21 Works

Operations Research Methods for Optimization in Radiation Oncology

Matthias Ehrgott & Allen Holder
Operations Research has a successful tradition of applying mathematical analysis to a wide range of applications, and problems in Medical Physics have been popular over the last couple of decades. The original application was in the optimal design of the uence map for a radiotherapy treatment, a problem that has continued to receive attention. However, Operations Research has been applied to other clinical problems like patient scheduling, vault design, and image alignment. The overriding theme...

PROsaiq: A Smart Device-Based and EMR-Integrated System for Patient-Reported Outcome Measurement in Routine Cancer Care

Alexis Andrew Miller & Thilo Schuler
The PROsaiq prototype, which is based on the use of smart devices, was developed to show the technical feasibility of a lean, low-cost ePRO system that integrated with the oncology information system MOSAIQ to provide the potential for benefits in routine patient care, and improved data for clinical research. The system was built with Free & Open Source Software and trialled for a limited number of assessments. The report describes the components used, the decisions...

A Rational Informatics-enabled approach to Standardised Nomenclature of Contours and Volumes in Radiation Oncology Planning

Alexis Andrew Miller
The standardising of nomenclature in the radiotherapy planning process has deep implications for the abilityof the profession to examine the adequacy of construction of radiotherapy plans in outcomes research, particularly in relation to disease control and toxicity generation. This paper proposes an interim standardisednomenclature which can be used by any institution as a template for a mappable local standard.The nomenclature is systematically constructed using the Foundational Model of Anatomy, ICRU Report 50 and ICRU report...

RadOnc: An R Package for Analysis of Dose-Volume Histogram and Three-Dimensional Structural Data

Reid F. Thompson
Purpose/Objectives: Dose volume histogram (DVH) data are generally analyzed within the context of a treatment planning system (TPS) on a per-patient basis, with evaluation of single-plan or comparative dose distributions. However, TPS software generally cannot perform simultaneous comparative dosimetry among a cohort of patients. The same limitations apply to parallel analyses of three-dimensional structures and other clinical data. Materials/Methods: We developed a suite of tools ("RadOnc" package) using R statistical software to better compare pooled...

Regmentation: A New View of Image Segmentation and Registration

Marius Erdt, Georgios Sakas & Sebastian Steger
Image segmentation and registration have been the two major areas of research in the medical imaging community for decades and still are. In the context of radiation oncology, segmentation and registration methods are widely used for target structure definition such as prostate or head and neck lymph node areas. In the past two years, 45% of all articles published in the most important medical imaging journals and conferences have presented either segmentation or registration methods....

Determination of the source dwell position of an afterloading device with a detector array

Markus Arn, Samuel Peters, Ferdinand Breithuth, Wolf Seelentag & Johann Schiefer
It was the aim to develop and test a measurement technique for the source position of an afterloading system using an electronic two-dimensional detector array (2D array). A "GammaMed plus IX" high dose rate afterloading device (Varian Medical Systems, Palo Alto, USA), and a Seven29 2D detector array (PTW Freiburg GmbH, Freiburg, Germany) have been used. A hollow needle has been connected to the afterloading device. Its outer diameter is 3.0 mm and its length...

Automated contrast painting for position verification in radiotherapy

Paul-Martin Putora, Ludovit Paulis & Ludwig Plasswilm
The influence of information technology in medicine has been constantly rising and represents a central part in many medical disciplines, especially radio-oncology. For the proper delivery of radiation treatment, the correct position of the patient is essential. To verify the correct position of the patient radiological images are made. In order to compare positions, contours of structures (often bones) may be used, these need to be identified and painted. The software that was provided with...

Techniques and software tool for 3D multimodality medical image segmentation

Issam M. El Naqa, Joseph Deasy, Jie Zheng, Deshan Yang & Ahmad Nofal
The era of noninvasive diagnostic radiology and image-guided radiotherapy has witnessed burgeoning interest in applying different imaging modalities to stage and localize complex diseases such as atherosclerosis or cancer. It has been observed that using complementary information from multimodality images often significantly improves the robustness and accuracy of target volume definitions in radiotherapy treatment of cancer. In this work, we present techniques and an interactive software tool to support this new framework for 3D multimodality...

Multimodal Document Management in Radiotherapy, an Update

Harald Fahrner, Mark Gainey, Martin Vogel, Stefan Kirrmann, Felix Ernst Heinemann & Marianne Schmucker
Background: In 2013, we presented a study entitled “Multimodal document management in radiotherapy”, demonstrating the excellent routine performance of the system about four years after its initiation by evaluating a sample of n=500 documents. During this time the system saw additional developments and significant improvements: the most important innovative step being the automatic document processing. This has been completely reworked, to minimize staff-machine interaction, to increase processing speed and to further simplify the overall document...

Fully Automatic Danger Zone Determination for SBRT in NSCLC

Michael Mix, Jose Dolz, Sonja Adebahr, Alin Chirindel, Montserrat Carles, Ursula Nestle, Tobias Fechter & Matthias Schlachter
Lung cancer is the major cause of cancer death worldwide. The most common form of lung cancer is non-small cell lung cancer(NSCLC). Stereotactic body radiation therapy (SBRT) has emerged as a good alternative to surgery in patients with peripheralstage I NSCLC, demonstrating favorable tumor control and low toxicity. Due to spatial relationship to several critical organs atrisk, SBRT of centrally located lesions is associated with more severe toxicity and requires modification in dose application andfractionation,...

Developing a tool for crowd-sourcing to Verify a Radiation Oncology Ontology: a Summer Project

Joshua Pratt, Evan Morrison, Vishal Pandian & Alexis Andrew Miller
We have been unable to find a verified, published Radiation Oncology Ontology. We undertook the process of verifying a Radiation Oncology Ontology with a mixture of crowd-sourcing and expert-based approaches to verify relationships in the ontology. We used a natural language based approach to portray concepts and relationships, surveying users to assess the relationships between concepts in the Radiation Oncology ontology. The work used a description of a patient's history expressed in XML. The natural...

Relational database of treatment planning system information

Michael Eugene Kantor, Peter Balter & George Starkschall
The purpose of the present work was to develop a relational database and associated applications to facilitate retrospective review of data present in radiation treatment plans. The data source was a commercial radiation treatment planning system (Pinnacle3, Philips Medical Systems, Milpitas CA), which is specifically characterized by an open data storage format and internal scripting capability. The database is an open-source, relational database (PostgreSQL, PostgreSQL Global Development Group, http://www.postgresql.org). The data is presented through a...

A Graphical Tool and Methods for Assessing Margin Definition From Daily Image Deformations

David Mansur, Gisele Pereira, Issam M. El Naqa, Rawan Al-Lozi, Aditya P. Apte & Matthew Johnson
Estimating the proper margins for the planning target volume (PTV) could be a challenging task in cases where the organ undergoes significant changes during the course of radiotherapy treatment. Developments in image-guidance and the presence of onboard imaging technologies facilitate the process of correcting setup errors. However, estimation of errors to organ motions remain an open question due to the lack of proper software tools to accompany these imaging technological advances. Therefore, we have developed...

A Step Forward in Cancer Informatics—It Is Mandatory to Make Guidelines Machine Readable

Ivan Igrutinovic, Paul-Henry Mackeprang, Eugenia Vlaskou Badra, Alexandros Tsikkinis & Nikola Cihoric
Clinical guidelines are general recommendations for practicing clinicians regarding prevention, diagnosis and treatment of a given disease. One of the most comprehensive and used guidelines are developed and regularly updated by the National Comprehensive Cancer Network (NCCN). Guidelines are readily available for download in portable document format (PDF). A machine-readable representation of NCCN guidelines is currently not available. In this writing, we argue on the necessity that clinical guidelines should be published in a machine-readable...

Procedural Creation of Medical Reports with Hierarchical Information Processing in Radiation Oncology

Marianne Schmucker, Stefan Kirrmann, Mark Gainey, Harald Fahrner, Martin Vogel & Felix Ernst Heinemann
Background: For many years, the oncological doctor's letter has been the pivotal means of information transfer to general practitioners, medical specialists or medical consultants. Yet, both creator and recipient require a high level of abstraction, retentiveness and analysis due to the large number of diagnoses and therapies. In contrast to the commonly used structure of doctor's letters, where all diagnoses and therapies are listed in sequential order with all diagnoses first, it is by no...

The Informatics of the Planning Target Volume -- why it cannot and should not be changed

Scott Turner & Alexis Andrew Miller
The ICRU defined the Planning Target Volume (PTV) as a static and geometrical volume in 1993. Radiation oncologists continue to manually alter PTVs in their daily practice when critical organs at risk (OAR) are too close to high dose PTVs. This practice is examined and shown to be non-standard (defies the ICRU definitions), inaccurate (all DVHs look perfect when the plan is manifestly NOT perfect), and useless for outcomes research (automatically analysed DVHs will find...

Dodes (diagnostic nodes) for Guideline Manipulation

Ludwig Plasswilm, Marcel Blattner, Alexander Papachristofilou, Fabio Mariotti, Paul-Martin Putora & Beatrice Paoli
Background: Treatment recommendations (guidelines) are commonly represented in text form. Based on parameters (questions) recommendations are defined (answers). Objectives: To improve handling, alternative forms of representation are required. Methods: The concept of Dodes (diagnostic nodes) has been developed. Dodes contain answers and questions. Dodes are based on linked nodes and additionally contain descriptive information and recommendations. Dodes are organized hierarchically into Dode trees. Dode categories must be defined to prevent redundancy. Results: A centralized and...

Towards Prediction of Radiation Pneumonitis Arising from Lung Cancer Patients Using Machine Learning Approaches

Aditya Apte, Jeffrey Bradley, Issam M. El Naqa, Jung Hun Oh & Rawan Al-Lozi
Radiation pneumonitis (RP) is a potentially fatal side effect arising in lung cancer patients who receive radiotherapy as part of their treatment. For the modeling of RP outcomes data, several predictive models based on traditional statistical methods and machine learning techniques have been reported. However, no guidance to variation in performance has been provided to date. In this study, we explore several machine learning algorithms for classification of RP data. The performance of these classification...

Pilot Study of a Radiation Oncology Telemedicine Platform

Ceferino Obcemea, Ceferino Obcemea, Sang Sim, Boris A. Mueller & James Lee
Purpose: A pilot study was undertaken to develop an integrated telemedicine platform for radiation oncology at Memorial Sloan-Kettering Cancer Center (MSKCC) and its regional sites. The platform consisted of a computer system with simultaneous display of multiple live data portals including 1) video-conferencing between physicians, 2) radiology, and 3) radiation treatment-planning system (RTPS). Methods and Materials: Two MSKCC regional centers were set up with a widescreen monitor, a dedicated computer, and a web camera with...

A Radiation Oncology Based Electronic Health Record in an Integrated Radiation Oncology Network

David S. Parda, Athanasios Colonias, T. Horrigan, Marc Luick, Richard Billy, Stephen M. Karlovits, Staci Strickland, Russell Fuhrer, E. Day Werts & Mark G. Trombetta
Purpose: The goal of this ongoing project is to develop and integrate a comprehensive electronic health record (EHR) throughout a multi-facility radiation oncology network to facilitate more efficient workflow and improve overall patient care and safety. Methodology: We required that the EHR provide pre-defined record and verify capability for radiation treatment while still providing a robust clinical health record. In 1996, we began to integrate the Local Area Network Treatment Information System (LANTIS®) across the...

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