Including Radiation Dose Distribution Maps in Medical Records May Enhance Cancer Care
Readily available radiation dose history an increase the ease and accuracy of image interpretation
When a patient undergoes radiation therapy for cancer, radiation oncologists create a radiation dose distribution map — a visual representation of the dose given to each anatomic structure volumetrically.
While a radiation dose distribution map is a critical part of a patient’s medical record, it is not easily accessible to all of a patient’s medical providers — but it should be, according to Ricky R. Savjani, MD, PhD, resident physician in the Department of Radiation Oncology at the University of California Los Angeles (UCLA).
Dr. Savjani is the lead author of, “A Framework for Sharing Radiation Dose Distribution Maps in the Electronic Medical Record for Improving Multidisciplinary Patient Management,” recently published in Radiology: Imaging Cancer.
“Having ready access to radiation dose maps can directly improve patient care across many health care settings,” Dr. Savjani said. “In the emergency department, for example, knowing precisely when and where a patient has had previous spine radiation can help a physician triage the person with spinal cord compression to determine the most appropriate treatment more rapidly.”
Watch Dr. Savjani discuss including radiation dose distribution maps in medical records:
Launching the Pilot Program
To begin the project, the IT staff enabled the treatment planning computers in the radiation oncology department to send images to PACS.
Dr. Savjani and colleagues then configured their treatment software to include PACS as a Digital Imaging and Communications in Medicine (DICOM) location and to send images as a secondary capture DICOM structure set.
“This method takes each section in the desired plane exactly as it appears in our treatment software and compiles them into a composite single-standard DICOM file,” he said.
This DICOM file can then be uploaded to PACS and viewed by all health care providers, Dr. Savjani said.
“A dosimetrist, physicist or medical resident physician reviews the case after the completion of treatment for quality assurance and prepares the radiation therapy dose distribution map to upload to PACS,” Dr. Savjani said. “The dose map is never uploaded until after the patient has completed treatment, ensuring that planned or incorrect dose maps are not erroneously sent.”
After uploading to PACS, the volumes are retrieved in the PACS viewer and are inspected again to ensure the upload was successful. A treatment course can be added to PACS quickly — in approximately two minutes.
Improving Communication and Encouraging Innovation
Sharing radiation dose distribution maps in PACS creates an opportunity for radiation oncologists and other medical providers who have less radiation oncology expertise to communicate with each other, Dr. Savjani said.
“But this is not a one-way stream,” he noted. “Our neuroradiologists have been educating us on how they radiographically differentiate effects of radiation changes versus progression, which is now made easier by having the dose information on the diagnostic studies.”
According to Dr. Savjani, making dose distribution maps easily accessible in PACS has simplified multidisciplinary meeting discussions.
“It has made discussions at our tumor board meetings faster and more productive,” Dr. Savjani said. “Now that everyone can see the new imaging and we can superimpose the old dose information, we can make our decisions more in real time, rather than having to dig through the data afterward.”
In an accompanying Radiology: Imaging Cancer editorial, co-authors Shiv R. Khandelwal, MD, associate professor of radiation oncology and Sarah B. Scarboro, PhD, an assistant professor of radiation oncology, both at the University of Virginia School of Medicine, say that making radiation dose information available in PACS has the potential to improve imaging interpretation and management of oncology patients.
However, making this information readily available could, in some cases, increase the risk of misinterpretation of imaging findings and enhance the need for further education, according to Drs. Khandelwal and Scarboro.
“Given the need for diagnostic radiologists to also interpret radiation isodose maps accurately, perhaps there is a need to reintroduce a modest degree of formalized cross-training in radiology and radiation oncology residency programs,” the authors write.
For More Information
Access the Radiology: Imaging Cancer study, “A Framework for Sharing Radiation Dose Distribution Maps in the Electronic Medical Record for Improving Multidisciplinary Patient Management."
Access the accompanying Radiology: Imaging Cancer editorial, “Giving Radiologists and Other Clinicians the Tools to Identify Radiation Effects on Imaging Studies."
Read previous RSNA News articles on radiation dose:
- Report Shows Average Medical Radiation Doses in U.S. Are Decreasing
- Academic Pediatric Imaging Facilities Deliver the Lowest Radiation Dose