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Development of an electronic radiation

oncology patient information management
system
ABSTRACT Abhijit Mandal,
Anupam Kumar Asthana,
The quality of patient care is critically influenced by the availability of accurate information and its efficient management. Radiation Lalit Mohan Aggarwal
oncology consists of many information components, for example there may be information related to the patient (e.g., profile, disease
site, stage, etc.), to people (radiation oncologists, radiological physicists, technologists, etc.), and to equipment (diagnostic, planning, Department of
Radiotherapy and
treatment, etc.). These different data must be integrated. A comprehensive information management system is essential for efficient Radiation Medicine,
storage and retrieval of the enormous amounts of information. Institute of Medical
Sciences, Banaras Hindu
A radiation therapy patient information system (RTPIS) has been developed using open source software. PHP and JAVA script was University, Varanasi-221
used as the programming languages, MySQL as the database, and HTML and CSF as the design tool. This system utilizes typical web 005, UP, India
browsing technology using a WAMP5 server. Any user having a unique user ID and password can access this RTPIS. The user ID and
For correspondence:
password is issued separately to each individual according to the persons job responsibilities and accountability, so that users will be
Dr. Abhijit Mandal,
able to only access data that is related to their job responsibilities. Department of
With this system authentic users will be able to use a simple web browsing procedure to gain instant access. All types of users in Radiotherapy and
Radiation Medicine,
the radiation oncology department should find it user-friendly. The maintenance of the system will not require large human resources Institute of Medical
or space. The file storage and retrieval process would be be satisfactory, unique, uniform, and easily accessible with adequate data Sciences, Banaras
protection. There will be very little possibility of unauthorized handling with this system. There will also be minimal risk of loss or Hindu University,
Varanasi221005, Uttar
accidental destruction of information. Pradesh, India. E-mail:
amandal751@yahoo.co.in

KEY WORDS: Radiation oncology, patient information system, information management

INTRODUCTION for problem solving and decision making.

The availability of accurate information and its
efficient management is crucial for quality patient
care. Organizing and communicating the vast
amounts of information generated in radiation
oncology is a great challenge. During the last two
decades, radiation oncology has witnessed great
technological advancements. Nowadays, we deal
with huge amounts of diagnostic information,
complex treatment planning, accurate dose
calculations, and very complicated treatment
delivery information. For precise treatment in
radiation oncology, a comprehensive information
management scheme has become essential for
the storage and rapid retrieval of the enormous
amounts of information.
The need for management of medical information
to provide better patient care, effective medical
education, and research has given rise to a new
subject known as medical informatics. Medical
informatics deals with the acquisition, storage,
retrieval, and optimal use of medical information
Information data sets and interfaces between
different disciplines are combined by medical
informatics.It also involves understanding
the evolving technology and relationships
and standards by which this information can
be managed. Radiation therapy treatment
incorporates many facets of modern medical
informatics. Medical professionals work closely
together, using computer-controlled equipment,
and use large amounts of patient and machine
data for optimization of the complex techniques in
treatment planning, delivery, and verification. The
information system (IS) provides the main base
for communication, documentation, and quality
control by integrating all necessary data/images
in a seamless, reliable, and efficient manner.
The IS also provides the capability for numerical
and statistical analysis of this wealth of data.
Modern electronic IS are built on networks of
computers connected in complex arrays, running
sophisticated software, to ensure transparent and
seamless information availability to the users.
Investment of human and capital resources in

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 Mandal, et al.: Patient information system

IS and networks is an essential and continuing process for and spatial data sets from magnetic resonance imaging (MRI),
improving patient care in radiation oncology. computed tomography (CT), positron emission tomography
(PET), radiography, mammography, etc.; it also includes
INFORMATION COMPONENTS IN RADIATION ONCOLOGY report data in text form and laboratory results. This massive
amount of information is required to localize target volume
Radiation oncology consists of following information and organs at risk (OAR) to develop a treatment strategy that
components: will deliver the prescribed therapeutic dose to the target,
Patient information while restricting the dose to the OAR to the minimum.
Patient profile Patient information includes patient profile, history, disease
Patient history status, and the management plan derived from interaction
Disease status of the patient with the consulting radiation oncologists and
Diagnostic (Dx) data referring physicians; this is necessary for the selection of the
Treatment plan appropriate patient-specific treatment approach. Therefore,
Simulation data the patient data may have many sources, including those
Treatment planning data outside the department of radiation oncology. A qualification
Physics data test to determine which therapy technique best meets the
Treatment (Tx) data patients need is also part of the record. Using all this diverse
Treatment verification data information, the treatment regimen is then defined. The
Radiation biology data simulation step may include combining diagnostic and patient
Follow-up information data with specific geometry goals and the constraints of the
Record/billing/discharge therapy delivery system. Adequate information is gathered for
the treatment planning as per the ICRU-50 recommendations.[1]
People Treatment planning brings the simulation and imaging
Radiation oncologists information objects together with treatment machine/device
Radiological physicists characteristics. This allows the therapy team to develop a
Radiation therapy technologists computer-based treatment plan with optimized distribution.
Nursing staff Whether it involves forward or inverse planning and fixed
Receptionists or dynamic technique, the planning system must aim to
realize the treatment goal and must specify all treatment and
Equipments reference information related to the accurate and safe delivery
Diagnostic equipment of the desired radiation dose.
Simulation equipment
Treatment planning system (TPS) Whether the treatment delivery method is traditional physical
Treatment equipment compensation, custom micro-collimation, tomotherapy,
Treatment verification equipment dynamic collimator, or dynamic multi-leaf collimation, detailed
information must be provided accurately and efficiently to the
In networking, hardware and software provide a medium treatment machine/device. The new treatment techniques like
through which systems and individuals can communicate. intensity-modulated radiation therapy (IMRT), image-guided
A complete IS for radiation oncology manages information radiation therapy (IGRT), etc., are completely dependent on
through data acquisition, presentation, communication, computers for planning, treatment, and verification. However,
storage, and retrieval. The IS must guarantee that all the even simple conventional radiation therapy based on wedges
resources will be available as and when necessary for the or tissue compensators requires detailed information for
delivery of effective, efficient, and compassionate patient care. compensator design and orientation. In every case, the
The IS comprises various information objects. treatment plan must be verified for its accuracy and safety.
This includes verification of the treatment devices (record
Information objects and verify), the radiation field geometry (portal imaging),and
There are a large number of information objects involved in dosimetry. The computer-controlled treatment delivery must
radiation oncology. These objects can be grouped into different be fail-safe. Finally, dose record, details of treatment, and
categories according to the major task or event they are related billing information must be captured in an organized manner.
to. Availability of these information entities may be required at All personnel related to the treatment delivery are components
various stages of the radiation therapy process. Each of these of the information needed to complete a successful treatment.
objects could be further subdivided into basic information In radiation oncology, the active involvement of all the staff is
pieces of patient events. required and must be incorporated in the IS. Quality control
and quality assurance remain critical components of each
Figure 1 highlights the specific information objects used in step of the process. As therapy becomes more complex and
radiation oncology. Diagnostic data may include volumetric intensive, data integrity, clear communication, and accurate

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 Mandal, et al.: Patient information system
devices become more important. The scheduling component
must be able to reconcile complex schedule data from multiple
sources, so that all information and personnel are available
when needed to deliver the best possible patient care. Thus,
the availability of coordinating staff, treatment machine, and
all patient-specific data must be integrated.
Information integration
The pieces of key information objects, as described in Figure
1, exist in most radiation oncology facilities, but they are
rarely integrated. The goal of the IS is to integrate all of these
objects in an effective manner as indicated in Figure 2. This
figure shows the integration of each component to form a
perfect and regular information geometry. Any missing key
information object or a misfit key can distort this perfect
information geometry and shape. The organization of these
information objects, their definitions, the communication
formats, and connecting pathways forms the IS.
The simplest version of the IS is the manually movable paper
patient file. This IS contains each of the information objects
mentioned above, usually separated into sections. Pen,
paper, and sneakers represent the communication web and
all data relevant to the patient treatment is available in the
patient chart. Manually movable patient file systems have the
following limitations:
Time consuming
Require large amounts of human resources and space
File retrieval process is not unique
Information entries are nonuniform, individual
dependent
Messy
Difficult to maintenance
Possibility of unauthorized handling
Information can often go missing
Can not be operated remotely
Chances of destruction of information
Electronic IS have been developed to reduce error, increase
efficiency, automate recording, and organize large amounts
of data.[2] The rapid advancements and decreasing costs in
computer technology has boosted the use of IS in radiation
oncology for patient care. Computer-controlled radiation
therapy systems have been described by Fraass et al. and
Burman et al.,[3,4] but these systems only encompass a portion
of the informatics problem. The IS must integrate and
communicate all data/information necessary for the radiation
oncology patient to receive a complete treatment. Many of
the issues related to IS in radiotherapy have been discussed
partially in PACS,[5,6] electronic medical record,[7] and IS.[8,9]
Whereas, the complete IS should have all the jumbled pieces
of information integrated together in an organized fashion.
Anderson has described the social, ethical, and legal aspects
of e-health.[10] Bakker explored the need for possibility to
reconstruct electronic medical data for health care professional
at a specified moment in the past.[11] He has also described the
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differences between digital patient data and paper records.
Linden et al. described the aspects of a multidisciplinary
electronic health record system.[12] Andrade et al. explored
the strategies to access digital imaging and communications
in medicine (DICOM)compliant medical data on mobile
devices.[13]
DESIGNING AND DEVELOPMENT OF A RTPIS
A radiation oncology patient information system (IS) has been
developed using open source software. PHP and JAVA script
have been used as the programming language, MySQLas
database, and HTML and CSF as the design tool. This system
runs through typical web browsing technology using a WAMP5
server.
DESCRIPTION OF THE RTPIS SOFTWARE
Opening the system
The radiation oncology patient management system can be
accessed by clicking on the Internet Explorer icon on desktop
and then entering the http address of the server.
Log in
Once the system is opened the log-in page will be displayed
[Figure 3], where any authentic user (having a unique user
ID and password issued by the administrator) can access the
RTPIS software.
User library
The user ID and password are issued separately for the
administrator, radiation oncologist, radiation physicist,
and radiation technologist according to their respective job
responsibilities and accountability. Thus, users have limited
ability to access or enter data in the IS, which is strictly decided
by their job responsibilities.
Administration overview
The administrator provides the user ID and password to the
new user. Administrator can also limit/edit/delete any users
access by using the User Management Button [Figure 4]. The
special icons are also described.
Patient profile
The data on the patient profile can only be entered by the
radiation oncologist. The patient profile form will be displayed
by clicking on the Create Patient File button. The name, age,
sex, occupation, address, department no., consulting radiation
oncologist, radiological physicist, date of first visit, referring
hospital, diagnosis, and stage of the disease can be entered
in this form [Figure 5].
Patient history
After submitting the patient profile, the patient history form
will be displayed [Figure 6]. Only the radiation oncologist
can enter the information in this form. Patient history and
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 Mandal, et al.: Patient information system

Patient information Simulation

Pat profile Immobilisation
Patient information Pat history Simulation portal
Pat profile Record & Billing Disease status Set up information
Pat history Diagnostic data Management plan
Disease status Blood investigation
Management plan Biopsy
X-ray/USG/CT/MRI/PET

Diagnostic data Treatment

Equipments
Dx units Blood investigation Set up information
Personnel Simulation equipment Biopsy Dose delivery inf.
Radiation Oncologist TPS X-ray/USG/CT/MRI/PET
Radiation Physicist Tx equipments
Radiation Dosimetrist Tx verification equipments
Radiation Technologist
Nursing staff Personnel Tx Verification &
Receptionist Evaluation
Treatment Radiation Oncologist
Set up information Radiation Physicist Geometrioal
Dose delivery inf. Radiation Dosimetrist Dosimetrical
Radiation Technologist Radiobiology
Simulation
Immobilisation
Nursing staff
Simulation portal Receptionist
Set up information Tx Verification & Equipments
Evaluation
Geometrical Dx units
Dosimetrical Simulation equipment
Record & Billing TPS
Radiobiology
Tx equipments
Tx Verification equipmens

Figure 1: Key information objects in the radiation oncology Figure 2: Integration of key objects in the radiation oncology
department department

Figure 3: Log-in page Figure 4: Administrator overview

Figure 5: Patient profile input form Figure 6: Patient history input form

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 Mandal, et al.: Patient information system

examination findings, such as general condition, pulse, The patient list can be displayed by clicking the View Patient
temperature, blood pressure, information regarding the button [Figure 7]. The patient profile and patient history of
primary, lymph node, metastasis and treatment management any patient can be viewed by clicking the Click Here button
are entered in this form. against the particular patient.

View patient profile and patient history Investigation

Once the patient profile and patient history has been entered This form will appear by clicking the Create/Manage
properly, only then is the patient registered in the system. Investigation button [Figure 8]. This form is exclusively

Figure 7: List of the patients Figure 8: Investigation input form

Figure 9A: Simulation information input form Figure 9B: View simulation page

Figure 10A: Dose prescription messages Figure 10B: Dose prescription input form

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 Mandal, et al.: Patient information system
entered by radiation oncologist. Biopsy, x-ray, CT scan, and
MRI investigations reports, along with the relevant dates,
are entered in this form. Similarly, routine blood investigation
results are entered after clicking on the Create Blood Picture
button.
View investigations
Investigations can be viewed in tabular form by clicking on the
View Investigation button and, similarly, the blood picture
by clicking the View Blood Picture button.
Figure 10C: View dose prescription in tabular format
Figure 12: Portion of daily treatment record sheet
Figure 14: Radiation biology information page
J Cancer Res Ther - October-December 2008 - Volume 4 - Issue 4
Simulation
Simulation information of patient is incorporated by opening
the Create Simulation [Figure 9A]. Simulation images
are uploaded in the simulator workstation by simple file
browsing. Simulation parameters like field description,
technique, collimator angle, gantry angle, and field size are
entered as necessary. Simulation images of the final planned
portals and related description of the portal are viewed by
View Simulation button [Figure 9B]. The simulation data
can only be entered/edited by the radiological physicist or
Figure 11: Physics calculation messages
Figure 13: Brachytherapy information page
Figure 15: Follow-up details page
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 Mandal, et al.: Patient information system
radiation oncologist by using the Create Simulation button,
but all users can view it in tabular form by using the View
Simulation button.
Dose prescription
The next module of patient management in radiation oncology
is dose prescription. A web page displaying the patient
information and simulation image is opened by clicking
the Dose Prescription button, where a Click Here for Dose
Prescription message is displayed against each simulated final
field [Figure 10A]. The Dose Prescription button will only be
active for the radiation oncologist. In the dose prescription
form [Figure 10B], tumor dose, number of fractions, dose/
fraction/field, technique, gantry angle, collimator angle,
wedge description, shielding description, treatment unit,
patient separation, and instruction to the therapy technologist
are entered. The dose prescription can be viewed in tabular
form [Figure 10C] by any user by clicking on the View Dose
Prescription button.
Physics calculation
This is a typical radiological physicist area in radiation
oncology. The radiological physicist opens the Physics
Calculation web page [Figure 11], which consists of patients
basic information dose prescription information and message
for each field Click here for Physics Calculation. In the physics
calculation form, the physicist enters the physics parameters
such as equivalent square field, output, percentage depth dose/
tissue air ratio, tray factor, wedge factor, tumor dose rate,
and treatment time. The physics calculation can be viewed in
tabular form by any user.
Daily treatment record sheet
The daily treatment record is entered specifically by the
radiotherapy technologist. This web page is opened by the
technologist during treatment by clicking the Daily Treatment
Record button. This page consists of basic patient information,
dose prescription, physics calculation, previous daily treatment
information in tabular format [Figure 12], and an empty form
for information on the fraction being delivered that particular
day. In this empty form the technologist enters the intended
and measured tumor dose for each field, the cumulative
intended and measured tumor dose, and the number of
fractions in days.
Brachytherapy
Brachytherapy is a part of the patient management system
and the brachytherapy information is entered by filling the
brachytherapy form [Figure 13], where the date of application,
total dose, dose prescription point, and total treatment time
are entered.
Radiation biology
Radiation biology information is very useful for assessing the
treatment efficacy, to predict the treatment outcome, and for
comparison of treatment regimes.[1416] The received biological
184
effective doses (BEDs) for acutely-reacting tissues BED (10)
and late-reacting tissues BED (3) are effectively calculated
and entered in the radiation biology form [Figure 14] by the
radiation oncologist or the physicist.
Follow-up
Follow-up details are entered by the radiation oncologist
[Figure 15], where the date of follow-up, disease status, and
normal tissue complications are entered.
Print summary
In this system a Print Summary option is available. This button
will be active only for the radiation oncologist. This option
allows the radiation oncologist to get a single-page treatment
summary of a patient, which will have patient details, external
beam radiotherapy information, brachytherapy information,
and follow-up information. This printed summary can be used
for referral, documentation, audit, and research purposes.
CONCLUSION
We have developed a simple and indigenous radiation
therapy patient information system (RTPIS). This system is
instantly accessible by any authentic user through a simple
web browsing procedure. All types of users in the radiation
oncology department will find this system to be very user-
friendly. The maintenance of the system does not require large
amounts of human resources or space. The file storage and
retrieval process is very satisfactory, unique and uniform. By
sharing this software through a wireless local area network
(LAN), it may be possible to create a clean, smart, and
paperless department. There would be very little possibility
of accessing the data in this system by unauthorized person.
The information can be stored in a double server, which
will minimize the risks of loss or accidental destruction of
information. This system can be uploaded on to the internet
through a LAN, which will make it possible for an authorized
user to operate this system from anywhere in the world.
ACKNOWLEDGMENTS
The authors would like to thank Mr. Amitava Mandal (Software
Engineer, Matrix Media Solution Pvt. Ltd., Kolkata) for his help in
designing and developing the RTPIS software.
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