Connectivity Issues in Radiation Oncology: The Role of Integrating the Healthcare Enterprise — Radiation Oncology (IHE-RO). Chapter 14

The delivery of radiation in the treatment of cancer represents a challenging technical and clinical undertaking. Technology is an integral part of radiation oncology, providing the advanced treatments that bring improved clinical outcomes, while also reducing the burden on the staff. The flow of patient treatment in a modern radiotherapy clinic is detailed. The many exchanges of information between the different systems of radiotherapy are shown. In each exchange of information between systems there exist opportunities for errors to be introduced. As new and future technologies are added to the treatment process (e.g. adaptive therapy, gating or active breath management, real time position monitoring), additional avenues for error open. Improvement in this area will further improve the safety and efficacy in the field of radiation oncology. Understanding the work flow of treatment planning and delivery is fundamental to understanding the systems involved and the integration required. For a patient undergoing a simple radiation treatment, the work flow is as follows. The patient undergoes a computed tomography (CT) scan. A treatment isocentre is determined and marked on the patient externally with the aid of lasers connected to, but not part of, the CT scanner. The CT and isocentre are exported to the treatment planning system (TPS). The tumour and nearby organs at risk (OAR) are delineated by the physician, and then criteria for tumour and OAR radiation doses are set. A plan is developed to best meet these criteria. After the plan is accepted by the physician, a second calculation of the dose resulting from the planned radiation beams is performed to verify the accuracy of the TPS. This may involve the transfer of the beam parameters to a purpose built beam calculation programme. The plan is then sent to the treatment management system (TMS). Images for patient alignment may also be sent to the TMS. Additional details about the plan may be entered by hand in the TMS.