Health Imaging & IT - October 2007 - (Page 38) special section: Oncology Imaging ware 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, 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 “The accelerator, treatment planning system and image management system all have to talk to each other. Integration is key. A piecemeal solution is nothing but a headache.” Vasudha Lingareddy, MD, medical director, department of radiation oncology, Edward Cancer Center, Naperville, Ill. 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 38 O C T O B E R 2 0 07 | Health Imaging & IT 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, associate clinical professor, chief of clinical physics at the University of California-San Diego department of radiation oncology, storage is a big concern when considering new oncology imaging technologies. DeMarco has two linear accelerators from Siemens Medical Solutions, both with electronic portal imaging devices to take digital images to ensure patient alignment. While that replaced a lot of the hard-copy film the department used in the past, “with these devices, we have to figure out how to store the images along with the corresponding images we’re comparing against.” When the UCSD department became a Siemens customer, they installed the company’s MB3000 archiving system. “The system provides very good workflow. You can archive from any machine, any CT scanner, to this archiving system.” However, the ongoing technological changes may mean that the system isn’t the ideal candidate for the current generation of equipment. “Because Siemens is selling so many systems because they work so well and people are excited about the technology, they’re now moving toward the next generation of archiving to better meet large dataset storage requirements.” In general, “image acquisition and image guidance is taking off, but storage and archiving is lagging behind,” DeMarco says. A regular radiology department uses PACS with large databases for storing and archiving. Radiation therapy is moving toward a mini-PACS, he says, not a fullblown PACS. At the conclusion of a patient’s treatment, all of their digital reconstructed radiographs and matching portal images need to be stored and kept forever. With more and more image-guided treatment—virtually all of radiation therapy is done with some 3D imaging—a separate storage process is required. “We can either store on the existing UCSD PACS or archive the images locally in the department in case the patient comes back for retreatment,” he says. “We need to remember what we did and what the anatomy looked like 5 or 10 years ago.” On top of retention requirements, electronic portal imaging devices have led to treatment that is “a paradigm shift in how we do our image guidance for patient setup and positioning,” says DeMarco. “That comes at a cost. Instead of taking a single planar image once a week, now we could be taking a CT of a patient every day over the course of treatment.” While that provides an unprecedented way to evaluate whether the patient is in the correct position for treatment, it’s a huge challenge in image storage and image movement throughout the department. HealthImaging.com http://HealthImaging.com
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