accumulation Before / after treatment Single / double exposure

Required Parameters Segmentation Treatment planning Dose calculation List of organs List of colors Margins Treatment planning Technique Number of beams Treatment unit Dose calculation Algorithm Dose grid Inhomogeneity correction Physical constraints Biological constraints Port film Beam related With dose accumulation Before / after treatment Single / double exposure

Ion Therapy Manufacturers of Ion Therapy equipment are now actively involved in implementation of Ion Therapy systems, even though all the work on this new DICOM function is not finalized

Two New IODs Created RT Ion Plan contains pretreatment definition RT Ion Treatment Record contains post treatment records New IODs created because: Existing RT Plan has type 1 and 2 (Required) attributes that are not applicable to Ion Therapy New type 1 and 2 attributes are introduced for Ion Therapy for interoperability

Beam Line Modifiers All Ion Therapy beam line modifiers have been categorized into: Range Shifting Devices Lateral Spreading Devices Range Modulation Devices Snout Some machines have interchangeable Snouts

Traditional Accessories Range Compensators Bolus Apertures

Other Differences No Source-to-Axis distance All measurements taken from isocenter X/Y dependant Virtual SAD added for device manufacturing 6 Degrees of freedom couch Pitch and Roll angles defined All imaging performed by x-ray sources Passive and Scanning beams

Status of On-Going Work Has undergone final review by WG7 Ion Subcommittee and is out for vote. Subcommittee has T-CON at least once a month. Two meetings held in conjunction with PT-COG. Several implementations are undergoing testing – they go live January 2006.

IHE in Radiation Oncology (IHE-RO) A stage 1 demonstration scenario was developed: involves a “normal flow” use case for a patient in a radiotherapy department can be achieved using existing DICOM components extended set of query/retrieve attributes specific to radiation therapy is being defined to enhance interoperability between radiation therapy systems enhanced General Purpose Worklist for RT may also be used in the demonstrations. A number of extensions and “non-normal flows” have been identified for implementation in future years.

Thank You!