Clinical applications of picture archival and communications systems in radiation oncology

Picture archival and communications systems (PACS) for radiation oncology present an entirely different set of constraints and requirements from systems developed for diagnostic imaging. PACS for radiation oncology aid in organizing the complex, interrelated functions of radiation oncology. Integration of PACS with clinical data management systems will provide the backbone for the comprehensive computer system that has long been sought in radiation oncology. Simulation, geometric and dosimetric treatment planning, field shaping, set-up, verification, and delivery are now all observable and/or controllable from computer systems that can be interfaced with the departmental PACS. Costs are substantially lower then with diagnostic PACS because the systems can be based on desktop computers and the image resolution requirements are not as stringent. Each PACS user will have more information more easily available than under current systems of organization. Vendor support of digital image communications (DICOM) protocols will enable full integration of equipment regardless of manufacturer. Potential increases in productivity will be realized if the systems for handling and evaluating images are fully automated and provide the users with analytic tools that enhance the utility of systems such as electronic portal imagers, multileaf collimators, and clinical data management systems. This report describes our efforts in producing such a system.