gms | German Medical Science

48th Meeting of the Particle Therapy Co-Operative Group

Particle Therapy Co-Operative Group (PTCOG)

28.09. - 03.10.2009, Heidelberg

Improving proton therapy accessibility through seamless electronic integration of remote treatment planning sites

Meeting Abstract

  • B. Tinnel - Radiology, Walter Reed Army Medical Center, Washington DC, USA
  • A. Belard - Radiology, Walter Reed Army Medical Center, Washington DC, USA
  • J. McDonough - Radiation Oncology, Hospital University of Pennsylvania, Philadelphia, USA
  • J. O'Connell - Radiology, Walter Reed Army Medical Center, Washington DC, USA
  • Z. A. Tochner - Radiation Oncology, Hospital University of Pennsylvania, Philadelphia, USA
  • R. Ferro - Radiation Oncology, Hospital University of Pennsylvania, Philadelphia, USA

PTCOG 48. Meeting of the Particle Therapy Co-Operative Group. Heidelberg, 28.09.-03.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09ptcog205

doi: 10.3205/09ptcog205, urn:nbn:de:0183-09ptcog2055

Published: September 24, 2009

© 2009 Tinnel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



For the past several years, the Radiation Oncology Department of the University of Pennsylvania Health System and the Walter Reed Army Medical Center have been developing a remote planning system with the goal of improving access to proton radiation therapy for patients while minimizing treatment delays and time spent away from home and work. Our solution allows for the elimination of duplicate consultations by different Radiation Oncologists, duplicate tumor board reviews and duplication of image staging. Additionally, significant time away from work and family can be spared for patients by performing the entire treatment planning process (i.e. simulation, fabrication of immobilization devices, contouring, plan creation, dose calculation and plan approval and prescription) locally. We further believe our solution will facilitate the determination of protocol eligibility and enrollment at the local level. In routine cases, the net time-savings associated with this solution is estimated to be between one to three weeks per patient.

Initially developed over Internet2, our prototype was then migrated to the hospitals' LANs. This design solution was far from trivial due to the stringent security restrictions required on the Department of the Army's domain. After testing and evaluating multiple VTC and application sharing products we designed a hybrid system merging a web-based application sharing solution with desktop VTC units used as a second PC monitor. Although several web-based solutions were considered for this system, we selected Adobe Connect, a robust web conferencing platform with application-sharing capabilities. For audio-video interaction, several units were considered, with the three principle variables being cost, image-quality (standard definition versus high-definition and frame-rates) and assimilation into our existing infrastructure as a secondary LCD in a dual-monitor configuration. Based on our design criteria and ease of integration into the Department of Defense network, the Tandberg 1700 models were tested extensively between our two institutions. The testing of this prototype system evolved over a period of 12 months, during which the capabilities to conduct point to multi-point ad-hoc and scheduled video-conferences were validated.

We conclude that this hybrid approach is a robust, secure and cost-effective solution that allows greater power and flexibility in the integration of satellite clinics into regional proton therapy centers. Through this potential integration, proton therapy can easily be made more widely available.

This work was supported by the US Army Medical Research and Materiel Command under Contract Agreement No. DAMD17-W81XWH-04-2-0022. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the US Army.