Oncology Imaging: Pushing Efficiency, Outcomes, and More

Siemens ONCOR ExpressionA variety of oncology imaging IT offerings allow facilities of all sizes and resources to improve their operations from going filmless to providing the very latest in radiation therapy.

Improving cost-efficiency

St. Mary’s Cancer Centers in Knoxville, Tenn., operate KODAK 2000RT CR Plus systems in its main radiation oncology department and a new outpatient facility. The CR systems produce images for intensity modulated radiation therapy (IMRT) and dosimetry procedures. The two facilities see about 40 patients a day.

Scott Warwick, clinical leader at St. Mary’s, says the 2000RT system is more cost-effective than an electronic portal imaging device (EPID). In the organization’s efforts to go filmless, the CR system offers both a significantly lower initial investment and reduced expenses for additional plates, says Warwick. While his department saves $10,000 in film costs alone per year, the real benefit is increased productivity for radiation therapists. The CR system is right where the therapists work, so they can capture images efficiently and spend more time with patients, he says. In the past, one of the two therapists would have to take 15 minutes to go process six films leaving the other therapist to treat patients alone. Now, that second therapist is never lost in processing.

Warwick also likes the ability to adjust contrast and density of images using Kodak’s radiation oncology software. “If the film was too dark, we had to re-image the patient. Now we’re able to adjust the image for optimum viewing, and then archive it in an electronic chart.” Workflow is streamlined because images from the 2000RT CR system are routed to the hospital’s IMPAC electronic medical record system with the click of a mouse.

Another advantage of the CR system is that now a patient’s images can be accessed from any location at either facility. Before, there was only one set of films which could get lost. Plus, with just one radiation oncologist for the two facilities, it has improved physician turnaround time in approving films. The films are used to verify radiation treatment so they are an important part of the entire treatment process.

“We’re really where we want to be,” says Warwick. “We try to stay cutting edge.” The fact that Kodak and IMPAC coordinated well and the installation, set up and training went relatively smoothly all helped. He does caution that physicians have a tendency to get their expectations too high. “They still have to use the same type of energy to image the patients,” he says. But, the ability to manipulate images, once obtained, is a big bonus.
St. Mary’s also has IGRT technology installed that works well with CR. The separate system images patients right before treatment to verify that they are in the exact correct position. “The computer takes images and compares them to the original, fusing them together. If the alignment is off, the system automatically moves the patient to the right position,” Warwick says.

Preventing errors

At the MIMA Cancer Center in Melbourne, Fla., patients are imaged to ensure the accuracy of IMRT treatment. The facility has had the previous version of Varian Medical Systems’ ARIA — Varis — for the past three years but currently is undergoing installation of the ARIA.

The system serves three purposes, says Joseph Ting, PhD, chief medical physicist. “First, and most important, is to reduce any possibility of human error. The computer will keep a watchful eye over treatment parameters.” The system flags the user if there are any differences between the treatment plan and the execution. The system also tracks each procedure to assist with charge capture and helps with scheduling and logistics.

The Varian system is the “information backbone of the department,” Ting says. With no less than 20 parameters per patient to set up, it is easy to make a human mistake. I cannot imagine nowadays a complex treatment machine that doesn’t have a system watching over the human tasks. Without it, there is a high potential for errors.” With automatic set up features, about 80 percent of treatment parameters are ready when the patient arrives in the room.

With more than 100 patients, scheduling alone is a major task, Ting says. When factoring in patients changing appointments, appointments that require more of the doctor’s time than was scheduled and other changes throughout the day, there are “so many pieces of the puzzle,” he says. “It’s a very, very complex kind of scheduling system.” The system schedules patients, physicians, the machines and the rooms. One single screen shows who and what is available at any time.

And assistance with charges has made an impact as well, he reports. Once a patient is treated, the list of charges goes right to the billing office. The staff examines and authorizes the list and sends out the charges. This process eliminates the need for charge slips and the chance of lost charges or charges being tacked on to the wrong patient.

Offering cutting-edge treatment

The Savannah Oncology Center in Georgia has two ONCOR linear accelerators from Siemens Medical Solutions primarily used for radiation therapy, says Morris Geffen, MD, medical director. Geffen likes the equipment because the radiation used to perform a CT scan prior to treatment is already accounted for in the treatment plan. The beam taking the CT is the same beam used to treat. That allows for more precise, 4D treatment—three dimensions plus motion is embedded in the image set. “This is the only system that will allow you to integrate the radiation dose in the treatment plan,” he says.

When seeking out new equipment, Geffen says the facility’s staff was looking for a vendor that was both an imaging company and a treatment company. They found that in Siemens. He found that other vendors’ methods required another set of arms to calibrate and perform other tasks. “We wanted a system with a simple solution.” Plus, Siemens is the leader in wide-bore CT, he says. He uses an 82 cm, 40-slice CT scanner rather than the standard 50 cm. “We can put the patient in the exact radiation position and scan them in the treatment position.” He also purchased gating software for the ability to turn the machine off and on at the appropriate time to limit the dose to the normal tissue. “We can map motion over time and use the data for planning and confirmation.”

The equipment offers everything Geffen wanted. “It has a mutual information algorithm that associates images and CT. That allows for almost instantaneous association for computer-aided diagnostics.” If the data isn’t collected fast enough, the retargeting may be in error. Once the data is obtained, you must be ready to treat within three minutes. The Siemens ONCOR obtains the required information in 40 seconds and the reconstructed image set is fused with the planning data within another minute or so. “We think that 40-second data loop is enough to project motion,” Geffen says. “I am intrigued by how quick Siemens MVision cone beam is acquired and merged.”

“We are big proponents that technology shouldn’t be in educational institutions only,” Geffen says. Rather, it should be refined for use in the community setting if it’s user-friendly and patients can get the same quality of care. “The vast majority of cancer patients can benefit from this technology,” he points out. The two doctors and two physicists at the facility “are able to use the equipment day in and day out flawlessly. It’s cutting edge treatment and we’ve been very excited to be able to offer it.”