Making Image Management Easier

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 From CT imaging to progress made in image-guided radiation therapy, effective image management is crucial to oncology imaging. Storage, retrieval and tools for comparing images must all come together in a cohesive, seamless process for effective and efficient cancer diagnosis, staging, re-staging and treatment. New offerings are making image management itself easier to manage.

“The amount of images we’re dealing with in oncology is a hundred times more than just a few years ago,” says Vasudha Lingareddy, MD, medical director of the Edward Cancer Center department of radiation oncology in Naperville, Ill. The 40,000-square-foot facility opened in February 2005, and has seen double-digit volume growth each year since. As a result, plans are underway to open a second outpatient cancer center in another Chicago suburb in late 2008 or early 2009.

Filmless for efficiency

From day one, the facility was designed to be filmless. “We worked toward everything being electronic,” says John Fan, PhD, senior medical physicist. The center started out with a Clinac linear accelerator with On-board Imaging and obtained a Trilogy linear accelerator for IMRT within a year of opening, both from Varian Medical Systems. The equipment helps with image management because “it is easier than film,” says Fan. “It’s more efficient and the images are better. There is less wait time for imaging prior to treatment” which lets the clinicians treat patients more efficiently.

The center uses CT cone beam imaging, fiducial markers and image fusion for its cancer patients. Radiation oncology clinicians routinely use PET, MR as well as simulation CT images for treatment planning. These images must be fused together to provide correct tumor and anatomical locations. All of these techniques require a lot of storage. The hospital provides redundancy for the facility through its PACS. “Some people set up a little server in their department and they’re limited,” says Fan. “The whole thing has to fit into the general scheme of data storage.”

Fan has built upon the Varian Aria framework for image management. The team also uses Arian Offline Review software on the physician end to review cine and port films. “That gives us a task list for which films need to be checked. That software is very helpful in managing those images,” says Fan.

The hospital’s radiology department stores more data, but the cancer center is catching up. Since the facility has dramatically exceeded planned growth, more hard drives are added as necessary. “Nowadays, it’s pretty cheap,” says Fan. That’s a very good thing since “4D imaging and cone beam scanning take up a lot of storage space.” A 4D CT study set with 1,000 to 2,000 images can take 0.5 to 1 GB of storage. A cone beam study set occupies 30 MB. Daily cone beam CT scans for 45 days results in 1.4 GB of cone beam CT images for one patient.

An integrated solution

Fan and Lingareddy say it was an easy decision to go with single technology vendor, Varian. “The accelerator, treatment planning system and image management system all have to talk to each other,” says Lingareddy. “Integration is key. A piecemeal solution is nothing but a headache.”

The team used another treatment planning system in the past but “as the technology gets more complicated it has to seamlessly talk to each other,” says Lingareddy. “We’re moving toward dynamic adaptive therapy so the information has to flow back and forth instantaneously.”

That makes communication between different vendors’ systems impractical. Although data and images can be pushed through different systems with the DICOM protocol, any time you use the DICOM transfer you need a quality assurance program in place to check the integrity of data.  Also, DICOM RT protocol does not include all the treatment parameters in radiation oncology. Some parameters will be lost during transfer/conversion. “Thinking about that amount of work is unbelievable,” Lingareddy says. As a result, “almost from day one, we decided to use an integrated solution. With an integrated solution, data and images from treatment planning to treatment delivery are stored in one database. There is no need for data/image transfer and conversion. Down the road, our field is heading towards dynamic adaptive radiation therapy which requires daily imaging and daily modification of treatment plan while the patient is waiting on the treatment table. Instantaneous information flow is a must.”

Storage is top of mind

For John DeMarco, MD,