1. Online Review Zheng Chang, Ph.D.; Bridget Koontz M.D. Zheng Chang, Ph.D.; Bridget Koontz M.D. Department of Radiation Oncology, Duke University Durham, North Carolina, 27710, United States 2011 IHE-RO Use Case: Online review

2. Online review now available for planar and volumetric imaging, but 1. online approval, 2. match, and 2. adaptive geometric match, and 3. online dosimetric review not available. Treatment now greatly reliant on timely therapy delivery (1), reliable and accurate positioning (2), and understanding of dose consequences of small positioning differences (3), for both SBRT and standard fractionation therapy. “Online Review” Clinical Motivation / Need 2011 IHE-RO Use Case: Online review

3.  Information Share: Information from RTP/Server to Online Review WS  Adaptive Dosimetric Assessment: Precursor of Adaptive Radiotherapy  Dosimetric Analysis: Accumulated and Individual Session  Online Administration: Online Approval  Adaptive Geometric Assessment: Deformable Registration 2011 IHE-RO Use Case: Online review  Reference Guidance: Reference Planar 2D/2D registration available for daily treatment guidance in addition to DRR. Reference can be set based on volumetric imaging Desirable Features of “Online Review”

4. Hypo-fractioned Therapy Workflow RTP WS Geometric review with Deformable registration Information Share 2011 IHE-RO Use Case: Online review Server Online Review WS Volumetric Imaging Dosimetric ReviewDosimetric Analysis and Report Online Approval Pt Shift Treatment

5. Fractionated Therapy Workflow Patient positioned KV – DRR Match CBCT – planCT Pt Shift 1 ST FRACTION 2-n th FRACTION * Option if KV-DRR match did not reproduce shift required for soft tissue match 2011 IHE-RO Use Case: Online review Set 2D refKV Treatment Patient positionedKV – refKV* Match Treatment Online Approval

6. Thank you! 2011 IHE-RO Use Case: Online review