Radiation therapy is a critical component of cancer treatment, but its effectiveness depends on uninterrupted, continuous care. Offline treatment modes are historically underutilized due to the complexity of preparing and managing treatment data for offline use. However, emerging solutions are helping healthcare providers streamline these workflows, ensuring high-quality care even during disruptions. This post explores how radiation therapy workflows, particularly for offline treatment, are being improved.
The Challenges in Offline Workflow
Many external beam radiation therapy machines support loading treatment data (plans, images, structure sets) from external DICOM files. Depending on the vendor, this may be referred to as DICOM-RT/File Mode, Service Mode or similar. These modes are designed to address both planned (e.g., system upgrades) and unplanned down time events (e.g., server failures, ransomware attacks, or weather-related disruptions).
Despite its utility, offline treatment is often underutilized due to the labor-intensive process required to prepare, export, and import treatment data. In a typical radiation oncology facility with 2-3 treatment machines, exporting data for 60-90 patients daily becomes a manual and time-consuming task that demands significant resources, including therapists, dosimetrists, and medical physicists.
In my nearly 30 years of experience in radiation oncology, I've encountered only a few departments that maintained the rigor necessary to manage offline treatment workflows consistently.
Key Challenges in Offline Treatment Workflows
Several challenges hinder the efficiency and effectiveness of offline workflows:
Naming Conventions: Ensuring consistent and accurate naming conventions for both exported treatment data and history files is essential. Patients with multiple treatment plans must have their data stored separately, which can be challenging, as exported files typically lack patient-identifiable information.
Storage Management: Identifying, securing, and maintaining storage for exported treatment data is a common issue. Shared directories on available console workstations are often used but require reliable access across multiple systems from where the data is exported.
Managing Plan Changes: When treatment plans are updated, ensuring that outdated data is properly deleted and replaced with new information is critical for maintaining confidence in the accuracy of the data.
Importing History Data: Once offline treatment is complete, importing the history data back into the system is essential to ensure accurate treatment records when the primary system is restored.
Usability of the Data: When loading treatment data at the console, users often have to navigate through multiple directories and layers to access the treatment plan and associated files for the next treatment, complicating the process and potentially slowing down workflow.
Recognizing and addressing these challenges is key to developing a more efficient and reliable offline workflow.
Leveraging Technology To Optimize Workflows
The challenges identified are typical of workflows that can benefit from technological optimization. Automated software solutions can streamline the process of exporting data, creating consistent naming conventions, and ensuring data synchronization. Some facilities may even centralize these tasks by preparing data for import to a standby "warm" OIS server in the event of a primary server failure(1). However, the time required to activate a standby server, along with the need for coordination with the OIS vendor, makes this solution primarily suitable for extended down times, typically lasting a day or more.
Improving Offline Treatment Workflow
To make offline treatment workflows more effective across various downtime scenarios, several factors need consideration:
Eliminate Single Points of Failure: Centralized treatment data poses a risk in the event of server failure. Distributing the data across multiple sites or using secondary backup servers can mitigate some of this risk, but it doesn’t eliminate the possibility of disruption to multiple treatment machines in the same facility.
Data Availability at the Point of Use: During down time events, treatment data should be immediately accessible at the treatment machine where it is needed, reducing dependence on remote servers during downtime.
Simplify File Management: While offline file modes require data to be loaded from external files, simplifying the process and focusing on patient-specific data flows allows therapists, clinicians and related staff to prioritize treatment over technical details.
Real-Time Data Synchronization: Instead of frequent polling, real-time data capture ensures the latest information is always available, without overloading the server.
Minimize Downtime Recovery Time: To make offline workflows truly effective, the time between detecting a disruption and switching to offline treatment mode should be minimal.
Simplify User Experience: Ensuring that offline workflows resemble online workflows as closely as possible reduces the learning curve for therapists, allowing them to quickly resume treatment.
MATT: Streamlining Offline Treatment Workflow
The adoption of offline treatment modes is crucial for disaster recovery and minimizing disruptions during planned or unplanned downtime. However, for offline treatment to be effective, it must be easy to implement and reliable. The MATT device (Modular Accessory for Teletherapy Treatment) addresses the shortcomings of traditional offline solutions by enabling a seamless transition between online and offline modes.
The MATT device simplifies the offline treatment process by:
One MATT per Console/Gantry: Each treatment machine or proton therapy gantry is equipped with a dedicated MATT device. This localized approach ensures that the data for each machine is managed independently, reducing the impact of any outages.
Flexible Synchronization Options: MATT devices perform scheduled synchronization, can be manually initiated by the user, and update in real-time. As a transparent DICOM proxy, MATT ensures data is maintained locally during online mode, reducing the need for constant manual intervention.
Patient-Centric Treatment Queue: The data stored on a MATT is organized and accessible via a standard, appointment-based interface. This structure maintains the online workflow, allowing therapists to manage treatments in a familiar, efficient manner.
Direct DICOM Synchronization: Once the downtime event is resolved, data can be easily exported from the MATT to the back end system using DICOM transfers, ensuring seamless integration back to the primary system.
Support for New Starts: In the case of extended downtime, provided a compatible stand alone treatment planning system is available, new patient plans can be exported to the MATT or imported from external storage and used in offline treatment mode.
The Future of Offline Treatment in Radiation Therapy
Historically, the impact of missed treatments due to downtime in radiation therapy has been tolerated due to the complexity of making treatment data available for offline use. However, with MATT deployed at each compatible machine and proton gantry, this issue is largely eliminated. With MATT, treatment slots remain available, patients continue to receive care, and valuable resources are maximized.
By improving offline treatment workflows, MATT significantly enhances patient throughput and supports disaster recovery planning, enabling radiation therapy departments to focus on what matters most: patient care.
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