JASTRO
Integrating the Healthcare Enterprise

IHE-Japan Radiation Oncology
Technical Framework
Supplement – Enterprise Schedule
Integration Profile
2009

Draft
March 3, 2009

Copyright © 2009: JASTRO, ASTRO

Comments may be submitted to:
http://forums.rsna.org under the “IHE” forum
Select the “Radiation Oncology Technical Framework” sub-forum.
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Contents

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1

Foreword .................................................................................................................................. 3
1.1 Content of the IHE-RO Technical Framework ................................................................. 4
1.1.1 Volume 1 – Integration Profiles.................................................................................. 4
1.1.2 Volume 2 – Transactions ............................................................................................ 4
2 Preface to Volume 1.................................................................................................................. 5
2.1 Intended Audience ............................................................................................................ 5
2.2 How this Volume is Organized ......................................................................................... 5
2.3 Conventions Used in this Document................................................................................. 5
2.3.1 Technical Framework Cross-references ..................................................................... 5
2.3.2 IHE Actor and Transaction Diagrams and Tables ...................................................... 5
2.3.3 Process Flow Diagrams............................................................................................... 5
2.4 Copyright Permissions ...................................................................................................... 5
2.5 Comments ......................................................................................................................... 5
3 Introduction............................................................................................................................... 5
3.1 Relationship to Standards.................................................................................................. 5
3.2 Relationship to Product Implementations ......................................................................... 5
3.3 Framework Development and Maintenance ..................................................................... 5
3.4 Integration Profiles Overview ........................................................................................... 5
3.5 Radiation Oncology Integration Profiles .......................................................................... 5
3.5.1 Overview..................................................................................................................... 5
3.5.2 Scope of Future Work................................................................................................. 5
3.6 Product Implementations .................................................................................................. 5
4 Enterprise Schedule Integration Profile .................................................................................... 5
4.1 Scope and Purpose ............................................................................................................ 5
Appendix A Actors ...................................................................................................................... 5
A.1 Actor Descriptions............................................................................................................ 5
A.2 RT Specific Actors ........................................................................................................... 5
Appendix B Transactions............................................................................................................. 5
B.1 Transaction Descriptions .................................................................................................. 5
Appendix C Glossary................................................................................................................... 5

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IHE-J RO Supplement Technical Framework Enterprise Schedule Integration: Draft______________________________________________________________________________

1 Foreword
In this supplement, sections 1 through 2.4 are boilerplate taken from the Technical Framework,and are intended to provide sufficient background to the reader. Sections 2.5 and greater are
intended to be added to the Japanse National/Regional Specialization of the Technical
Framework with numbering appropriate to the Technical Framework at the time they are added.
Integrating the Healthcare Enterprise (IHE) is an initiative designed to stimulate the integrationof the information systems that support modern healthcare institutions. Its fundamental objective
is to ensure that in the care of patients all required information for medical decisions is bothcorrect and available to healthcare professionals. The IHE initiative is both a process and aforum for encouraging integration efforts. It defines a technical framework for the
implementation of established messaging standards to achieve specific clinical goals. It includes
a rigorous testing process for the implementation of this framework. And it organizes
educational sessions and exhibits at major meetings of medical professionals to demonstrate thebenefits of this framework and encourage its adoption by industry and users.

DRAFT

The approach employed in the IHE initiative is not to define new integration standards, but rather
to support the use of existing standards, HL7, DICOM, IETF, and others, as appropriate in theirrespective domains in an integrated manner, defining configuration choices when necessary.
When clarifications or extensions to existing standards are necessary, IHE refers
recommendations to the relevant standards bodies.
This initiative has numerous sponsors and supporting organizations in different medical specialty
domains and geographical regions. In North America the primary sponsors are the American
College of Cardiology (ACC), the Healthcare Information and Management Systems Society(HIMSS) and the Radiological Society of North America (RSNA). IHE Canada has also been
formed. IHE Europe (IHE-EUR) is supported by a large coalition of organizations including theEuropean Association of Radiology (EAR) and European Congress of Radiologists (ECR), theCoordination Committee of the Radiological and Electromedical Industries (COCIR), Deutsche
Röntgengesellschaft (DRG), the EuroPACS Association, Groupement pour la Modernisation duSystème d'Information Hospitalier (GMSIH), Société Francaise de Radiologie (SFR), andSocietà Italiana di Radiologia Medica (SIRM). In Japan IHE-J is sponsored by the Ministry of
Economy, Trade, and Industry (METI); the Ministry of Health, Labor, and Welfare; and MEDISDC; cooperating organizations include the Japan Industries Association of Radiological Systems(JIRA), the Japan Association of Healthcare Information Systems Industry (JAHIS), Japan
Radiological Society (JRS), Japan Society of Radiological Technology (JSRT), and the Japan
Association of Medical Informatics (JAMI). Other organizations representing healthcare
professionals are actively involved and others are invited to join in the expansion of the IHE
process across disciplinary and geographic boundaries.
The IHE Technical Frameworks for the various domains (Patient Care Coordination, IT
Infrastructure, Cardiology, Laboratory, Radiation Oncology, Radiology, etc.) define specificimplementations of established standards to achieve integration goals that promote appropriate___________________________________________________________________
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sharing of medical information to support optimal patient care. These are expanded annually,
after a period of public review, and maintained regularly through the identification andcorrection of errata. The current version for these Technical Frameworks may be found at
www.ihe.net.
The IHE Technical Framework identifies a subset of the functional components of the healthcare
enterprise, called IHE Actors, and specifies their interactions in terms of a set of coordinated,
standards-based transactions. It describes this body of transactions in progressively greater depth.
The volume I provides a high-level view of IHE functionality, showing the transactionsorganized into functional units called Integration Profiles that highlight their capacity to address
specific clinical needs. The subsequent volumes provide detailed technical descriptions of each
IHE transaction.

1.1 Content of the IHE-RO Technical Framework
This profile defines the relevant standards and constraints on those standards in order toimplement a specific use case for the transfer of information between systems. This document isorganized into 2 volumes as follows:
1.1.1 Volume 1 – Integration Profiles
This volume is provided as a high level overview of the profiles including descriptions of the use
cases, the actors involved, the process flow, and dependencies on other standards and IHE
profiles. It is of interest to care providers, vendors’ management and technical architects and to
all users of the profile
1.1.2 Volume 2 – Transactions
This volume is intended as a technical reference for the implementation of specific transactionsin the use case including references to the relevant standards, constraints, and interaction
diagrams. It is intended for the technical implementers of the profile.

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IHE-J RO Supplement Technical Framework Enterprise Schedule Integration: Draft______________________________________________________________________________

2 Preface to Volume 1
2.1 Intended Audience
The intended audience of this document is:
Healthcare professionals involved in informatics
IT departments of healthcare institutions
Technical staff of vendors participating in the IHE initiative
Experts involved in standards development
Those interested in integrating healthcare information systems and workflows

2.2 How this Volume is Organized
Section 2 describes the general nature, purpose and function of the Technical Framework.

DRAFT

Section 3 and the subsequent sections of this volume provide detailed documentation on each
integration profile, including the clinical problem it is intended to address and the IHE actors andtransactions it comprises.
The appendices following the main body of the document provide a summary list of the actors
and transactions, detailed discussion of specific issues related to the integration profiles and aglossary of terms and acronyms used.

2.3 Conventions Used in this Document
This document has adopted the following conventions for representing the framework concepts
and specifying how the standards upon which the IHE Technical Framework is based should beapplied.
2.3.1 Technical Framework Cross-references
When references are made to another section within a Technical Framework volume, a section
number is used by itself. When references are made to other volumes or to a Technical
Framework in another domain, the following format is used:<domain designator> TF-<volume number>: <section number>where:<domain designator> is a short designator for the IHE domain (PCC= Patient Care Coordination,
ITI = IT Infrastructure, RAD = Radiology, RO = Radiation Oncology)<volume number> is the applicable volume within the given Domain Technical
Framework (e.g., 1, 2, 3), and<section number> is the applicable section number.
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For example: RO TF-1: 3.1 refers to Section 3.1 in volume 1 of the IHE Radiation Oncology
Technical Framework, ITI TF-2: 4.33 refers to Section 4.33 in volume 2 of the IHE IT
Infrastructure Technical Framework.
2.3.2 IHE Actor and Transaction Diagrams and Tables
Each integration profile is a representation of a real-world capability that is supported by a set ofactors that interact through transactions. Actors are information systems or components of
information systems that produce, manage, or act on categories of information required byoperational activities in the enterprise. Transactions are interactions between actors that
communicate the required information through standards-based messages.
The diagrams and tables of actors and transactions in subsequent sections indicate whichtransactions each actor in a given profile must support.
The transactions shown on the diagrams are identified both by their name and the transaction
number as defined in RO TF-2 (Volume 2 of the RO Technical framework). The transaction
numbers are shown on the diagrams as bracketed numbers prefixed with the specific Technical
Framework domain.
In some cases, a profile is dependent on a prerequisite profile in order to function properly andbe useful. These dependencies, if any would be found by locating the desired profile in Table
2.6-1 to determine which profile(s) are listed as prerequisites. An actor must implement all
required transactions in the prerequisite profiles in addition to those in the desired profile.
2.3.3 Process Flow Diagrams
The descriptions of integration profiles that follow include process flow diagrams that illustrate
how the profile functions as a sequence of transactions between relevant actors.
These diagrams are intended to provide an overview so the transactions can be seen in thecontext of an institution’s or cross-institutions’ workflow. Certain transactions and activities notdefined in detail by IHE are shown in these diagrams in italics to provide additional context on
where the relevant IHE transactions fit into the broader scheme of healthcare information
systems.
These diagrams are not intended to present the only possible scenario. Often other actor
groupings are possible, and transactions from other profiles may be interspersed.
In some cases the sequence of transactions may be flexible. Where this is the case there will
generally be a note pointing out the possibility of variations. Transactions are shown as arrows
oriented according to the flow of the primary information handled by the transaction and notnecessarily the initiator.

2.4 Copyright Permissions
Health Level Seven, Inc., has granted permission to the IHE to reproduce tables from the HL7
standard. The HL7 tables in this document are copyrighted by Health Level Seven, Inc. All rights
reserved. Material drawn from these documents is credited where used.

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IHE-J RO Supplement Technical Framework Enterprise Schedule Integration: Draft______________________________________________________________________________

2.5 Comments
IHE Sponsors welcome comments on this document and the IHE initiative. They should bedirected to the discussion server at http://forums.rsna.org or to:
Director of Research
American Society for Therapeutic Radiology and Oncology (ASTRO)
8280 Willow Oaks Corporate Drive, Suite 500
Fairfax, VA 22031
ihero@astro.org
Co-Chair of the IHE-Japan RO Committee
Integrating the Healthcare Enterprise-Japan
504, Monteberude Dai-2-Todaimae
6-2-9, Hongo, Bunkyo
Tokyo, 113-0033, Japanro-info@ihe-j.org

DRAFT

一般財団法人 日本 IHE 協会
放射線治療委員会〒113-0033

東京都文京区本郷 6-2-9 モンテベルデ第２東大前 504
ro-info@ihe-j.org___________________________________________________________________
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3 Introduction
This document, the IHE-Japan Radiation Oncology Technical Framework Supplement forEnterprise Schedule Integration, defines specific implementations of established standards.
These are intended to achieve integration goals that promote appropriate exchange of medical
information to coordinate the optimal patient care among care providers in different care settings.
The Technical Framework is expanded annually, after a period of public review, and maintained
regularly through the identification and correction of errata. The latest version of the document isalways available via the Internet at http://www.ihe.net/Technical_Framework/ , where thetechnical framework volumes specific to the various healthcare domains addressed by IHE may
be found.
The IHE Radiation Oncology Technical Framework identifies a subset of the functional
components of the healthcare enterprises and health information networks, called IHE actors, andspecifies their interactions in terms of a set of coordinated, standards-based transactions.
The other domains within the IHE initiative also produce Technical Frameworks within theirrespective areas that together form the IHE Technical Framework. Currently, the following IHE
Technical Framework(s) are available:
IHE IT Infrastructure Technical Framework
IHE Cardiology Technical Framework
IHE Eye CareIHE Laboratory Technical framework
IHE Radiology Technical Framework
IHE Patient Care Coordination Technical Framework
Where applicable, references are made to other technical frameworks. For the conventions onreferencing other frameworks, see the preface of this volume.

3.1 Relationship to Standards
The IHE Technical Framework identifies functional components of a distributed healthcare
environment (referred to as IHE actors), solely from the point of view of their interactions in thehealthcare enterprise. At its current level of development, it defines a coordinated set oftransactions based on standards (such as HL7, IETF, ASTM, DICOM, ISO, OASIS, etc.) inorder to accomplish a particular use case. As the scope of the IHE initiative expands, transactions
based on other standards may be included as required.
In some cases, IHE recommends selection of specific options supported by these standards.
However, IHE does not introduce technical choices that contradict conformance to thesestandards. If errors in or extensions to existing standards are identified, IHE’s policy is to reportthem to the appropriate standards bodies for resolution within their conformance and standards
evolution strategy.
IHE is therefore an implementation framework, not a standard. Conformance claims for products
must still be made in direct reference to specific standards. In addition, vendors who have
implemented IHE integration capabilities in their products may publish IHE Integration
Statements to communicate their products’ capabilities. Vendors publishing IHE Integration
Statements accept full responsibility for their content. By comparing the IHE Integration
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IHE-J RO Supplement Technical Framework Enterprise Schedule Integration: Draft______________________________________________________________________________
Statements from different products, a user familiar with the IHE concepts of actors andintegration profiles can determine the level of integration between them. See
http://www.ihe.net/Resources/upload/ihe_integration_statements.pdf for the format of IHE
Integration Statements.

3.2 Relationship to Product Implementations
The IHE actors and transactions described in the IHE Technical Framework are abstractions of
the real-world healthcare information system environment. While some of the transactions are
traditionally performed by specific product categories (e.g. HIS, Clinical Data Repository,
Electronic Health record systems, Radiology Information Systems, Clinical Information Systems
or Cardiology Information Systems), the IHE Technical Framework intentionally avoids
associating functions or actors with such product categories. For each actor, the IHE Technical
Framework defines only those functions associated with integrating information systems. The
IHE definition of an actor should therefore not be taken as the complete definition of any productthat might implement it, nor should the framework itself be taken to comprehensively describe
the architecture of a healthcare information system.

DRAFT

The reason for defining actors and transactions is to provide a basis for defining the interactions
among functional components of the healthcare information system environment. In situations
where a single physical product implements multiple functions, only the interfaces between the
product and external functions in the environment are considered to be significant by the IHE
initiative. Therefore, the IHE initiative takes no position as to the relative merits of an integrated
environment based on a single, all-encompassing information system versus one based on
multiple systems that together achieve the same end.

3.3 Framework Development and Maintenance
The IHE Radiation Oncology Technical Framework is continuously maintained and expanded on
an annual basis by the IHE Radiation Oncology Technical Committee. The development andmaintenance process of the Framework follows a number of principles to ensure stability of thespecification so that both vendors and users may use it reliably in specifying, developing andacquiring systems with IHE integration capabilities.
The first of these principles is that any extensions or clarifications to the Technical Framework
must maintain backward compatibility with previous versions of the framework (except in rarecases for corrections) in order to maintain interoperability with systems that have implemented
IHE Actors and Integration Profiles defined there.
The IHE Radiation Oncology Technical Framework is developed and re-published annuallyfollowing a three-step process:
The Radiation Oncology Technical Committee develops supplements to the current stableversion of the Technical Framework to support new functionality identified by the IHE
Strategic and RO Planning Committees and issues them for public comment.
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The Committee addresses all comments received during the public comment period andpublishes an updated version of the Technical Framework for “Trial Implementation.”
This version contains both the stable body of the Technical Framework from thepreceding cycle and the newly developed supplements. It is this version of the Technical
Framework that is used by vendors in developing trial implementation software for the
IHE Connectathons.
The Committee regularly considers change proposals to the Trial Implementation version of
the Technical Framework, including those from implementers who participate in theConnectathon. After resolution of all change proposals received within 60 days of theConnectathon, the Technical Framework version is published as “Final Text”.
The Committee as part of the Technical framework maintenance will consider change proposals
received after the publication to the “Final Text”.

3.4 Integration Profiles Overview
In this document, each IHE Integration Profile is defined by:
The IHE actors involved
The specific set of IHE transactions exchanged by each IHE actor.
These requirements are presented in the form of a table of transactions required for each actor
supporting the Integration Profile. Actors supporting multiple Integration Profiles are required tosupport all the required transactions of each Integration Profile supported. When an Integration
Profile depends upon another Integration Profile, the transactions required for the dependent
Integration Profile have not been included in the table.
Note that IHE Integration Profiles are not statements of conformance to standards, and IHE is nota certifying body. Users should continue to request that vendors provide statements of theirconformance to standards issued by relevant standards bodies, such as HL7 and DICOM.
Standards conformance is a prerequisite for vendors adopting IHE Integration Profiles.
Also note that there are critical requirements for any successful integration project that IHE
cannot address. Successfully integrating systems still requires a project plan that minimizes
disruptions and describes fail-safe strategies, specific and mutually understood performance
expectations, well-defined user interface requirements, clearly identified systems limitations,detailed cost objectives, plans for maintenance and support, etc.

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IHE-J RO Supplement Technical Framework Enterprise Schedule Integration: Draft______________________________________________________________________________

3.5 Radiation Oncology Integration Profiles
3.5.1 Overview
IHE Integration Profiles offer a common language that healthcare professionals and vendors canuse to discuss integration needs of healthcare enterprises and the integration capabilities of
information systems in precise terms. Integration Profiles specify implementations of standards
that are designed to meet identified clinical needs. They enable users and vendors to state which
IHE capabilities they require or provide, by reference to the detailed specifications of the IHE
Radiation Oncology Technical Framework.
Integration profiles are defined in terms of IHE Actors, transactions and their content. Actors(listed in RO TF-1: Appendix A) are information systems or components of information systems
that produce, manage, or act on information associated with clinical and operational activities.
Transactions (listed in RO TF-1: Appendix B) are interactions between actors that communicate
the required information through standards-based messages.

DRAFT

Vendor products support an Integration Profile by implementing the appropriate actor(s) andtransactions. A given product may implement more than one actor and more than one integration
profile as in example below.
Insert Diagram Here describing Enterprise Schedule Integration (Actors and Transactions)

Create Radiotherapy Parent Order [RO-ESI-01] Æ
Cancel Radiotherapy Parent Order [RO-ESI-07] ÆOrder PlacerÅ Create Radiotherapy Delivery Child Order [RO-ESI-02]

Treatment
Management
SystemÅ Modify Radiotherapy Delivery Child Order [RO-ESI-03]
Å Cancel Radiotherapy Delivery Child Order [RO-ESI-04]
Å Update Radiotherapy Delivery Child Order Status [RO-ESI-05]
Å Update Radiotherapy Parent Order Status [RO-ESI-06]
Å Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]
Å Unsolicited Cancel Radiotherapy Parent Order [RO-ESI-09]

Figure 3.5-1 IHE Radiation Oncology Enterprise Schedule Integration Profiles___________________________________________________________________
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To support a dependent profile, an actor must implement all required transactions in theprerequisite profiles in addition to those in the dependent profile. In some cases, the prerequisite
is that the actor selects any one of a given set of profiles.

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IHE-J RO Supplement Technical Framework Enterprise Schedule Integration: Draft______________________________________________________________________________
The following profiles are documented in this supplement (to be added to the Technical
Framework):•

Enterprise Schedule Integration Profile: This integration profile involves
the exchange of Schedule, Order, and Results information between hospital information
systems and (Radiation Oncology) treatment management systems. The emphasis forthis profile is on improving schedule and procedure coordination between the Radiation
Oncology department and the rest of the clinical enterprise.

3.5.2 Scope of Future Work•

3.6 Product Implementations
Developers have a number of options in implementing IHE actors and transactions in productimplementations. The decisions cover three classes of optionality:

DRAFT

For a system, select which actors it will incorporate (multiple actors per system are acceptable).
For each actor, select the integration profiles in which it will participate.
For each actor and profile, select which options will be implemented.
All required transactions must be implemented for the profile to be supported.
Implementers should provide a statement describing which IHE actors, IHE integration profiles
and options are incorporated in a given product. The recommended form for such a statement isdefined at http://www.ihe.net/Resources/upload/ihe_integration_statements.pdf .
In general, a product implementation may incorporate any single actor or combination of actors.
When two or more actors are grouped together, internal communication between actors is
assumed to be sufficient to allow the necessary information flow to support their functionality.
The exact mechanisms of such internal communication are outside the scope of the IHE
Technical Framework.
When multiple actors are grouped in a single product implementation, all transactions originatingor terminating with each of the supported actors shall be supported (i.e., the IHE transactions
shall be offered on an external product interface).

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4 Enterprise Schedule Integration Profile
4.1 Scope and Purpose
Currently in Japan, Healthcare enterprises attempt to coordinate scheduling between Hospital
Information Systems and Oncology Information Systems by use of intermediaries which
communicate to the Hospital Information System using either proprietary interface specifications
or de-facto standard interfaces, utilizing the Japanese language, and to Oncology Information
Systems utilizing the English language and using proprietary interface specifications andcustomized implementations. Integration between systems is painstaking, and the lack ofJapanese on many of the Radiation Oncology systems makes use of these systems more difficultand less efficient.
This integration profile involves the exchange of Schedule information between hospital
information systems and (Radiation Oncology) treatment management systems. The emphasis
for this profile is on improving schedule and procedure coordination between the Radiation
Oncology department and the rest of the clinical enterprise. The transactions involve both
workflow and content.

DRAFT

It is expected that the actual products commonly referred to as Hospital Information Systems andOncology Information Systems will each implement one of the actors (Order Placer andTreatment Management System respectively). The Treatment Management System actor is
explicitly intended to be the same as the Treatment Management System actor in the “Integrated
Positioning and Delivery” profile. There are already IHE-J regional specializations of profiles
for the Radiology domain, these specializations of profiles and systems implementing them havebeen tested in Japanese region supported Connectathons, and this profile is intended to build on
those efforts.

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4.2 Enterprise Schedule Integration Process Flow
4.2.1 Issue Order from Order Placer

Treatment
Management
SystemOrder Placer

Create Radiotherapy Parent Order [RO-ESI-01]
Create Radiotherapy Delivery Child Order [RO-ESI-02]
Update Radiotherapy Parent Order Status [RO-ESI-06]

In-ProgressCompletedUpdate Radiotherapy Delivery Child Order Status [RO-ESI-05]
1..nCompletedUpdate Radiotherapy Parent Order Status [RO-ESI-06]

Figure 4.2.1-1 Normal Process Flow – Issue Order from OP

Treatment
Management
SystemOrder Placer

Create Radiotherapy Parent Order [RO-ESI-01]
Cancel Radiotherapy Parent Order [RO-ESI-07]

Figure 4.2.1-2 Cancel Process Flow(Non-Delivery Child Order)16

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Treatment
Management
SystemOrder Placer

Create Radiotherapy Parent Order [RO-ESI-01]
Create Radiotherapy Delivery Child Order [RO-ESI-02]
Cancel Radiotherapy Parent Order [RO-ESI-07]

Cancel Radiotherapy Delivery Child Order [RO-ESI-04]

DRAFT

Figure 4.2.1-3 Cancel Process Flow(Scheduled Delivery Child Order, Non-Delivery)

Treatment
Management
SystemOrder Placer

Create Radiotherapy Parent Order [RO-ESI-01]
Create Radiotherapy Delivery Child Order [RO-ESI-02]
Update Radiotherapy Parent Order Status [RO-ESI-06]

In-ProgressCompletedUpdate Radiotherapy Delivery Child Order Status [RO-ESI-05]
Cancel Radiotherapy Parent Order [RO-ESI-07]
Cancel Radiotherapy Delivery Child Order [RO-ESI-04]

Figure 4.2.1-4 Discontinue Process Flow___________________________________________________________________
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Treatment
Management
SystemOrder Placer

Create Radiotherapy Parent Order [RO-ESI-01]
Create Radiotherapy Delivery Child Order [RO-ESI-02]
Modify Radiotherapy Delivery Child Order [RO-ESI-03]
In-Progress
Update Radiotherapy Parent Order Status [RO-ESI-06]

Update Radiotherapy Delivery Child Order Status [RO-ESI-05]

Completed

1..nUpdate Radiotherapy Parent Order Status [RO-ESI-06]

Completed

Figure 4.2.1-5 Modify Delivery Child Order Process Flow

Treatment
Management
SystemOrder Placer

Create Radiotherapy Parent Order [RO-ESI-01]
Cancel Radiotherapy Parent Order [RO-ESI-07]

Create Radiotherapy Parent Order [RO-ESI-01]

Figure 4.2.1-6 Modify Parent Order Process Flow18

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4.2.2 Issue Order from Treatment Management System

Treatment
Management
SystemOrder Placer

Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]
Create Radiotherapy Delivery Child Order [RO-ESI-02]
Update Radiotherapy Parent Order Status [RO-ESI-06]

In-ProgressCompleted
Completed

DRAFT
Update Radiotherapy Delivery Child Order Status [RO-ESI-05]

1..nUpdate Radiotherapy Parent Order Status [RO-ESI-06]

Figure 4.2.2-1 Normal Process Flow – Issue Order from TMS

Treatment
Management
SystemOrder Placer

Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]
Unsolicited Cancel Radiotherapy Parent Order [RO-ESI-09]

Figure 4.2.2-2 Cancel Process Flow(Non-Delivery Child Order)___________________________________________________________________
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Treatment
Management
SystemOrder Placer

Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]
Create Radiotherapy Delivery Child Order [RO-ESI-02]
Cancel Radiotherapy Delivery Child Order [RO-ESI-04]
Unsolicited Cancel Radiotherapy Parent Order [RO-ESI-09]

Figure 4.2.2-3 Cancel Process Flow(Scheduled Delivery Child Order, Non-Delivery)

Treatment
Management
SystemOrder Placer

Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]
Create Radiotherapy Delivery Child Order [RO-ESI-02]

In-ProgressCompletedUpdate Radiotherapy Parent Order Status [RO-ESI-06]
Update Radiotherapy Delivery Child Order Status [RO-ESI-05]
Cancel Radiotherapy Delivery Child Order [RO-ESI-04]
Unsolicited Cancel Radiotherapy Parent Order [RO-ESI-09]

Figure 4.2.2-4 Discontinue Process Flow

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Treatment
Management
SystemOrder Placer

Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]
Create Radiotherapy Delivery Child Order [RO-ESI-02]
Modify Radiotherapy Delivery Child Order [RO-ESI-03]

Update Radiotherapy Parent Order Status [RO-ESI-06]

In-ProgressCompleted

CompletedUpdate Radiotherapy Delivery Child Order Status [RO-ESI-05]

DRAFT

1..n

Update Radiotherapy Parent Order Status [RO-ESI-06]

Figure 4.2.2-5 Modify Delivery Child Order Process Flow

Treatment
Management
SystemOrder Placer

Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]
Unsolicited Cancel Radiotherapy Parent Order [RO-ESI-09]

Unsolicited Create Radiotherapy Parent Order [RO-ESI-08]

Figure 4.2.2-6 Modify Parent Order Process Flow___________________________________________________________________
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Appendix A
A.1

ActorsActor Descriptions<No Additions>

A.2

RT Specific Actors<for reference purposes, no changes implied>
Archive (including RT) – A system that stores the RT SOP Classes in addition to the CT
images and is capable of transmitting them.
Treatment Delivery Device (TDD) – A system that delivers therapeutic radiation to a correctly
positioned patient. The TDD fulfils the role of a UPS-Pull ‘Pull Performer’ SCU as described in
DICOM Supplement 96 Part 17 Table Z.1-1.
<additions/changes>
Treatment Management System (TMS) – An information system that manages oncology
information and is responsible for the scheduling of radiotherapy activities (i.e. is a workflow
manager). The TMS is similar to an Order Filler/Department System Scheduler as described in
the IHE Radiology Domain.
The TMS fulfils the role of a UPS-Pull ‘Worklist Manager’ SCP as described in DICOM
Supplement 96 Part 17 Table Z.1-1. Note that a specific product implementation could
potentially fulfill the role of both a TMS and an Archive, in which case the supplied AE Title in
Input and Output Sequences may be an AE Title managed by that implementation.
Order Placer (OP) – A system that operates at the Enterprise level (rather than just within the
Radiation Oncology department) and initiates orders for radiation oncology. The order placeralso receives schedule information that is necessarily managed within the Radiation Oncology
department (e.g. fractionation).

22

IHE-J RO Supplement Technical Framework Enterprise Schedule Integration: Draft______________________________________________________________________________

The following table is to be added to the Appendix, and it shows which transactions are required
to be supported by the actors in the Enterprise Schedule Integration profile.
Table A.2-5 Enterprise Schedule Integration

ActorsTransactions

Optionality Section in
Vol. 2OP

Create Radiotherapy Parent Order

R

RO-ESI-01

Create Radiotherapy Delivery Child
Order

R

RO-ESI-02

Modify Radiotherapy Delivery Child
Order

R

RO-ESI-03

Cancel Radiotherapy Delivery Child
Order

R

RO-ESI-04

Update Radiotherapy Delivery Child
Order Status

R

RO-ESI-05

Update Radiotherapy Parent Order
StatusR

RO-ESI-06

Cancel Radiotherapy Parent Order

R

RO-ESI-07

Unsolicited Create Parent Order

R

RO-ESI-08

Unsolicited Cancel Parent Order

R

RO-ESI-09

Create Radiotherapy Parent Order

R

RO-ESI-01

Create Radiotherapy Delivery Child
Order

R

RO-ESI-02

Modify Radiotherapy Delivery Child
Order

R

RO-ESI-03

Cancel Radiotherapy Delivery Child
Order

R

RO-ESI-04

Update Radiotherapy Delivery Child
Order Status

R

RO-ESI-05

Update Radiotherapy Parent Order
StatusR

RO-ESI-06

DRAFT
Treatment
Management
System___________________________________________________________________
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Copyright ©2006- 2009: ASTRO, AAPM, RSNA, HIMSSCancel Radiotherapy Parent Order

R

RO-ESI-07

Unsolicited Create Parent Order

R

RO-ESI-08

Unsolicited Cancel Parent Order

R

RO-ESI-09

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IHE-RO Technical Framework V3.0: Draft for Trial Implementation________________________________________________________________________

Appendix B
B.1

Transactions

Transaction Descriptions

Transactions are interactions between actors that transfer the required information
through standards-based messages. The following are the transactions defined in this
supplement and referenced throughout the rest of this document. <The transactions
contain the identifer ESI to avoid numbering clashes, however, when inserted in to theTechnical Framework, the transactions will be renumbered to align with the Technical
Framework at that time. The Transactions will be referred to by name rather than number
throughout the document to avoid confusion>

RO-ESI-01: Create Radiotherapy Parent Order
The top level request for a patient to receive radiation therapy. Thisorder is issued typically in response to a request by a referring
physician (that request is out of the scope of this profile). In Japan,
the Radiation Oncologist is the User who interacts with the OP togenerate the Radiotherapy Parent Order.

DRAFT

RO-ESI-02: Create Radiotherapy Delivery Child OrderRadiotherapy delivery is provided in individual fractions, each ofwhich is scheduled for a particular date. The TMS creates afractionation schedule, and for each fraction issues a Radiotherapy
Delivery Child Order.
RO-ESI-03: Modify Radiotherapy Delivery Child Order
When an individual Radiotherapy Delivery Child Order must bechanged (e.g. rescheduled for the next day), the order is modified.
RO-ESI-04: Cancel Radiotherapy Delivery Child OrderIn various circumstances a fraction must be cancelled. These
circumstances may include a decision to terminate radiotherapy for___________________________________________________________________
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the patient, or a decision to make a significant change to the courseof therapy.
RO-ESI-05: Update Radiotherapy Delivery Child Order Status
When a fraction is delivered, the status of the child order changes tocomplete, and the OP must be notified of this by the TMS.
RO-ESI-06: Update Radiotherapy Parent Order Status
When all of the fractions corresponding to a Radiotherapy Parent
order have been completed, the status of the Parent Order is updated.
RO-ESI-07: Cancel Radiotherapy Parent Order
When a decision is made to discontinue a Radiotherapy Parent Order,
the OP cancels the order and notifies the TMS using this transaction.
RO-ESI-08: Unsolicited Create Radiotherapy Parent Order
Similar to the “Create Radiotherapy Parent Order”, but with the roles
reversed between actors in terms of creator and consumer of themessage.
RO-ESI-09: Unsolicited Cancel Radiotherapy Parent Order
Similar to the “Cancel Radiotherapy Parent Order”, but with the roles
reversed between actors in terms of creator and consumer of themessage.

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IHE-RO Technical Framework V3.0: Draft for Trial Implementation________________________________________________________________________
The following table (Table B.1-1) shows which transactions are used in which
Integration Profiles.
<This corresponding table in the IHE-RO TF is to be modified to include all of thetransactions in this supplement which are all part of Enterprise Schedule Integration
profile, and these transactions are not used in any other profile. The profile defined inthis supplement does not utilize any transactions other than the ones defined in this
supplement>

Table B.1-1 IHE-RO Profile Transactions

DRAFT___________________________________________________________________
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Copyright ©2006- 2009: ASTRO, AAPM, RSNA, HIMSSAppendix C

Glossary28