Computerized Treatment Planning Directives for Adaptive Radiation Therapy Management

摘要

Treatment planning directives have been developed for radiation therapy process and workflow improvement. Initial plan directives were developed on paper forms. These directives have improved our department's workflow based on a lean thinking approach to process improvement. Treatment plan directives describe a standard path for each type of case in the belief that standard work leads to fewer quality problems, less rework, better attention to patient needs, more effective communication, and more efficient use of resources. The standard planning patterns represent a clinical consensus for each type of case. The directives lead to better-documented decisions and instructions, and more easily allow specification of non-standard instructions.In this paper, we describe treatment planning directives, how these directives relate to existing radiotherapy treatment planning concepts, and how the directive concept enables better management of individualized adaptive radiotherapy treatment courses. We also describe our efforts to computerize these directives in order to automate and improve workflow using an open-source healthcare data system. The ability to capture (web-based) directive instructions, the use of a rules-based decision support system, and the ability to interact with other systems (imaging, planning and delivery systems) provide flexibility to describe and manage a variety of complex adaptive treatment scenarios.