1. 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
* * * * * *
Co-Chair DICOM Standards Committee
DICOM Conference - Singapore April 1, 2005
Radiation Oncology v Slide # 1

2. 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

3. 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.)

4. 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

5. 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

6. General Purpose Worklist

7. 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

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

9. 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

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

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

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

13. 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

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

15. 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

16. 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

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

18. Scenarios – Plan Evalutation
Approve treatment plan
Parameters

19. 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

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

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

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

23. 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

24. 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

25. 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

26. 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

27. Traditional Accessories
Range Compensators
Bolus
Apertures

28. 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

29. 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.

30. 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.

31. Thank You!