Radiation Oncology Enters the Digital Age

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Radiation oncology has fairly unique and sophisticated image and information management needs. Imaging is the focal point in radiation oncology. "Imaging is probably the most important first step in the practice of radiation oncology," says Morris Geffen, MD, medical director of Savannah Oncology in Savannah, Ga.

As radiation therapy becomes an increasingly precise practice with IMRT (intensity modulated radiation therapy) and IGRT (image guided radiation therapy), image datasets are booming. The field has transitioned from treatment planning based on plain films to CT-based planning to fused CT and MRI planning to fused PET, CT and MRI image-based planning. Sasa Mutic, MS, associate professor of radiation oncology at Washington University School of Medicine in St. Louis, confirms, "Until three or four years ago, treatment planning systems could handle more data than a CT scanner could produce." Not anymore. Dynamic CT scans for capturing organ motion can produce up to 7,000 low resolution images per patient, and use of data-intense multi-modality imaging such as PET-CT continues to spread.

The result? Radiation oncology providers, particularly those that offer newer treatment options like IMRT and IGRT, need to implement solutions that allow them to store, recall and compare more

and larger image datasets. Sites that have deployed digital solutions report a number of benefits. "There's clearly a time savings going into the digital age. With digital technology, we can provide more precise treatment in the same 10- to 15-minute time slot," says Geffen.

In addition to enhancing patient care by enabling better treatments, digital image solutions also can serve as multipurpose workflow boosters. For example, some incorporate electronic charting features that allow physicians to shave off up to an hour of daily charting.

On the other hand, some sites are still looking for an ideal solution to meet their radiation oncology image and data management needs. Unlike the practice of diagnostic radiology, which primarily depends on images, radiation oncology relies on both images and data such as radiation dose distribution plans, contours and treatment plans. This dual focus can complicate radiation oncology image and information management. Most digital solutions are designed to streamline image management processes with data management serving as a secondary or tertiary focus. Thus the image management solution may not provide comprehensive storage and management of radiation oncology data like treatment plans.

Inside the state-of-the-art radiology oncology facility

Oncology Alliance (Milwaukee, Wis.) opened as a new oncology practice two years ago. "It made sense from a cost-benefit point of view to open as a digital site," explains Perry Gould, MD, radiation oncologist with Oncology Alliance. Oncology Alliance relies on Impac Medical System Inc.'s ViewStation to meet its image transfer, manipulation and storage needs.

Gould reports a number of workflow benefits. "This system makes it easy to read port films; I can read 20 ports in five minutes," states Gould. ViewStation stores images on a server and transfers requested images with one button click. According to Gould, some software can make the port film review process more cumbersome by pulling up all patient images, forcing the radiation oncologist to search through multiple images for the single required image.

On the dosimetry side of the equation, ViewStation's electronic record and verify features reduce the amount of manual labor to complete a treatment plan by electronically sending treatment parameters from the planning computer to the linear accelerator control center.

Other features complement the streamlined image management processes. "I've set up templates for weekly management notes and charting," says Gould. "The result is more consistent, thorough and faster charting." Gould fills in templates while he is in the room with the patient, eliminating the dictation process entirely. He estimates that electronic charting easily saves an hour a day over traditional dictation processes.

On the downside, the system does not store treatment plans. Oncology Alliance overcomes this hurdle by printing treatment plans and dose data; however, the practice's IT staff is working on an IT solution to allow digital storage of treatment plans.

The large scale solution

The Tom Baker Cancer Centre in Calgary, Alberta, is a comprehensive tertiary cancer center that houses a large