IT safety requirements in the Radiation Therapy field: risks and solutions all over the process M. Coevoet Pr. P. Scalliet
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Radiation oncologists Physicists RTTs Quality Manager Technical IT support Secretary Booking 3
Radiation Oncology Workflow 4
Imaging OIS Transfert Planning Treatment 0.0 Administrative 0.1 Demographic médicales data 1. Simulation 2. Scanner 3. Dose Plan Basis 4. Contouring 5. Planning 5.1 Plan approval 5.2 TP QC & Docs 6. Blocks 7. RO Approval 8. Simulation 2 9. Imaging 10. Chart 11. Treatment RO Med.Phys. RTT Tech./IT 5
Issues from a «multi-disciplinary & sequentiel work», impacts? Where are the CT images? When? What is the prescription? What about? 6
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Quality Checks Quality Assurance Source: Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom 8
«Who runs the systems?» 9
IT spread in Rad. Onc. Dept. 10
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Example 1 Screen: 1980 x 1080 px = 2M Pixels CT: 512 x 512 px = 262k Pixels Degraded to 256 x 256 65k px Human eyes: «576M Pixels» WYSIWYG «What You See Is What You Get» «What You See Is MAYBE What You Get» 12
Example 2 1,000.000 1.000,000 cm versus mm, quid? 13
Example 2.1 14
Example 3 Couch position in Absolute / Relative 34 mm difference! Virtual / Physical GPU card Impact on TPS calculation results! 15
2 medical protocols HL7 DICOM (-RT) Health Level 7 «set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers.» Wikipedia Digital imaging and communications in medicine «The DICOM standard does not address issues of security policies.» «Authentification only at the application level, not the owner.» «DICOM enables a very wide variety of authentication and access control policies, but does not mandate them.» «When Application Entities agree to interchange information via DICOM through association negotiation, they are essentially agreeing to some level of trust in the other Application Entities. Primarily Application Entities trust that their communication partners will maintain the confidentiality and integrity of data under their control.» DICOM PS3.15 2016a - Security and System Management Profiles 16
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Same «standard» medical practice 1970: 2 clinical FTE 2000: > 15 clinical FTE Healthcare world: 4000 medical procedures 6000 drugs Too complex for 1 expert 20
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Solution? 22
How does it work? = Airplane checklist: 1. Do not forget incident 2. Reminder rare action 3. Standardisation 4. 23
Document management 24
How does it work? 25
How does it work? 26
How does it work? 27
Numbers itherapy Process (itp) has first been developed under the name of «Intranet Radiotherapy» 1 st version: 2005 (88 «checks» - 16 steps) Latest version: 387 «checks» - 35 steps Experience of more than 16 000 treatments DB: 40 requests/sec 6500 views per day Installed in Alger, Liège, (Bordeaux),... 28
Checklists «Reminder of key things to not forget» Institute for Safe Medical Medication practices. Medication error prevention toolbox. Med Safe Alert 1999;4:1. 29
Cheese Model, J. Reason 30
Herbert William Heinrich 31
Conclusions Standardization of workflow Integration of checklists and forcing functions Clear task attribution Workflow monitoring Increased efficiency Decreased risk of error Challenges Automation More integration Clinical & Digital WORKFLOWS link 32
Thank you! www.itp.wf 33
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