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PT Software – The importance of subsystems integration for machine performance

David Pahor

This is the first article in the blog series “Developing great software for particle therapy systems”. At Cosylab, we often stress that particle therapy machines are highly complex, and their integration is heavily underestimated. Engineers should take special care to thoughtfully design and develop software that has such a significant impact. The software connects all the subsystems and machine parts in a cohesive and functioning entirety that should treat patients quickly and effectively. Nevertheless, software’s critical role is often overlooked and underestimated, for example, in integration and workflows.

"PT Software – The importance of subsystems integration for machine performance"

Integration’s effect on overall system performance

It is a no-brainer that the attentiveness and quality of integrating a multitude of components, units and subsystems into one system determine its end performance. What are the lessons learnt in particle therapy (PT) machine integration?

Uros Mitrovic believes a typical approach of new vendors entering the market or of individual scientific spin-offs is to buy commercial off-the-shelf (COTS) products for various parts of the particle therapy machine and expect them to be well integrated, with minimal effort. Nevertheless, all of these independent devices and units have their own communication protocols, behaviour, internal/local states and workflows.

In the end, such systems may work poorly or not at all. In this respect, wise and purposeful integration planning and software development is the key to the success of a particle therapy system. For example, in a treatment room, one has a multitude of highly complex devices. Among them are the image-guided radiation therapy (IGRT) unit, the gantry, the patient positioning and setup (PPS) mechanism and the dose delivery system (DDS). Each of them comes with its interface, specifics and limitations. Basically, these devices were never tested before working together in a target system. The latter makes integrating all of these COTS products in a way that enables meaningful and efficient clinical workflows quite challenging.

QA and Clinical Workflows

Performant software also plays an essential part in delivering efficient clinical and quality assurance (QA) workflows that are transparent and have accessible data, i.g. through comprehensive QA logging. Information presented to technical users should, obviously, be different to the information shown to clinical users. Technical users require insight into the full complexity of the workflows, while clinical users need to see just the essential facts.

Zuofeng Li points out that people are creatures of habit. In radiation oncology, for example, we have the therapist, physician and physicist. Although all of these work together, each of them has been trained in a distinct way and has become accustomed to a certain flow of procedures and familiar scenarios.

There is also an additional, international dimension to workflow management and display: radiotherapy “standard operating procedures” can differ from country to country and well-designed software for clinical and QA workflows takes this into account. It may become an issue, for instance, when one introduces a solution totally against user intuition or country-specific practice and develop into a safety concern.

Read the rest of the series …

This is the opening article in a series of blogs dealing with the challenges of developing good software for particle therapy systems and is based on the PTCOG 59 round table “SOFTware: the HARD part of proton therapy“.



Jay Flanz, PhD, served as Assoc. Prof. at the Harvard Medical School and Technical Director at the Francis H. Burr Proton Therapy Center of the Massachusetts General Hospital before retiring in 2020.  Before that, he was Principal Research Scientist at MIT.  At the former, he contributed to the design and optimisation of the proton therapy (PT) equipment and its adaptation to clinical uses. A central focus for Dr Flanz is upgrading the beam delivery modality for optimal patient treatments.  He is the President of the Particle Therapy CoOperative Group (PTCOG) international organisation.

Zuofeng Li, PhD, is the chief physicist of the Meizhong Jiahe Medical Group (Concord Medical Holdings) and Guangzhou Concord Cancer Center. He is also a Fellow of the American Association of Physicists in Medicine, a Prof. at the University of Florida College of Medicine and was a Member of the steering committee of PTCOG. Dr Li has more than ten years of experience, specialising in radiation physics, brachytherapy, image-based brachytherapy, combined IMRT and brachytherapy delivery.

Thomas Rockwell (“Rock”) Mackie, PhD is Emeritus Prof. in Medical Physics, Human Oncology, and Engineering Physics at the University of Wisconsin-Madison and the Director of Medical Devices Focus Area at the Morgridge Institute for Research. He is a medical physicist that also developed a safer type of radiotherapy called tomotherapy, which produces less radiation without lowered effectiveness and is the marriage of a linac and a CT scanner. Dr Mackie is also focused on the development of a compact proton therapy machine.

Uros Mitrovic, PhD, is a technical expert with more than ten years of experience in several medical fields, including radiotherapy and medical imaging. He holds a PhD in medical image processing and is the author or co-author of several papers in prestigious journals, conference proceedings and US patents. At Cosylab, Uros is the Medical Product Portfolio Manager of OncologyOne product suite.

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