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DICOM Virtues and Deficiencies for Oncology Information Management

DICOM Virtues and Deficiencies for Oncology Information Management. plus some implementor’s remarks Michael Neumann, Helax AB. CT. MR. Archive. HIS / RIS. Portal Imaging. LiteBox. LiteBox. LiteBox. Simulator. Virtual Sim. TPS. Review St. Treatment. Radiation Oncology Scenario.

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DICOM Virtues and Deficiencies for Oncology Information Management

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  1. DICOMVirtues and Deficiencies forOncology Information Management plus some implementor’s remarks Michael Neumann, Helax AB

  2. CT MR Archive HIS / RIS Portal Imaging LiteBox LiteBox LiteBox Simulator Virtual Sim. TPS Review St. Treatment Radiation Oncology Scenario

  3. LiteBox LiteBox LiteBox Data Transfer CT MR Archive HIS / RIS Portal Imaging Simulator Virtual Sim. TPS Review St. Treatment

  4. LiteBox LiteBox LiteBox Sharing Data CT MR Archive HIS / RIS Portal Imaging Simulator Virtual Sim. TPS Review St. Treatment

  5. LiteBox LiteBox LiteBox Workflow Management CT MR Archive HIS / RIS Portal Imaging Simulator Virtual Sim. TPS Review St. Treatment

  6. ACTIVITY MANAGEMENT Workflow processing Scheduling Charge Administration DATA MANAGEMENT DICOM and non-DICOM Data (ePF) Centralized Database / Archive Connectivity ‘Blue’ and ‘Green’ Oncology Information Management Oncology Applications Target definition, Treatment planning, Dose calculation, Chemo care, Verification, ...

  7. Current Situation • Limited data transfer between applications • Limited linking between applications • Proprietary databases • Lack of information management • More paper flow than electronic workflow • CLOSED environments

  8. Data • Radiotherapy Treatment Planning • Non-coplanar techniques • Blocks • Dynamic (MLC) field shaping • Compensators • Segmented / Dynamic Multi-Leaf Modulation • Radiotherapy Treatment Verification • Treatment Records, In vivo Dosimetry, EPID, Image Matching • Chemotherapy

  9. Data (Contd.) • Patient’s ‘Disease History’ • Diagnoses, Reports, Lab-results, Treatment outcome • Scheduling • Time planning for Patients, Equipment, Staff • Charge Capture • Documentation, Billing • Administration • Hospital Information System

  10. Data Formats • Images • DICOM, ACR-NEMA 2.0 • Treatment Data • DICOM • TMS Export Format • RTP Link • VARiS Link • ‘Link’ to Afterloader • RTOG

  11. Data Formats (Contd.) • Block / Compensator • HEK, PAR Scientific • Portal Images • TIFF, JPEG, DICOM • Water Phantom Data • Scanditronix, Wellhöfer, PTW, Multidata, AAPM TG 11 Initiative • Administration • HL7, SAP-HCM, XML

  12. RTOG Specifications for Tape/Network Formatfor Exchange of Treatment Planning Information • Based on AAPM Report #10 (1982) • Description of RT related data • CT data • Structures • Treatment data • Dose distributions

  13. Desirable Situation Sim Viewing Station Virtual Sim R&V Database TPS Portal Imaging Doctor’s Console CT/ MR

  14. Local Working Databases Sim Viewing Station Virtual Sim R&V Database TPS PortalImaging Doctor’s Console CT/ MR

  15. DICOM Can you help us ?

  16. Patient Visit Study Image Sup. 29 Sup. 11 RT Image RT Dose RT Structure Set RT Plan RT Treatment Record DICOM (RT Extension)

  17. The Role of DICOM • DICOM • Describes most of the data needed in Radiotherapy • Major vendors currently adopting the standard for their applications • DICOM is well suited to communicate radiotherapy information • DICOM a step towards interface standards

  18. The Role of DICOM • DICOM as basis for a data model ? • DICOM defines a hierarchical data structure • DICOM defines information objects and services on objects • DICOM based archives already available • DICOM as basis for a database ? • DICOM archives a step towards an open environment ?

  19. DICOM Restrictions • DICOM does not handle all data, e.g. • Administrative data • Scheduling data (Patients, Equipment, Staff) • Annotations, Doctor’s notes • Chemotherapy, Regimes, Pharmacy ordering • Charge capture • QA related data (Dosimetric data)

  20. DICOMArchive or Database ?

  21. DICOM Archives • Minimal object identification information • Image-level information stored in ‘BLOBs’ • Retrieval of complete objects necessary • Small and simple database • Mainly unstructured information

  22. DICOM Databases • More than object identification information • Other information stored in ‘BLOBs’ • Object Query sufficient (e.g. References) • Large and more complex database • Mainly structured information

  23. Patient Study Study Study Study Study Series Series Series Series Series Series RT-PLAN RT-IMAGE RT-IMAGE RT-IMAGE RT-IMAGE RT-TREATM.RECORD Logical Data Structure Plan and reference image Portal images

  24. EPID PLAN RT IMAGE Study Study Series Series STRUCT ? Study PLAN Series Study Series DOSE TREATRC Study Study Series Series Logical Data Structure: Coercion

  25. PATIENT PATIENT Study Study Study Study Ser Ser Ser Ser Ser Ser Ser Ser Ser ST IM ST PL ST DS IM PL DS ST Logical Data Structure: UID Mapping IMAGE STRUCT PLAN DOSE STRUCT Study Study Study Study Series Series Study Series Series Series

  26. Access Control Virtualsimulator Store RT-PLAN Store RT-PLAN Simulator DICOM Archive DICOM Archive Load RT-PLAN Load RT-PLAN TPS Store RT-PLAN

  27. Prescription Patient Setup Fractionation Treatment Technique Radiotherapy Data is dynamic R&V Doctor’sConsole RT Plan DICOM Archive VirtualSimulator TPS

  28. Making an Archive a Database • More than object identifying information • Logical Data Structure • Tools for Linking/Re-Linking, Coercion, UID Mapping • Access Control • Object Locking • Considering dynamic character • Handling of ‘modified’ objects, Application behavior

  29. Manager Managed DICOM Archive • Archive Management • Handles DICOM communication • Extended item storage • Object Linking / Re-Linking • Object Locking • non-DICOM access • DICOM Database DICOM Archive

  30. DICOMWhat about Management ?

  31. Full DICOM Support Patient IOD Study IOD Series RT Series RT Series RT Series ImageIOD PlanIOD StrStIOD DoseIOD RT Series RT Series RT Series PlanIOD StrStIOD DoseIOD

  32. Patient IOD Visit IOD Visit IOD Study IOD Study IOD Study Comp. IOD Study Comp. IOD Series RT Series RT Series RT Series ImageIOD PlanIOD StrStIOD DoseIOD RT Series RT Series RT Series PlanIOD StrStIOD DoseIOD Full DICOM Support

  33. Patient / Visit / Study Management • Handling ‘Normalized Objects’ • Manage Patient IOD • Create, Admit, Transfer, Discharge • Manage Visit IOD • Create, Schedule, Update • Manage Study IOD • Create, Schedule, Start, Complete, Verify, Read, Update

  34. Patient / Visit / Study Management Patient Management Study Management Schedule Visit Admit Patient Transfer Patient Create Study Schedule Study Prepare for Study Create Patient Discharge Patient Read Study Verify Study Perform Study

  35. Workflow Management • Patient / Visit / Study Management • Create Patient, Create and schedule Visit and Study • Modality Worklist Management • Management of scheduled ‘Procedure Steps’ for a modality • Modality Performed Procedure Step • Management of performed ‘Procedure Steps’ for a modality • Results Management • Create, Record, Transcribe, Approve

  36. HIS Integration • HL7-DICOM Protocol Translation • Developed by HL7 Image Management Group (IMSIG) • HL7-DICOM Gateway • Commercially available • Provides access to HL7 HIS/RIS information via DICOM • DICOM AEs can receive HL7 HIS/RIS originated messages • Implements the DICOM Worklist Management Service Class

  37. DICOM Virtues and Deficiencies • Describes most of the data needed in Radiotherapy • Major vendors currently implementing the standard • DICOM is well suited for communication • DICOM includes information management capabilities • DICOM may be used as data model • DICOM does not handle all data needed in oncology • DICOM archives are not to be used as databases

  38. DICOMSome Notes on Implementation

  39. DICOM Implementation Notes The ‘Communication’ part works, butthe ‘Interoperation’ part may be difficult. • Label and ID Mapping • Interpretation Issues • Required Optional Elements • Unsupported DICOM Elements

  40. Linac 1 Li 1 RT Plan RT Plan RT Plan TPS R&V Linac1 Linac 1 Li 1 Linac 1 Li 1 Linac 1 Li 1 Label and ID Mapping • Treatment Units, Wedges, Electron Applicators Treatment Unit: Linac 1 Treatment Unit: Li 1 ?

  41. + = Interpretation Issues Four Control Points Three Control Points

  42. Required Optional Elements • Patient Position • Important for 3D modeling • May be entered by the operator • Manufacturer’s Model Name for CT Images • Adapt to different ‘interpretation issues’ • Structure Set Reference for RT Plan • Reference to underlying coordinate system (Frame of Reference)

  43. RT Plan Prescription Patient Setup Fractionation Treatment Technique Treatment Technique Unsupported DICOM Elements Doctor’sConsole R&V VirtualSimulator TPS

  44. Thank you for your attention. Questions ?

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