Grid Applications in Health

1. Grid Applications in Health Andres Gómez, PhD CESGA agomez@cesga.es

2. OBJECTIVES • Provide terminology • Show real clinical real applications • Some legal issues • Future

3. GRID INFRASTRUCTURE

4. HEALTH GRID REQUIREMENTS • Data confidentiality • Interactivity • Work-flow • Fast return of short jobs • Hide infrastructure details (portals)

5. Source: EELA-2 Source:EGEE Source: Crossgrid project GRID HEALTH APPLICATIONS • Surgical simulation • Image processing • In silico drug discovery • Share patient’s images and data • Many more (EELA-2)

6. CLINICAL RADIOTHERAPY • 60-70% cancer patients • Established methods • Many protocols

8. DATA ACQUISITION • DICOM-CT • INCLUDES PATIENT’S DATA • IMAGES • NEEDS ANONIMYZATION/SECURITY • ACCESS FROM GRID • TRENCADIS • MEDICAL DATA MANAGER (EGEE)

9. MEDICAL DATA MANAGER. Insert data J. Montagnat, et.al. ”A Secure Grid Medical Data Manager Interfaced to the gLite Middleware” in Journal of Grid Computing (JGC), 6 (1), pages 45–59, Kluwer, march 2008 Source: EGEE. Johan Montagnat

10. MEDICAL DATA MANAGER. Get data Source: EGEE. Johan Montagnat

11. GTV: Gross Target Volume Extent of Tumour Visible on Scan CTV: Clinical Target Volume Extension of GTV to include possible microscopic disease or additional structures (e.g. seminal vesicles in prostate ca) PTV: Planned Target Volume Include margins for organ motion, set-up inaccuracies (may be non-uniform i.e. larger margin AP than Inf-Sup) Ensures CTV will be covered despite variables. TV: Target or Treatment Volume Volume Irradiated (if possible PTV=TV) IV: Irradiated Volume Volume, which receives a ‘significant’ dose CTV GTV TV PTV IV ANATOMIC MODEL • DICOM-STRUCT

12. TREATMENT SELECTION • CONFORMAL RADIOTHERAPY (CRT) • INTENSITY MODULATED RADIOTHERAPY (IMRT) • IMAGE GUIDE RADIOTHERAPY (IGRT) • BRACHITHERAPY • ETC.

13. Accelerator Multileaf Collimator CONFORMAL RADRIOTHERAPY (CRT) Tumour is irradiated from several angles Collimator takes the shape of the tumour http://eimrt.cesga.es TUMOUR Organ at risk

14. INTENSITY MODULATED RADIATION THERAPY (IMRT) Collimator moves during beam-time, modulating intensity Also from different angles TUMOUR Organ at risk

15. DOSE CALCULATION. • SOFTWARE: TREATMENT PLANNING SYSTEM • USE FAST ALGORITHMS • RUN LOCALLY: WORKSTATIONS/CLUSTER • OUTPUTS (OPTIONAL) • DICOM-RTDOSE. CALCULATED DOSE • Dose Matrix, • Dose Points (2D & 3D), • Isodoses, • DVH • DICOM-RTPLAN: TREATMENT PLAN • Fractionation, • Tolerance, • Patient Setup, • Beams, & Sources

16. DOSE CALCULATION

17. PLAN VERIFICATION. EIMRT SERVICE • BASED ON BEAMnrc and DOSXYZ MONTE CARLO • CALCUTES DOSE DISTRIBUTIONS FOR AN EXISTING TREATMENT • ADDS TOOLS FOR COMPARING REFERENCE AND CALCULATED DOSES (3D GAMMA MAPS) J. Pena, et. al. “eIMRT: a web platform for the verification and optimization of radiation treatment plans”, in press in Journal of Applied Clinical Medical Physics

18. eIMRT Proposal Results Results • Commisioning • Verification < 5 hours • Optimization < minutes CTs Treatment BEFORE TPS WITH E-IMRT

19. ARCHITECTURE PERSONAL DATA REMOVED FROM INPUT FILES BEFORE UPLOAD SERVER CLIENT GRID + CLUSTER Service Oriented Architecture Based on GRID technologies

20. GRIDWAY ARCHITECTURE SERVER SIDE DEMO CLIENT DRMAA SLA SOA Architecture Based on GRID technologies

21. DRMAA • Init/exit • Job template interfaces • Job submit • Individual jobs • Jobs arrays (bulk) • Job monitoring and control • Auxiliary or system routines

22. DRMAA Example import org.ggf.drmaa.*; public class DrmaaRunJob { public static void main (String[] args) { SessionImpl session = new SessionImpl(); JobTemplateImpl jt = new JobTemplateImpl(); session =(SessionImpl) SessionFactory.getFactory().getSession(); try { session.init(null); jt = (JobTemplateImpl) session.createJobTemplate(); jt.setWorkingDirectory("wdir"); //Basic parameters jt.setJobName("taskname.jt"); jt.setRemoteCommand(“/bin/ls"); jt.setArgs(“-al”); //Output files, from local to remote (including protocol) jt.setOutputPath("stdout." + SessionImpl.DRMAA_GW_JOB_ID+".txt"); jt.setErrorPath("stderr." + SessionImpl.DRMAA_GW_JOB_ID+".txt"); //Job submission to GridWay Stgring id = session.runJob(jt); session.exit(); } catch (DrmaaException e) { e.printStackTrace(); } } }

23. SLA Negotiation overview GRID TREATMENT SERVICES GRIDWAY DRMAA SLA Negotiator client SLA SLA Negotiator server EXTERNAL RESOURCES PROVIDER

24. SLA components interaction SLA Negotiator client Provider List Broker GW-SLA SLA Negotiator server Pre SLA GW Internal Struct SLA Evaluation Resources provider DB Services Plugin GW-SLA GRIDWAY

25. E-IMRT VERIFICATION • Phase 1: Accelerator simulation. • Phase 2: Accelerator treatment head simulation (GRID) • Phase 3: Patient simulation. • Phase 4: Dose delivered to the patient(GRID) • Phase 5: Dose collection and end of process. Radiotherapist manually compares TPS and e-IMRT Monte Carlo doses Using different maps

26. E-IMRT VERIFICATION (II)

27. E-IMRT VERIFICATION (III)

28. PLAN OPTIMIZATION. EIMRT SERVICE • BASED ON MCDOSE • OPTIMIZE FLUENCES • RETURNS SEVERAL TREATMENT POSSIBILITIES • GENERATE DVH FOR CHECK J. Pena, et. al. “eIMRT: a web platform for the verification and optimization of radiation treatment plans”, in press in Journal of Applied Clinical Medical Physics

29. PLAN OPTIMIZATION. EIMRT SERVICE J. Pena, et. al. “eIMRT: a web platform for the verification and optimization of radiation treatment plans”, in press in Journal of Applied Clinical Medical Physics

30. INPUT/OUTPUT SUMMARY VERIFICATION OPTIMIZATION • Input: • DICOM RTplan • DICOM RTstruct • DICOM CT • DICOM RTdose (from TPS, optional) • Output: • DICOM RTdose (MCarlo) • Input: • DICOM RTstruct • DICOM CT • Other data: • Prescriptions • Output: • DICOM RTplan

31. RESEARCH CHALLENGES HEALTHGRID Source: http://eu-share.org/roadmap/SHARE_roadmap_long.pdf

32. RESEARCH CHALLENGES HEALTHGRID

33. LEGAL ISSUES • 2007/47/EC of 5 September 2007 • http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2007:247:0021:0055:EN:PDF • Medical device: “medical device” means any instrument, apparatus, appliance, software, material or other article, whether used alone or in combination, together with any accessories, including the software intended by its manufacturer to be used specifically for diagnostic and/or therapeutic purposes and necessary for its proper application, intended by the manufacturer to be used for human beings for the purpose of: • diagnosis, prevention, monitoring, treatment or alleviation of disease, • diagnosis, monitoring, treatment, alleviation of or compensation for an injury or handicap, • investigation, replacement or modification of the anatomy or of a physiological process, • control of conception • For devices which incorporate software or which are medical software in themselves, the software must be validated according to the state of the art taking into account the principles of development lifecycle, risk management, validation and verification

34. LEGAL ISSUES • Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data • the processing of data concerning health is prohibited by default • Only allowed for clinical usage by health professional with obligation of secrecy • Anyother case, patient consent

35. Grid Computing vs Cloud Computing Cloud Computing Source:Trends.google.com

36. Cloud Computing “Clouds are a large pool of easily usable and accessible virtualized resources (such as hardware, development platforms and/or services). These resources can be dynamically reconfigured to adjust to a variable load (scale), allowing also for an optimum resource utilization. This pool of resources is typically exploited by a pay-per-use model in which guarantees are offered by the Infrastructure Provider by means of customized SLAs.” Luis M. Vaquero, et.al.: “A Break in the Clouds: Towards a Cloud Definition“

37. Cloud Computing

38. THANK YOU Any questions? Visithttp://eimrt.cesga.es