1. THE DICOM 2013 INTERNATIONAL CONFERENCE & SEMINAR March 14-16Bangalore, India A Standardized Approach to Patient Positioning for Radiation Therapy Treatments using DICOM Christof Schadt Brainlab AG Senior Software Specialist Vice-Chair DICOM WG-07 “Radiotherapy”

2. Introduction Basic problem in radiotherapy: Where is the patient with respect to the treatment delivery device? Basic solution: Use some kind of patient landmark and align this with a reference from the planning data March 2013 DICOM International Conference & SeminarPatient Positioning for Radiation Therapy Treatments

3. Required Steps Get planning data Acquire current patient reference Register against ideal reference Apply difference to current position If required, repeat to verify Perform post-treatment review Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

4. Real-World Set-Up Peer-to-peer Communication Proprietary Protocols Weak references to DICOM RT Plans No way to report correction Lots of error-prone user interaction Assigning patients to procedures Selecting treatment locations for verification Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

5. Ideal Set-Up Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) Treatment Delivery Device (TDD) Patient Positioning Device (PPD) March 2013 DICOM International Conference & SeminarPatient Positioning for Radiation Therapy Treatments

6. Approach Definition of DICOM IODs based on Supplement 96 „Unified Worklist and Procedure Step“ Supplement 147 „Second Generation Radiotherapy“ → Supplement 160 „Positioning and Workflow“ Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

7. Challenges Not only a multi-vendor environment, but also multi-technique: kV/MV imaging (planar, volumetric) Ultrasound imaging Surface scanning (visible light, laser) Marker tracking (visible light, infra-red, radio- frequency, radioactive) Patient Positioning for Radiation Therapy Treatments

8. Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Reference Acquisition Patient Position Acquisition Geometry IOD Patient Position Acquisition Instruction IOD Result: image objects (CT, US,...) Surface Segmentation IOD Optical Surface Scanner IOD Fiducials IOD Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

9. Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Registration Registration Instruction IOD Result: Registration IOD Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

10. Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Position Modification Patient Position Correction Instruction IOD Patient Position Modification Instruction IOD Result: Patient Position Modification Result IOD Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

11. Patient Position Acquisition System (PPAS) Patient Position Registration System (PPRS) Patient Position Monitoring System (PPMS) Treatment Delivery Device (TDD) Patient Positioning Device (PPD) Monitoring Patient Position Monitoring Instruction IOD Result: Patient Position Monitoring Result IOD Waveform IOD Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

12. Cooperation Joint Enterprise by: DICOM Working Group 07 „Radiotherapy“ – Sub-Group „Positioning and Workflow“ IHE Radiation Oncology Technical Committee – Sub-Group „Discrete Positioning and Delivery Workflow“ Patient Positioning for Radiation Therapy TreatmentsMarch 2013 DICOM International Conference & Seminar

13. References http://www.IHE.net/ http://dicom.nema.org/ DICOM Supplement 96 “Unified Worklist and Procedure Step” DICOM Supplement 147 “2 nd Generation Radiation Therapy” DICOM Supplement 160 “Positioning & Workflow” IHE-RO Supplement “Discrete Positioning and Delivery Workflow” March 2013 DICOM International Conference & SeminarPatient Positioning for Radiation Therapy Treatments

14. Author Contact Christof Schadt christof.schadt@brainlab.com Brainlab AG Kapellenstrasse 12 85622 Feldkirchen Germany Thank you for your attention ! March 2013 DICOM International Conference & SeminarPatient Positioning for Radiation Therapy Treatments