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Informatics in c
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Radiation Oncology
S Informatics in
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Edited by
George Starkschall • R. Alfredo C. Siochi Radiation Oncology
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Strengthening the collaborations between radiation oncology and informatics professionals, f
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Informatics in Radiation Oncology discusses the benefits of applying informatics principles
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to the processes within radiotherapy. It explores how treatment and imaging information is
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represented, stored, and retrieved as well as how this information relates to other patient data. The
book deepens your knowledge of current and emerging information technology and informatics a
principles applied to radiation oncology so that all the data gathered—from laboratory results to t
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medical images—can be fully exploited to make treatments more effective and processes more c
efficient. s
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After introducing the basics of informatics and its connection to radiation oncology, the book
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examines the process of healthcare delivery in radiation oncology, the challenges of managing
images in radiotherapy, and the burgeoning field of radiogenomics. It then presents teaching, R
clinical trials, and research tools; describes the role of informatics in imaging; and looks at how a
informatics can improve treatment planning, delivery, and assessment. The book concludes with d
discussions on how outcomes modeling evaluates the effectiveness of treatments, how quality
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control informatics improves the reliability of processes, and how to perform quality assurance on a
the informatics tools. t
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With contributions from a host of top international experts in radiation oncology, medical physics,
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and informatics, this book leads the way in moving the field forward. It encourages you to find
new ways of applying informatics to radiation oncology and help your patients in their fight O
against cancer.
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George Starkschall
R. Alfredo C. Siochi
K11239
ISBN: 978-1-4398-2582-2
90000
9 781439 825822
K11239_Cover_final.indd 1 7/24/13 12:26 PM
Informatics in
Radiation Oncology
ImagIng In medIcal dIagnosIs and Therapy
William R. Hendee, Series Editor
Quality and safety in radiotherapy comprehensive Brachytherapy:
Todd Pawlicki, Peter B. Dunscombe, Arno J. Mundt, physical and clinical aspects
and Pierre Scalliet, Editors Jack Venselaar, Dimos Baltas, Peter J. Hoskin,
ISBN: 978-1-4398-0436-0 and Ali Soleimani-Meigooni, Editors
ISBN: 978-1-4398-4498-4
adaptive radiation Therapy
physics of mammographic Imaging
X. Allen Li, Editor
Mia K. Markey, Editor
ISBN: 978-1-4398-1634-9
ISBN: 978-1-4398-7544-5
Quantitative mrI in cancer
physics of Thermal Therapy:
Thomas E. Yankeelov, David R. Pickens, and
Fundamentals and clinical applications
Ronald R. Price, Editors
Eduardo Moros, Editor
ISBN: 978-1-4398-2057-5
ISBN: 978-1-4398-4890-6
Informatics in medical Imaging
emerging Imaging Technologies in medicine
George C. Kagadis and Steve G. Langer, Editors
Mark A. Anastasio and Patrick La Riviere, Editors
ISBN: 978-1-4398-3124-3
ISBN: 978-1-4398-8041-8
adaptive motion compensation in
cancer nanotechnology: principles and
radiotherapy
applications in radiation oncology
Martin J. Murphy, Editor
Sang Hyun Cho and Sunil Krishnan, Editors
ISBN: 978-1-4398-2193-0
ISBN: 978-1-4398-7875-0
Image-guided radiation Therapy
monte carlo Techniques in radiation Therapy
Daniel J. Bourland, Editor
Joao Seco and Frank Verhaegen, Editors
ISBN: 978-1-4398-0273-1
ISBN: 978-1-4665-0792-0
Targeted molecular Imaging Image processing in radiation Therapy
Michael J. Welch and William C. Eckelman, Editors Kristy Kay Brock, Editor
ISBN: 978-1-4398-4195-0 ISBN: 978-1-4398-3017-8
proton and carbon Ion Therapy Informatics in radiation oncology
C.-M. Charlie Ma and Tony Lomax, Editors George Starkschall and R. Alfredo C. Siochi, Editors
ISBN: 978-1-4398-1607-3 ISBN: 978-1-4398-2582-2
Forthcoming titles in the series
stereotactic radiosurgery and radiotherapy cone Beam computed Tomography
Stanley H. Benedict, Brian D. Kavanagh, and Chris C. Shaw, Editor
David J. Schlesinger, Editors ISBN: 978-1-4398-4626-1
ISBN: 978-1-4398-4197-6
Tomosynthesis Imaging
Ingrid Reiser and Stephen Glick, Editors
ISBN: 978-1-4398-7870-5
Informatics in
Radiation Oncology
Edited by
George Starkschall
R. Alfredo C. Siochi
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2014 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20130715
International Standard Book Number-13: 978-1-4398-2583-9 (eBook - PDF)
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Contents
Series Preface ......................................................................................................................................................................vii
Preface. ................................................................................................................................................................................... ix
Editors .................................................................................................................................................................................... xi
Contributors .......................................................................................................................................................................xiii
Section i introduction
1 What Is Biomedical Informatics? ..........................................................................................................3
Paul G. Nagy
2 Ontology for Radiation Oncology .......................................................................................................11
Daniel L. McShan
3 Web-Based Information Delivery ........................................................................................................27
Charles Mayo and Steven Conners
4 Electronic Medical Record ...................................................................................................................37
Alexis Andrew Miller
5 Toward a Terminology for Radiation Oncology. .................................................................................49
Michael D. Mills and Robert J. Esterhay
6 Informatics for Accessing Hospital Information Systems ..................................................................55
Collin D. Brack
Section ii information and the Radiation oncology Process
7 Information Flow through the Radiation Oncology Process .............................................................63
Luis Fong de los Santos and Michael G. Herman
8 Integrating Radiology with Radiation Oncology: Challenges and Opportunities ............................77
George C. Kagadis, Steve G. Langer, Peter Kijewski, and Paul G. Nagy
9 Image Management in Radiotherapy. ..................................................................................................85
Volker Steil, Stuart Swerdloff, Fred Röhner, Frank Schneider, Frederik Wenz, Gerald Weisser, and Frank Lohr
10 Connectivity .........................................................................................................................................95
R. Alfredo Siochi and Stuart Swerdloff
11 Information Resources for Radiation Oncology ...............................................................................101
R. Alfredo Siochi
v
vi Contents
12 Radiogenomics: The Future of Personalized Radiation Therapy?. ...................................................115
Bryan Allen
Section iii informatics for teaching and Research
13 Teaching Support ...............................................................................................................................121
Joann I. Prisciandaro
14 Communication, Collaboration, IT, and Informatics Infrastructure for Clinical Trials ................133
Ying Xiao and Mike Tilkin
15 Research Data Management, Integration, and Security ...................................................................141
Ashish Sharma, Yusuf N. Saghar, and Joel H. Saltz
16 Open-Source Informatics Tools for Radiotherapy Research ............................................................147
Joseph O. Deasy and Aditya P. Apte
Section iV imaging informatics
17 NCI Cancer Imaging Program: Imaging Informatics and Radiotherapy Implications ...................163
John Freymann, Justin S. Kirby, and C. Carl Jaffe
18 Informatics for Multimodality Imaging ............................................................................................171
Eduard Schreibmann and Timothy H. Fox
19 Imaging for Radiation Treatment Planning ......................................................................................189
Gig S. Mageras, Yu-Chi Hu, Stephen McNamara, Hai Pham, and Jian-Ping Xiong
Section V informatics for treatment Planning, Delivery, and Assessment
20 Evaluation of Treatment Plans ...........................................................................................................207
Kevin L. Moore and Deshan Yang
21 Human–Computer Interaction in Radiation Therapy ......................................................................221
Junyi Xia and John E. Bayouth
22 Informatics for Image-Guided Radiation Therapy ...........................................................................235
Peter Balter and George Starkschall
23 Patient Assessment Tools ...................................................................................................................245
Todd McNutt and Joseph M. Herman
Section Vi outcomes Modeling and Quality Assurance informatics
24 Outcomes Modeling ...........................................................................................................................255
Issam El Naqa
25 Quality Assurance in Informatics .....................................................................................................275
Sasa Mutic and Scott Brame
26 Quality Assurance and the Informatics Environment. .....................................................................287
Collin D. Brack and Ivan L. Kessel
Series Preface
Advances in the science and technology of medical imaging and topic of conversation during a lunch hosted by Taylor & Francis
radiation therapy are more profound and rapid than ever before, Publishers and involving a group of senior medical physicists
since their inception over a century ago. Further, the disciplines (Arthur L. Boyer, Joseph O. Deasy, C.-M. Charlie Ma, Todd
are increasingly cross-linked as imaging methods become more A. Pawlicki, Ervin B. Podgorsak, Elke Reitzel, Anthony B.
widely used to plan, guide, monitor, and assess treatments in Wolbarst, and Ellen D. Yorke). The conclusion of this discus-
radiation therapy. Today, the technologies of medical imaging sion was that a book series should be launched under the Taylor
and radiation therapy are so complex and so computer-driven & Francis banner, with each volume in the series addressing a
that it is difficult for the persons (physicians and technologists) rapidly advancing area of medical imaging or radiation ther-
responsible for their clinical use to know exactly what is hap- apy of importance to medical physicists. The aim would be
pening at the point of care, when a patient is being examined for each volume to provide medical physicists with the infor-
or treated. The persons best equipped to understand the tech- mation needed to understand technologies driving a rapid
nologies and their applications are medical physicists, and these advance and their applications to safe and effective delivery of
individuals are assuming greater responsibilities in the clinical patient care.
arena to ensure that what is intended for the patient is actually Each volume in the series is edited by one or more individuals
delivered in a safe and effective manner. with recognized expertise in the technological area encompassed
The growing responsibilities of medical physicists in the by the book. The editors are responsible for selecting the authors
clinical arenas of medical imaging and radiation therapy are not of individual chapters and ensuring that the chapters are com-
without their challenges, however. Most medical physicists are prehensive and intelligible to someone without such expertise.
knowledgeable in either radiation therapy or medical imaging The enthusiasm of volume editors and chapter authors has been
and are experts in one or a small number of areas within their gratifying and reinforces the conclusion of the Minneapolis lun-
discipline. They sustain their expertise in these areas by read- cheon that this series of books addresses a major need of medical
ing scientific articles and attending scientific talks at meetings. physicists.
In contrast, their responsibilities increasingly extend beyond Imaging in Medical Diagnosis and Therapy would not have
their specific areas of expertise. To meet these responsibilities, been possible without the encouragement and support of the
medical physicists periodically must refresh their knowledge series manager, Luna Han of Taylor & Francis Publishers. The
of advances in medical imaging or radiation therapy, and they editors and authors, and most of all I, are indebted to her steady
must be prepared to function at the intersection of these two guidance of the entire project.
fields. How to accomplish these objectives is a challenge.
At the 2007 annual meeting of the American Association of William R. Hendee, Series Editor
Physicists in Medicine in Minneapolis, this challenge was the Rochester, MN
vii
Preface
The vast array of patient information acquired during the diag- power are enabling us to discover knowledge that could make
nosis and treatment of disease has created a large reservoir of our treatments more effective and our processes more efficient.
data. Laboratory results, medical images, medication lists, aller- We will see improvements in healthcare as we process the
gies, and patient histories are among the many sets of data that data in new ways, automate systems for safety and efficiency,
have moved from paper to digital media, making the informa- mine the data, and improve data access (e.g., through the Web).
tion easier to find and access. The move to electronic medical These improvements also demand new methodologies for
records (EMRs) has also made it more convenient to store large security, privacy, and compliance with laws such as the Health
amounts of data, including previously uncaptured data, fur- Insurance Portability and Accountability Act (HIPAA). The field
ther opening the floodgates for these deepening pools of data. of radiation oncology can benefit from experts in informatics, as
Government mandates to transition to EMRs will hasten the they apply their skills to our knowledge domain. Informatics in
increase in the amount of data, and a growing number of clini- radiation oncology is, in many ways, still in its infancy. Many of
cal trials will prompt the collection of even more data. the authors of this book have learned informatics on the job, but
This explosion of data has become very obvious in radia- we need informaticists to become familiar with radiation oncol-
tion oncology, where electronic databases are used to automate ogy. This book is the first of its kind and fills this gap, with the
and verify the correct delivery of radiation treatments. These hope of strengthening the collaborations between the domain
“record and verify” systems have been around much longer than knowledge experts and informaticists, enabling the full use of
EMRs and have lived side-by-side with paper charts for almost all the data that are being gathered in our data-rich environ-
two decades. This long history has provided a wealth of experi- ment. Similarly, this book will help researchers and physicists in
ence that has led to the development of the modern radiation radiation oncology deepen their knowledge of the information
oncology treatment management system (TMS). Part EMR, part technology and informatics principles being applied to our field.
medical delivery device, the TMS stores not only patient demo- In the Introduction section, the first three chapters (1–3)
graphics but also every single movement and combination of describe the basics of informatics in general, while the next
treatment machine settings for radiation treatments. With the three chapters explore their connection to radiation oncology:
increased complexity in treatments, beginning with intensity- where and how the data are stored (4), their relationships and
modulated radiation therapy (IMRT) and continuing to such connections to other parts of the hospital (6), and the terminol-
delivery techniques as volume-modulated arc therapy (VMAT), ogy that facilitates the application of informatics to our field (5).
TMS has become essential. It is impossible to manually program The second section examines the process of healthcare delivery
contemporary dynamic delivery techniques, because they may in radiation oncology: how information flows from one step to
have on the order of 100,000 parameters. Moreover, the treat- the next (7), the logical and physical connections among the
ment is only one part in the entire chain of the radiotherapy various steps (10), and the resources we need and how to find
process. Imaging, simulation, planning, immobilization, local- them (11). Within that process, one can see our dependence on
ization, and image guidance contribute to the data stored in imaging and the benefits of working with radiology informat-
radiotherapy databases and picture archiving systems. With ics (8). Drawing on their experience would be helpful since the
approximately 5000 treatments per accelerator per year, with image-guided radiotherapy era has brought with it the chal-
potentially half of them receiving daily 3D imaging for patient lenges of managing images in radiotherapy (9). A brief foray into
setup, it is no wonder that data storage systems are now mea- the emerging field of radiogenomics (12) concludes the section.
sured in multiples of terabytes. The remaining sections dive deeper into the processes within
With all these data at our fingertips, we are poised to move radiotherapy, showing how we can benefit from applying infor-
into the next phase of the transition into a paperless environ- matics principles to them. Section III looks at how we share
ment. For the most part, however, we have merely replaced the the results of our work, discussing teaching (13), clinical tri-
media that captures the data, mimicking paper forms in a digital als (14), information sharing and data federation (15), and tools
environment. Efforts to tame this flood of data and harness its that have been developed to promote informatics research in
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