Radiation Oncology in the Age of Informatics

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Nearly two thirds of cancer patients will receive some form of radiation therapy during their illness. While the marriage of informatics and radiation oncology is not changing treatment options for patients, it is providing the radiotherapy team with smarter, more efficient tools to help receive, transmit and store electronic information, flawlessly - ultimately improving the many steps involved in advanced treatments. Radiation oncology is an intense, demanding field that is currently suffering a shortage of radiation therapists. Informatics is lending a helping hand.

Workflow at the Rock Hill Radiation Therapy Center (RHRTC) has improved significantly since implementing an oncology image and information management system. Transitioning to an electronic charting environment, the online data repository holds 15 years of patient clinical data. Electronic images and information are now available to each member of the radiotherapy team with the click of a button.

RHRTC (Rock Hill, S.C.), a freestanding radiation treatment center affiliated with the Carolinas Healthcare System, offers treatments such as conventional and conformal radiotherapy and IMRT (intensity modulated radiation therapy). An average of 50 patients are treated daily on two linear accelerators (linacs) - Varian Medical Systems' Clinac 21EX and 23EX. The center also utilizes GE Healthcare's new QXI wide-bore CT scanner.

To efficiently manage the electronic data, RHRTC implemented Varian's VARiS Vision record and verify system, along with the company's Eclipse treatment planning software. The systems operate in a single database environment, says Roy Lowe, RT, medical physicist at RHRTC. This creates a single electronic chart for each patient that is easily accessible for the medical staff anytime, anywhere.

"For example, when a CT scan is acquired and saved, it is saved to the VARiS database server," explains Lowe. "When these images are picked up for treatment planning, the plan is developed on the server. The images are not pushed around like they normally would be in the past.

"In the past, we used one entity to acquire data, then we pushed them through the DICOM protocol to a treatment planning system. Once the plan was complete, using the DICOM protocol, we would have to push it to the record and verify system. Then that information was pushed to the linac to actually treat the patient," Lowe says.

Now when a treatment plan is developed and saved using VARiS, it is saved to the server for near real-time access. Doctors can immediately review any updated information in their office or in remote locations. Radiation therapists can instantly access updated digital reconstructed radiographs (DDRs) minutes before a patient receives treatment.

A new clinical assessment module, part of VARiS, contributes to streamlined working conditions, Lowe says. The module electronically documents and manages a patient's diagnosis, disease staging, evaluation and management, patient vital signs, lab results, patient counseling and education, and medications. A smart staging feature guides physicians through the staging process according to current clinical guidelines so that an optimal treatment approach can be determined.

Digital technology has improved the process of acquiring portal images. "After the patient is irradiated with the portal imager, the electronic portal image is immediately available," explains Lowe. "There is no film developed by the radiation therapist. This cuts down dramatically the time that the therapist spends dealing with films, cassettes and processing. Most importantly, it cuts down the amount of time the patient needs to lie on the table to be treated."

RT and IT unite

Digital image management and electronic charting systems developed for radiation therapy provide oncology centers and departments with the confidence to routinely carry out technically advanced treatments. In addition, they significantly improve patient throughput.

Informatics is not viewed as improving treatment options, but rather as a way to improve the many steps needed in developing and executing a successful treatment plan - making the process more efficient and perhaps less arduous.

In lieu of the intense, demanding nature of the field, the current shortage of radiation therapists and the large number of patients who receive some form of radiotherapy annually, this is important.

According to the 2002 Radiation Oncology Workforce study from the American Society for Therapeutic