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Dr. Francesco Di RosaEsperto Qualificato - Esperto in Fisica Medica
U.O.C. Radioterapia
Direttore: Giovanni Cartia
L'IMPATTO TECNOLOGICO IN DIAGNOSTICA PER
IMMAGINI E IN TERAPIA
AZIENDA SANITARIA PROVINCIALE DI
CALTANISSETTA
SISTEMI RIS/PACS: MODALITÀ DI
IMPLEMENTAZIONE DI UN PACS
DEDICATO ALLA RADIOTERAPIA
TREND ON HEALTHCARE
• THE PROGRESSIVELY AGING POPULATION
• INCRISING IMAGING
• EVOLUTION OF TECHNOLOGY
• MANAGEMENT OF A LARGE NUMBER OF INFORMATION
• INFORMATION TECHNOLOGY (IT) PROGRESS
• REDUCTION OF BUDGET SPENDING PER PERSON
KEY ELEMENTS FOR EXCELLENCE OF IMAGING
• SYSTEMATIC APPLICATION OF PROTOCOLS AND
GUIDELINES
• MANAGEMENT ERRORS AND CLINICAL RISK
• RATIONALIZATION OF RESOURCES
• EXPERIENCE, SCIENTIFIC RESEARCH AND EBM
• BUSINESS MANAGEMENT
REQUIREMENT OF IMAGING
~ Ottimizzazione del flusso di lavoro e delle risorse
~ Gestione e integrazione efficace di sistemi e/o metodiche
~ Distribuzione di immagini e informazioni tramite l’uso di tecnologie
standard
~ Sicurezza nella gestione degli errori
~ Diminuzione drastica delle immagini perse
~ Risposta più veloce da parte dei medici
~ Immagini disponibili ovunque, a chiunque, in qualunque momento
~ Immagini precedenti provenienti da diverse modalità sempre
disponibili per confronto con facile e immediato recupero del
pregresso
~ Gestione della dose erogata al paziente
PACS: A POWERFUL TOOL
SISTEMA PACS
STRUMENTO INFORMATICO (INFORMATIC TOOL)
OR
STRUMENTO DIAGNOSTICO (DIAGNOSTIC TOOL)
✓ SECOND OPINION REMOTA
✓ FUSIONE DI IMMAGINI
✓ SISTEMI CAD (Computer Aided Detection) INTEGRATI ALL’INTERNO DEI PACS
✓ IMPIEGO DELL’INTELLIGENZA ARTIFICIALE
✓ STRUMENTO ATTRAVERSO CUI SI PRODUCONO DIAGNOSI
OTTIMIZZAZIONE DEL FLUSSO DI
LAVORO
STAFF
DI PROGETTAZIONE
STAFF DI GESTIONE
RESPONSABILE DI PROCESSO
SICUREZZA
E
FATTORI LEGALI
PACS: A POWERFUL TOOL
STAFF PROGETTAZIONE
PROJECT MANAGER DEL SISTEMA:È una figura che esplica la sua funzione nell’organizzazione
dell’implementazione di un sistema RIS-PACS
Mansioni principali:
➢ Gestisce globalmente il sistema
➢ Competenze relative alle apparecchiature, alla gestione e qualità delle immagini
➢ Competenze informatiche
➢ Conosce il workflow di tutti i reparti che producono immagini medicali
➢ Traduce in termini tecnici le esigenze cliniche del responsabile del servizio
➢ Assicura l’efficienza e l’efficacia del sistema
➢ Definisce protocolli e linee guida (interconfronto multidisciplinare)
➢ Coordina tutte le figure che interagiscono sul sistema
STAFF GESTIONE
AMMINISTRATORE DI SISTEMATSRM si occupa della gestione delle immagini prodotte.
Per il campo in cui opera, necessita di conoscenze radiologiche e informatiche.
È una figura che si interfaccia con molte altre, dal tecnico analista del RIS-PACS
della ditta fornitrice, con il responsabile di progetto, ai collaboratori TSRM
Mansioni principali:
• Eseguire un controllo giornaliero del workflow degli esami dal RIS al PACS;
• Correzione degli abbinamenti Referti-Immagini
• Modifica, sposta e cancella gli esami presenti nel Ris non eseguiti.
• Backup del database del Server ;
• Gestione dei dischi per l'archiviazione a lungo termine
• Primo intervento nel caso di blocco del Sistema;
RESPONSABILE PROCESSO
RESPONSABILE DELLA CONSERVAZIONE
SOSTITUTIVAGestisce l’archiviazione legale delle immagini e referti; apponendo la marcatura
temporale (time stamping) dopo la archiviazione
Mansioni principali:
➢ Organizza e definisce le procedure e le caratteristiche dei supporti per la
archiviazione legale sostitutiva
➢ Archivia e rende disponibili i supporti archiviati con i dati memorizzati
➢ Si occupa delle procedure di sicurezza e di tracciabilità
➢ Adotta le misure necessarie per la sicurezza fisica del sistema (Disaster Recovery)
➢ Verifica periodicamente la leggibilità dei documenti conservati, provvedendo
eventualmente a un cambio dei supporti
ONCE UPON A TIME
ONCE UPON A TIME
ONCE UPON A TIME
ONCE UPON A TIME
CLOUD
CLOUDOU
D
Ospedale
Modalità
Workstations
Produzione CD
RIS
Cache Locale
Backup
Web portal
CLOUD SOLUTIONS
PRES. OSPEDALIERO RADIOLOGO
SPECIALISTAMEDiCO DI FAMIGLIA
CONSULTAZIONE. Accesso alle informazioni importanti
POLIAMBULATORIO
CONDIVISIONE DATI. Unico repository virtuale
CONDIVISIONE DEL FLUSSO DI LAVORO.
Unica comunità virtualeUnico desktop virtuale TELERADIOLOGIA.
Refertazione remota
TELECONSULTOCollaborare alla diagnosidel paziente
UNITA’ MOBILE
CLOUD
CLOUD READY
p.16
1 2 3Hospital
Referti ed immagini sono collegati al portale subito dopo che il paziente ne ha dato il consenso
Una email viene mandata al paziente con un link e le credenziali di accesso.
Il paziente può visualizzare il proprio esame e condividerne il contenuto con il suo medico.
CLOUD
CLOUD WORKFLOW
VNA = VENDOR NEUTRAL ARCHIVE
VNA = VENDOR NEUTRAL ARCHIVE
p.19
Problemi e necessità diverse per ruolo
ARCHIVIAZIONE DI BIOIMMAGINI
VNA
PACS
Attualmente il PACS contine solo le immagini di Radiologia...
Archiviazione completa
VNA
PACS
Immagini e videoTracciati Documenti
Gestione di tutte le bioimmagini create in ospedale...
Innovazione clinica
VNA
Immagini e video
TracciatiDocumenti
Tutte le bioimmagini vengono rese disponibili all’ospedale per
visualizzazione attraverso uno strumento unico...
RadiologiaDa internet i medici
autorizzati possono vedere tutta la storia clinica del
paziente...
Communication Solutions: integration of RIS/PACS of different vendors without new interface
Unico Access Point
HL7, DICOM HL7, DICOM
HL7, DICOM
COMMUNICATION SOLUTIONS
Richiesta di consulenza
Spo
ke
Cloud
Ricezione della consulenza
Cloud
Spo
ke
Hu
b
Rete di consulenza
Radiologo
Dermatologo
Neonatologo
Anatomo patologo
Spo
keH
ub
Cloud
OFFERTA BASATA SU CLOUD
❑Modello di business innovativo (“pay-per-study”)
❑ Diminuzione del costo di gestione
❑Minori investimenti iniziali con maggiori servizi, scalabilità e
sicurezza
CLOUD OFFER
L’offerta Cloud basata su una tecnologia a banda larga promette costi
contenuti e propone le basi per creare comunità virtuali “vendor
neutral” flessibili e sicure
La tecnologia è pronta a creare
collaborazioni tra diversi enti
RDIM
RDIM: RADIATION DOSE INDEX MONITORING
I
N
S
E
R
T
TERMINOLOGY
1) DICOM Radiation Dose SR (RDSR)
- capturing procedure dose information
2) IHE Radiation Exposure Monitoring Profile (REM)
- coordinating the capture and management of RDSR objects
- applying in a radiology practice
3) "CT dose screens"
- porting legacy scanner data into RDSR
5) IHE Integration Statements & DICOM Conformance Statements
- specifying these standards & features when
purchasing and integrating radiology systems
RDSR
RADIATION DOSE STRUCTURATED REPORT
BEFORE RDSR… and NOW!!
Headers & Screen Shots
- Useful but limited: Missing details, Not machine-readable, Duplication issue,
Size issue (all images are need)
Modality Performed Procedure Step (MPPS Class)
- Designed for workflow, it is not persisted (e.g. stored, archived) and weaknesses
BEFORE
NOW
“SR Objects” – DICOM Structured Reports
– Easily ingested (and regurgitated) by PACS
Granularity: “Irradiation Event” & “Accumulated Dose over Study”
Series Templates: CT, X-Ray (Mammo, Fluoro, DR/CR), PET/NM
Not addressed for RT
• CT Dose
– DLP, CTDIvol, kVP, mA, sec, …
– Effective Dose [ Optional; Reference estimation method ]
• Projection X-Ray Dose
– DAP, Dose @ RP, kVP, mA, sec, …
– Fluoro Dose, Fluoro Time
– CR/DR: Exposure Index, Deviation Index
• Mammography Dose
– AGD, Entrance Exposure@RP, kVP, mA, sec, …
– Compression, Half Value Layer
ftp://medical.nema.org/medical/dicom/2011/11_16pu.pdf
KEY MEASUREMENTS
WHY MONITORING?
http://www.nytimes.com/2010/08/01/health/01radiation.html?pagewanted=all
WHY MONITORING?
http://www.nytimes.com/2009/10/16/us/16radiation.html
Software that passively or actively collect Radiation Dose Index
(RDI)
Collect data from ionizing radiation modalities
Store RDI in a database along with patient demographic and study
information
Allows the end user to visualize RDI by study type and/or patient
Used for Quality Assurance or patient of study specific investigations
They ARE NOT the patient dose and patient organ dose
data base
Modality output & Useful parameters to compare different
modalities
RADIATION DOSE INDEX MONITORING (RDIM)
SYSTEMS
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
National Registry
ArchiveDose Information
Reporter
some text: #Numerical Details12.2 14.511.8 7.6
Outlier: #Performing Phys.Over Target: 12.2%
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
some text: #Numerical Details12.2 14.511.8 7.69.5 10.9
Numer12.2 14.5
9.5 10.9
IHE REM (Radiation Exposure Monitoring)
Profile
DEDICATED PACS SYSTEM
Clinical Oncology 2010 22, 681-687DOI: (10.1016/j.clon.2010.06.010)
RT WORKFLOW
Radiation therapy continues to evolve with modern computers and digital imaging…
Technological developments in radiotherapy reduce the morbidity and toxicity of
treatment, facilitate patient convenience improving outcome of therapy…
Modern radiation delivery systems are digital, with analog units continually
being replaced with modern digital technology. The planning and delivery of
radiation therapy are computer-controlled events with electronic digital image
acquisition and verification at the time of therapy
A majority of radiation therapy treatment planning now incorporates 3D anatomy
attained by computed tomography (CT) images for registration. These images can
be fused with magnetic resonance imaging (MRI) or positron emission tomography
(PET) images for further definition of the target
OVERVIEW OF MODERN RADIATION THERAPY
Caltanissetta
Gela
Mussomeli
Niscemi
Mazzarino
San Cataldo
Two facilities, located in distant geographical areas, arranged in
only one RT Department with the same management staff
P. O. San Cataldo
P. O. Gela
SAME
DEPARTMENT
THERAPEUTIC TECHNOLOGY ON OUR
TERRITORY
THE PROCESSES INVOLVED IN RADIATION
THERAPY
1
2
3
4
5
Examination and therapeutic decision
Imaging (CT + MRI + PET) and Virtual Simulation (RT Structure)
Contouring (Target e OAR = RT Structure)
Planning (RT Dose, RT Plan, RT Images)
Verify of the positioning (OBI)
Treatment (Setup, Verify and Delivery)
Follow-up
6
7
Caltanissetta
Gela
Mussomeli
Niscemi
Mazzarino
San Cataldo 1 2 3 4 5 6 7
1 2 3 4 5 6 7
PRIMUS Conception
ARTISTE Conception
PRIMUS Conception = 3DCRT
ARTISTE Conception = 3DCRT & IMRT
ALLOCATION OF THERAPEUTIC PROCESSES
DIVIDED BY THE FACILITY
Caltanissetta
Gela
Mussomeli
Niscemi
Mazzarino
San Cataldo 1 2 3 4 5 6 7
1 2 3 4 5 6 7
Waiting times decreasing & High-Grade
EXAMPLE 1: PATIENT NEEDS A 3DCRT
TREATMENT
For each phase of treatment, the patient
selects the facility with shorter waiting list as
well as greater personal comfort
Caltanissetta
Gela
Mussomeli
Niscemi
Mazzarino
San Cataldo 1 2 3 4 7
5 64
The patient will go to a different location
just for the Daily Treatment ...
Remaning steps are recognized in his center
Minimal discomfort for
the patient
EXAMPLE 2: PATIENT LIVES IN
CALTANISSETTA NEEDS IMRT TREATMENT
The patient continues the treatment…
He reachs the center with working linac
Treatment can be assuredCaltanissetta
Gela
Mussomeli
Niscemi
Mazzarino
San Cataldo
5 6
4 5
6
6
4
EXAMPLE 3: PLANNED DOWNTIME OR
BREAKDOWN MACHINE
Department where multi-modality imaging, clinical and physical information
are involved in the processes of planning and delivery of radiation therapy
requiring a dedicated DICOM standard
Radiotherapy treatment consists of a complex sequence of data all referred to a
defined case that the therapist needs in structured patient-related design
A possible solution to improve patient care and reduce errors sharing files
would be to extend the information on a central communication system
(i.e. radiotherapy network)
The use of a Radiotherapy PACS becomes essential for a
full management of a complex Modern Radiotherapy
Department
WHY A RADIOTHERAPY NETWORK?
Caltanissetta
Gela
Mussomeli
Niscemi
Mazzarino
San Cataldo
All clinical and physical information related to the same patient should be requested and
retrieved by the physicians and the physicists in any of the two facilities
P. O. San Cataldo
P. O. Gela
SAME
DEPARTMENT
Multi-centre Study Dataset & QA program
PACS could be important in modern Radiotherapy for massive storage needs
(e.g. IGRT creates 30/40 times more image data, e.g. multimodality imaging)
Many RT departments, that haven’t chosen to purchase all equipment from a single
vendor, have as result that the same data are stored in multiple proprietary databases.
Communication between different systems is suboptimal (smooth workflow!!)
A real time connection for the complete management of RT Department
RADIOTHERAPY PACS PECULIARITIES
We have designed and implemented a server infrastructure to perform a real
time connection for the complete management of RT Department
Our RT network has been implemented as a multi-node server infrastructure based on Multi
Protocol Label Switching to create a Virtual Private Network (MPLS-VPN)
Full compatibility with the TCP/IP technologies
An IP address is assigned to each “Client” (i.e. TPS, R&V, Linac, CT Simulator and RT
Dicom Viewer) in order to detect and identify any device univocally
Flexible system able to transport
and route several types of network
traffic
Our server architecture is based on a PACS system
dedicated to radiotherapy requirements employing
advanced DICOM forwarding rules
RT PACS - STRUCTURE
Full management of all equipment installed in our
RT Department
DICOM RT consists of five extended
Information Object Definitions (IOD) to report
clinical activities of radiotherapy
Patient
Study
RT Image RT Dose
RT Structure Set RT Plan
RT Treatment
RecordImages obtained on a
conical imaging
geometry:
Simulators and
portal imaging or
calculated images
using the same
geometry: DRRs
Information related
to patient anatomy:
Structures (VOIs),
markers, Isocenter,
Dose Reference
Points,
Observations/Chara
cterizations
Dose data generated
by a TPS in one or
more of several
formats: 3D dose
data, Isodose curves,
DVHs, or dose points
Geometric (Patient
setup) and
dosimetric data
(fractionation
scheme and
tolerance table)
specifying a course
of external beam
treatment
Used to record
the treatment
session/summary
parameters
(rather than
planned ones)
Even though the DICOM Standard has the potential to facilitate implementations of PACS solutions, use of the Standard
alone does not guarantee that all the goals of a PACS will be met. This Standard facilitates interoperability of systems
claiming conformance in a multi-vendor environment, but does not, by itself, guarantee interoperability (DICOM PS 3.1-
2011, “Goal of the DICOM Standard”)
ftp://medical.nema.org/medical/dicom/final/sup11_ft.pdf
RT DICOM STANDARD
ftp://medical.nema.org/medical/Dicom/Final/sup29_ft.pdf
DICOM RT extension to the current DICOM standard to accommodate the fast evolving
radiotherapy procedures
RAID system with four identical HDD
formatting in order to perform a RAID 5 system
to guarantee fast performances and a secure
system (no data are lost if a drive fails)
A remote Network Attached Storage (NAS
RAID) assures the coherence and the safety of
RT data (disaster recovery plan using Replica
Sincrona)
Multi-core Workstation (Intel ® Xenon® CPU E5-
1603 D @ 2.8 GHz & 8 GB RAM MS Window 7) with
4 TB of storage to store up to 25 millions of images
(RAID 1)
RT PACS - HARDWARE
DCMTK (http://dicom.offis.de/dcmtk.php.en) is a collection of libraries and
applications implementing large parts the DICOM standard. It includes software for
examining, constructing and converting DICOM image files, handling offline media,
sending and receiving images over a network connection, as well as demonstrative
image storage and worklist servers
ConQuest DICOM Server (http://ingenium.home.xs4all.nl/dicom.html) is a collection
of libraries and applications implementing large parts of the DICOM standard
dcm4chee (http://www.dcm4che.org) is an Image Manager/Image Archive
(according to IHE). The application contains the DICOM, HL7 services and
interfaces that are required to provide storage, retrieval and workflow to a healthcare
environment
DICOMIZER 2.0 (http://www.roniza.com/products/dicomizer/) converts images and
documents from common file formats (BMP, JPG, PNG and PDF) to DICOM
DICOM SOFTWARE (http://www.idoimaging.com)
RT PACS - SOFTWARE
RT DICOM PACS – DICOM SERVER
Network architecture is managed by a ConQuest DICOM server (v.1.4.15)
dedicated to radiotherapy purposes
ConQuest includes a collection of libraries and
applications implementing large parts of the DICOM
standard
It provides a complete DICOM interface with the possibility to create many servers
on a single PC offering a concrete solution to satisfy the requirements for a robust
and long term storage
The server supports a wide range of databases
including a programmable SQL
A database browser, integrated in our PACS
system, is available for the full management of the
patient images:
Designed to be field/run
time programmable
Integration between ZeroBraneStudio, a
lean and mean Lua IDE and Conquest to
unleasg Lua scripting in the Conquest
DICOM server
The DICOM Server can
act as an advanced (Lua)
scriptable DICOM image
forwarder, processor
and/or DICOM image
cache
RT DICOM PACS – DICOM SERVER
A DICOM web access for viewing and data
administration is implementable
PACS organization becomes a powerful vehicle
that manages, compares and records the
quality control results performed by images
with an integrated tool to convert non-DICOM
objects to supported files and viceversa
CQ
➢ fast transferring rate both in send and in receiving mode
➢ prompt loading and browsing of a considerable number of images
➢ possibility to process all kind of DICOM RT files
➢ images analysis with a list of 2D graphic function
➢ display datasets in volume rendering with 3D post processing function
➢ view and/or calculate DVHs (dose-volume histograms) by IOD
Main properties of the tested Viewer
RT DICOM PACS – DICOM VIEWER
DICOM VIEWERS
Fratoria DICOM RT Studio, our main Dicom RT Viewer
The peculiarity of DICOM RT objects requires a dedicated Viewer installed in the network
We have used commercial and non-commercial Viewers in order to offer an useful and
complete comparison among these systems
DICOMan© developed by Department of Radiation Oncology
of the at University of Arkansas for Medical Sciences
Dicompyler, an extensible open source radiation therapy research
platform, based on the DICOM standard functioning as a cross-
platform DICOM RT viewer
DICOM VIEWER – FRATORIA RT STUDIO
It provides an a solution
to meet requirements for
long term storage, as
everything can be stored
and viewed in DICOM RT
format, independent of
the TPS in your
department
Fratoria DICOM RT Studio is designed as an universal Treatment Planning System (TPS)
independent solution for viewing and evaluation of radiotherapy plans, together with all
relevant DICOM-3 and DICOM RT data
DICOMan© developed by Department of Radiation Oncology of the at University of
Arkansas for Medical Sciences
All-In-One DICOM/DICOM-RT Wizard for Radiation Oncology and Radiology
DICOM VIEWER - DICOMAN
DVH calculated by TPS have been compared to DVH calculated by Viewers: differences in the
maximum dose, in the mean dose and in the V95% (target volume value receiving 95% of
prescribed dose) have been evaluated
We have carried on an investigation on reliability of DVH calculation: Fratoria
DICOM RT Studio, DICOMan and a Viewer undercostruction
We have performed the study considering Planned Target Volume (PTV) and Organ At Risk
(OAR):
1) ipsilateral lung for breast treatment
2) rectum for prostate treatment
3) eye lenses and optic chiasm in the Glioblastoma treatment (small structures)
DVHs COMPARISON
If it’s technologically possible plan a treatment in remote mode!
Is also possible approve it??
A server infrastructure was designed to perform a non-stop connection and
communication of the two facilities for the full management of our Department
First twenty patients analyzed: maximum differences TPS vs Viewers are: < 3% for PTV,
< 10% for Lung and <23% for rectum. About small structures, differences in Dmax < 15%
DVHs COMPARISON
A simple DICOM Modality Worklist implementation with HL7 import with configurable
translation
A complete DICOM interface, an easy installation procedure, creating many servers on a single
PC and a solution to satisfy the requirements for a robust and long term storage
A database browser is available for the full management of the patient images: delete, change and edit
data patient, anonymize, print, image format conversion, send and receive images over the entire
network connection handling directories using a simple query/move user interface
PACS organization becomes a powerful vehicle that manages, compares and records the
quality control results performed by images with an integrated tool to convert non-DICOM objects
to supported files and viceversa
A DICOM web access for viewing and data administration is implementable (A CGI WEB
interface working with several possible viewers)
The server can act as an advanced (Lua) scriptable DICOM image forwarder, processor and/or
DICOM image cache
It is able to manage and store all types of DICOM and NON-DICOM data under the same patient
data entry making them available for any other RT system located in the network
MAIN PACS FEATURES
HOSPITAL PCS
TC Simulatore
Linac Artiste
TPS
R&V
R&V TPS
QA Browser
RT DICOM PACS
TC Simulatore
Linac Primus
Facility Gela
Facility San
Cataldo
P. O. Gela
P. O. San Cataldo
INTERACTIVE WORKFLOW
Archived data on RT PACS can be reviewed by any “Client” workstation of RT
Department, thus the staff can easily access to all patient data and to a single
patient waiting list
The patient could carry out first consultation, multi-modal images acquisition,
daily treatment and follow-up checks in the facility preferred minimizing
logistical difficulties.
This increases quality and provides a continuous service avoiding treatment
interruptions caused by machine maintenance or downtime
RESULTS
A server infrastructure was designed to perform a non-stop connection and communication of
the two facilities for the full management of our Department. Each step of radiation treatment
process produces DICOM and non-DICOM objects that must be recorded, shared and stored.
This PACS makes more feasible the supply of radiotherapy procedures eliminating
the incompatibility among different multi-vendor systems
The network facilitates consultation (clinical research) across Facilities and Departments with a better organization of human resources, including the institution of Medical Physics
Services that could constitute an independent Department in the territorial area
This network answers to the needs and cares of the oncologic patient in our territorial area. The patient could carry out first consultation, imaging, daily treatment and follow-up in the
facility that he prefers, minimizing logistical difficulties. This increases quality and provides a continuous service avoiding treatment interruptions caused by machine maintenance or
downtime. It represents an innovative, easy and affordable solution providing a “high quality” clinical service
The development of OUR RT NETWORK is still subject to many iterative stages of testing, refinement and evaluation before its complete implementation in the clinical environment
The same treatment can be PLANNED, VALUED, APPROVED AND DELIVERED in both facilities
Archived data on RT PACS can be reviewed by any “Client” workstation of RT Department
CONCLUSION
A RT network implementation, in our territorial area, joining two far facilities of the same RT Department, answers to the needs and cares of the oncologic patient
The benefits of the implementation of such network are multiple: it can be used as a standard to perform an effective and an efficient clinical service and as a common platform
for radiotherapy data exchange and expert consultation.
CONCLUSION
A system integration infrastructure based on standards is crucial for streamlining clinical work-flow and for the establishment of medical research related to outcomes for future
radiation therapy patients
The open based architecture of the RT-Server facilitates consultation or clinical research across other Radiotherapy Department and Institutions and permits a better collaboration
between radiation oncologist and medical physicist of the same Department
A unique RT data management is a right way to go for a better organization of human resources, including the institution of Medical Physics Services that could constitute an
independent Department in the territorial area
A RT network implementation, in our territorial area, joining two far facilities of the same RT Department, answers to the needs and cares of the oncologic patient
GRAZIE!!!
Ex. Quentry a cloud system by BrainLab
(http://www.brainlab.com/product/item/quentry)
OUTLOOK
An App for mobile device is under construction and all PACS data should migrate to a CLOUD service
For the future, have got your head in the
clouds!!
