Total planned dose of radiation is delivered over several weeks in smaller fractions. Precision in delivery of dose for each fraction in accordance with the plan is the basis for safety and effectiveness of treatment. Dose for each fraction must be given precisely in accordance with the plan. Therefore, several procedures are incorporated for verification of radiotherapy treatment on a continuous basis.

DISHA Oncology Information System monitors the treatment and implementation of procedures for verification of patient setup for treatment. It addresses the safety and effectiveness concerns of radiotherapy treatment by employing a computerized on-line system for recording the activities of oncology department as they take place. Patient visits, OPD consultation and follow-up, investigations, results of investigations, planned course of radiation treatment, results of verification of treatment setup, record of treatment events, quality checks of equipment and record of patient demographic data are examples of activities that are recorded on-line through a network of computer terminals. Radiotherapy PACS is also included for making the Images obtained from CT / MRI and other equipment available to the users. Software monitors the events as they take place. Alerts are generated for different functions by comparing the activities with the plan. Users have the opportunity to apply corrections for continuation of safe treatment. All the data of the department is organized into a database. This data can be used for research purposes. Operating efficiency is improved by minimizing reliance on paper and film records.

Alerts and Events Analyser
Alerts and Events Analyser is a user interface through a client workstation for reviewing the alerts and marked events of the department. This procedure is designed to assist the department to continually review and update the procedures and policies of the operating system to minimize the incidence of unforeseen alerts and events. Alerts pertaining to dose delivery to the patient are provided at the user modules DUIF0108 through DUIF0112 and DUIF0114 for immediate redress. User may define the events for reporting, such as non-availability of scheduled machine, patient not available for treatment, etc.

The system is designed to be modular. It may be configured for a small, medium or large oncology department for information exchange with DICOM compliant equipment. Data exchange with non-DICOM compliant equipment is supported with special procedures. Other data exchanges are based on proprietary or HL-7 interface protocol. System supports interface with Linear Accelerators, Brachytherapy Units, Treatment Planning Systems, CT / MRI units, Simulator units, Water Phantom Systems, OPD Work-stations, Record-Room Work-stations, Resource scheduling Work-stations, Operational Work-stations and Research Work-stations for data exchange, data display, data acquisition, operation and decision making in a local network. Gateway for exchange of data with other databases in a wide area network is available as add-on procedures. Communication with remote servers is DICOM or X3D compliant.

Radiotherapy Treatment Record & Verify
Electronic Chart & Dose Delivery is a user interface through a client workstation for reviewing progress of teletherapy treatment. planned fractionation schedule for each beam portal, actual delivery of dose with time stamps, digital photo of patient setups, port and simulation images verification comments, alert notices (visual, audio and written), patient Lab investigation results, patient clinical conditions as recorded, etc. Patient data is retrieved from various DISHA Database servers in the network using SQL Linked Server technology through a unique ID assigned to the patient. Prescription, schedule of treatment, and beam setups may be allowed to be altered by authorized specialist, as a Hospital option. Corresponding databases may be updated through this interface.

Portal Image Database Server
Database of Radiation Beam Portal images (BEV) as DICOM RT IOD or in other formats. The image data may or may not have superimposed curves describing collimator, beam modifying devices, patient structures and target volumes. Authorized clients in the network can query and retrieve images from the server. Images are acquired from Linear Accelerator equipped with Electronic Portal Imaging Devices through DICOM message exchange or file transfer or acquired from film digitizer. User configurable archival of images.

Portal Image for Verification
System may be networked with Virtual Simulation System and Linac Electronic Portal Imaging Device for real time acquisition of images and verification. Offline verification may also be performed. System quantifies shift of portal image with Reference DRR image and suggests correction. Correction advice is provided as couch adjustment by specified distances in x, y and z directions to achieve more accurate registration of beam for that specific fraction. System is designed to detect and advise correction with an accuracy of better than a millimeter. Verification and correction process is user assisted at this time. Procedure to make the correction automatic is feasible in future by networking the System with Linac and communicating the correction through DICOM RT-Plan object.

OPD Management
OPD Services system registers and schedules patients for OPD consultation. It records diagnosis and treatment procedures though online services at OPD clinics. Data is created with international standard codes. OPD billing may be implemented for cash and credit patients as per hospital policy. The system provides information on the pattern of diseases being reported and trends, in addition to data on utilization of hospital resources. A small, medium or large hospital can use this system. The system can be integrated with other functions of the hospital in a comprehensive hospital information and management system.

Investigations - Imaging and Labs
The system provides support for hospital imaging service centers such as MRI, CT Scan, Ultrasound, General Radiology, Interventional Radiology, Computerized Radiography, Gamma Camera, etc. The system enables scheduling of appointments for examinations, use of standardized nomenclature for examination procedures, maintain status of examinations, enable results reporting, film tracking and finalization of investigation report along with conclusions. Radiology images also may be stored electronically. DICOM compliance modalities in radiology department may be interfaced with this system using Medical Image Management system.

Image Management
MEDICAL IMAGE MANAGEMENT is a Picture Archiving and Communication System for computerized on-line receiving, storing, archiving and visualizing of medical images in digital form for use in a department of a hospital. It communicates with other departments in a local area network or outside the hospital using wide area network technology. Adoption of DICOM standard for creating, storing and communicating digital images has accelerated the development of new solutions in the practice of medicine. Digital images provide more information to the doctors compared to images on films. Doctors can use the data for better diagnosis and treatment of patients. All images can be accessed and viewed on computer display terminals through PACS implementation included in this system. The system enables users to capture, process, and transmit or receive radiological data. Text data, such as studies and patient data, as well as high-resolution images can be processed and transmitted. This system is intended for improving the productivity of the department through better access to medical images for quality of patient care. The system is designed to be modular. It may be configured for a small, medium or large department for information exchange with any DICOM compliant source. The system can also be configured for a small clinic as well as individual doctor having access to DICOM images in a network or through media exchange.

Patient Registry and Demography Database Server
Patient registry creates the entry for the patient with a unique ID. This ID is used to identify the patient in all databases. Database stores collections of items related to patient history and data acquired by Social Investigator and General OPD clinician. The database is created / updated on a routine basis from the client workstations. Patient Registry, Social Investigator workstation, General OPD, Consultant OPD, Operational workstations, etc. perform this task. Data items maintained in the Database and archival of data are user configurable

Modular Design
The system is designed to be modular. It may be configured for a small, medium or large oncology department for information exchange with DICOM compliant equipment. Data exchange with non-DICOM compliant equipment is supported with special procedures. Other data exchanges are based on proprietary or HL-7 interface protocol. System supports interface with Linear Accelerators, Brachytherapy Units, Treatment Planning Systems, CT / MRI units, Simulator units, Water Phantom Systems, OPD Work-stations, Record-Room Work-stations, Resource scheduling Work-stations, Operational Work-stations and Research Work-stations for data exchange, data display, data acquisition, operation and decision making in a local network. Gateway for exchange of data with other databases in a wide area network is available as add-on procedures. Communication with remote servers is DICOM or X3D compliant.

DISHA Oncology Information System consists of a DISHA Manager, choice of DISHA Servers, DISHA Modality Interfaces, DISHA User Modules, DISHA Report Modules and DISHA Networks.