IHE-RO Radiation Oncology

1. IHE-RORadiation Oncology IHE Workshop 2006 Scott Johnson, Keith La Plain

2. Agenda • Sponsors • RO Team • Road Map • Actors • Connectathon 2006 • Connectathon 2007 • Future Direction

3. Primary Membership Sponsors • Radiation Oncology Vendors • Delivery Devices – Linacs, Cobalt, Brachytherapy • Simulators • Treatment Planning Systems • Oncology Information Systems • Physician Associations & Colleges • ASTRO • AAPM (American Association of Physicists in Medicine) • ATC (Advanced Technology Consortium)

4. Planning Committee Keith La Plain (Varian) Jay Cooper, MD Prabhakar Tripuraneni, MD (ASTRO) Jatinder Palta, PhD (U Florida) Technical Committee Bruce Curran (U Mich) Stuart Swerdloff (Impac) Dave Murray (Tomotherapy) Bill Bennett (CMS) Ulrich Busch (Varian) Jaap Pijpelink (Nucletron) Brian Frederiksen (Siemens) Colin Winfield (Elekta) Scott Johnson (Philips) Jeff Szuhay (NOMOS/NAS) Walter Bosch (Wash U ATC) Stephen Vastagh (NEMA) Alan Gay (ASTRO) RO Team – Who’s Who

5. Profile Roadmap • Year 2005-2006 (Initial Implementation) • Image Set Contouring • Storage & Retrieval • Structure Set • Geometric Plan • Dosimetric Plan • Dose • Multi Series Image Review • Combined CT Storage • Year 2006-2007 • RT Plan – enlarging scope of objects : wedges, arcs • Scheduling of Treatment Delivery - GPWL • Fusion (Multi-modality) • Query / Retrieve • Future • Further RT Plan enlargement • 4D Support for gating, breath-hold, adaptive therapy

6. Domain Visibility & Support • ASTRO Annual Conference • 2006 ASTRO : Inaugural IHE-RO Showcase • Other Potential Conferences • AAPM • HIMSS • RSNA

7. Actors • Archive • Contourer • Geometric Planner • Dosimetric Planner • Dose Displayer

8. Connectathon 2006 • Timing Week of September 25th, 2006 • Location “undetermined” • Use Cases • Single Contoured/Image Series Retrieval • Structure Set Storage • Geometric Plan Storage • Dosimetric Plan Storage • Dose Storage • Multi Series Image Review • Structure Set Retrieval • Geometric Plan Retrieval • Dosimetric Plan Retrieval • Dose Retrieve • Combined CT Storage

9. Single Contoured/Image Series Retrieval • Description: In the Single/Contoured Image Series Retrieve transaction, the Archive sends a series of CT-Images to the Contourer, Geometric Planner, or Dosimetric Planner. • Actor: Archive • Role: Transmit CT Series to Contourer, Geometric Planner, or Dosimetric Planner • Actor: Contourer, Geometric Planner, or Dosimetric Planner • Role: Receives and stores CT Series from Archive

10. Structure Set Storage • Description: In the Structure Set Storage Transaction, the Contourer stores a Structure Set on an Archive to make it available. • Actor: Contourer • Role: Sends Structure Set to Archive • Actor: Archive • Role: Stores Structure Set received from Contourer

11. Geometric Plan Storage • Description: In the Geometric Plan Storage transaction, the Geometric Planner sends the newly created Geometric Plan to the Archive. • Actor: Geometric Planner • Role: Transmit generated Geometric Plan to the Archive • Actor: Archive • Role: Receives and stores Geometric Plans from the Geometric Planner

12. Dosimetric Plan Storage • Description: In this transaction, the Dosimetric Planner sends the plan containing the references to the structure set to the Image Archive. • Actor: Dosimetric Planner • Role: Transmit generated plan to Image Archive. • Actor: Archive • Role: Accept and store plan from Dosimetric Planner.

13. Dose Storage • Description: In the Dose Storage transaction, the Dose planner sends the newly created Dose to the Archive. • Actor: Dosimetric Planner • Role: Transmit generated Dose to the Archive • Actor: Archive • Role: Receives and stores Doses from the Dosimetric Planner

14. Multi Series Image Review • Description: In the Multi-Series Image Retrieve Transaction, the Archive stores CT Images from multiple series (but a single study) on a Contourer to make these Images available for contouring. • Actor: Archive • Role: Sends CT Images to the Contourer • Actor: Contourer • Role: Stores CT Images received from Archive

15. Structure Set Retrieval • Description: In the Structure Set Retrieval Transaction, the Archiver stores a Structure Set on a Contourer, Geometric Planner, Dosimetric Planner, or Dose Displayer. • Actor: Archive • Role: Sends Structure Set to Contourer, Geometric Planner, Dosimetric Planner, or Dose Displayer • Actor: Contourer, Geometric Planner, Dosimetric Planner, or Dose Displayer • Role: Stores Structure Set received from Archive

16. Geometric Plan Retrieval • Description: In the Geometric Plan Retrieve Transaction, the requested Geometric Plan is transferred from the Archive to the Dosimetric Planner. • Actor: Dosimetric Planner • Role: Receives requested Geometric Plan from the Archive • Actor: Archive • Role: Sends requested Geometric Plan instance to the Dosimetric Planner

17. Dosimetric Plan Retrieval • Description: In this transaction, the dose displayer retrieves the plan containing the references to the structure set to the Image Archive. • Actor: Dose Displayer • Role: Accepts plan from Archive. • Actor: Archive • Role: Transmits plan to Dose Viewer.

18. Dose Retrieve • Description: In the Dose Retrieve Transaction, the requested Dose is transferred from the Archive to the Dose Displayer. • Actor: Dose Displayer • Role: Receives requested Dose from the Archive • Actor: Archive • Role: Sends requested Dose instance to the Dose Displayer

19. Combined CT Storage • Description: In the Resampled/Combined CT Series Storage Transaction, the Contourer stores CT Images which have been combined or resampled into a single series on the Archive. • Actor: Contourer • Role: Sends CT Images to the Archive • Actor: Archive • Role: Stores CT Images received from Contourer

20. Connectathon 2007 • Worklist / Scheduling & GP Worklist • Query/Retrieve Extensions to support RT Objects • Complete External Beam Definition of RT Plan • Multi-Modality Registration/Fusion

21. GP Worklist Treatment Delivery including • Selecting a Treatment from the Oncology Information System (OIS) • Sending Treatment to Treatment Delivery System • Setup & Position Verification including Imaging and Other Devices • Image Acquisition Including CT • Delivering Treatment • Saving Treatment Record • Updating the OIS IODs Documented in DICOM Draft Supplement 74 : Utilization of Worklist in Radiotherapy Treatment Delivery

22. Query/Retrieve Profiles • Support Query/Retrieval of RT Objects from PACS, et al • RT Objects have richer set of references than radiology objects • Required query elements include referenced objects • Modalities themselves (Planners, Contourers) may also support Q/R of RT Objects

23. RT Plan Profiles • Profiles will be specified in terms of beam delivery types. • Each beam type supports a subset of modifiers. • Conformance will be specified with respect to the beam type profile and supported modifiers.

24. RT Plan Conformance Beam Modifiers Beam Profiles

25. Registration/Fusion • Affine, Deformable, Global, Local • CT, MR, PET, US, SPECT • Multiple (~30) Volume Datasets • CBCT Support • Contour redefinition vs Contour Pasting

26. Future Direction • Brachytherapy (LDR & HDR) • Clinical Trials Submissions • 4D : gating, breath hold, adaptive, fluoroscopic monitoring • Plan transfer to treatment delivery device • Enhanced dose exchange • Enhanced worklist : Dose Calculation Scheduling, Planning Scheduling (Simulation, Contouring, Planning) • Multiple-independent delivery devices – Micro MLCs • ION Support