IHE-RO

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IHE-RO

• Prabhakar Tripuraneni, MD, FACR, FASTRO
• On behalf of IHE-RO ASTRO

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I have a dream!
We have a dream, that one day, We can buy
any radiation therapy hardware or software, plug
and play! We have a dream! --Jay Cooper
--Prabhakar Tripuraneni
--Phillip Devlin
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Ever Frustrated with Connectivity?
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• Have you ever had any connectivity problems with
  Radiation Oncology hardware and software?
• Would you like to buy hardware and software from
  different vendors and still be able to use it?
• If yes, why dont you?

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IHE-RO The Concept

• Hell is a place where nothing connects. - T
  S Eliot

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Radiation Therapy is a Complex Process
With Many Parts And We All Want The Best
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The Risk Of Choosing Each Best Of Breed
Is the Tower of Babel
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I Want To Buy Equipment I Can Plug In My Network
And Not Worry About The Shape of The Plug!
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We Need To Agree on Standards of Interchange
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And Not Creatively Apply The Standards
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IHE-RO BASICS

• IHE-RO does not will not dictate what a product
  does
• IHE-RO ONLY specifies how a product interacts
  with other products
• For example

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Jaguar, Lexus, Mercedes, BMW

• Unique non-interchangeable parts, but
• Gasoline, oil, etc. non-specific
• Choices for tires.
• Compete on features!

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What Is IHE-RO?

• IHE-RO Integrating the Healthcare Enterprise in
  Radiation Oncology
• Global effort of radiotherapy healthcare
  professionals, societies and vendors to improve
  interoperability in radiation oncology domain

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IHE-RO

• A multi-specialty, -society, -national
  initiative to integrate radiotherapy equipment
  and patient health information systems
• The IHE-RO initiative is driven forward by both a
  Planning and Technical Committee

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IHE-RO

• IHE-RO Co-Chairs
• Prabhakar Tripuraneni
• Jatinder Palta
• Planning Co-chairs Technical Co-chairs
• May Abdel-Wahab Bruce Curran
• Mika Miettinen Stuart Swerdloff
• Colin Field
• Ramesh Rengan

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IHE

• Integrating HealthCare Enterprise
• HIMS
• RSNA
• together formed IHE

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IHE Standards-Based Integration Solutions

Prof
essional
Societies Sponsorship


Healthcare Providers Software Developers

Healthcare IT Standards

General IT Standards

HL7, DICOM, etc.
Internet, ISO, etc.
IHE

Process

Interoperable Healthcare IT
Solution Specifications

Interoperable Healthcare IT

IHE Integration Profile
Solution Specifications

Interoperable Healthcare IT

IHE Integration Profi

• le

Solution Specifications

Interoperable Healthcare IT

IHE Integration Profile
Solution Specifications


IHE Integration Profile
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IHE Organizational Structure Multi-Domain
Multi-National
IHE Domain-related Planning and Technical
Committees
Global DevelopmentRadiology,IT
Infrastructure,Cardiology,Radiation Oncology
Lab, etc.
contribute
Participants
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IHE Organizational Structure
ASTRO AAPM ACR AROI CARO
CSRO ESTRO JASTRO
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IHE-RO Participants

• Vendor participants include BrainLabCMS-Elekta-
  IMPAC MIM-VistaNucletronPhilipsSiemensTomothe
  rapyVarian
• Others ATC, IAEA, NCI, NEMA

• Professional society participants include
  ASTROAAPMACRAROI (India)CARO (Canada)CSRO
  (China)ECS-RO (Egypt)ESTRO (Europe)JASTRO
  (Japan)RSNA

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IHERO What does it do for you?

• Improves the connectivity of various radiation
  oncology hardware and software products
• Improves radiation oncology work flow
• Helps you to select products based on features,
  productivity and cost efficiency
• Helps vendors to focus on improving patient care
  instead of solving interface and connectivity
  problems

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IHE-RO Process
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IHE-RO process

• Identify interoperability problems
• Specify integration profiles
• Test integration profiles at Connectathon
• Publish integration profiles for use in
  RFPs(Request for Proposal)

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IHE-RO 2006 ConnectathonWashington DC
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IHE-RO 2007 ConnectathonWashington DC
Elekta
Impac
Tomotherapy
CMS
Philips
Brainlab
Nucletron
Varian
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IHE-RO 2008 Connectathon Houston TX
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Proposed Use Cases2006 - 2008

• Simple Treatment Planning Use
• Dose Compositing
• Residual Dose Optimization
• Image Fusion for Dose Review
• On-line Image Review
• Off-line Image Review
• Treatment Delivery Workflow
• Instance-level Query-Retrieve
• Configuration Management
• Advanced Integration Objects
• Clinical Trial Submissions
• Prescription Automation

• Transfer of Anatomy/Aperture Data for
  Localization
• User Authentication and Authorization
• Registration Data Transfer
• Radiotherapy Planning and Treatment Record
• Structure Template Creation, Import And Export
• Brachytherapy
• Integration with Proton Therapy
• Bronchoscopy position data transfer
• Radiation Oncology Schedule Workflow (ROSWF)

? Use cases are prioritized in a multi-year
roadmap
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IHE-RO Progress 2007-2008
Contouring System
Imaging Study
Simulation System
Planning Workstation
Rad Onc IMS
Treatment Delivery
Treatment Verification
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IHE-RO 2007-2008Achievements

• Objective 1
• Reduce DICOM RT connectivity problems in
  CT-simulation and Treatment Planning domain
• Objective 2
• Break the CT-simulation and Treatment Planning
  tasks to smaller, well-defined tasks (actors)
• Contouring, image registration, geometric
  planning, dose calculation, dose display
• Define how the communication between these tasks
  (actors) happens
• Enables you to choose the best of all treatment
  planning tools in the market place, and connect
  them reliably together

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Example of Benefits -Retreat Patient With
Confidence
DRR of previous RT

• Available patient dosimetry information from
  previous treatment using a different TPS is often
  inadequate
• IHE-RO unifies information format of treatment
  and dosimetry in RT devices
• You can view the plan and dosimetry of previous
  RT on your TPS
• Design the best new treatment plan for your
  patient.

Planned new RT
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Success Stories from Formal Connectathon

• At the IHE-RO Formal Connectathon,
• We were able to take a head and neck patient CT,
  draw contours on Brainlab, place a non-co-planar
  beam on Brainlab, dose plan on Philips, dose
  display on Varian, archiving and distributing
  with Impac.
• For the prostate patient CT, we drew contours on
  TomoTherapy, beam placement and dose plan on CMS,
  and displayed on Elekta.
• Real life examples of Interconnectivity among
  Radiation Oncology Systems

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Formal Connecthaton Results (2007-2008)
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IHE-RO 2009 (Future)Treatment Delivery Workflow

• Problem
• New techniques, like IGRT, are difficult to
  implement due to lack of standardized data and
  workflow between products
• Objective
• Break the treatment deliver process to
  well-defined tasks (actors)
• Standardize the data and workflow between
  information management system, patient
  positioning device, treatment delivery device,
  and mass data storage
• Benefits
• Single clinic-wide schedule
• Centralized DICOM RT data storage to manage e.g.
  rapidly increasing image data
• Smooth IGRT and adaptive therapy workflow in both
  single and multiple system/vendor Tx environments

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How IHE-RO Helps You Purchasing Products?

• Youll get the product connectivity you wanted
• Specify your connectivity needs using IHE-RO
  terminology, which is also unambiguously
  understood by the vendors
• Vendors are required to publish IHE Integration
  Statement
• Describes what tasks in the radiation oncology
  workflow the product is able to perform in terms
  of connectivity
• States the version number (or estimated release
  date), when the product conforms the IHE-RO
  specifications
• Use IHE-RO Integration Profiles in your RFP
  (Request for Proposal) process

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IHE-RO Integration Profiles 2007-Technical
Descriptions

• Simple Treatment Planning -profile
• Data flow of DICOM images and treatment planning
  data, from CT scan through contouring, for 3D
  conformal planning and dose display of external
  beam radiation therapy.
• The emphasis is to reduce ambiguity and
  facilitate basic interoperability in the exchange
  of DICOM RT objects.
• Information Exchange Between (Actors)
• CT Scanner
• Performs CT Imaging and is able to export CT
  images
• Contourer
• Is able to import CTs contours, perform
  contouring, and export CT images contours
• Geometric Planner
• Is able to import CTs contours, perform beam
  geometry planning, and export geometric plan
• Dosimetric Planner
• Is able to import CT, contours geometric plan,
  perform dose calculation, and export plan dose
  distribution
• Dose Displayer
• Is able to import CT, contours, geometric plan,
  dose distribution, and display the dose
• Archive
• Is able to import export CT images, contours,
  geometric plan, and dose distribution

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IHE-RO Integration Profiles 2008 -Technical
Descriptions

• Multi-Modality Image Registration -profile
• Specifies how images, RT Structure Sets, RT
  Doses, and associated spatial registration
  information can be exchanged, stored, processed
  and displayed
• Information Exchange Between (Actors)
• Registrator
• Is able to import image sets, perform spatial
  registration between the image sets, and export
  spatial registration information
• Registered Display
• Is able to import image sets, contours, spatial
  registration information, and display the
  registered images
• Registered Dose Display
• Is able to import image sets, contours, spatial
  registration information, dose distributions, and
  display the registered images and dose
  distributions
• Registered Contourer
• Is able to import image sets, contours and
  spatial registration information, perform image
  registration and contouring (on registered
  images), and export contours and spatial
  registration information
• Archive
• Is able to import export CT images, spatial
  registration information and contours

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Purchase Situation- Example 1

• Your clinic is evaluating new treatment planning
  systems Y Z
• You are getting quite many referrals (complicated
  cases patients already received RT in the past)
  from one of the satellite hospitals, which is
  using product X
• You want to make sure you are able to review the
  dose distributions from the treatment planning
  system X (used in the other clinic) with your new
  planning system
• Your requirements to the vendors (as part of RFP)
• Request vendors of products Y Z to provide an
  integration statement, which includes dose
  displayer
• Request vendor of product X (as part of the
  upgrade) to provide an integration statement,
  which includes dosimetric planner

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Purchase Situation- Example 1
TPS Product X
TPS Product Y or Z
Registrator - Registers multimodality images
Registrator - Registers multimodality images
Contourer - Defines contours
Contourer - Defines contours
Registered Contourer - Defines contours on
multimodality images
Registered Contourer - Defines contours on
multimodality images
Registered Display- Displays image fusion
Registered Display- Displays image fusion
Geometric Planner- Defines plan geometry
Geometric Planner- Defines plan geometry
Dosimetric Planner- Calculates dose
Dosimetric Planner- Calculates dose
Registered Dose Displayer- Displays dose on
multimodality images
Registered Dose Displayer- Displays dose on
multimodality images
Dose Displayer- Displays dose distribution
Dose Displayer- Displays dose distribution
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Purchase Situation- Example 1
TPS Product X
TPS Product Y or Z
Dosimetric Planner- Calculates dose
Dose Displayer- Displays dose distribution
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Purchase Situation- Example 2

• Satellite clinic is planning to buy a treatment
  planning system
• Main Campus has product X
• Physicians like the image registration
  contouring tools and dose review of product Y
• Physicists want consistency between clinics
• Your requirements to the vendors (as part of RFP)
• Request vendor of product Y to provide an
  integration statement, which includes contourer,
  registrator, registered display and registered
  contourer, dose displayer and registered dose
  displayer
• Request vendor of product X (as part of the
  upgrade) to provide an integration statement,
  which includes geometric planner and dosimetric
  planner

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Purchase Situation- Example 2
TPS Product X
TPS Product Y
Registrator - Registers multimodality images
Registrator - Registers multimodality images
Contourer - Defines contours
Contourer - Defines contours
Registered Contourer - Defines contours on
multimodality images
Registered Contourer - Defines contours on
multimodality images
Registered Display- Displays image fusion
Registered Display- Displays image fusion
Geometric Planner- Defines plan geometry
Geometric Planner- Defines plan geometry
Dosimetric Planner- Calculates dose
Dosimetric Planner- Calculates dose
Registered Dose Displayer- Displays dose on
multimodality images
Registered Dose Displayer- Displays dose on
multimodality images
Dose Displayer- Displays dose distribution
Dose Displayer- Displays dose distribution
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Purchase Situation- Example 3
TPS Product X
TPS Product Y
Registrator - Registers multimodality images
Contourer - Defines contours
Registered Contourer - Defines contours on
multimodality images
Registered Display- Displays image fusion
Geometric Planner- Defines plan geometry
Dosimetric Planner- Calculates dose
Registered Dose Displayer- Displays dose on
multimodality images
Dose Displayer- Displays dose distribution
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Future (2009) Purchase Situation- Example 3

• You have been tasked to find the best system
  solution to provide state-of-art IG-IMRT
  treatments in your clinic
• Vendor Z has introduced very innovative and
  accurate new patient positioning device using
  X-rays, which you are very interested about
• You have invested heavily to the treatment
  devices from vendor Y
• The data storage must be scalable due to massive
  amount of imaging data
• You must make sure that all this works with your
  existing Treatment Management System W
• Your requirements to the vendors (as part of RFP)
• Request positioning system vendor Z to provide an
  integration statement, which includes patient
  positioning device -actor of Managed Delivery
  Workflow
• Request vendor of product Y (as part of the
  treatment device upgrade) to provide an
  integration statement, which includes treatment
  device actor of Managed Delivery Workflow
• Request vendor of product W (as part of the
  treatment management system upgrade) to provide
  an integration statement, which includes
  treatment management system actor of Managed
  Delivery Workflow
• Request vendors competing for the RT data storage
  solutions to provide an integration statement,
  which includes archive- actor of Managed Delivery
  Workflow

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Future (2009) Purchase Situation- Example 3
Product W
Product Y
Treatment Management System- Plan management and
Tx records - Scheduling
Treatment Delivery System- Tx verification
delivery
Product Z
Product X
Patient Positioning System- Patient localization
and positioningusing e.g. X-rays, optical,
internal fiducials
Archive- Stores all DICOM RT data
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Impact toRadiation Oncology Vendors

• Participation in IHE-RO Development
• Marketing Planning Committee
• Engineering Technical Committee
• Connectathons
• Product Development to adhere to the Profiles
• Advantages for vendors
• Cost-effective and efficient interface testing
• Simplifies the tender (RFP) stage
• Eventually lesser overall engineering effort
• Easier quicker installations
• Improved promotion opportunities
• Improved workflow leading to happier customers
• Excellent channel to communicate with the
  radiation therapy thought-leaders

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What can you do for IHE-RO?

• Healthcare professionals
• Encourage your vendors to participate in IHE-RO
• Be an evangelist for IHE-RO in the community
• Use IHE-RO integration profiles in your RFP
  (Request for Proposals) when you buy new products
• Vendor employees
• Encourage your customers to participate in IHE-RO
• Participate on planning and technical committee
• Increase the awareness of IHE-RO in your company
• Participate in the process of IHE-RO in
  identifying the interconnectivity problems and
  defining standards

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How to Contact IHE-RO?

• ASTRO
• Sunita Ranjitkar (sunitar_at_astro.org)
• IHE-RO Co-Chairs
• Prabhakar Tripuraneni (prabhakar_at_tripuraneni.com)
• Jatinder Palta (paltajr_at_ufl.edu)
• IHE-RO Planning Committee Co-chairs
• May Abdel-Wahab (MWahab_at_med.miami.edu)
• Mika Miettinen (mika.miettinen_at_varian.com)
• Colin Field (cfield_at_cancerboard.ab.ca)
• IHE-RO Technical Committee Co-chairs
• Bruce Curran (bcurran1_at_lifespan.org)
• Stuart Swerdloff (sswerdloff_at_impac.com)
• On-line
• http//wiki.ihe.net

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IHE-RO Summary

• Wins for you
• Improves the connectivity of various radiation
  oncology hardware and software products
• Improves radiation oncology work flow
• Helps you to select products based on features,
  productivity and cost efficiency
• Helps vendors to focus on improving patient care
  instead of solving interface and connectivity
  problems
• How to help
• Evangelize IHE-RO in the community
• Encourage your colleagues, vendors, customers to
  participate
• Use IHE-RO profiles in purchasing (RFP) process
• Participate in the process of IHE-RO in
  identifying the interconnectivity problems and
  defining standards

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• http//wiki.ihe.net

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We have a dream!
We have a dream, that one day, We can buy
any radiation therapy hardware or software, plug
and play!We have a dream! --Jay Cooper
--Prabhakar Tripuraneni
--Phillip DevlinIHE-RO is making this dream
to come true
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