Electronic Oncology Systems - NewYork-Presbyterian
Transcript of Electronic Oncology Systems - NewYork-Presbyterian
Electronic Oncology SystemsElectronic Oncology Systems–– the Management and the Safety Measuresthe Management and the Safety Measures
Hansen Chen, Director, TDSIHansen Chen, Director, TDSI
Sep 2009Sep 2009 Hansen ChenHansen Chen 22
Radiation Oncology DepartmentRadiation Oncology Department
PeoplePeople
PlacePlace
EquipmentsEquipments
ProceduresProcedures
PatientsPatients
Sep 2009Sep 2009 Hansen ChenHansen Chen 33
Radiation Oncology StaffRadiation Oncology Staff
OncologistOncologist
NurseNurse
PhysicistPhysicist DosimetristDosimetrist Sim TechSim Tech
TherapistTherapist
EngineerEngineer
ClericalClericalAdministratorAdministrator BillingBilling
PeoplePeople
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Tx PlanTx Plan OfficesOffices
Front DeskFront Desk
Department LayoutDepartment Layout
Exam RoomExam Room
Brachy SuiteBrachy Suite
CT VaultCT Vault
Linac VaultLinac Vault
PlacePlace
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Machines and SystemsMachines and SystemsExternal Beam MachinesExternal Beam Machines Brachytherapy MachinesBrachytherapy Machines
Calibration DevicesCalibration Devices
Treatment Plan SystemsTreatment Plan Systems Oncology Info SystemsOncology Info Systems
Treatment AccessoriesTreatment Accessories
CT SimulatorsCT Simulators
IT InfrastructureIT Infrastructure
Oncology PACSOncology PACS
EquipmentEquipment
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Clinical ProceduresClinical ProceduresExternal Beam IMRTExternal Beam IMRT
HDR BrachytherapyHDR Brachytherapy
Prostate Seeds ImplantProstate Seeds Implant
CT SimulationCT Simulation
Stereotactic RadiosurgeryStereotactic Radiosurgery
Stereotactic Body RadiotherapyStereotactic Body Radiotherapy
Image Guided RadiotherapyImage Guided Radiotherapy
MammoSite APBIMammoSite APBI
ProcedureProcedure
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Patient Visit Flow Patient Visit Flow (ex. IMRT)(ex. IMRT)
ConsultConsult CT ScanCT Scan Virtual SimVirtual Sim Tx PlanTx Plan
Physics QAPhysics QAPortal FilmPortal FilmTx DeliveryTx DeliveryFollowFollow--upup
PatientPatient
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Yes, ItYes, It’’s Quite Complicated Operation!s Quite Complicated Operation!
PeoplePeople PlacePlace
EquipmentEquipment ProcedureProcedure
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Mitigation of Potential ErrorsMitigation of Potential Errors
More ManpowerMore Manpower
More Checking ProceduresMore Checking Procedures
More EquipmentsMore Equipments
Use of Computer TechnologiesUse of Computer Technologies
Buy More Liability InsuranceBuy More Liability Insurance……
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What Computer Can DoWhat Computer Can DoJaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000 Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Relative Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Epid Acquisition: 0Epid Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0VW Original MU: 0.000000, VW Dynamic Jaw: 0.00Data Valid 32-Bit Mask: 0x0000f1ef
Jaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Relative Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Epid Acquisition: 0Epid Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0VW Original MU: 0.000000, VW Dynamic Jaw: 0.00Data Valid 32-Bit Mask: 0x0000f1ef
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What Computer Can NOT DoWhat Computer Can NOT Do
Preparing the DataPreparing the Data
Potential Error in Data EntryPotential Error in Data Entry
Jaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000 Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Relative Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Epid Acquisition: 0Epid Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0VW Original MU: 0.000000, VW Dynamic Jaw: 0.00Data Valid 32-Bit Mask: 0x0000f1ef
Jaw Treatment Setup Message Downloaded (TSD - JAW)Patient ID: A050809Course: 1, Field: '001A', Fraction 0, Attempt: 1Oper. Mode: 1, Seg. Total: 20, Seg. number: 1, Seg. Attribute: 0x00301000Mode: X-ray, Energy 6, Technique: FixedDose: 50.0 MU, Dose Rate: 0 MU/Min# Used: 1, Accessory A: RETIC, Accessory B: ,Accessory C: Collimator: 90.0, Gantry: 0.0, Arc: 0.0, Direction: CCWField Type: 0Jaw X1: 5.0, Jaw X2: 100.1Jaw Y1: 5.0, Jaw Y2: 100.1MLC X1: 10.2, 10.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 10.6, 11.3MLC X2: 7.2, 6.5, 8.7, 6.3, 7.2, 8.1, 9.5, 9.5, 9.6, 9.8, 6.9, 9.3Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Relative Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0
Isocentric: 0.0, Eccentric: 0.0Epid Acquisition: 0Epid Table Longitudinal: 0.0, Lateral: 0.0, Vertical: 0.0VW Original MU: 0.000000, VW Dynamic Jaw: 0.00Data Valid 32-Bit Mask: 0x0000f1ef
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Electronic Oncology Systems (EOS)Electronic Oncology Systems (EOS)Treatment Plan SystemTreatment Plan System Oncology Information SystemOncology Information System
Treatment Delivery SystemTreatment Delivery System Treatment Verification SystemTreatment Verification System
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EOS System Design GuidelinesEOS System Design Guidelines
PatientPatientSafetySafety
OperationOperation&& Care CostCare Cost
QualityQualityof Careof Care
Time Time &&EffortsEfforts
Electronic Oncology Electronic Oncology
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Electronic Oncology Systems ManagementElectronic Oncology Systems Management
IT InfrastructureIT InfrastructureServers and Clients
Data Safety in StorageData Safety in StorageBackup and Archive
Data Safety in CommunicationData Safety in CommunicationData Integrity in Transmission & Execution
Systems MonitoringSystems MonitoringResponsibilities
Policy & ProceduresPolicy & ProceduresSystem Malfunction etc
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EOS IT InfrastructureEOS IT Infrastructure
Centralized ComputingCentralized Computing System RedundancySystem Redundancy
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Systems Infrastructure BeforeSystems Infrastructure BeforeColumbia CampusColumbia Campus Cornell CampusCornell Campus
License + ServiceLicense + Service
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Centralized System InfrastructureCentralized System InfrastructureColumbia CampusColumbia Campus Cornell CampusCornell Campus
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Systems RedundancySystems Redundancy
Clustered Data ServersClustered Data Servers SAN (Storage Area Network)SAN (Storage Area Network)
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Application Deployment ServersApplication Deployment Servers
Citrix Server FarmsCitrix Server Farms SunRay Server ArraySunRay Server Array
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Citrix ITA Thin Client AccessCitrix ITA Thin Client Access
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Oncology Information System TopologyOncology Information System Topology
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Pinnacle SunRay Thin ClientPinnacle SunRay Thin Client
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Pinnacle SmartEnterprise TopologyPinnacle SmartEnterprise Topology
SunGuard SANStorage SystemSunGuard SANStorage System
Philips PinnacleServer Cluster x 2Philips Pinnacle
Server Cluster x 2
Philips PinnacleCompute Modules x 2
Philips PinnacleCompute Modules x 2
Server EndServer End
Client SitesClient Sites
NYP P3PC Gateway x 2 NYP P3PC
Gateway x 2
NetworkSwitch
NetworkSwitch
Fiber OpticsFiber Optics
Cornell + Columbia CampusesCornell + Columbia Campuses
Cornell CampusTeaching Units
Cornell CampusTeaching Units
810 Server810 Server 810 Client810 Client 810 Client810 Client
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Centralized Tx Plan TopologyCentralized Tx Plan TopologyCentralized
Tx Plan OfficeCentralized
Tx Plan Office
Server VaultServer Vault
HospitalHospital
Physician & Physics OfficesPhysician & Physics Offices
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One Workstation for 10 PeopleOne Workstation for 10 People
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Bring Technology to PeopleBring Technology to PeopleNot People to TechnologyNot People to Technology
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ContouringContouring
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Tx PlanTx Plan
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Plan ReviewPlan Review
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MultiMulti--User EnvironmentUser Environment
CTCT--SimSim Image FusionImage Fusion ContourContour
Define Isocenter Import Diagnostic Images
Registration
Import Planning CT Images
Target Delineation
Run DIR
Contour Modification
Define Beams
PlanPlan
Dose Shaping ROI
Beams
Dose Objective
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Workflow StreamlineWorkflow Streamline≠≠ a Straight Linea Straight Line
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PACSPACS--RT SystemRT System
Candelis ImageGridCandelis ImageGrid
TCP/IP Network
Redundant ServerRedundant Server
PACSPACS--RTRT RT/WFMRT/WFM
Auto ReplicationAuto Replication
Data Data
(4D) CT Simulator
PET/CT/MR
Enterprise PACS
DICOM & Data
PSI Brachy TPS
Tx Plan Systems
HDR Brachy TPS
Physics W/S
Contouring W/S
Plan Review W/S
Reporting W/S
RTT IGRT W/S
Oncologist W/S
DICOM
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Workflow ManagementWorkflow Management
PACSPACS--RTRT
SystemFunctions
PatientWorkflow
Staff Views
Web Based Workflow Manager
Dicom/RT Store/Receive
Dicom/RT Query/Retrieve
Unattended TPS Backup
TPS Patient Restore
R&V, HIS Patient Archive
Off-Line / Off-Site Backup
Patient Simulation
Fusion & Contouring
Physician Physicist
Treatment Plan
Tx Plan Review
Physics Check/QA
IGRT / VGRT
Image/Report Review
Weekly & EOT Chk
Dosimetrist Therapist
User Configurable Workflow Required
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Oncology PACS StorageOncology PACS Storage
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Patient DataPatient Schedule
Patient DataPatient Schedule
PACSPACS--RT ServerRT Server
CT SimulationCT Simulation
Tx PlanTx Plan RTT W/SRTT W/S
Oncologist W/SOncologist W/S
OIS ServerOIS Server
Input:CT-Sim Worklist
Output:Patient CT ImagesRT Plan & RTSSAcknowledge Completed Input:
CT-Sim WorklistPatient CT ImagesRT Plan & RTSS
Output:All RT Objects
Input:CT-Sim WorklistPatient CT ImagesRT Plan & RTSS
Output:All RT Objects
Input:CT-Sim WorklistPatient CT ImagesRT Plan & RTSS
Output:All RT Objects
Centralized PACSCentralized PACS--RT ServerRT Server
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Integration with PACSIntegration with PACS--RTRT
Use of BackUse of Back--bone PACSbone PACS--RT ServerRT ServerSupporting DICOM Query & DICOM Work ListSupporting DICOM Query & DICOM Work List
PACS-RTPACS-RT
Contour Evaluation Contour
Evaluation
Oncologist Review
Oncologist Review
DVH Analysis
DVH Analysis
IMRT/IGRTQA Evaluation
IMRT/IGRTQA Evaluation
PhysicistMonitoringPhysicist
Monitoring
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Data TsunamiData Tsunami
Active DataActive DataPatients Under Care
Static DataStatic DataPatient Follow-Ups
Data TypesData TypesMedical Records, DICOM Images, DICOM RT Objects
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EOS Safety in StorageEOS Safety in Storage
Online Data Redundancy Online Data Redundancy –– Clustered Servers Clustered Servers and SANand SAN
Patients Under Treatment
NearNear--Line Data Redundancy Line Data Redundancy –– Oncology PACSOncology PACS6 Months to a Year
OffOff--Line Data Redundancy Line Data Redundancy –– Enterprise Enterprise Archive in Different Geometric LocationsArchive in Different Geometric Locations
Beyond a Year
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EOS Safety in CommunicationEOS Safety in Communication
Adapting from FDA 510K GuidelinesAdapting from FDA 510K GuidelinesHigh Level System DescriptionArchitecture Design ChartHazard Analysis & Risk ManagementSystem Requirement Specification (SRS)System Design Specification (SDS)Hazard Trace Matrix & Traceability AnalysisOperation EnvironmentVerification and ValidationUnresolved Anomalies
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High Level Systems DescriptionHigh Level Systems Description
Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx Delivery
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Architecture Design ChartArchitecture Design Chart
Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx Delivery
R&V SystemR&V System
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Hazard Analysis & Risk ManagementHazard Analysis & Risk Management
Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx DeliveryR&V SystemR&V System
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SRS & SDS to Mitigate the RisksSRS & SDS to Mitigate the Risks
Extensive BitExtensive Bit--toto--Bit Data Check by Human is Bit Data Check by Human is Too Much WorkToo Much Work
Designing a Computer Software Tool to Designing a Computer Software Tool to Mitigate the RisksMitigate the Risks
A ComputerA Computer--Aided Tx Data Auditing Software Aided Tx Data Auditing Software to Improve the Efficiencyto Improve the Efficiency
A Software which can Automatically Monitor A Software which can Automatically Monitor Tx Data being DeliveredTx Data being Delivered
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SRS & SDS to Mitigate the RisksSRS & SDS to Mitigate the RisksModule A: New Plan ChecksModule A: New Plan Checks
Approved Tx PlanApproved Tx Plan R&V SystemR&V System
New Software forNew Software forTx Data CheckingTx Data Checking
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SRS & SDS to Mitigate the RisksSRS & SDS to Mitigate the Risks
Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx Delivery
Module B: Daily Tx Log ChecksModule B: Daily Tx Log Checks
New Software forNew Software forTx Data CheckingTx Data Checking
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Hazard Traceability AnalysisHazard Traceability Analysis
Approved Tx PlanApproved Tx Plan Daily Tx DeliveryDaily Tx DeliveryR&V SystemR&V System
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Electronic Oncology System MonitoringElectronic Oncology System Monitoring
Whose Responsibility?Whose Responsibility?
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Whose Fault?Whose Fault?
RAID 5 Array FailingRAID 5 Array Failing
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Whose Fault?Whose Fault?
Restarting a Database ServiceRestarting a Database Service
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Balance with True ColorsBalance with True Colors
ServerServer
NetworkNetwork
DatabaseDatabase
ApplicationApplication
ConfigurationConfiguration
InstallationInstallation User RightsUser Rights
Clinical DataClinical Data
TroubleshootingTroubleshooting
Operating SystemOperating System
DesktopDesktop
ReportingReporting
ResearchResearch
DevelopmentDevelopment
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Policy & ProceduresPolicy & Procedures
When Server is DownWhen Server is DownShould off-line treatment be carried out?Off-line data roll back integrity checks
OverwriteOverwriteStaff role and their rights for overwritingQuality auditing for overwritten data
User RightsUser RightsFor each staff group, plus “senior” staffWho can define user rightsGeneric user account?
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Policy & ProceduresPolicy & Procedures
Paperless Chart / Electronic Medical RecordPaperless Chart / Electronic Medical RecordPatient medical record accessibility by other medical staffPaper signing off vs. electronic signature
Login & LogoutLogin & LogoutLogin & logout enforcementUser activity logging
System ContinuitySystem ContinuityConfiguration change policySystem update policy
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SummarySummary
Electronic Oncology System (EOS) is playing Electronic Oncology System (EOS) is playing an essential role in todayan essential role in today’’s Radiation s Radiation Oncology serviceOncology service
EOS Management ConsiderationsEOS Management ConsiderationsIT InfrastructureData Safety in StorageData Safety in CommunicationSystems MonitoringPolicy & Procedures
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ConclusionConclusionThe emerging radiation therapy technology has The emerging radiation therapy technology has became more and more complicated with became more and more complicated with increased clinical procedures and equipmentsincreased clinical procedures and equipments
Electronic Oncology System provides one solution Electronic Oncology System provides one solution to such complicated environmentto such complicated environment
Well designed EOS management from its Well designed EOS management from its infrastructure to the implementation is importantinfrastructure to the implementation is important
Safety measures for EOS is by no means critical Safety measures for EOS is by no means critical to the Radiation Oncology practiceto the Radiation Oncology practice
Thank YouThank You