A web-based system for rapid multidirectional communication has been created in the Radiology department at San Francisco General Hospital. The system allows messaging among radiology attendings, residents, and technologists, as well as other members of the hospital community, such as Emergency Department physicians and nurses. Instead of being tied to a particular workflow, this system provides a flexible communication infrastructure which can be easily adapted for different functions and user roles. The system has so far been configured to successfully support the standard “wet reading” workflow, to support marking and tracking of critical results, as well as multiple educational and quality improvement workflows. In the 19 months of operation, the system has gained over 1,800 users (virtually all providers at our institution), it has been accessed by radiologists over 39,000 times and by non-radiologists over 34,000 times. It has become an integral part of the radiology department operations and non-radiology clinical workflows. Unlike most existing softwares, our system is not a task-specific application, but a multipurpose communication system. It is able to effectively accommodate multiple workflows and user roles through configuration (without additional programming). This flexibility has helped this system to be rapidly and widely adopted within our enterprise. The extended reach of the system enables improved monitoring and documentation of workflows, helping with management decision making, and quality assurance. We report a successful radiology communication system based on the principles of flexibility and inclusiveness of users inside and outside the radiology department.
The aim of this work was to develop and incorporate a simple knowledge-based planning (KBP) tool into the volumetric modulated arc therapy (VMAT) treatment plan production process and to determine whether the tool improved plan quality and consistency. A study of 92 existing clinical prostate VMAT plans showed correlation between the proportion of organ at risk (OAR) overlapping with the planning target volume (PTV) and various OAR volume-doses of clinical interest. Simple linear models were generated that predicted the achievable rectum and bladder volume-doses according to the fraction of OAR volume overlapping with the PTV. The models were integrated into the planning process via a script using the Eclipse scripting application programming interface (ESAPI). The script's impact on plan quality was evaluated by comparing the plans before and after script implementation using the parameter d=achieved volume-dose-predicted volume-dose, the amount by which the achieved volume-dose exceeded the predicted value. All OAR volume-doses investigated demonstrated smaller d and reduced variability following script implementation. The largest reductions in d value were observed for bladder V 60Gy and V 50Gy , which reduced from 2.9±2.3 to 0.5±1.6, and 4.9±4.7 to 1.5±3.4 respectively. Variability was most significantly improved for rectum V 50Gy , for which the standard deviation was reduced from 7.2 to 3.8% following script implementation. A survey of the treatment planners found that the majority believed the script helped to improve the quality and consistency of their plans (57%) and save time (86%).
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