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Pacheco VMG, Paiva JPQ, Furriel BCRS, Santos PV, Ferreira Junior JR, Reis MRC, Tornieri D, Ribeiro GAS, Silva LO, Nogueira SA, Loureiro RM, Calixto WP. Pilot deployment of a cloud-based universal medical image repository in a large public health system: A protocol study. PLoS One 2024; 19:e0307022. [PMID: 39208265 PMCID: PMC11361589 DOI: 10.1371/journal.pone.0307022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/27/2024] [Indexed: 09/04/2024] Open
Abstract
This paper outlines the protocol for the deployment of a cloud-based universal medical image repository system. The proposal aims not only at the deployment but also at the automatic expansion of the platform, incorporating Artificial Intelligence (AI) for the analysis of medical image examinations. The methodology encompasses efficient data management through a universal database, along with the deployment of various AI models designed to assist in diagnostic decision-making. By presenting this protocol, the goal is to overcome technical challenges and issues that impact all phases of the workflow, from data management to the deployment of AI models in the healthcare sector. These challenges include ethical considerations, compliance with legal regulations, establishing user trust, and ensuring data security. The system has been deployed, with a tested and validated proof of concept, possessing the capability to receive thousands of images daily and to sustain the ongoing deployment of new AI models to expedite the analysis process in medical image exams.
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Affiliation(s)
- Viviane Margarida Gomes Pacheco
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Technology Research and Development Center (GCITE), Federal Institute of Goias, Goiania, Goias, Brazil
| | | | - Brunna Carolinne Rocha Silva Furriel
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Electrical, Mechanical & Computer Engineering School, Federal University of Goias, Goiania, Brazil
| | - Paulo Victor Santos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Electrical, Mechanical & Computer Engineering School, Federal University of Goias, Goiania, Brazil
| | | | - Marcio Rodrigues Cunha Reis
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Technology Research and Development Center (GCITE), Federal Institute of Goias, Goiania, Goias, Brazil
| | | | | | | | | | | | - Wesley Pacheco Calixto
- Electrical, Mechanical & Computer Engineering School, Federal University of Goias, Goiania, Brazil
- Technology Research and Development Center (GCITE), Federal Institute of Goias, Goiania, Goias, Brazil
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Xiao Q, Li G. Application and Challenges of Statistical Process Control in Radiation Therapy Quality Assurance. Int J Radiat Oncol Biol Phys 2024; 118:295-305. [PMID: 37604239 DOI: 10.1016/j.ijrobp.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
Quality assurance (QA) is important for ensuring precision in radiation therapy. The complexity and resource-intensive nature of QA has increased with the continual evolution of equipment and techniques. An effective approach is to improve the process control technology and resource optimization. Statistical process control is an economical and efficient tool that has been widely used to monitor, control, and improve quality management processes and is now being increasingly used for radiation therapy QA. This article reviews the development and methodology of statistical process control technology, evaluates its suitability in radiation therapy QA practices, and assesses its importance and challenges in optimizing radiation therapy QA processes.
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Affiliation(s)
- Qing Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guangjun Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Donahue WP, Draeger E, Han DY, Chen Z. Frequency of errors in the transfer of treatment parameters from the treatment planning system to the oncology information system in a multi-vendor environment. J Appl Clin Med Phys 2023; 24:e13868. [PMID: 36527239 PMCID: PMC10113690 DOI: 10.1002/acm2.13868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/19/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Technological advancements have made it possible to improve patient outcomes in radiotherapy, sparing both normal tissues and increasing tumour control. However, these advancements have resulted in an increase in the number of software systems used, which each require data inputs to function. For institutions with multiple vendors for their treatment planning systems and oncology information systems, the transfer of data between them is potentially error prone and can lead to treatment errors. PURPOSE The goal of this work was to determine the frequency of errors in data transfers between the Varian Eclipse treatment planning system and the Elekta Mosaiq oncology information system. METHODS An in-house program was used to quantify the number of errors for 2700 unique plans over an 8-month period. Using this information, the frequency of the errors were calculated. A risk priority number was calculated using the calculated frequencies to determine the impact on the clinic. RESULTS The most common errors discovered were backup timer settings (10.7%), Field label (8.5%), DRR associations (3.3%), imaging field types (3.1%), dose rate (1%), Field Id (0.8%), imaging isocenter (0.7% and SSD (0.7%). Based on the risk priority numbers, the DRR association error was ranked as having the highest potential impact on the patient. CONCLUSIONS The results of the work show that the most effort should be focused on checking the manual steps performed in the transfer process, while items that are imported directly from DICOM-RT without modification are highly likely to be transferred accurately. The data can be used to help guide the implementation of future automated tools and process improvement in the clinic.
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Affiliation(s)
- William P. Donahue
- Department of Therapeutic RadiologyYale University School of MedicineNew HavenConnecticutUSA
| | - Emily Draeger
- Department of Therapeutic RadiologyYale University School of MedicineNew HavenConnecticutUSA
| | - Dae Yup Han
- Department of Therapeutic RadiologyYale University School of MedicineNew HavenConnecticutUSA
| | - Zhe Chen
- Department of Therapeutic RadiologyYale University School of MedicineNew HavenConnecticutUSA
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Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update. Pract Radiat Oncol 2023; 13:97-111. [PMID: 36585312 DOI: 10.1016/j.prro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE This updated report on image guided radiation therapy (IGRT) is part of a series of consensus-based white papers previously published by the American Society for Radiation Oncology addressing patient safety. Since the first white papers were published, IGRT technology and procedures have progressed significantly such that these procedures are now more commonly used. The use of IGRT has now extended beyond high-precision treatments, such as stereotactic radiosurgery and stereotactic body radiation therapy, and into routine clinical practice for many treatment techniques and anatomic sites. Therefore, quality and patient safety considerations for these techniques remain an important area of focus. METHODS AND MATERIALS The American Society for Radiation Oncology convened an interdisciplinary task force to assess the original IGRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology, and task force members indicated their level of agreement based on a 5-point Likert scale from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who selected "strongly agree" or "agree" indicated consensus. SUMMARY This IGRT white paper builds on the previous version and uses other guidance documents to primarily focus on processes related to quality and safety. IGRT requires an interdisciplinary team-based approach, staffed by appropriately trained specialists, as well as significant personnel resources, specialized technology, and implementation time. A thorough feasibility analysis of resources is required to achieve the clinical and technical goals and should be discussed with all personnel before undertaking new imaging techniques. A comprehensive quality-assurance program must be developed, using established guidance, to ensure IGRT is performed in a safe and effective manner. As IGRT technologies continue to improve or emerge, existing practice guidelines should be reviewed or updated regularly according to the latest American Association of Physicists in Medicine Task Group reports or guidelines. Patient safety in the application of IGRT is everyone's responsibility, and professional organizations, regulators, vendors, and end-users must demonstrate a clear commitment to working together to ensure the highest levels of safety.
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Moran JM, Bazan JG, Dawes SL, Kujundzic K, Napolitano B, Redmond KJ, Xiao Y, Yamada Y, Burmeister J. Quality and Safety Considerations in Intensity Modulated Radiation Therapy: An ASTRO Safety White Paper Update. Pract Radiat Oncol 2022; 13:203-216. [PMID: 36710210 DOI: 10.1016/j.prro.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE This updated report on intensity modulated radiation therapy (IMRT) is part of a series of consensus-based white papers previously published by the American Society for Radiation Oncology (ASTRO) addressing patient safety. Since the first white papers were published, IMRT went from widespread use to now being the main delivery technique for many treatment sites. IMRT enables higher radiation doses to be delivered to more precise targets while minimizing the dose to uninvolved normal tissue. Due to the associated complexity, IMRT requires additional planning and safety checks before treatment begins and, therefore, quality and safety considerations for this technique remain important areas of focus. METHODS AND MATERIALS ASTRO convened an interdisciplinary task force to assess the original IMRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology, and task force members indicated their level of agreement based on a 5-point Likert scale, from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who select "strongly agree" or "agree" indicated consensus. CONCLUSIONS This IMRT white paper primarily focuses on quality and safety processes in planning and delivery. Building on the prior version, this consensus paper incorporates revised and new guidance documents and technology updates. IMRT requires an interdisciplinary team-based approach, staffed by appropriately trained individuals as well as significant personnel resources, specialized technology, and implementation time. A comprehensive quality assurance program must be developed, using established guidance, to ensure IMRT is performed in a safe and effective manner. Patient safety in the delivery of IMRT is everyone's responsibility, and professional organizations, regulators, vendors, and end-users must work together to ensure the highest levels of safety.
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Affiliation(s)
- Jean M Moran
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jose G Bazan
- Department of Radiation Oncology, Ohio State University, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | | | | | - Brian Napolitano
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jay Burmeister
- Department of Oncology, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, Michigan
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Readiness for Radiation Treatment Continuity: Survey on Contingency Plans Against Cyberattacks. Adv Radiat Oncol 2022; 7:100990. [PMID: 36148373 PMCID: PMC9486412 DOI: 10.1016/j.adro.2022.100990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/30/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Cyberattacks on health care systems have been on the rise over the past 5 years. Formulation and implementation of a robust postattack business continuity plan and/or contingency plan (CP) is essential for minimal disruption to patient care. The level of awareness and planning within the radiation oncology community for cyberattacks is not clear. This study was undertaken to survey and assess cyberattack CP awareness and preparedness. Methods and Materials A survey instrument comprising 5 questions on awareness and preparedness of cyberattack CPs was e-mailed to 150 radiation oncology departments. Recipients included 105 institutions with residency programs in therapeutic medical physics, as listed by the Commission on Accreditation of Medical Physics Education Program (usually either school-based or large institutional settings), and 45 additional smaller settings within the United States, representing community practices. Results Forty-three responses were deemed evaluable for analysis. Forty-two percent (18 respondents) of respondents responded that they are well-aware of the concept of a cyberattack CP. A large discrepancy in awareness exists between larger hospitals (LH) that have 5 or more treatment machines and smaller hospitals (SH) that have 4 or fewer, 54% versus 24 % (P < .05). Fifty-eight percent of respondents considered it “essential” to have such a plan in place, and 28% considered it “desirable” to do so but not practical. Nine percent regarded a cyberattack CP as unnecessary. No significant differences in responses were noted among different types or sizes of institutions on this issue. Sixty-two percent of LH responded that they were either preparing or evaluating a CP, compared with only 29% of SH (P = .03). However, no respondents explicitly replied that they already had a CP in place in their practices. Conclusions The importance of cyberattack preparedness and implementation does not seem to be well-recognized in radiation oncology. Both the awareness and the preparedness of SH are substantially less than those of LH. Specific and ongoing education efforts in parallel with development of appropriate programs are needed to counter the increasingly pervasive and complex threat of cyberattacks.
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Geurts MW, Jacqmin DJ, Jones LE, Kry SF, Mihailidis DN, Ohrt JD, Ritter T, Smilowitz JB, Wingreen NE. AAPM MEDICAL PHYSICS PRACTICE GUIDELINE 5.b: Commissioning and QA of treatment planning dose calculations-Megavoltage photon and electron beams. J Appl Clin Med Phys 2022; 23:e13641. [PMID: 35950259 PMCID: PMC9512346 DOI: 10.1002/acm2.13641] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines:
Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. While must is the term to be used in the guidelines, if an entity that adopts the guideline has shall as the preferred term, the AAPM considers that must and shall have the same meaning. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
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Simpson-Page E, Coogan P, Kron T, Lowther N, Murray R, Noble C, Smith I, Wilks R, Crowe SB. Webinar and survey on quality management principles within the Australian and New Zealand ACPSEM Workforce. Phys Eng Sci Med 2022; 45:679-685. [PMID: 35834171 DOI: 10.1007/s13246-022-01160-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Healthcare relies upon the accurate and safe delivery of patient care. This is only achievable when systems are developed to ensure high quality, robust outcomes, for instance quality management systems. The concept of quality management can take on a different meaning depending on the context in which it is found. To add complication, the amount of education required for quality management will vary depending on one's exposure to the implementation of quality systems. In part to address these issues, the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Queensland Branch held a quality management webinar for members and non-members across Australia and New Zealand. The purpose of the webinar was to educate and facilitate discussion regarding the application of quality management principles for the ACPSEM profession. In conjunction, a pre- and post-webinar survey was conducted to gain an insight into existing knowledge and attitudes within the professions governed by the ACPSEM and students undertaking related studies. This paper authored by the webinar speakers reintroduces the quality management principles that were discussed in webinar, exemplifies the importance of quality management skills within the ACPSEM professions and presents the results of the surveys, promoting the need for more educational resources on quality management tools.
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Affiliation(s)
- Emily Simpson-Page
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Paul Coogan
- Q-TRaCE, Department of Nuclear Medicine & Specialised PET Services Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Tomas Kron
- Physical Sciences Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas Lowther
- Wellington Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - Rebecca Murray
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia
| | - Christopher Noble
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Ian Smith
- St. Andrews War Memorial Hospital, Brisbane, Australia
| | - Rachael Wilks
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Scott B Crowe
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Herston Biofabrication Institute, Metro North Hospital and Health Service, Brisbane, Australia.,School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia.,School of Chemistry and Physics, Queensland University of Technology, Brisbane, Australia
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Kron T, Fox C, Ebert MA, Thwaites D. Quality management in radiotherapy treatment delivery. J Med Imaging Radiat Oncol 2022; 66:279-290. [PMID: 35243785 DOI: 10.1111/1754-9485.13348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022]
Abstract
Radiation Oncology continues to rely on accurate delivery of radiation, in particular where patients can benefit from more modulated and hypofractioned treatments that can deliver higher dose to the target while optimising dose to normal structures. These deliveries are more complex, and the treatment units are more computerised, leading to a re-evaluation of quality assurance (QA) to test a larger range of options with more stringent criteria without becoming too time and resource consuming. This review explores how modern approaches of risk management and automation can be used to develop and maintain an effective and efficient QA programme. It considers various tools to control and guide radiation delivery including image guidance and motion management. Links with typical maintenance and repair activities are discussed, as well as patient-specific quality control activities. It is demonstrated that a quality management programme applied to treatment delivery can have an impact on individual patients but also on the quality of treatment techniques and future planning. Developing and customising a QA programme for treatment delivery is an important part of radiotherapy. Using modern multidisciplinary approaches can make this also a useful tool for department management.
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Affiliation(s)
- Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Institute of Oncology, Melbourne University, Melbourne, Victoria, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chris Fox
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Martin A Ebert
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physics, Mathematics and Computing, University of Western Australia, Perth, Western Australia, Australia.,5D Clinics, Perth, Western Australia, Australia
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia.,Medical Physics Group, Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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