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      Visualization of data in radiotherapy using web services for optimization of workflow

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          Abstract

          Background

          Every day a large amount of data is produced within a radiotherapy department. Although this data is available in one form or other within the centralised systems, it is often not in the form which is of interest to the departmental staff. This work presents a flexible browser based reporting and visualization system for clinical and scientific use, not currently found in commercially available software such as MOSAIQ TM or ARIA TM. Moreover, the majority of user merely wish to retrieve data and not record and/or modify data. Thus the idea was conceived, to present the user with all relevant information in a simple and effective manner in the form of web-services. Due to the widespread availability of the internet, most people can master the use of a web-browser. Ultimately the aim is to optimize clinical procedures, enhance transparency and improve revenue.

          Methods

          Our working group (BAS) examined many internal procedures, to find out whether relevant information suitable for our purposes lay therein. After the results were collated, it was necessary to select an effective software platform. After a more detailed analysis of all data, it became clear that the implementation of web-services was appropriate. In our institute several such web-based information services had already been developed over the last few years, with which we gained invaluable experience. Moreover, we strived for high acceptance amongst staff members.

          Results

          By employing web-services, we attained high effectiveness, transparency and efficient information processing for the user. Furthermore, we achieved an almost maintenance-free and low support system. The aim of the project, making web-based information available to the user from the departmental system MOSAIQ, physician letter system MEDATEC R and the central finding server MiraPlus (laboratory, pathology and radiology) were implemented without restrictions.

          Conclusion

          Due to widespread use of web-based technology the training effort was effectively nil, since practically every member of staff can master the use of a web-browser. Moreover, we have achieved high acceptance amongst staff members and have improved our effectiveness resulting in a considerable time saving.

          The many MOSAIQ-specific parts of the system can be readily used by departments which use MOSAIQ as the departmental system.

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          Most cited references19

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          Multiple breath-hold CBCT for online image guided radiotherapy of lung tumors: simulation with a dynamic phantom and first patient data.

          Computer controlled breath-hold effectively reduces organ motion for image-guided precision radiotherapy of lung tumors. However, the acquisition time of 3D cone-beam-CT (CBCT) exceeds maximum breath-hold times. We have developed an approach enabling online verification using CBCT image acquisition with ABC®-based breath-hold. Patient CBCT images were acquired with ABC®-based repeat breath-hold. The clinical situation was also simulated with a Motion Phantom. Reconstruction of patient and phantom images with selection of free-breathing and breath-hold projections only was performed. CBCT-imaging in repeat breath-hold resulted in a precisely spherical appearance of a tumor-mimicking structure in the phantom. A faint "ghost" structure (free-breathing phases) can be clearly discriminated. Mean percentage of patient breath-hold time was 66%. Reconstruction based on free-breathing-only shows blurring of both tumor and diaphragm, reconstruction based on breath-hold projections only resulted in sharp contours of the same structures. From the phantom experiments, a maximal repositioning error of 1mm in each direction can be estimated. CBCT during repetitive breath hold provides reliable soft-tissue-based positioning. Fast 3D-imaging during one breath-hold is currently under development and has the potential to accelerate clinical linac-based volume imaging. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
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            Clinical implementation of volumetric intensity-modulated arc therapy (VMAT) with ERGO++.

            Volumetric modulated arc therapy (VMAT) has the potential to deliver dose distributions comparable to the established intensity-modulated radiotherapy techniques for a multitude of target paradigms. Prior to implementing VMAT into their clinical routine in December 2008, the authors evaluated the dose calculation/delivery accuracy of 24 sample VMAT plans (prostate and anal cancer target paradigms) with film and ionization dosimetry. After the start of the clinical program, in vivo measurements with a rectal probe were performed. The VMAT plans were generated by the treatment-planning system (TPS) ERGO++ (Elekta, Crawley, UK) and transferred to a phantom. Film dosimetry was performed with Kodak EDR2 films, and evaluated with dose profiles and gamma-index analysis. Appropriate ionization chambers were used for absolute dose measurements in the phantom and for in vivo measurements. The ionization chamber was used with localization of the measurement volume based on positioning cone-beam computed tomography. Plans were transferred from ERGO++ to the record and verify (R&V) system/linear accelerator (linac). The absolute dose deviations recorded with the ionization chamber were 1.74% +/- 1.62% across both indications. The gamma-index analysis of the film dosimetry showed no deviation > 3%/3 mm in the high-dose region. On in vivo measurements, a deviation between calculation and measurement of 2.09% +/- 2.4% was recorded, when the chamber was successfully positioned in the high-dose region. VMAT plans can be planned and treated reproducibly in high quality after the commissioning of the complete delivery chain consisting of TPS, R&V system and linac. The results of the individual plan verification meet the commonly accepted requirements. The first in vivo measurements confirm the reproducible precision of the delivered dose during clinical treatments.
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              Technologies for image distribution in hospitals.

              After the establishment of web-based image distribution, three challenges for image distribution can be identified today. Firstly, PACS (picture archiving and communication system) and the distribution of radiological images and reports need to be integrated with the emerging electronic medical record. Secondly, report and image data should be available on mobile devices like PDAs (personal digital assistants) or smartphones in the future. Thirdly, future systems must be available not only to transmit sectional images, but also to allow access to three- and four-dimensional data that are produced by multidetector CT and modern MR scanners.
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                Author and article information

                Contributors
                Stefan.Kirrmann@uniklinik-freiburg.de
                Mark.Gainey@uniklinik-freiburg.de
                Fred.Roehner@uniklinik-freiburg.de
                Markus.Hall@uniklinik-freiburg.de
                Gregor.Bruggmoser@uniklinik-freiburg.de
                Marianne.Schmucker@uniklinik-freiburg.de
                felix.heinemann@uniklinik-freiburg.de
                Journal
                Radiat Oncol
                Radiat Oncol
                Radiation Oncology (London, England)
                BioMed Central (London )
                1748-717X
                20 January 2015
                20 January 2015
                2015
                : 10
                : 1
                : 22
                Affiliations
                Klinik für Strahlenheilkunde, Department für Radiologische Diagnostik und Therapie, Universitätsklinikum Freiburg, Robert Koch Str. 3, 79106 Freiburg, Germany
                Article
                322
                10.1186/s13014-014-0322-3
                4307130
                25601225
                9a67c485-8de7-4451-9b41-7df41c84b5cb
                © Kirrmann et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 November 2014
                : 23 December 2014
                Categories
                Research
                Custom metadata
                © The Author(s) 2015

                Oncology & Radiotherapy
                clinic management,web-services,information management,workflow,quality management,radiotherapy

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