Connecting Radiation Therapy

As the American Society for Therapeutic Radiology and Oncology (ASTRO) meets this month in Atlanta, the focus of the educational sessions is on intensity modulated radiation therapy (IMRT), brachytherapy, stereotactic radiosurgery, PET/CT, and image-guided treatment planning and therapy. Of the varied types of cancers, prostate, breast, lung and head and neck cancers are getting the most attention. (A preview of new products on the exhibit floor starts on page 14.)

This month, we're talking about IMRT, too - and its role in treating head, neck and prostate tumors and its migration into treating lung, pelvis, kidney, breast and pancreatic cancers - plus we've added an IT twist. Radiation oncology information systems are showing that IT is the enabler for managing the increasing quantity and volume of images that assist in planning, tracking and assessing radiation therapy. And security and integrity of radiation therapy networks is high on the priority list for radiation oncology departments and facilities that simply can't have snafus or downtime.

IMRT offers more accurate targeting of tumors and thus sparing of healthy tissue and critical structures (see page 36). Popularity is rising, with IMRT now used in treating 30 to 40 percent of cancer types. But IMRT is a great challenge to implement and carry out - from CT scans to track image-based calculations, planning software, dose determination for the tumor and surrounding tissue, inverse planning, recording and verifying the plan and QA - with one patient's plan taking 3 hours to 3 days to complete. IMRT requires between 40 and 140 separate, individual radiation fields be downloaded to the linac alone! But radiation oncology departments are looking past the challenges and investing, with 38 percent of all radiation oncology facilities utilizing IMRT, according to IMV.

Investment is taking off in image management for radiation therapy as well. It has to to handle the surge in imaging studies necessary to plan more complex therapies such as IMRT, image-guided radiation therapy and gated imaging - and wider use of on-board imaging and 4D treatment just around the corner. Day-to-day charting and documentation is streamlined, image viewing is more timely and efficient, and electronic annotation and signatures speed report completion. Plus, department workflow and patient care benefits, as "Image Management for Radiation Therapy" on page 40 shows.

And radiation oncology departments are getting smart on guarding their computer networks from invasion, as you'll see in the story beginning on page 44. Facilities such as Fox Chase Cancer Center, University of Texas M.D. Anderson Cancer Center and Memorial Sloan-Kettering Cancer Center are smart about networks, such as: designing networks with redundancy and resiliency; multiple fiber paths; switches with primary and secondary backups; uninterruptible power sources; back-up generators; firewalls starting at the desktop; antivirus and internet content security software; and isolating mission-critical computers on separate networks with a different IP address as well as being able to operate independently if hospital-wide networks go down.

With two-thirds of cancer patients receiving radiation therapy during their treatment, radiation therapy - and the care of its devices, IT and network architecture - is vital to cancer care. And if you're one of the more than 2,500 radiology oncology readers we've recently added to our subscriber list, welcome and thanks for doing what you do everyday.