Integrating the Healthcare Enterprise - Radiation Oncology (IHE-RO) project is an ASTRO sponsored initiative to facilitate information exchange across different treatment planning systems (TPS). IHE-RO promotes accurate and safe radiation treatment delivery by developing a framework for integration and interoperability of information. In this study we evaluate the status of dose import/export and re-planning functionalities of different TPS. Four planning systems (Elekta XiO v4.6, Elekta Monaco v2.03, Varian Eclipse v8.1, BrainLAB iPlan v4.1.2 with Monte Carlo) were considered for a test case in which a patient previously planned and treated with one TPS presents for re-treatment in a clinic that uses a different TPS. CT data for the test case was imported into one of the TPS and PTV/OARs delineated. Three treatment plans were generated using fixed conformal fields, dynamic conformal arcs, and IMRT. The image set, structure set and plans were exported to a different TPS. A repeat CT scan of the patient was also sent to the new TPS for re-planning. Each TPS was evaluated for import/export of RT images, structures, and dose as well as for its ability to effectively re-plan previously irradiated sites. Integrity and ease of data transfer was also studied. All TPS vendors included in this study allowed export of RT images, structures, plan, and dose. Whereas import of CT images and structure sets was possible with all planning systems, only one TPS currently allows RT plan and dose import. This TPS also displayed composite dose/DVH from old and new plans, if they were calculated on the old data set. Composite dose data may be used to manually optimize PTV/OAR doses. A future plan release is expected to allow dose summation from different image sets as well as fully automated dose optimization. Dose import functionality was independent of plan type, but was easier done from within the same planning system than across different TPS. Fixed field doses were easy to optimize on compared to dynamic conformal arc or IMRT plans. All RT structures and planning information (beam angles, field size, MLC) were accurately transferred across TPS. Other vendor TPS projected to incorporate missing import options and dose optimization features in their future planning release. Patients with recurrence in close proximity to previously treated areas pose a difficult planning challenge. This is especially problematic if the patient was originally planned on a different TPS. The IHE-RO initiative is designed to stimulate integration and portability of RT plan information between various TPS. Although efforts are underway, not all vendors have fully complied with this objective. This study may be useful for vendors and clinicians alike in TPS upgrade decision process.

The ASTRO sponsored Integrating the Healthcare Enterprise - Radiation Oncology (IHE-RO) works to address issues of interoperability and information sharing between various radiation oncology systems that impact the quality of care in radiation oncology. IHE-RO has recently completed testing of the Advanced RT Objects Integration Profile, which facilitates the re-planning of a patient on a different treatment planning system (TPS). In this study we assess the current clinical process/status of re-planning using five different vendor's TPS available to the co-authors and which participated in the testing of the integration profile. A 3D conformal and IMRT plan developed using TPS vendor A was exported using its export feature. The CT dataset, RT structure set, RT plan and RT dose were all exported. These plans were imported using the import feature of the remaining vendors (B, C, D, and E). We track and report the import process and any errors or data omissions for each planning method. The imported image data and structure set is used to create a 3D conformal and an IMRT plan on each TPS. These plans are then exported and subsequently imported to each vendor TPS. One system, vendor E, export features were not tested in this study. Vendor systems include Varian Eclipse v 8.1, Elekta XIO v 4.5, Elekta Monaco v 2.03, Nucletron Oncentra Masterplan v 3.3, and BrainLab iPlan v 4.1.1. All the export features of the TPS tested allow the user to determine what components of the plan will be included: image dataset, RT structure set, RT plan and/or RT dose. All the TPS import features were automated once the location of the plan data was defined. The result of plan import was the same regardless of the system exporting the plan or the type of plan (3D or IMRT) exported. Each TPS displayed the results of the import using dialog boxes displaying errors and/or the objects imported. All systems successfully imported the image dataset and the RT structure set. Results of the importation of RT plan and dose was mixed. Vendor D does not currently support dose import. Vendor B, C, and E successfully imported beam geometry. Only Vendor E imported the MLC plan of each beam. Vendor B and E imported RT dose with complete dose-volume analytical capability. The Advanced RT Objects integration profile facilitates the TPS import and export of image dataset(s), RT structure set, RT plan, and RT dose. This integration profile has not been fully implemented by the vendors reviewed in this study. Clinics can request the capability included in this integration profile in their next TPS upgrade or new purchase by including its DICOM conformance statement in the purchase order or request for proposal (RFP). http://wiki.ihe.net/index.php?title = Radiation_Oncology