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Informatics Systems Informatics Systems OverviewOverview
R Dahl*, M Herman Mayo R Dahl*, M Herman Mayo FoundationFoundation
Rochester, MNRochester, MN
ObjectivesObjectives
Understand basic network infrastructure Understand basic network infrastructure for both LANfor both LAN’’s and s and WANWAN’’ssUnderstand interfaces to both hospital IS Understand interfaces to both hospital IS systems and radiation oncology devicessystems and radiation oncology devicesUnderstand network requirements for Understand network requirements for single and multisingle and multi--department institutionsdepartment institutions
Understand what is needed for Understand what is needed for migration from a paper to an electronic migration from a paper to an electronic treatment recordtreatment recordGenerate specifications for an Generate specifications for an information systeminformation systemPersonnel requirements for Personnel requirements for implementing and maintaining an implementing and maintaining an information system information system Review basic specifications of available Review basic specifications of available Treatment Management systemsTreatment Management systems
Objectives Objectives concon’’tt
Local Ethernet NetworkLocal Ethernet Network
Ethernet
Workstation
Laser printer
Workstation Server
Desktop
Most common type of networkIEEE 802.3 standard
Star topologyStar topologyBus topologyBus topology
Ethernet
Workstation Workstation Workstation
Workstation Workstation
Workstation
Workstation
Workstation
Workstation
Workstation
Reference (4)
Multiple NetworksMultiple Networks
Token Ring
Ethernet
Ethernet
Workstation
Workstation
Switch
Workstation
Mainframe
Router
Workstation
Workstation
Laser printer
Bridge
Desktop
Desktop
WAN
ProtocolsProtocols
TCP/IP TCP/IP –– Transmission Control Transmission Control Protocol/Internet ProtocolProtocol/Internet ProtocolIPX/SPX IPX/SPX –– Novell protocol (current Novell protocol (current Netware supports TCP/IP)Netware supports TCP/IP)NetBEUI / NetBIOS (old protocols)NetBEUI / NetBIOS (old protocols)
TCP/IPTCP/IP
Most common network protocolMost common network protocolBased on a suite of protocolsBased on a suite of protocolsIs routableIs routableSupports DHCP and WINSSupports DHCP and WINS
Application
Transport
Internet
Network Interface
WAN ConnectionsWAN Connections
Different types of communication Different types of communication connections availableconnections available−− T1 (1.536 Mbps)T1 (1.536 Mbps)−− T3 (44 Mbps)T3 (44 Mbps)−− SDSL, HDSL (1.544 Mbps)SDSL, HDSL (1.544 Mbps)−− Cable ModemCable Modem−− SatelliteSatellite
WAN CommunicationsWAN Communications
““ThickThick”” clientclient−− Standard desktop computer, application Standard desktop computer, application
loaded on computerloaded on computer−− Reduces network traffic by not having to load Reduces network traffic by not having to load
application over Netapplication over Net−− Increases software maintenance by having to Increases software maintenance by having to
upgrade applications on each computerupgrade applications on each computer
““ThinThin”” clientclient−− Application is loaded over the networkApplication is loaded over the network−− Increases network trafficIncreases network traffic−− Reduces software maintenance timeReduces software maintenance time
WAN SolutionsWAN Solutions
Software with web forms based interfaceSoftware with web forms based interface−− Specific application not needed on Specific application not needed on
workstationworkstation−− Reduced network traffic Reduced network traffic –– only loads only loads
requested datarequested data−− Can be run from any computer with a web Can be run from any computer with a web
browserbrowser
Thin client using CitrixThin client using Citrix®® MetaframeMetaframe™™ or or Windows Terminal ServerWindows Terminal Server−− Software maintenance reducedSoftware maintenance reduced−− Network traffic reducedNetwork traffic reduced−− Need at least one more server depending on Need at least one more server depending on
client loadclient load−− Configuration more difficultConfiguration more difficult
CitrixCitrix®® MetaframeMetaframe™™Software that runs as an extension to Software that runs as an extension to Terminal ServerTerminal ServerICA (Independent Computing ICA (Independent Computing Architecture) clientArchitecture) clientCan have Citrix Server Farms to load Can have Citrix Server Farms to load balance across multiple serversbalance across multiple serversMultiple clients available Multiple clients available –– Windows, Windows, McIntosh, UNIX, DOSMcIntosh, UNIX, DOSSupports multiple communication Supports multiple communication protocolsprotocols
Citrix Citrix concon’’tt
Application actually runs on the Citrix Application actually runs on the Citrix serverserverVideo and keyboard/mouse information Video and keyboard/mouse information are transferred over the networkare transferred over the networkPrinter configuration can be difficultPrinter configuration can be difficultSolution for multiSolution for multi--site departmentssite departments
DICOMDICOM
Digital Image Communication in MedicineDigital Image Communication in MedicineStandards designed for image Standards designed for image communicationcommunicationDICOMDICOM--RT Extensions added to the RT Extensions added to the standard to support radiation therapy standard to support radiation therapy objectsobjects
DICOM DICOM concon’’ttService Object Pair (SOP) is the basic Service Object Pair (SOP) is the basic unit of communicationunit of communicationAn action or service is performed on an An action or service is performed on an information objectinformation objectExampleExample
Service InformationObject
Applied to
SOP ClassService Object Pair
Reference (4)
CompositeObject
Patient
Object
SeriesFindings
Study 1Visit
Makes
Creates
Action
Contains
Study 2
Procedure
FindingsImages
References
TxStrategy
Modality,Equipment
TxOptions
Standard Objects
References
Contains
References
Creates
Documents
Example Example -- Information objects and Information objects and relationships for Pt. visitrelationships for Pt. visit
Reference (4)
DICOMDICOM--RT information objects and RT information objects and definitionsdefinitions
DICOM RT modality (Information Object) Object Definition
RT Image RT specific images, such as DRR, EPID digital simulation capture, digitized film.
RT Structure Set Curves or points representing patient contours and structures.
RT DoseRT Dose 2 and 3D isodose curves or surfaces, point doses, dose volume histograms
RT PlanRT Plan Detailed planned data, beams, applicators, fractionation scheme
RT Beams Tx Record Record/Verify data, as treated for external beam
RT Brachy Record Record/Verify data, as treated for brachytherapy
RT Summary Record Summary, cumulative data for entire course/patient
Compatibility exampleCompatibility example
App 1 SOP App 2 Compatible? Comment
A Store RT-Plan to B YES A is an SCU and B is an SCP for RT-Plan
AStore RT-Image to
B NO A is an SCU, but B does not support RT-Image
BStore RT-Plan to
A NO A is an SCP, but B is not an SCU for RT-Plan
BStore RT-Structure
to A NO A is not an SCP and B is not an SCU for RT-Structures
Application can be a service class user (SCU) or Application can be a service class user (SCU) or service class provider (SCP)service class provider (SCP)
Reference (4)
DataflowDataflow
Knowledge of departmental dataflow is Knowledge of departmental dataflow is required for any information systemrequired for any information systemExamples of dataflow, connectivity, and Examples of dataflow, connectivity, and equipment interfacesequipment interfaces
InterconnectionsInterconnections
Analyze computer information flow within Analyze computer information flow within the departmentthe departmentDetermine the method of communication Determine the method of communication between each componentbetween each componentExamine the type of data sent between Examine the type of data sent between each componenteach component
IMPAC (Pervasive)
IMPAC
ViewStation(Images)
Eclipse/VisionTPP+Brain lab(Storage Locally)
TPP+ (*.rtp)Storage H:\
(Storage Network Server)(Dbase (sybase)) Varsrv02
(Images)
LINACComputer
MLC
LINAC
R &
VPortalVision
IAS
Radexsend
Eclipse Proc.
winscp32
DCM moduleIMPAC (port 104)
Dosimetry computer
RT Image
NAMER
RT Plan (rtp format)
RTP interface*.rtp
IMPAC permanent flat image storage (DFS)
RTP to IMPAC(Optional)
Translation
Process
Storage
Varian
IMPAC
RTP
DICOM
GE
SIM PACSMIDIA, Mrex
(Storage Clinic Level)
Onc Box n(Storage Locally) SIM computer
Nucletron BrainLab
NPV6
RT Image (per machine)
IMPAC Workstation(Sequencer)
SIM
Onc Box n(Storage Locally)
Eclipse/VisionBrain lab(Network Storage)
PortalVisionWorkstationLINAC
Computer
MLCWorkstation
LINAC
R & V
SIM computer
IAS
Radexsend
Eclipse Proc.
winscp32
DCM moduleIMPAC (port 104)
Dosimetry computer
IMPAC (Pervasive)Server
RTP interface*.rtp
IMPAC image form onInstitutional server directory
NPV6RT Image (per machine) IMPAC server directory
Translation
MIDIA
PACS
QREADS
MRex
QREADSDigital JacketVariseed
Plato(UNIX)
FDIMPORTFTP-get
(Dbase (sybase))
RT Plan (*.rtp format)IMPAC server directory
RT Image IMPAC server directory
TPP+
RTP export
RTP to IMPAC(Optional) Adds more info
MLCController
DataTap
save
NAMER
Non-4DITC
EPID
Fuel
RTP
exp
ort
filedata(Images)
IMPACViewstation(Images)
IMPAC Workstation(Sequencer)
LINACComputer
LINAC
Verification
IMPAC (Pervasive)Server
IMPAC image formatInstitutional server directory
IMPAC
ViewStation(Images)
RT Image IMPAC server directory
MLCController
NAMER
4DITC
4D network switch
4DITCWorkstation
OBIWorkstationIAS
4DITC Images
EPID OBI
Images via DICOM
SIM
Onc Box n(Storage Locally)
Eclipse/VisionBrain lab(Network Storage)
SIM computer
Radexsend
Eclipse Proc.
winscp32
DCM moduleIMPAC (port 104)
Dosimetry computer
RTP interface*.rtp
Translation
MIDIA
PACS
QREADS
MRex
QREADSDigital JacketVariseed
Plato(UNIX)
FDIMPORTFTP-get
Dbase (sybase)
RT Plan (*.rtp format)IMPAC server directory
TPP+
RTP export
RTP to IMPAC(Optional) Adds more info
Fuel
RTP
exp
ort
Institutional server dir(Images)
Record
LVI
LINACComputer
LINAC
MLCController
4DITCTentative
4D network switch
4DITCWorkstation
OBIWorkstationIAS
EPID OBI
SIMOnc Box n
(Storage Locally)
Eclipse/VisionBrain lab(Storage Institutional
server)
SIM computer
Radexsend
winscp32
MIDIA
PACS
QREADS
MRex
QREADSDigital JacketVariseed
Plato(UNIX)
FDIMPORT
FTP-get
Dbase (sybase)
TPP+
Fuel
Institutional serverdir. (Images)
VARiS (ARIA)
Processes
Varian
IMPAC
GE
Nucletron
BrainLab
StorageLocation
DICOM Transfer(in black)
Multivendors:
Color Code:Color Code:
In-house
TMIS SpecificationsTMIS SpecificationsThe Treatment Management Information The Treatment Management Information System (TMIS) ties together the various System (TMIS) ties together the various sources of informationsources of informationIdeally Ideally –– Information goes directly to Information goes directly to TMIS with no user interventionTMIS with no user interventionIdeally Ideally -- Conversion programs are not Conversion programs are not neededneededIdeally Ideally -- Redundant entry of data is Redundant entry of data is avoidedavoided
Developing TMIS SpecificationsDeveloping TMIS Specifications
Complete a process map of information Complete a process map of information flowflowCover all areas including nurses, doctors Cover all areas including nurses, doctors and secretariesand secretariesWho enters what data, how many times is Who enters what data, how many times is it enteredit enteredHow many times is the same data How many times is the same data entered?entered?
Users:► Physicians► Physicists► Therapists► Dosimetrists► IS team► Administrative Staff
Clinical Operations:*I. Patient Registration ProcessII. Patient Consultation ProcessIII. Departmental Scheduling ProcessIV. Departmental Patient Charting
ProcessV. Patient Treatment Sim ProcessVI. Patient Treatment ProcessVII.Administrative Services
* Van Dyk J. The Modern Technology of Radiation Oncology. Chapter 14 by Brooks K.W.
IS Infrastructure management:
I. Archiving & Data miningII. Database Technology (Sybase vs.
MS SQL)III. Interface capabilities (i.e. HL7,
DICOM, other)IV. Vendor supportV. IS/ITPerformance.
Technological Innovations:I. New imaging modalities (Cone Beam
CT, EPID-MV, OBI-kV, kV – MV)II. Image-guided stereotactic
treatmentsIII. New Image-Guided Radiation
Therapy modalitiesIV. Etc.
• Major Components
Example SpecificationsExample SpecificationsPhysics / DosimetryPhysics / DosimetryACCESS TO DEPARTMENT AND ACCESS TO DEPARTMENT AND
INSTITUITIONAL SCHEDULESINSTITUITIONAL SCHEDULES1.1. AutoAuto-- notification to appropriate physicist notification to appropriate physicist
when special procedures are scheduled or when special procedures are scheduled or changed.changed.
2.2. Access to all Access to all RadRad OncOnc physician, physician, simulator, treatment machine, shop and simulator, treatment machine, shop and patient schedules patient schedules
3.3. Ability to attach info or appointments to Ability to attach info or appointments to patients treatment, simulation and block patients treatment, simulation and block room schedules in TMISroom schedules in TMIS…………..
Physics / Dosimetry Physics / Dosimetry concon’’ttINFORMATION TRANSFERINFORMATION TRANSFER
1.1. All patient treatment information available in All patient treatment information available in digital format must follow the latest digital format must follow the latest
2.2. DICOMDICOM--RT standards to allow for seamRT standards to allow for seam--less less transfer of datatransfer of data
3.3. Sectional image based treatment port design Sectional image based treatment port design should not produce multiple data sets should not produce multiple data sets
4.4. Transfer of data should be done without Transfer of data should be done without ““patched patched network softwarenetwork software”” or programsor programs
5.5. Information should be able to be imported into the Information should be able to be imported into the TMIS from normal page scanners or digital TMIS from normal page scanners or digital camerascameras…………....
Electronic Treatment RecordElectronic Treatment Record
The use on an electronic treatment record The use on an electronic treatment record has numerous advantages over a paper has numerous advantages over a paper recordrecord−− Available for viewing at any timeAvailable for viewing at any time−− It can be viewed simultaneously by several It can be viewed simultaneously by several
peoplepeople−− No physical transport of record neededNo physical transport of record needed−− Data more easily available for analysisData more easily available for analysis
Electronic Treatment Record Electronic Treatment Record concon’’tt
There are disadvantagesThere are disadvantages−− Paper record has evolved over many yearsPaper record has evolved over many years−− Electronic treatment records are not as Electronic treatment records are not as
flexible flexible –– vendor specificvendor specific−− More computer resources are requiredMore computer resources are required
Electronic Treatment Record Electronic Treatment Record concon’’tt
Will probably not result in reduction in Will probably not result in reduction in personnelpersonnelMay need 1 FTE to manage the systemMay need 1 FTE to manage the systemIf dedicated IS personnel are not available If dedicated IS personnel are not available will need a computer guruwill need a computer guruMay need to hire computer consultants to May need to hire computer consultants to manage networkmanage network
Major Available TMIS SystemsMajor Available TMIS Systems
IMPAC MOSAIQIMPAC MOSAIQVarian ARIAVarian ARIANucletronNucletron OncentraOncentraSiemens Siemens LantisLantis
Server Operating Systems / HWServer Operating Systems / HWO.S.O.S. HW SmallHW Small HW LargeHW Large
MOSAIQMOSAIQ Windows Windows 2003 Server2003 Server
ZEON, 3+ GHz, 3 ZEON, 3+ GHz, 3 GB RAM, 18 GB RAM, 18 –– 146 146
GB StorageGB Storage
Quad ZEON, 3+ Quad ZEON, 3+ GHz, 4 GB RAM, GHz, 4 GB RAM,
72 72 –– 146 GB 146 GB StorageStorage
ARIAARIA Windows Windows 2003 Server2003 Server
ZEON, 3+ GHz, 2 GB RAM, 6x73 GB ZEON, 3+ GHz, 2 GB RAM, 6x73 GB RAID 5 StorageRAID 5 Storage
OncentraOncentra Windows Windows 2000 Server2000 Server
ZEON, 3+ GHz, 1 GB RAM, 6x73 GB ZEON, 3+ GHz, 1 GB RAM, 6x73 GB RAID 5 StorageRAID 5 Storage
LantisLantis Windows Windows 2003 Server2003 Server
P4, 3+ GHz, 1 GB P4, 3+ GHz, 1 GB RAM, 2x36 GB RAM, 2x36 GB RAID 1 StorageRAID 1 Storage
ZEON, 3+ GHz, 2 ZEON, 3+ GHz, 2 GB RAM, 3x70 GB GB RAM, 3x70 GB RAID 5 StorageRAID 5 Storage
Database EngineDatabase Engine
MOSAIQMOSAIQ Microsoft SQLMicrosoft SQL
ARIAARIA Sybase 12.5Sybase 12.5
OncentraOncentra OracleOracle
LantisLantis Pervasive 8Pervasive 8
ConclusionConclusionComplexity of Complexity of RadRad. . TxTx. are increasing . are increasing every yearevery yearComputers are a vital part of the Computers are a vital part of the treatment processtreatment processA electronic TMIS and A electronic TMIS and TxTx. Record will be . Record will be needed to handle the large amount of needed to handle the large amount of informationinformationMedical physicist will (does) play an Medical physicist will (does) play an important role in the operation of a TMISimportant role in the operation of a TMIS
ReferencesReferences
1.1. NEMA , Digital Imaging and Communications in Medicine NEMA , Digital Imaging and Communications in Medicine (DICOM), National Electrical Manufacturers Association, (DICOM), National Electrical Manufacturers Association, Washington, D.C. 2001. http://Washington, D.C. 2001. http://medical.nema.orgmedical.nema.org//
2.2. Microsoft Press, Microsoft Windows NT Server Networking Guide, Microsoft Press, Microsoft Windows NT Server Networking Guide, Redmond WA, Microsoft Press, 1996. Redmond WA, Microsoft Press, 1996.
3.3. GarmesGarmes, Jason et. al., Windows NT Server 4 Unleashed, , Jason et. al., Windows NT Server 4 Unleashed, Indianapolis, Indianapolis, SamsSams Publishing, 1997.Publishing, 1997.
4.4. Herman, M.G., Computer networking and Information Systems in Herman, M.G., Computer networking and Information Systems in Radiation Oncology. AAPM Refresher Course, 1999.Radiation Oncology. AAPM Refresher Course, 1999.
5.5. MathersMathers, T.W., Windows NT/2000 Thin Client Solutions, , T.W., Windows NT/2000 Thin Client Solutions, Indianapolis IN, Indianapolis IN, MacmillianMacmillian Technical Publishing, 2000.Technical Publishing, 2000.
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