Electronic Oncology Systems - NewYork-Presbyterian

Electronic Oncology SystemsElectronic Oncology Systems–– the Management and the Safety Measuresthe Management and the Safety Measures

Hansen Chen, Director, TDSIHansen Chen, Director, TDSI

Sep 2009Sep 2009 Hansen ChenHansen Chen 22

Radiation Oncology DepartmentRadiation Oncology Department

PeoplePeople

PlacePlace

EquipmentsEquipments

ProceduresProcedures

PatientsPatients


Radiation Oncology StaffRadiation Oncology Staff

OncologistOncologist

NurseNurse

PhysicistPhysicist DosimetristDosimetrist Sim TechSim Tech

TherapistTherapist

EngineerEngineer

ClericalClericalAdministratorAdministrator BillingBilling

PeoplePeople


Tx PlanTx Plan OfficesOffices

Front DeskFront Desk

Department LayoutDepartment Layout

Exam RoomExam Room

Brachy SuiteBrachy Suite

CT VaultCT Vault

Linac VaultLinac Vault

PlacePlace


Machines and SystemsMachines and SystemsExternal Beam MachinesExternal Beam Machines Brachytherapy MachinesBrachytherapy Machines

Calibration DevicesCalibration Devices

Treatment Plan SystemsTreatment Plan Systems Oncology Info SystemsOncology Info Systems

Treatment AccessoriesTreatment Accessories

CT SimulatorsCT Simulators

IT InfrastructureIT Infrastructure

Oncology PACSOncology PACS

EquipmentEquipment


Clinical ProceduresClinical ProceduresExternal Beam IMRTExternal Beam IMRT

HDR BrachytherapyHDR Brachytherapy

Prostate Seeds ImplantProstate Seeds Implant

CT SimulationCT Simulation

Stereotactic RadiosurgeryStereotactic Radiosurgery

Stereotactic Body RadiotherapyStereotactic Body Radiotherapy

Image Guided RadiotherapyImage Guided Radiotherapy

MammoSite APBIMammoSite APBI

ProcedureProcedure


Patient Visit Flow Patient Visit Flow (ex. IMRT)(ex. IMRT)

ConsultConsult CT ScanCT Scan Virtual SimVirtual Sim Tx PlanTx Plan

Physics QAPhysics QAPortal FilmPortal FilmTx DeliveryTx DeliveryFollowFollow--upup

PatientPatient


Yes, ItYes, It’’s Quite Complicated Operation!s Quite Complicated Operation!

PeoplePeople PlacePlace

EquipmentEquipment ProcedureProcedure


Mitigation of Potential ErrorsMitigation of Potential Errors

More ManpowerMore Manpower

More Checking ProceduresMore Checking Procedures

More EquipmentsMore Equipments

Use of Computer TechnologiesUse of Computer Technologies

Buy More Liability InsuranceBuy More Liability Insurance……


What Computer Can DoWhat Computer Can DoJaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000 Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0

Isocentric: 0.0, Eccentric: 0.0Relative Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0

Isocentric: 0.0, Eccentric: 0.0Epid Acquisition: 0Epid Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0VW Original MU: 0.000000, VW Dynamic Jaw: 0.00Data Valid 32-Bit Mask: 0x0000f1ef

Jaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0




What Computer Can NOT DoWhat Computer Can NOT Do

Preparing the DataPreparing the Data

Potential Error in Data EntryPotential Error in Data Entry

Jaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000 Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0



Jaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0




Electronic Oncology Systems (EOS)Electronic Oncology Systems (EOS)Treatment Plan SystemTreatment Plan System Oncology Information SystemOncology Information System

Treatment Delivery SystemTreatment Delivery System Treatment Verification SystemTreatment Verification System


EOS System Design GuidelinesEOS System Design Guidelines

PatientPatientSafetySafety

OperationOperation&& Care CostCare Cost

QualityQualityof Careof Care

Time Time &&EffortsEfforts

Electronic Oncology Electronic Oncology


Electronic Oncology Systems ManagementElectronic Oncology Systems Management

IT InfrastructureIT InfrastructureServers and Clients

Data Safety in StorageData Safety in StorageBackup and Archive

Data Safety in CommunicationData Safety in CommunicationData Integrity in Transmission & Execution

Systems MonitoringSystems MonitoringResponsibilities

Policy & ProceduresPolicy & ProceduresSystem Malfunction etc


EOS IT InfrastructureEOS IT Infrastructure

Centralized ComputingCentralized Computing System RedundancySystem Redundancy


Systems Infrastructure BeforeSystems Infrastructure BeforeColumbia CampusColumbia Campus Cornell CampusCornell Campus

License + ServiceLicense + Service


Centralized System InfrastructureCentralized System InfrastructureColumbia CampusColumbia Campus Cornell CampusCornell Campus


Systems RedundancySystems Redundancy

Clustered Data ServersClustered Data Servers SAN (Storage Area Network)SAN (Storage Area Network)


Application Deployment ServersApplication Deployment Servers

Citrix Server FarmsCitrix Server Farms SunRay Server ArraySunRay Server Array


Citrix ITA Thin Client AccessCitrix ITA Thin Client Access


Oncology Information System TopologyOncology Information System Topology


Pinnacle SunRay Thin ClientPinnacle SunRay Thin Client


Pinnacle SmartEnterprise TopologyPinnacle SmartEnterprise Topology

SunGuard SANStorage SystemSunGuard SANStorage System

Philips PinnacleServer Cluster x 2Philips Pinnacle

Server Cluster x 2

Philips PinnacleCompute Modules x 2

Philips PinnacleCompute Modules x 2

Server EndServer End

Client SitesClient Sites

NYP P3PC Gateway x 2 NYP P3PC

Gateway x 2

NetworkSwitch

NetworkSwitch

Fiber OpticsFiber Optics

Cornell + Columbia CampusesCornell + Columbia Campuses

Cornell CampusTeaching Units

Cornell CampusTeaching Units

810 Server810 Server 810 Client810 Client 810 Client810 Client


Centralized Tx Plan TopologyCentralized Tx Plan TopologyCentralized

Tx Plan OfficeCentralized

Tx Plan Office

Server VaultServer Vault

HospitalHospital

Physician & Physics OfficesPhysician & Physics Offices


One Workstation for 10 PeopleOne Workstation for 10 People


Bring Technology to PeopleBring Technology to PeopleNot People to TechnologyNot People to Technology


ContouringContouring


Tx PlanTx Plan


Plan ReviewPlan Review


MultiMulti--User EnvironmentUser Environment

CTCT--SimSim Image FusionImage Fusion ContourContour

Define Isocenter Import Diagnostic Images

Registration

Import Planning CT Images

Target Delineation

Run DIR

Contour Modification

Define Beams

PlanPlan

Dose Shaping ROI

Beams

Dose Objective


Workflow StreamlineWorkflow Streamline≠≠ a Straight Linea Straight Line


PACSPACS--RT SystemRT System

Candelis ImageGridCandelis ImageGrid

TCP/IP Network

Redundant ServerRedundant Server

PACSPACS--RTRT RT/WFMRT/WFM

Auto ReplicationAuto Replication

Data Data

(4D) CT Simulator

PET/CT/MR

Enterprise PACS

DICOM & Data

PSI Brachy TPS

Tx Plan Systems

HDR Brachy TPS

Physics W/S

Contouring W/S

Plan Review W/S

Reporting W/S

RTT IGRT W/S

Oncologist W/S

DICOM


Workflow ManagementWorkflow Management

PACSPACS--RTRT

SystemFunctions

PatientWorkflow

Staff Views

Web Based Workflow Manager

Dicom/RT Store/Receive

Dicom/RT Query/Retrieve

Unattended TPS Backup

TPS Patient Restore

R&V, HIS Patient Archive

Off-Line / Off-Site Backup

Patient Simulation

Fusion & Contouring

Physician Physicist

Treatment Plan

Tx Plan Review

Physics Check/QA

IGRT / VGRT

Image/Report Review

Weekly & EOT Chk

Dosimetrist Therapist

User Configurable Workflow Required


Oncology PACS StorageOncology PACS Storage


Patient DataPatient Schedule

Patient DataPatient Schedule

PACSPACS--RT ServerRT Server

CT SimulationCT Simulation

Tx PlanTx Plan RTT W/SRTT W/S

Oncologist W/SOncologist W/S

OIS ServerOIS Server

Input:CT-Sim Worklist

Output:Patient CT ImagesRT Plan & RTSSAcknowledge Completed Input:

CT-Sim WorklistPatient CT ImagesRT Plan & RTSS

Output:All RT Objects

Input:CT-Sim WorklistPatient CT ImagesRT Plan & RTSS


Input:CT-Sim WorklistPatient CT ImagesRT Plan & RTSS


Centralized PACSCentralized PACS--RT ServerRT Server

http://www.dell.com/content/products/compare.aspx/blade?c=us&cs=04&l=en&s=bsd


Integration with PACSIntegration with PACS--RTRT

Use of BackUse of Back--bone PACSbone PACS--RT ServerRT ServerSupporting DICOM Query & DICOM Work ListSupporting DICOM Query & DICOM Work List

PACS-RTPACS-RT

Contour Evaluation Contour

Evaluation

Oncologist Review

Oncologist Review

DVH Analysis

DVH Analysis

IMRT/IGRTQA Evaluation

IMRT/IGRTQA Evaluation

PhysicistMonitoringPhysicist

Monitoring

http://www.dell.com/content/products/compare.aspx/blade?c=us&cs=04&l=en&s=bsd


Data TsunamiData Tsunami

Active DataActive DataPatients Under Care

Static DataStatic DataPatient Follow-Ups

Data TypesData TypesMedical Records, DICOM Images, DICOM RT Objects


EOS Safety in StorageEOS Safety in Storage

Online Data Redundancy Online Data Redundancy –– Clustered Servers Clustered Servers and SANand SAN

Patients Under Treatment

NearNear--Line Data Redundancy Line Data Redundancy –– Oncology PACSOncology PACS6 Months to a Year

OffOff--Line Data Redundancy Line Data Redundancy –– Enterprise Enterprise Archive in Different Geometric LocationsArchive in Different Geometric Locations

Beyond a Year


EOS Safety in CommunicationEOS Safety in Communication

Adapting from FDA 510K GuidelinesAdapting from FDA 510K GuidelinesHigh Level System DescriptionArchitecture Design ChartHazard Analysis & Risk ManagementSystem Requirement Specification (SRS)System Design Specification (SDS)Hazard Trace Matrix & Traceability AnalysisOperation EnvironmentVerification and ValidationUnresolved Anomalies


High Level Systems DescriptionHigh Level Systems Description

Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx Delivery


Architecture Design ChartArchitecture Design Chart


R&V SystemR&V System


Hazard Analysis & Risk ManagementHazard Analysis & Risk Management

Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx DeliveryR&V SystemR&V System


SRS & SDS to Mitigate the RisksSRS & SDS to Mitigate the Risks

Extensive BitExtensive Bit--toto--Bit Data Check by Human is Bit Data Check by Human is Too Much WorkToo Much Work

Designing a Computer Software Tool to Designing a Computer Software Tool to Mitigate the RisksMitigate the Risks

A ComputerA Computer--Aided Tx Data Auditing Software Aided Tx Data Auditing Software to Improve the Efficiencyto Improve the Efficiency

A Software which can Automatically Monitor A Software which can Automatically Monitor Tx Data being DeliveredTx Data being Delivered


SRS & SDS to Mitigate the RisksSRS & SDS to Mitigate the RisksModule A: New Plan ChecksModule A: New Plan Checks

Approved Tx PlanApproved Tx Plan R&V SystemR&V System

New Software forNew Software forTx Data CheckingTx Data Checking


SRS & SDS to Mitigate the RisksSRS & SDS to Mitigate the Risks


Module B: Daily Tx Log ChecksModule B: Daily Tx Log Checks

New Software forNew Software forTx Data CheckingTx Data Checking


Hazard Traceability AnalysisHazard Traceability Analysis

Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx DeliveryR&V SystemR&V System


Electronic Oncology System MonitoringElectronic Oncology System Monitoring

Whose Responsibility?Whose Responsibility?


Whose Fault?Whose Fault?

RAID 5 Array FailingRAID 5 Array Failing


Whose Fault?Whose Fault?

Restarting a Database ServiceRestarting a Database Service


Balance with True ColorsBalance with True Colors

ServerServer

NetworkNetwork

DatabaseDatabase

ApplicationApplication

ConfigurationConfiguration

InstallationInstallation User RightsUser Rights

Clinical DataClinical Data

TroubleshootingTroubleshooting

Operating SystemOperating System

DesktopDesktop

ReportingReporting

ResearchResearch

DevelopmentDevelopment


Policy & ProceduresPolicy & Procedures

When Server is DownWhen Server is DownShould off-line treatment be carried out?Off-line data roll back integrity checks

OverwriteOverwriteStaff role and their rights for overwritingQuality auditing for overwritten data

User RightsUser RightsFor each staff group, plus “senior” staffWho can define user rightsGeneric user account?


Policy & ProceduresPolicy & Procedures

Paperless Chart / Electronic Medical RecordPaperless Chart / Electronic Medical RecordPatient medical record accessibility by other medical staffPaper signing off vs. electronic signature

Login & LogoutLogin & LogoutLogin & logout enforcementUser activity logging

System ContinuitySystem ContinuityConfiguration change policySystem update policy


SummarySummary

Electronic Oncology System (EOS) is playing Electronic Oncology System (EOS) is playing an essential role in todayan essential role in today’’s Radiation s Radiation Oncology serviceOncology service

EOS Management ConsiderationsEOS Management ConsiderationsIT InfrastructureData Safety in StorageData Safety in CommunicationSystems MonitoringPolicy & Procedures


ConclusionConclusionThe emerging radiation therapy technology has The emerging radiation therapy technology has became more and more complicated with became more and more complicated with increased clinical procedures and equipmentsincreased clinical procedures and equipments

Electronic Oncology System provides one solution Electronic Oncology System provides one solution to such complicated environmentto such complicated environment

Well designed EOS management from its Well designed EOS management from its infrastructure to the implementation is importantinfrastructure to the implementation is important

Safety measures for EOS is by no means critical Safety measures for EOS is by no means critical to the Radiation Oncology practiceto the Radiation Oncology practice

Thank YouThank You

Date post:	31-Dec-2021
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Electronic Oncology Systems - NewYork-Presbyterian

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