1. September, 2005What IHE Delivers 1 IHE-RO Radiation Oncology IHE Workshop 2006 Scott Johnson, Keith La Plain

2. 2 Agenda Sponsors RO Team Road Map Actors Connectathon 2006 Connectathon 2007 Future Direction

3. 3 Primary Membership Sponsors Radiation Oncology Vendors Delivery Devices – Linacs, Cobalt, Brachytherapy Delivery Devices – Linacs, Cobalt, Brachytherapy Simulators Simulators Treatment Planning Systems Treatment Planning Systems Oncology Information Systems Oncology Information Systems Physician Associations & Colleges ASTRO ASTRO AAPM (American Association of Physicists in Medicine) AAPM (American Association of Physicists in Medicine) ATC (Advanced Technology Consortium) ATC (Advanced Technology Consortium)

4. 4 RO Team – Whos Who Planning Committee Keith La Plain (Varian) Jay Cooper, MD Prabhakar Tripuraneni, MD (ASTRO) Jatinder Palta, PhD (U Florida) Technical Committee Bruce Curran (U Mich) Stuart Swerdloff (Impac) Dave Murray (Tomotherapy) Bill Bennett (CMS) Ulrich Busch (Varian) Jaap Pijpelink (Nucletron) Brian Frederiksen (Siemens) Colin Winfield (Elekta) Scott Johnson (Philips) Jeff Szuhay (NOMOS/NAS) Walter Bosch (Wash U ATC) Stephen Vastagh (NEMA) Alan Gay (ASTRO)

5. 5 Profile Roadmap Year 2005-2006 (Initial Implementation) Image Set Contouring Image Set Contouring Storage & Retrieval Storage & Retrieval Structure Set Structure Set Geometric Plan Geometric Plan Dosimetric Plan Dosimetric Plan Dose Dose Multi Series Image Review Multi Series Image Review Combined CT Storage Combined CT Storage Year 2006-2007 RT Plan – enlarging scope of objects : wedges, arcs RT Plan – enlarging scope of objects : wedges, arcs Scheduling of Treatment Delivery - GPWL Scheduling of Treatment Delivery - GPWL Fusion (Multi-modality) Fusion (Multi-modality) Query / Retrieve Query / RetrieveFuture Further RT Plan enlargement Further RT Plan enlargement 4D Support for gating, breath-hold, adaptive therapy 4D Support for gating, breath-hold, adaptive therapy

6. 6 Domain Visibility & Support ASTRO Annual Conference 2006 ASTRO : Inaugural IHE-RO Showcase 2006 ASTRO : Inaugural IHE-RO Showcase Other Potential Conferences AAPM AAPM HIMSS HIMSS RSNA RSNA

7. 7 Actors ArchiveContourer Geometric Planner Dosimetric Planner Dose Displayer

8. 8 Connectathon 2006 TimingWeek of September 25 th, 2006 Locationundetermined Use Cases Single Contoured/Image Series Retrieval Single Contoured/Image Series Retrieval Structure Set Storage Structure Set Storage Geometric Plan Storage Geometric Plan Storage Dosimetric Plan Storage Dosimetric Plan Storage Dose Storage Dose Storage Multi Series Image Review Multi Series Image Review Structure Set Retrieval Structure Set Retrieval Geometric Plan Retrieval Geometric Plan Retrieval Dosimetric Plan Retrieval Dosimetric Plan Retrieval Dose Retrieve Dose Retrieve Combined CT Storage Combined CT Storage

9. 9 Single Contoured/Image Series Retrieval Description:In the Single/Contoured Image Series Retrieve transaction, the Archive sends a series of CT-Images to the Contourer, Geometric Planner, or Dosimetric Planner. Actor:Archive Role: Transmit CT Series to Contourer, Geometric Planner, or Dosimetric Planner Actor:Contourer, Geometric Planner, or Dosimetric Planner Role: Receives and stores CT Series from Archive

10. 10 Structure Set Storage Description: In the Structure Set Storage Transaction, the Contourer stores a Structure Set on an Archive to make it available. Actor: Contourer Role: Sends Structure Set to Archive Actor: Archive Role: Stores Structure Set received from Contourer

11. 11 Geometric Plan Storage Description:In the Geometric Plan Storage transaction, the Geometric Planner sends the newly created Geometric Plan to the Archive. Actor:Geometric Planner Role:Transmit generated Geometric Plan to the Archive Actor:Archive Role:Receives and stores Geometric Plans from the Geometric Planner

12. 12 Dosimetric Plan Storage Description:In this transaction, the Dosimetric Planner sends the plan containing the references to the structure set to the Image Archive. Actor:Dosimetric Planner Role:Transmit generated plan to Image Archive. Actor:Archive Role:Accept and store plan from Dosimetric Planner.

13. 13 Dose Storage Description:In the Dose Storage transaction, the Dose planner sends the newly created Dose to the Archive. Actor:Dosimetric Planner Role:Transmit generated Dose to the Archive Actor:Archive Role:Receives and stores Doses from the Dosimetric Planner

14. 14 Multi Series Image Review Description: In the Multi-Series Image Retrieve Transaction, the Archive stores CT Images from multiple series (but a single study) on a Contourer to make these Images available for contouring. Actor: Archive Role: Sends CT Images to the Contourer Actor: Contourer Role: Stores CT Images received from Archive

15. 15 Structure Set Retrieval Description: In the Structure Set Retrieval Transaction, the Archiver stores a Structure Set on a Contourer, Geometric Planner, Dosimetric Planner, or Dose Displayer. Actor: Archive Role: Sends Structure Set to Contourer, Geometric Planner, Dosimetric Planner, or Dose Displayer Actor: Contourer, Geometric Planner, Dosimetric Planner, or Dose Displayer Role: Stores Structure Set received from Archive

16. 16 Geometric Plan Retrieval Description:In the Geometric Plan Retrieve Transaction, the requested Geometric Plan is transferred from the Archive to the Dosimetric Planner. Actor:Dosimetric Planner Role:Receives requested Geometric Plan from the Archive Actor:Archive Role:Sends requested Geometric Plan instance to the Dosimetric Planner

17. 17 Dosimetric Plan Retrieval Description:In this transaction, the dose displayer retrieves the plan containing the references to the structure set to the Image Archive. Actor:Dose Displayer Role:Accepts plan from Archive. Actor:Archive Role:Transmits plan to Dose Viewer.

18. 18 Dose Retrieve Description:In the Dose Retrieve Transaction, the requested Dose is transferred from the Archive to the Dose Displayer. Actor:Dose Displayer Role:Receives requested Dose from the Archive Actor:Archive Role:Sends requested Dose instance to the Dose Displayer

19. 19 Combined CT Storage Description:In the Resampled/Combined CT Series Storage Transaction, the Contourer stores CT Images which have been combined or resampled into a single series on the Archive. Actor: Contourer Role: Sends CT Images to the Archive Actor: Archive Role: Stores CT Images received from Contourer

20. 20 Connectathon 2007 Worklist / Scheduling & GP Worklist Query/Retrieve Extensions to support RT Objects Complete External Beam Definition of RT Plan Multi-Modality Registration/Fusion

21. 21 GP Worklist Treatment Delivery including Selecting a Treatment from the Oncology Information System (OIS) Sending Treatment to Treatment Delivery System Setup & Position Verification including Imaging and Other Devices Image Acquisition Including CT Delivering Treatment Saving Treatment Record Updating the OIS IODs Documented in DICOM Draft Supplement 74 : Utilization of Worklist in Radiotherapy Treatment Delivery

22. 22 Query/Retrieve Profiles Support Query/Retrieval of RT Objects from PACS, et al RT Objects have richer set of references than radiology objects Required query elements include referenced objects Modalities themselves (Planners, Contourers) may also support Q/R of RT Objects

23. 23 RT Plan Profiles Profiles will be specified in terms of beam delivery types. Each beam type supports a subset of modifiers. Conformance will be specified with respect to the beam type profile and supported modifiers.

24. 24 RT Plan Conformance Beam Modifiers Beam Profiles

25. 25 Registration/Fusion Affine, Deformable, Global, Local CT, MR, PET, US, SPECT Multiple (~30) Volume Datasets CBCT Support Contour redefinition vs Contour Pasting

26. 26 Future Direction Brachytherapy (LDR & HDR) Clinical Trials Submissions 4D : gating, breath hold, adaptive, fluoroscopic monitoring Plan transfer to treatment delivery device Enhanced dose exchange Enhanced worklist : Dose Calculation Scheduling, Planning Scheduling (Simulation, Contouring, Planning) Multiple-independent delivery devices – Micro MLCs ION Support