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

IHE-ROIHE-ROPrabhakar Tripuraneni, MD, FACR, FASTROPrabhakar Tripuraneni, MD, FACR, FASTRO

On behalf of IHE-RO & ASTRO On behalf of IHE-RO & ASTRO

I have a dream!I have a dream!

We have a dream, that one day, We have a dream, that one day, We can buy any radiation We can buy any radiation therapy hardware or software, therapy hardware or software, plug and play!plug and play!

We have a dream!We have a dream!--Jay Cooper--Jay Cooper

--Prabhakar Tripuraneni --Prabhakar Tripuraneni --Phillip Devlin --Phillip Devlin

Ever Frustrated with Ever Frustrated with Connectivity?Connectivity?

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 don’t you?

IHE-RO: The ConceptIHE-RO: The Concept

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

Radiation Therapy is a Radiation Therapy is a Complex ProcessComplex Process

With Many Parts … And We All Want The Best

The Risk Of Choosing Each The Risk Of Choosing Each “Best Of Breed”“Best Of Breed”

Is the Tower of Babel

I Want To Buy Equipment I Want To Buy Equipment I Can Plug In My NetworkI Can Plug In My Network

And Not Worry About The Shape of The Plug!

We Need To Agree on We Need To Agree on Standards of InterchangeStandards of Interchange

AAndnd Not “Creatively Apply” Not “Creatively Apply” The StandardsThe Standards

IHE-RO BASICSIHE-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 …

Jaguar, Lexus, Mercedes, BMWJaguar, Lexus, Mercedes, BMW

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

What Is IHE-RO?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

IHE-ROIHE-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

IHE-ROIHE-ROIHE-RO Co-Chairs

Prabhakar Tripuraneni

Jatinder Palta

Planning Co-chairs Technical Co-chairsMay Abdel-Wahab Bruce Curran Mika Miettinen Stuart SwerdloffColin FieldRamesh Rengan

IHEIHE

Integrating HealthCare Enterprise HIMS

RSNA

together formed IHE

IHE Standards-Based Integration Solutions IHE Standards-Based Integration Solutions

Professional Societies Sponsorship

Healthcare Providers & Software Developers

Healthcare IT Standards HL7, DICOM, etc.

General IT Standards Internet, ISO, etc.

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

Interoperable Healthcare IT Solution Specifications

IHE Integration Profile Interoperable Healthcare IT

Solution Specifications IHE Integration Profile

IHE Process

IHE Organizational StructureMulti-Domain & Multi-NationalIHE Organizational StructureMulti-Domain & Multi-National

Participants

contribute

Global Development:Radiology,IT Infrastructure,Cardiology,Radiation Oncology Lab, etc.

Delegates

IHE Europe

IHE North America

IHE Asia/Oceania

Regional &NationalDeployment

supervises

reports

IHE (International) Strategic Development Committee

SponsorCo-Chairs

Global

Interoperability

IHE Domain-related Planning and Technical Committees

IHE Organizational IHE Organizational StructureStructure

ASTRO AAPM ACR AROI CARO CSRO ESTRO JASTRO

IHE-RO ParticipantsIHE-RO Participants

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

Vendor participants include: BrainLabCMS-Elekta-IMPAC MIM-VistaNucletronPhilipsSiemensTomotherapyVarian

Others: ATC, IAEA, NCI, NEMA

IHE–RO IHE–RO What does it do for you?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

IHE-RO ProcessIHE-RO Process

IHE-RO processIHE-RO process

Identify interoperability problems

Specify integration profiles

Test integration profiles at Connectathon

Publish integration profiles for use in RFPs(Request for Proposal)

IHE-RO 2006 ConnectathonIHE-RO 2006 ConnectathonWashington DCWashington DC

IHE-RO 2007 ConnectathonIHE-RO 2007 ConnectathonWashington DCWashington DC

NucletronNucletron VarianVarianPhilipsPhilips

TomotherapyTomotherapy

ImpacImpac

CMSCMSBrainlabBrainlab

ElektaElekta

IHE-RO 2008 Connectathon IHE-RO 2008 Connectathon Houston TXHouston TX

IHE-RO 2007-2008IHE-RO 2007-2008AchievementsAchievements

Objective #1 Reduce DICOM RT connectivity problems in CT-

simulation and Treatment Planning domainObjective #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) happensEnables you to choose the best of all treatment planning tools in the market place, and connect them reliably together

Example of Benefits -Example of Benefits -Retreat Patient With ConfidenceRetreat Patient With Confidence

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 devicesYou can view the plan and

dosimetry of previous RT on your TPS

Design the best new treatment plan for your patient.

DRR of previous RT

Planned new RT

Success Stories from Success Stories from Formal ConnectathonFormal 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

Formal Connecthaton Formal Connecthaton Results (2007-2008Results (2007-2008))

IHE-RO 2009 (Future)IHE-RO 2009 (Future)Treatment Delivery WorkflowTreatment 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

How IHE-RO Helps You How IHE-RO Helps You Purchasing Products?Purchasing Products?

You’ll 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

IHE-RO Integration Profiles 2007-IHE-RO Integration Profiles 2007-Technical DescriptionsTechnical 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

IHE-RO Integration Profiles 2008 -IHE-RO Integration Profiles 2008 -Technical DescriptionsTechnical 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

Purchase Situation- Purchase Situation- Example #1Example #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


TPS Product X

Contourer- Defines contours

Geometric Planner- Defines plan geometry

Dosimetric Planner- Calculates dose

Dose Displayer- Displays dose distribution

Registered Contourer- Defines contours on multimodality images

Registrator- Registers multimodality images

Registered Display- Displays image fusion

Registered Dose Displayer- Displays dose on multimodality images

TPS Product Y or Z










TPS Product X


TPS Product Y or Z



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


TPS Product X









TPS Product Y










TPS Product X



TPS Product Y







Future (2009) Purchase Situation- Future (2009) Purchase Situation-

Example #3Example #3You 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

Future (2009) Purchase Situation- Future (2009) Purchase Situation- Example #3Example #3

Product WTreatment Management System

- Plan management and Tx records- Scheduling

Product ZPatient Positioning System- Patient localization and positioning

using e.g. X-rays, optical, internal fiducials

Product Y

Treatment Delivery System- Tx verification & delivery

Product X

Archive- Stores all DICOM RT data

Impact toImpact toRadiation Oncology VendorsRadiation 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

What can you do for IHE-RO?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

How to Contact IHE-RO?How to Contact IHE-RO?ASTRO Sunita Ranjitkar ([email protected])

IHE-RO Co-Chairs Prabhakar Tripuraneni ([email protected]) Jatinder Palta ([email protected])

IHE-RO Planning Committee Co-chairs May Abdel-Wahab ([email protected]) Mika Miettinen ([email protected]) Colin Field ([email protected])

IHE-RO Technical Committee Co-chairs Bruce Curran ([email protected]) Stuart Swerdloff ([email protected])

On-line http://wiki.ihe.net

IHE-RO SummaryIHE-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

http://wiki.ihe.net

We have a dream!We have a dream!

We have a dream, that one day, We have a dream, that one day, We can buy any radiation therapy hardware We can buy any radiation therapy hardware or software, plug and play!or software, plug and play!We have a dream!We have a dream!

--Jay Cooper--Jay Cooper --Prabhakar Tripuraneni--Prabhakar Tripuraneni --Phillip Devlin--Phillip Devlin

IHE-RO is making this dream to come true…IHE-RO is making this dream to come true…

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

Documents

Transcript of IHE-RO Prabhakar Tripuraneni, MD, FACR, FASTRO On behalf of IHE-RO & ASTRO.