InterconnectivityInterconnectivity and Interoperability ......TPS LiteBox CT SIM MAGN ETOM R&V CT LINAC. Detailed Radiotherapy Process MAGN ETOM MAGN ETOM LiteBox CT MR DB ... Interoperability

InterconnectivityInterconnectivity and Interoperability:and Interoperability:Where are we in Radiation Oncology?Where are we in Radiation Oncology?Where are we in Radiation Oncology?Where are we in Radiation Oncology?

J ti d R P lt PhDJ ti d R P lt PhDJatinder R Palta PhDJatinder R Palta PhDUniversity of Florida,University of Florida,G i ill Fl idG i ill Fl idGainesville, FloridaGainesville, Florida

Simplified Radiotherapy Processp py

LiteBox

TPSLiteBox

CT SIM

MAGN

ETOM

R&V

CT LINAC

Detailed Radiotherapy Process

MAGNETOM

MAGNETOM

LiteBox

CT MR

DB

Archive

HIS/EMR

Portal Imaging

DB HIS/EMR

Image Image AllNon

DICOM Image

SS, Plan,Dose,

Image Record

PlanMulti Image

SS, Plan,Multi Image

SS, Plan,Dose,Multi Image

LiteBox LiteBoxLiteBox

PlanMulti Image Multi Image

Virtual SIM. TPS LinacReviewStation

Simulator

Distributed System

An Example of Interconnectivity and Interoperability ChallengeInteroperability Challenge

(GE Proprietary Formats)CT 8800 Image Data Fmt (Tape)CT 9000 I D F (T ) MediaCT 9000 Image Data Fmt (Tape)CT 9800 Image Data Fmt CT Pace Image Data Fmt

Media9 Track half inch tape1” tape8mm tapeCT Advantage Image data

CT SytecCT Imatron

8mm tapeInternal driveMagneto optical DriveWORMMR Max Image Data Fmt

MR Signa 4.x Mag Tape and Image Data Fmt (Genesis)CT HLA/HSA MR Si 5 I D t F t

WORM

CT HLA/HSA MR Signa 5.x Image Data Fmt CT HLA/HSA MR Signa 5.x Optical Disk Raw Partition CT HLA/HSA MR Signa 5 x Image Extract ToolCT HLA/HSA MR Signa 5.x Image Extract Tool CT HLA/HSA MR Signa 5.x DAT Archive Fmt PET 4096 Plus and 2048 Plus Image Fmt

What is the solution?DICOM ?

DICOMDICOM

Digital Imaging and Communications in Medicine

Interoperability Why doesn’t it work when two devices are

DICOM compliant?DICOM compliant?

The DICOM standard is open to multiple i t t tiinterpretations

There is room for data field variations (optional “type 2 and type 3” data, and private data) DICOM does not specify its use in specific real-world scenariosDICOM i d d i h l ldDICOM is a paper standard with no real-world testing services

Completed Use Completed Use ppCasesCases

Basic RT Planning (2007)k N l T t t Pl i Si l (NTPL S)aka Normal Treatment Planning – Simple (NTPL-S)

Multimodality Registration (2008)aka Multimodality Registration for Radiation aka Multimodality Registration for Radiation Oncology (MMROncology (MMR--RO)RO)

Advanced RT Planning (2009)Extension of NTPL-S :Advanced Interoperability of Treatment Planning Systems (AITPS)

NTPLNTPL SSNTPLNTPL--SSImaging Study

ContouringS tImaging Study System

SimulationSimulationSystem

PlanningPlanningWorkstationRad Onc

EMR

TreatmentDeliveryTreatment

ifi i AITPSVerification AITPS

Basic RT Planning (Basic RT Planning (20072007))Data flow of DICOM images and treatment planning Data flow of DICOM images and treatment planning data, from CT scan through contouring, for 3D data, from CT scan through contouring, for 3D conformal planning and dose display of externalconformal planning and dose display of externalconformal planning and dose display of external conformal planning and dose display of external beam radiation therapy beam radiation therapy The emphasis is to reduce ambiguity and facilitate The emphasis is to reduce ambiguity and facilitate b i i t bilit i th h f DICOM RTb i i t bilit i th h f DICOM RTbasic interoperability in the exchange of DICOM RT basic interoperability in the exchange of DICOM RT objectsobjectsInformation Exchange Between (Actors):Information Exchange Between (Actors):Information Exchange Between (Actors):Information Exchange Between (Actors):

CT Scanner: CT Scanner: Performs CT Imaging and is able to export CT imagesPerforms CT Imaging and is able to export CT imagesContourerContourer: : Is able to import CTs & contours, perform contouring, and export CT Is able to import CTs & contours, perform contouring, and export CT images & contoursimages & contoursG t i PlG t i PlGeometric Planner: Geometric Planner: Is able to import CTs & contours, perform beam geometry Is able to import CTs & contours, perform beam geometry planning, and export geometric planplanning, and export geometric planDosimetricDosimetric PlannerPlanner: Is able to import CT, contours & geometric plan, perform dose : Is able to import CT, contours & geometric plan, perform dose calculation, and export plan & dose : distributioncalculation, and export plan & dose : distributionDose Displayer: Dose Displayer: Is able to import CT, contours, geometric plan, dose distribution, and Is able to import CT, contours, geometric plan, dose distribution, and display the dosedisplay the doseArchive: Archive: Is able to import & export CT images, contours, geometric plan, and dose Is able to import & export CT images, contours, geometric plan, and dose distributiondistribution

Example of NTPLExample of NTPL--S:S:R t t t f P ti tR t t t f P ti tRetreatment of a PatientRetreatment of a Patient

Available patient dosimetry DRR f i RTAvailable patient dosimetry information from previous treatment using a different TPS is

DRR of previous RT

goften inadequateNTPL-S unifies information format of treatment and dosimetry in RT devices Planned new RT

You should be able to review the plan and dosimetry of previous RT on your TPSTPSDesign the best new treatment plan for the patient.

NTPLNTPL--S StatusS Status

Formal Connectathon completed (Aug 27Formal Connectathon completed (Aug 27--30, 2007)30, 2007)First PUBLIC DEMONSTRATION at ASTRO annual meeting in Los Angeles, Oct 2007First PUBLIC DEMONSTRATION at ASTRO annual meeting in Los Angeles, Oct 2007

Success Stories from Success Stories from Formal ConnectathonsFormal Connectathons

“At the IHE-RO Formal Connectathon, We were able to take a head and neck patient CT, draw contours on Brainlab place a non co planardraw contours on Brainlab, place a non-co-planar beam on Brainlab, dose plan on Philips, dose display on Varian, archiving and distributing with IMPAC EMRIMPAC EMR.

For the prostate patient CT, we drew contours on TomoTherapy, beam placement and dose plan on CMS, and displayed on Elekta.”*

*Real life examples of Interconnectivity among Radiation Oncology Systems

MultiMulti--ModalityModality Registration (2008)Registration (2008)yy g a o ( 008)g a o ( 008)

Specifies how images (CT, PET, MRI), RT Structure Sets, RT Doses, andSpecifies how images (CT, PET, MRI), RT Structure Sets, RT Doses, and associated spatial registration information can be exchanged, stored, processed and displayed for radiation oncology treatment planning systemsInformation Exchange Between (Actors):g ( )

RegistratorIs able to import image sets, perform spatial registration between the image sets, and export spatial registration information

Registered DisplayI bl t i t i t t ti l i t ti i f ti d di l thIs able to import image sets, contours, spatial registration information, and display the registered images

Registered Dose DisplayIs able to import image sets, contours, spatial registration information, dose distributions, and display the registered images and dose distributions

Registered ContourerIs able to import image sets, contours and spatial registration information, perform image registration and contouring (on registered images), and export contours and spatial registration information

ArchiveIs able to import & export CT images, spatial registration information and contours

Connectathon occurred March 2008Connectathon occurred March 2008

What is the realty?What is the realty?

h f hThe successes of IHE-RO Connectathons have not made it into commercial products circa 2010

Why?

The customers do not demand it………

Purchase SituationPurchase Situation--Example #Example #11

Your clinic is evaluating new treatment planning systems Y & Z

You are getting quite many referrals (complicated cases; ti t l d i d RT i th t) f f thpatients already received RT in the past) from one of the

satellite hospitals, which is using product XYou want to make sure you are able to review the dose distributions from the treatment planning system X (used in p g y (the other clinic) with your new planning system

Your requirements to the vendors (as part of RFP)Request vendors of products Y & Z to provide an integration t t t hi h i l d d di lstatement, which includes dose displayer

Request vendor of product X (as part of the upgrade) to provide an integration statement, which includes dosimetric plannerp

Purchase SituationPurchase Situation--E l #1E l #1Example #1Example #1

TPS Product X TPS Product Y or Z

ContourerDefines contours

Registrator- Registers multimodality images



- Defines contoursRegistered Contourer

- Defines contours on multimodality images

Registered DisplayDisplays image fusion




Geometric Planner- Defines plan geometry

- Displays image fusion



Dosimetric Planner- Calculates dose

Dose Displayer

Registered Dose Displayer- Displays dose on multimodality images


Dose Displayer


Dose Displayer- Displays dose distribution


Purchase SituationPurchase Situation--Example #1Example #1

TPS Product X TPS Product Y or Z


Dose DisplayerDose Displayer- Displays dose distribution

Purchase SituationPurchase Situation--Example #2Example #2

Satellite clinic is planning to buy a treatment planning system

Main Campus has product XPhysicians like the image registration & contouring tools and dose review of product YPhysicists want consistency between clinics

Your requirements to the vendors (as part of RFP)Your requirements to the vendors (as part of RFP)Request vendor of product Y to provide an integration statement, which includes contourer, registrator, registered display and registered contourer, dose displayer and p y g , p yregistered dose displayer Request vendor of product X (as part of the upgrade) to provide an integration statement, which includes geometric planner and dosimetric plannerplanner and dosimetric planner

Purchase SituationPurchase Situation--E l #E l #22Example #Example #22

TPS Product X TPS Product Y
















Dose Displayer



Dose Displayer




Purchase SituationPurchase Situation--E l #2E l #2Example #2Example #2

TPS Product X TPS Product Y









Dose Displayer



Future (2009) Purchase SituationFuture (2009) Purchase Situation--E l #3E l #3Example #3Example #3

You have been tasked to find the best system solution to provide state-of-art IG-IMRT treatments in your clinicprovide state of art IG IMRT treatments in your clinic

Vendor Z has introduced very innovative and accurate new patient positioning device using X-rays, which you are very interested aboutYou have invested heavily to the treatment devices from vendor YThe data storage must be scalable due to massive amount of imaging datae data sto age ust be sca ab e due to ass e a ou t o ag g dataYou must make sure that all this works with your existing Treatment Management System W

Your requirements to the vendors (as part of RFP)Request positioning system vendor Z to provide an integration statement, whichRequest positioning system vendor Z to provide an integration statement, which includes patient positioning device -actor of Managed Delivery WorkflowRequest vendor of product Y (as part of the treatment device upgrade) to provide an integration statement, which includes treatment device –actor of Managed Delivery WorkflowRequest vendor of product W (as part of the treatment management systemRequest vendor of product W (as part of the treatment management system upgrade) to provide an integration statement, which includes treatment management system –actor of Managed Delivery WorkflowRequest vendors competing for the RT data storage solutions to provide an integration statement, which includes archive- actor of Managed Delivery

fWorkflow

Future (2011?) Purchase SituationFuture (2011?) Purchase Situation--E l #3E l #3Example #3Example #3

Treatment Management System- Plan management and Tx records

Treatment Delivery System- Tx verification & delivery- Scheduling Tx verification & delivery

P ti t P iti i S tPatient Positioning System- Patient localization and positioning

using e.g. X-rays, optical, internal fiducials

Archive- Stores all DICOM RT data

SummaryyNeed for Standards compliant systems (IHE-RO certified) is increasing rapidly due to the ) g p ycomplexity of radiation therapy work flowUnderstand your workflow and the points of contact between your systems. Verify that the interface across those points of contact are IHE-RO compliant i e the s stems on eithe sideRO compliant, i.e. the systems on either side are in fact interoperable.Recognize that the Standards and TechnicalRecognize that the Standards and Technical Frameworks are not complete.

Keep an eye on those and encourage your vendorsKeep an eye on those, and encourage your vendors to participate on relevant committees

Documents

InterconnectivityInterconnectivity and Interoperability ......TPS LiteBox CT SIM MAGN ETOM R&V CT LINAC. Detailed Radiotherapy Process MAGN ETOM MAGN ETOM LiteBox CT MR DB ... Interoperability