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Radiation oncology and PACS: ramping up for the digital age

Radiation oncologist Dr Gordon Ray and his colleagues at the Palo Alto Medical Foundation (PAMF) in Palo Alto, CA, see between 500 and 600 cancer patients a year. Their organisation’s oncology practice is a large one, and makes use of two linear accelerators and a simulator.

But beyond the high patient volume, the organisation’s radiation oncology area is busy undergoing a workflow transformation as Ray’s group juggles an increasingly large load of digital images, both self-generated and by their counterparts in the imaging department.

While the large PACS vendors have sophisticated, elaborate systems with high levels of specific image-viewing functionality, the discipline of radiation oncology has very specific needs. As a result, PACS for radiation oncology remains in something of an in-between place: juggling images from the standard PACS networks with images produced by their own treatment planning systems.

“While a PACS can streamline workflow and improve patient care, the challenge is that the standard radiology PACS systems don’t meet the need for integration present in radiation oncology departments,” Ray said. “A radiation oncology PACS has to be seamlessly integrated with the medical record and treatment planning.”

The challenge that PACS vendors face is providing radiation oncologists with the kind of integration Ray described. PACS for radiation oncology needs to be fluid and iterative rather than based on one-time tasks, and, as a result, is a fundamentally tall order.

There are a number of hurdles that need to be jumped before that seamless integration takes places. One factor is the size and configuration of the radiation oncology vendor market.

“This is a small, specialised market dominated by just a few vendors, noted Atlanta-based Rick Belter, a sales specialist for Nucletron of Veenendaal, the Netherlands. “There are 2,800 radiation oncology departments (in the USA), and four, or possibly five, vendors, including a couple of dominant ones.” As a result, the market-driven push for integration is not as strong as it might be, though the functional need is there among radiation oncologists, Belter believes. At the same time, the increased digitisation of their work is nonetheless increasingly pulling radiation oncologists into the vortex of workflow and storage issues that have come with the implementation of digital image systems.

“Since most radiation oncology departments have their own CT (scanners), images are being created within the department, and at the same time, diagnostic PACS images are coming to radiation oncology from (the radiology department),” Belter said. It makes for a challenging situation, as there is no naturally occurring integration process involved, he added. Radiation oncologists want both kinds of images for diagnostic information and treatment planning.