Image Management for Radiation Therapy

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Managing radiation therapy images for IMRT, IGRT and gated imaging is getting more complex as images increase in number, volume and frequency. Digital image management is the clear answer for the healthcare facility demanding anytime, anywhere, real-time access to images critical to accurate, effective radiation therapy.

Like general radiology, radiation oncology is seeing an explosion in the number and size of images it is acquiring and managing. Consequently, it is increasingly important for radiation therapy departments to evaluate their image viewing and management needs and implement a proactive solution.

Randy Holt, PhD, chief medical physicist at Enloe Medical Center (Chico, Calif.), explains the situation. "Radiation oncology is becoming more and more dependent on imaging for diagnosis and treatment. We're dealing with massive amounts of imaging information." Indeed, some radiation oncology centers are transitioning from two to three port films per week to multiple films a day over the course of an eight-week treatment. The exponential increase in images allows radiation oncology centers to tap into the latest techniques in technology, including IMRT (intensity modulated radiation therapy), IGRT (image guided radiation therapy) and gated imaging. But the increased image volume and more precise treatment protocols present a dilemma. How can films be rapidly accessed, viewed, managed and stored to facilitate efficient and effective clinical decision-making?

In many cases, digital image management provides the answer. Anytime, anywhere, real-time electronic access to patient images carries a number of benefits in the radiation oncology department that include:

  • Improved productivity and workflow
  • Enhanced patient care
  • Reduced costs
  • Enhanced service to referring physicians


South Suburban Oncology Center (Quincy, Mass.) implemented Impac's (Mountain View, Calif.) ViewStation image management system 18 months ago and has seen dramatic improvements in workflow and patient care since installing the system.

Administrator Karen Donnellan explains the 'before' situation. "We have two linear accelerators and see 105 to 110 patients a day. It was hard to get port films approved by physicians in a timely manner." Films needed to be physically retrieved and hung; radiation oncologists typically spent anywhere from 30 minutes to two hours at the end of the day reviewing and approving the piles of films that accumulated throughout the day. Donnellan acknowledges, "The situation has improved tenfold with ViewStation." Now, radiation oncologists can review images electronically on their computers throughout the day, easily integrating on-the-spot review into their workflow.

This near-real-time review is one of several ways that electronic image management systems can improve patient care in radiation oncology. Most radiation oncology centers have or are moving toward IMRT and IGRT. Indeed, on-board imaging, gated imaging and 4D treatment is right around the corner. These advances promise to improve patient outcomes but hinge on an ever-increasing amount of imaging data to drive more precise treatment plans.


Enloe Medical Center has transitioned from the classic approach to radiation oncology, defined by looser, larger treatment fields, to the modern approach, characterized by tighter, more precise fields and increased radiation doses. The department relies on Varian Medical Systems' (Palo Alto, Calif.) VARiS Vision radiation oncology information management system, which includes physician and dosimetrist workstations, radiation oncology management software and electronic charting - to facilitate the modern approach.

Holt explains, "It's important for us to push images to the right people for decision-making. We need to move beyond passive management of images." The center and its satellite handle 50 patients per day and take daily films of all IMRT patients. "We don't have legions of staff to push images in front of physicians, and we can't afford to throw people at the problem. We have to do this with a budget."

Enloe Medical Center relies on the oncology management system to move images to radiation oncologists and enable a more active image management process. The software provides physicians with immediate access to images; any time a physician logs onto any workstation in the building, he is reminded to check films, which streamlines the image review