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Informatics Systems Informatics Systems OverviewOverview

R Dahl*, M Herman Mayo R Dahl*, M Herman Mayo FoundationFoundation

Rochester, MNRochester, MN

ObjectivesObjectives

Understand basic network infrastructure Understand basic network infrastructure for both LANfor both LAN’’s and s and WANWAN’’ssUnderstand interfaces to both hospital IS Understand interfaces to both hospital IS systems and radiation oncology devicessystems and radiation oncology devicesUnderstand network requirements for Understand network requirements for single and multisingle and multi--department institutionsdepartment institutions

Understand what is needed for Understand what is needed for migration from a paper to an electronic migration from a paper to an electronic treatment recordtreatment recordGenerate specifications for an Generate specifications for an information systeminformation systemPersonnel requirements for Personnel requirements for implementing and maintaining an implementing and maintaining an information system information system Review basic specifications of available Review basic specifications of available Treatment Management systemsTreatment Management systems

Objectives Objectives concon’’tt

Local Ethernet NetworkLocal Ethernet Network

Ethernet

Workstation

Laser printer

Workstation Server

Desktop

Most common type of networkIEEE 802.3 standard

Star topologyStar topologyBus topologyBus topology

Ethernet

Workstation Workstation Workstation

Workstation Workstation

Workstation

Workstation

Workstation

Workstation

Workstation

Reference (4)

Multiple NetworksMultiple Networks

Token Ring

Ethernet

Ethernet

Workstation

Workstation

Switch

Workstation

Mainframe

Router

Workstation

Workstation

Laser printer

Bridge

Desktop

Desktop

WAN

ProtocolsProtocols

TCP/IP TCP/IP –– Transmission Control Transmission Control Protocol/Internet ProtocolProtocol/Internet ProtocolIPX/SPX IPX/SPX –– Novell protocol (current Novell protocol (current Netware supports TCP/IP)Netware supports TCP/IP)NetBEUI / NetBIOS (old protocols)NetBEUI / NetBIOS (old protocols)

TCP/IPTCP/IP

Most common network protocolMost common network protocolBased on a suite of protocolsBased on a suite of protocolsIs routableIs routableSupports DHCP and WINSSupports DHCP and WINS

Application

Transport

Internet

Network Interface

WAN ConnectionsWAN Connections

Different types of communication Different types of communication connections availableconnections available−− T1 (1.536 Mbps)T1 (1.536 Mbps)−− T3 (44 Mbps)T3 (44 Mbps)−− SDSL, HDSL (1.544 Mbps)SDSL, HDSL (1.544 Mbps)−− Cable ModemCable Modem−− SatelliteSatellite

WAN CommunicationsWAN Communications

““ThickThick”” clientclient−− Standard desktop computer, application Standard desktop computer, application

loaded on computerloaded on computer−− Reduces network traffic by not having to load Reduces network traffic by not having to load

application over Netapplication over Net−− Increases software maintenance by having to Increases software maintenance by having to

upgrade applications on each computerupgrade applications on each computer

““ThinThin”” clientclient−− Application is loaded over the networkApplication is loaded over the network−− Increases network trafficIncreases network traffic−− Reduces software maintenance timeReduces software maintenance time

WAN SolutionsWAN Solutions

Software with web forms based interfaceSoftware with web forms based interface−− Specific application not needed on Specific application not needed on

workstationworkstation−− Reduced network traffic Reduced network traffic –– only loads only loads

requested datarequested data−− Can be run from any computer with a web Can be run from any computer with a web

browserbrowser

Thin client using CitrixThin client using Citrix®® MetaframeMetaframe™™ or or Windows Terminal ServerWindows Terminal Server−− Software maintenance reducedSoftware maintenance reduced−− Network traffic reducedNetwork traffic reduced−− Need at least one more server depending on Need at least one more server depending on

client loadclient load−− Configuration more difficultConfiguration more difficult

CitrixCitrix®® MetaframeMetaframe™™Software that runs as an extension to Software that runs as an extension to Terminal ServerTerminal ServerICA (Independent Computing ICA (Independent Computing Architecture) clientArchitecture) clientCan have Citrix Server Farms to load Can have Citrix Server Farms to load balance across multiple serversbalance across multiple serversMultiple clients available Multiple clients available –– Windows, Windows, McIntosh, UNIX, DOSMcIntosh, UNIX, DOSSupports multiple communication Supports multiple communication protocolsprotocols

Citrix Citrix concon’’tt

Application actually runs on the Citrix Application actually runs on the Citrix serverserverVideo and keyboard/mouse information Video and keyboard/mouse information are transferred over the networkare transferred over the networkPrinter configuration can be difficultPrinter configuration can be difficultSolution for multiSolution for multi--site departmentssite departments

DICOMDICOM

Digital Image Communication in MedicineDigital Image Communication in MedicineStandards designed for image Standards designed for image communicationcommunicationDICOMDICOM--RT Extensions added to the RT Extensions added to the standard to support radiation therapy standard to support radiation therapy objectsobjects

DICOM DICOM concon’’ttService Object Pair (SOP) is the basic Service Object Pair (SOP) is the basic unit of communicationunit of communicationAn action or service is performed on an An action or service is performed on an information objectinformation objectExampleExample

Service InformationObject

Applied to

SOP ClassService Object Pair

Reference (4)

CompositeObject

Patient

Object

SeriesFindings

Study 1Visit

Makes

Creates

Action

Contains

Study 2

Procedure

FindingsImages

References

TxStrategy

Modality,Equipment

TxOptions

Standard Objects

References

Contains

References

Creates

Documents

Example Example -- Information objects and Information objects and relationships for Pt. visitrelationships for Pt. visit

Reference (4)

DICOMDICOM--RT information objects and RT information objects and definitionsdefinitions

DICOM RT modality (Information Object) Object Definition

RT Image RT specific images, such as DRR, EPID digital simulation capture, digitized film.

RT Structure Set Curves or points representing patient contours and structures.

RT DoseRT Dose 2 and 3D isodose curves or surfaces, point doses, dose volume histograms

RT PlanRT Plan Detailed planned data, beams, applicators, fractionation scheme

RT Beams Tx Record Record/Verify data, as treated for external beam

RT Brachy Record Record/Verify data, as treated for brachytherapy

RT Summary Record Summary, cumulative data for entire course/patient

Compatibility exampleCompatibility example

App 1 SOP App 2 Compatible? Comment

A Store RT-Plan to B YES A is an SCU and B is an SCP for RT-Plan

AStore RT-Image to

B NO A is an SCU, but B does not support RT-Image

BStore RT-Plan to

A NO A is an SCP, but B is not an SCU for RT-Plan

BStore RT-Structure

to A NO A is not an SCP and B is not an SCU for RT-Structures

Application can be a service class user (SCU) or Application can be a service class user (SCU) or service class provider (SCP)service class provider (SCP)

Reference (4)

DataflowDataflow

Knowledge of departmental dataflow is Knowledge of departmental dataflow is required for any information systemrequired for any information systemExamples of dataflow, connectivity, and Examples of dataflow, connectivity, and equipment interfacesequipment interfaces

InterconnectionsInterconnections

Analyze computer information flow within Analyze computer information flow within the departmentthe departmentDetermine the method of communication Determine the method of communication between each componentbetween each componentExamine the type of data sent between Examine the type of data sent between each componenteach component

IMPAC (Pervasive)

IMPAC

ViewStation(Images)

Eclipse/VisionTPP+Brain lab(Storage Locally)

TPP+ (*.rtp)Storage H:\

(Storage Network Server)(Dbase (sybase)) Varsrv02

(Images)

LINACComputer

MLC

LINAC

R &

VPortalVision

IAS

Radexsend

Eclipse Proc.

winscp32

DCM moduleIMPAC (port 104)

Dosimetry computer

RT Image

NAMER

RT Plan (rtp format)

RTP interface*.rtp

IMPAC permanent flat image storage (DFS)

RTP to IMPAC(Optional)

Translation

Process

Storage

Varian

IMPAC

RTP

DICOM

GE

SIM PACSMIDIA, Mrex

(Storage Clinic Level)

Onc Box n(Storage Locally) SIM computer

Nucletron BrainLab

NPV6

RT Image (per machine)

IMPAC Workstation(Sequencer)

SIM

Onc Box n(Storage Locally)

Eclipse/VisionBrain lab(Network Storage)

PortalVisionWorkstationLINAC

Computer

MLCWorkstation

LINAC

R & V

SIM computer

IAS

Radexsend

Eclipse Proc.

winscp32

DCM moduleIMPAC (port 104)

Dosimetry computer

IMPAC (Pervasive)Server

RTP interface*.rtp

IMPAC image form onInstitutional server directory

NPV6RT Image (per machine) IMPAC server directory

Translation

MIDIA

PACS

QREADS

MRex

QREADSDigital JacketVariseed

Plato(UNIX)

FDIMPORTFTP-get

(Dbase (sybase))

RT Plan (*.rtp format)IMPAC server directory

RT Image IMPAC server directory

TPP+

RTP export

RTP to IMPAC(Optional) Adds more info

MLCController

DataTap

save

NAMER

Non-4DITC

EPID

Fuel

RTP

exp

ort

filedata(Images)

IMPACViewstation(Images)

IMPAC Workstation(Sequencer)

LINACComputer

LINAC

Verification

IMPAC (Pervasive)Server

IMPAC image formatInstitutional server directory

IMPAC

ViewStation(Images)

RT Image IMPAC server directory

MLCController

NAMER

4DITC

4D network switch

4DITCWorkstation

OBIWorkstationIAS

4DITC Images

EPID OBI

Images via DICOM

SIM

Onc Box n(Storage Locally)

Eclipse/VisionBrain lab(Network Storage)

SIM computer

Radexsend

Eclipse Proc.

winscp32

DCM moduleIMPAC (port 104)

Dosimetry computer

RTP interface*.rtp

Translation

MIDIA

PACS

QREADS

MRex

QREADSDigital JacketVariseed

Plato(UNIX)

FDIMPORTFTP-get

Dbase (sybase)

RT Plan (*.rtp format)IMPAC server directory

TPP+

RTP export

RTP to IMPAC(Optional) Adds more info

Fuel

RTP

exp

ort

Institutional server dir(Images)

Record

LVI

LINACComputer

LINAC

MLCController

4DITCTentative

4D network switch

4DITCWorkstation

OBIWorkstationIAS

EPID OBI

SIMOnc Box n

(Storage Locally)

Eclipse/VisionBrain lab(Storage Institutional

server)

SIM computer

Radexsend

winscp32

MIDIA

PACS

QREADS

MRex

QREADSDigital JacketVariseed

Plato(UNIX)

FDIMPORT

FTP-get

Dbase (sybase)

TPP+

Fuel

Institutional serverdir. (Images)

VARiS (ARIA)

Processes

Varian

IMPAC

GE

Nucletron

BrainLab

StorageLocation

DICOM Transfer(in black)

Multivendors:

Color Code:Color Code:

In-house

TMIS SpecificationsTMIS SpecificationsThe Treatment Management Information The Treatment Management Information System (TMIS) ties together the various System (TMIS) ties together the various sources of informationsources of informationIdeally Ideally –– Information goes directly to Information goes directly to TMIS with no user interventionTMIS with no user interventionIdeally Ideally -- Conversion programs are not Conversion programs are not neededneededIdeally Ideally -- Redundant entry of data is Redundant entry of data is avoidedavoided

Developing TMIS SpecificationsDeveloping TMIS Specifications

Complete a process map of information Complete a process map of information flowflowCover all areas including nurses, doctors Cover all areas including nurses, doctors and secretariesand secretariesWho enters what data, how many times is Who enters what data, how many times is it enteredit enteredHow many times is the same data How many times is the same data entered?entered?

Users:► Physicians► Physicists► Therapists► Dosimetrists► IS team► Administrative Staff

Clinical Operations:*I. Patient Registration ProcessII. Patient Consultation ProcessIII. Departmental Scheduling ProcessIV. Departmental Patient Charting

ProcessV. Patient Treatment Sim ProcessVI. Patient Treatment ProcessVII.Administrative Services

* Van Dyk J. The Modern Technology of Radiation Oncology. Chapter 14 by Brooks K.W.

IS Infrastructure management:

I. Archiving & Data miningII. Database Technology (Sybase vs.

MS SQL)III. Interface capabilities (i.e. HL7,

DICOM, other)IV. Vendor supportV. IS/ITPerformance.

Technological Innovations:I. New imaging modalities (Cone Beam

CT, EPID-MV, OBI-kV, kV – MV)II. Image-guided stereotactic

treatmentsIII. New Image-Guided Radiation

Therapy modalitiesIV. Etc.

• Major Components

Example SpecificationsExample SpecificationsPhysics / DosimetryPhysics / DosimetryACCESS TO DEPARTMENT AND ACCESS TO DEPARTMENT AND

INSTITUITIONAL SCHEDULESINSTITUITIONAL SCHEDULES1.1. AutoAuto-- notification to appropriate physicist notification to appropriate physicist

when special procedures are scheduled or when special procedures are scheduled or changed.changed.

2.2. Access to all Access to all RadRad OncOnc physician, physician, simulator, treatment machine, shop and simulator, treatment machine, shop and patient schedules patient schedules

3.3. Ability to attach info or appointments to Ability to attach info or appointments to patients treatment, simulation and block patients treatment, simulation and block room schedules in TMISroom schedules in TMIS…………..

Physics / Dosimetry Physics / Dosimetry concon’’ttINFORMATION TRANSFERINFORMATION TRANSFER

1.1. All patient treatment information available in All patient treatment information available in digital format must follow the latest digital format must follow the latest

2.2. DICOMDICOM--RT standards to allow for seamRT standards to allow for seam--less less transfer of datatransfer of data

3.3. Sectional image based treatment port design Sectional image based treatment port design should not produce multiple data sets should not produce multiple data sets

4.4. Transfer of data should be done without Transfer of data should be done without ““patched patched network softwarenetwork software”” or programsor programs

5.5. Information should be able to be imported into the Information should be able to be imported into the TMIS from normal page scanners or digital TMIS from normal page scanners or digital camerascameras…………....

Electronic Treatment RecordElectronic Treatment Record

The use on an electronic treatment record The use on an electronic treatment record has numerous advantages over a paper has numerous advantages over a paper recordrecord−− Available for viewing at any timeAvailable for viewing at any time−− It can be viewed simultaneously by several It can be viewed simultaneously by several

peoplepeople−− No physical transport of record neededNo physical transport of record needed−− Data more easily available for analysisData more easily available for analysis

Electronic Treatment Record Electronic Treatment Record concon’’tt

There are disadvantagesThere are disadvantages−− Paper record has evolved over many yearsPaper record has evolved over many years−− Electronic treatment records are not as Electronic treatment records are not as

flexible flexible –– vendor specificvendor specific−− More computer resources are requiredMore computer resources are required

Electronic Treatment Record Electronic Treatment Record concon’’tt

Will probably not result in reduction in Will probably not result in reduction in personnelpersonnelMay need 1 FTE to manage the systemMay need 1 FTE to manage the systemIf dedicated IS personnel are not available If dedicated IS personnel are not available will need a computer guruwill need a computer guruMay need to hire computer consultants to May need to hire computer consultants to manage networkmanage network

Major Available TMIS SystemsMajor Available TMIS Systems

IMPAC MOSAIQIMPAC MOSAIQVarian ARIAVarian ARIANucletronNucletron OncentraOncentraSiemens Siemens LantisLantis

Server Operating Systems / HWServer Operating Systems / HWO.S.O.S. HW SmallHW Small HW LargeHW Large

MOSAIQMOSAIQ Windows Windows 2003 Server2003 Server

ZEON, 3+ GHz, 3 ZEON, 3+ GHz, 3 GB RAM, 18 GB RAM, 18 –– 146 146

GB StorageGB Storage

Quad ZEON, 3+ Quad ZEON, 3+ GHz, 4 GB RAM, GHz, 4 GB RAM,

72 72 –– 146 GB 146 GB StorageStorage

ARIAARIA Windows Windows 2003 Server2003 Server

ZEON, 3+ GHz, 2 GB RAM, 6x73 GB ZEON, 3+ GHz, 2 GB RAM, 6x73 GB RAID 5 StorageRAID 5 Storage

OncentraOncentra Windows Windows 2000 Server2000 Server

ZEON, 3+ GHz, 1 GB RAM, 6x73 GB ZEON, 3+ GHz, 1 GB RAM, 6x73 GB RAID 5 StorageRAID 5 Storage

LantisLantis Windows Windows 2003 Server2003 Server

P4, 3+ GHz, 1 GB P4, 3+ GHz, 1 GB RAM, 2x36 GB RAM, 2x36 GB RAID 1 StorageRAID 1 Storage

ZEON, 3+ GHz, 2 ZEON, 3+ GHz, 2 GB RAM, 3x70 GB GB RAM, 3x70 GB RAID 5 StorageRAID 5 Storage

Database EngineDatabase Engine

MOSAIQMOSAIQ Microsoft SQLMicrosoft SQL

ARIAARIA Sybase 12.5Sybase 12.5

OncentraOncentra OracleOracle

LantisLantis Pervasive 8Pervasive 8

ConclusionConclusionComplexity of Complexity of RadRad. . TxTx. are increasing . are increasing every yearevery yearComputers are a vital part of the Computers are a vital part of the treatment processtreatment processA electronic TMIS and A electronic TMIS and TxTx. Record will be . Record will be needed to handle the large amount of needed to handle the large amount of informationinformationMedical physicist will (does) play an Medical physicist will (does) play an important role in the operation of a TMISimportant role in the operation of a TMIS

ReferencesReferences

1.1. NEMA , Digital Imaging and Communications in Medicine NEMA , Digital Imaging and Communications in Medicine (DICOM), National Electrical Manufacturers Association, (DICOM), National Electrical Manufacturers Association, Washington, D.C. 2001. http://Washington, D.C. 2001. http://medical.nema.orgmedical.nema.org//

2.2. Microsoft Press, Microsoft Windows NT Server Networking Guide, Microsoft Press, Microsoft Windows NT Server Networking Guide, Redmond WA, Microsoft Press, 1996. Redmond WA, Microsoft Press, 1996.

3.3. GarmesGarmes, Jason et. al., Windows NT Server 4 Unleashed, , Jason et. al., Windows NT Server 4 Unleashed, Indianapolis, Indianapolis, SamsSams Publishing, 1997.Publishing, 1997.

4.4. Herman, M.G., Computer networking and Information Systems in Herman, M.G., Computer networking and Information Systems in Radiation Oncology. AAPM Refresher Course, 1999.Radiation Oncology. AAPM Refresher Course, 1999.

5.5. MathersMathers, T.W., Windows NT/2000 Thin Client Solutions, , T.W., Windows NT/2000 Thin Client Solutions, Indianapolis IN, Indianapolis IN, MacmillianMacmillian Technical Publishing, 2000.Technical Publishing, 2000.

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