Radiation Oncology Image Management: Evolution in the Works

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Varian's Eclipse treatment planning and ARIA oncology information systemOver the last few years, radiation oncology has evolved at a rapid clip. Radiation oncologists are tapping into multiple new imaging options to more precisely define and target tumors, which may improve patient outcomes and minimize damage to normal tissue. The new vocabulary at radiation oncology sites across the country includes terms such as on-board imaging, cone beam CT, 4D imaging and image-guided adaptive radiation therapy (IGART). One consequence associated with the use of more sophisticated imaging technologies is an exponential increase in image size, and that’s only one part of the challenge.

IGART hinges on frequent imaging. Hansen Chen, PhD, senior medical physicist at Christiana Care in Newark, Del., explains, “In the past, we would take weekly portal images. Each patient would have a maximum of five or six images or the equivalent of a few megabytes of data per week. Patients undergoing IGART might have daily CT images for localization or for adapted treatment planning, and these CT images yield up to 100 to 200 megabytes of data per week.”

The other catch in the brave new world of radiation oncology is the need for physicians to access all relevant, current patient data. Radiation oncologists often need to refer back to images multiple times to target the cancer and design the treatment plan. “In the past, radiation oncologists would walk to the treatment room and approve portal films prior to treatment,” recalls Sharlon Rodgers, radiation oncology manager at Nebraska Methodist Hospital in Omaha. That sneaker net is not feasible with large datasets and more frequent imaging.

Radiation oncology departments are deploying various solutions to handle their burgeoning image management needs. At this point, image management is a work in progress; users rely on various processes and systems to meet or mitigate their radiation oncology image management needs. Nevertheless, sites have realized multiple benefits including:

  • Access to images throughout the department and across satellite sites
  • Improved patient care and safety
  • Less overtime and increased revenue
  • Fewer expenses related to making hard copies of images
  • Less physical storage space

This month, Health Imaging & IT visits with a few sites to learn about current and future radiation oncology image management solutions.

The quest for excellence

Over the last five years, the radiation oncology department at Nebraska Methodist Hospital has undertaken a major renovation and replacement project to become a center of excellence in radiation oncology. The project is centered on advanced technologies and superior patient care.

The department selected IMPAC Medical Systems image-enabled EMR as its radiation oncology management system for several reasons, says Rodgers. The software offers comprehensive record management for radiation oncologists and allied professionals; it stores and manages multiple types of images including cone-beam CT studies acquired on Elekta Synergy XVI and can house other essential radiation oncology data such as treatment plans. The ability to handle radiation oncology-specific data like treatment plans is essential to the success of a radiation oncology management system.

Another key component is the record and verify functionality. Radiation oncology departments must verify accurate treatment delivery and provide a permanent record of treatment. Acquiring a port film image is essential for verification. IMPAC records and stores these initial and ongoing reference images, allowing departments to graduate from film to digital images. “Images are accessible anywhere in the department. A radiation oncologist can approve the images or review a treatment plan without walking back to the linear accelerator. Faster, online approvals allow us to deliver treatment in a timelier manner,” explains Rodgers.

At the same time, radiation oncology departments are producing and consuming more and larger imaging datasets. “We realized storage would be a concern and worked closely with IMPAC and our IT department to build capacity to hold our images,” explains Rodgers. The department deployed IMPAC two years ago and has added more storage capacity, due to increased storage demands stemming associated with cone-beam CT. The radiation oncology department worked closely with the hospital’s IT department; IT was able to proactively alert radiation oncology of its diminishing storage capacity, enabling the department to plan and budget for a timely storage