The deployment of ProKnow for cloud-based clinical research in radiotherapy

ProKnow is an archive and restore tool for radiation oncology and imaging data, peer review, distributed contouring, study of metrics and discovery of trends; it represents a common ground for plan analysis and comparison due to an integrated industry standard Dose-Volume Histogram (DVH) engine, which can be used for all patient datasets. The aim of this work is to present a deep and easy-to-use implementation of the Elekta ProKnow DS cloud-based Picture Archiving and Communications in Radiotherapy (RT-PACS) system within our department. Two de-identification workflows of the DICOM data are presented, the first one is accomplished via the ProKnow Dicom Agent (PDA) and the second one involves a trusted third-party service. We can access ProKnow not only through the user interface, but also through the Application Programming Interface (API) with scripts written in the Python language to extract information from the uploaded data, calculate and store metrics as well as upload clinical data. A drawback of the currently implemented de-identification process is that in a subsequent clinical data upload, matching the original and de-identified IDs is not possible. To mitigate this drawback, we collaborate with the MeDICLMU(Data Integration Center [DIC]) for development and implementation of an automated de-identification process via a trusted third party service. With this architecture, it will be possible to merge clinical data in local DIC databases with de-identified data in ProKnow at any point in time, facilitating the longitudinal outcomes analysis. We used ProKnow for a retrospective dosimetric feasibility study of an isotoxic dose-escalated radiotherapy proof-of-concept for glioblastoma. Furthermore, to ensure protocol-compliant irradiation planning for the preparation of a prospective dose-escalation trial, we conducted a dummy run with 10 collaborating institutes in Germany. RT-structures were automatically downloaded (via the API) and the Dice Score and Hausdorff Distance were calculated and set as metric in ProKnow.