[Electronic dataflow management in radiotherapy: routine use of the DICOM-RT protocol]

The DICOM standard protocol of medical image exchange and its extensions to radiotherapy data has been implemented in order to enable electronic communication between all modalities within our radiology and radiotherapy departments. The network architecture used for radiotherapy includes as basic elements one CT simulator, several treatment planning systems, one linear accelerator fitted with multileaf collimator, one electronic portal imaging system and several laser imagers. As customary in radiotherapy departments, our equipments are heterogeneous with respect to manufacturers and computer operating systems. Choosing to resort to the DICOM-RT protocol spared us the acquisition of a proprietary information system because its elementary inter-connectivity characteristics can effectively be used for dataflow management. It has the advantage to minimally change the user's way of working since the electronic data transfer is taking place sequentially from one workstation to the other in a manner analogous to what is done with the paper document. Quality assurance management of treatments is simplified by the electronic nature of the transfers from the CT-simulation down to the accelerator since modalities interfaces, instead of users, are performing consistency checks. This process results in substantial time saving, but the DICOM computer interface is requiring a better skill that the one needed for operating standard office software. The DICOM-RT protocol is presently missing some functionality necessary for its integration into our hospital information system. Our experience is however showing that it represents a viable and promising solution for a small radiotherapy department.