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BACKGROUND: The structure of radiation oncology in designated cancer care hospitals in Japan was surveyed in terms of equipment, personnel, patient load, and geographic distribution, and compared with the structure in other radiotherapy facilities and the previous survey. METHODS: The Japanese Society for Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2009. The structures of 365 designated cancer care hospitals and 335 other radiotherapy facilities were compared. RESULTS: Designated cancer care hospitals accounted for 50.0 % of all the radiotherapy facilities in Japan. The patterns of equipment and personnel in designated cancer care hospitals and the other radiotherapy facilities were, respectively, as follows: linear accelerators per facility: 1.4 and 1.0; dual-energy function: 78.6 and 61.3 %; three-dimensional conformal radiotherapy function: 88.5 and 70.0 %; intensity-modulated radiotherapy function: 51.6 and 25.3 %; annual number of patients per linear accelerator: 301.3 and 185.2; Ir-192 remote-controlled after-loading systems: 31.8 and 4.2 %; and average number of full-time equivalent radiation oncologists per facility: 1.8 and 0.8. Compared with the previous survey, the ownership ratio of equipment and personnel improved in both designated cancer care hospitals and the other radiotherapy facilities. Annual patient loads per full-time equivalent radiation oncologist in the designated cancer care hospitals and the other radiotherapy facilities were 225.5 and 247.6, respectively. These values exceeded the standard guidelines level of 200. CONCLUSIONS: The structure of radiation oncology in designated Japanese cancer care hospitals was more mature than that in the other radiotherapy facilities. There is still a shortage of personnel. The serious understaffing problem in radiation oncology should be corrected in the future.

The ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution was evaluated in order to radiation identify and improve any deficiencies. A questionnaire-based national structure survey was conducted from March 2010 to January 2011 by the Japanese Society for Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study (PCS). The total numbers of new cancer patients and total of cancer patients (new and repeat) treated with radiation in 2009 were estimated at 201,000 and 240,000, respectively. The type and numbers of systems in actual use consisted of Linac (816), telecobalt (9), Gamma Knife (46), (60)Co remote afterloading system (RALS) (29) and (192)Ir RALS systems (130). The Linac systems used dual energy function for 586 (71.8%), 3DCRT for 663 (81.3%) and IMRT for 337 units (41.3%). There were 529 JASTRO-certified radiation oncologists (ROs), 939.4 full-time equivalent (FTE) ROs, 113.1 FTE medical physicists and 1836 FTE radiation therapists. The frequency of interstitial radiation therapy use for prostate and of intensity-modulated radiotherapy increased significantly. PCS stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more radiation therapy tended to be used for cancer patients. In conclusion, the Japanese structure has clearly improved during the past 19 years in terms of equipment and its use, although a shortage of manpower and variations in maturity disclosed by PCS stratification remained problematic in 2009.

PURPOSE: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. METHODS AND MATERIALS: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). RESULTS: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). CONCLUSIONS: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.

A novel microfabrication method for heteroepitaxial diamond was developed. Substrates used in present work were heteroepitaxial Ir(001) films deposited on MgO(001) by sputtering method. The Ir surfaces were treated with ion irradiation of CH 4 /H 2 gas by dc discharge using planar diode. Resist masks were patterned on the ion irradiated Ir surface by electron-beam lithography. The mask patterned Ir surface was etched by Ar ion to remove the irradiated surface at non-patterned area using an ion beam etching system. Then, diamond was grown on the substrate by dc plasma CVD method. As a result, we have successfully fabricated the heteroepitaxial diamond on the patterned areas of the substrate in submicron scale.

We have developed a novel microfabrication method by combining a microwave plasma treatment with a reactive ion etching (RIE) method. First, the RIE system was used for fabricating whiskers of single crystalline diamond. Then, the whiskers were exposed to microwave plasma of hydrogen gas. As a result, we have successfully fabricated a nano-scale diamond rod of the single crystal, which has the crystalline facets. The sizes of the ‘nano-rods’ were 50–200 nm in thickness and several microns in height. Morphology of the nano-rods could be controlled by changing the crystal orientation of the diamond substrate.

Backgrounds: In Japan, we have experienced the particle therapy for more than 30 years. The Japan Clinical Study Group of Particle Therapy (JCPT) studied the achievements of the Japanese particle therapy from 2002 to 2014. The JCPT member consisted of the twelve particle therapy institutions; (1) Southern Tohoku Proton Therapy Center, (2) Proton Medical Research Center, University of Tsukuba, (3) Gunma University Heavy Ion Medical Center (4) Division of Radiation Oncology and Particle therapy, National Cancer Center Hospital East, (5) Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, (6) Proton Therapy Division, Shizuoka Cancer Center Hospital, (7) The Wakasa Wan Energy Research Center, (8) Fukui prefectural Hospital Proton Therapy Center, (9) Nagoya Proton Therapy Center, Nagoya City West Medical Center, (10) Hyogo Ion Beam Medical center, (11) Ion Beam Therapy Center, SAGA HIMAT Foundation and (12) Medipolis Proton Therapy and Research Center. Our study group covered the all Japanese particle therapy institutions. The aim of this paper is to develop the clinical database concerning with Japanese particle therapy and to evaluate the feasibility of particle therapy case database. \nMethods: The JCPT office gathered each institution’s annual report and analyzed the number of treatments. Malignant primary tumors were classified into CNS, head and neck, lung, upper digestive organ, liver, pancreas, gynecological organ, prostate, bone and soft tissue, rectum and other or unclassified organs. Particle therapy was divided into a proton therapy and a carbon ion therapy. At 2012 we decided that we should develop the clinical particle therapy database for more precise analysis. We prepared the hardware and software of the clinical database. Participating institutions send records of cases after anonymization (Fig. 1). JCPT office handled each data in secure and safety environment. The office prepared a suitable conversion method from each hospital format to standard format. \nResults: The number of particle therapy treatment from 1979 to 2012 reached 21,506. Numbers of patients treated by proton and carbon ion are 12,150 and 9,356 showed in Fig.2. We defined the schema of database. This schema consists of (1) patient informations including primary lesion, stage, performance status, treatment purpose and (2) follow-up information including primary effect, recurrence and secondary effect. Many institutions cannot adapt to this schema of database. Some hospital database systems do not contain the suitable fields corresponding to the JCPT database fields. We found that the collecting method from a proprietary database to the common database needs more consideration. \nConclusions: We reported the activity of Japanese particle therapy for more than 30 years. Moreover we think that the analysis of the particle therapy is very important for the radiation oncology. We will be able to realize the desirable co-operation between the JCPT hospitals and establish the Japanese clinical database related to the proton and carbon ion therapy., PTCOG53rd(Annual Conference of the Particle Therapy Co-Operative Group)においてポスター発表を行う

Objectives: FBP is a standard method for quantitative analysis in human neuroreceptor binding assay, while OS-EM is used widely in tumor PET imaging. Owing to noise propagation from projection data, especially at high subset number, OS-EM leads to loss of signal to noise (SNR) and quantitative accuracy. A novel reconstruction algorithm DRAMA can suppress the noise propagation by using dynamic relaxation parameter with faster convergence compared to OSEM algorithm. In this study, we compared regional radioactivity concentrations and binding potential (BP) values between FBP, OS-EM and DRAMA to assess the effect of DRAMA algorithm on estimating human nuroreceptor binding. Methods: The PET scanning was carried out with Eminence Sophia(shimadzu corp.) . After 4min pre-injection transmission scan, [11C] FLB457, 90min dynamic PET scans were performed with 3D acquisition mode. To compare reconstruction parameter, a phantom scan was done with same scan protocol. Images were reconstructed with FBP, OSEM and DRAMA to assess quantitative accuracy and noise characteristics. Results: To evaluate the SNR, we performed the image quality tests along with NEMA NU-2 2007. Noise of DRAMA was 7% lower than that of FBP. On the other hands, Q10/N10 number of DRAMA was 5.3% higher than that of FBP,similarly, it is 3.5% higher than that of OS-EM. In patient study, the difference of BP by OSEM with iteration 4, subset 16 compared to FBP was+3.17% at maximum in the caudate, while that of DRAMA was +1.59%. Conclusions:There were no significant differences of BP values in thalamus,frontal cortex, temporal cortex and occipital cortex between DRAMA and FBP. Furthermore, noise propagation was not shown in DRAMA in phantom studies. These results indicated that DRAMA could provide similar performance of FBP with the improved SNR, therefore, DRAMA can be a novel standard reconstruction method of neuroreceptor PET studies., EANM'13 - Annual Congress of the European Association of Nuclear Medicine

Objective Various parameters are used for measuring tumor glucose metabolic activity with 18F-FDG PET including measuring the single maximum pixel value within the slice with highest radioactivity concentration (SUVmax) or placing a fixed ROI in the area of the tumor with the highest level of 18F-FDG uptake (SUVpeak), which it defines as the largest possible mean value of a spherical VOI with radius 10 mm positioned within a tumor (SUVpeak10). It is said that the amount of tumor stroma correlates with prognosis of patients with cancer. We estimated the amount of tumor stroma with 18F-FDG-PET using SUVmax and SUVpeak10, and evaluated the prediction performance of the amount of tumor stroma with 18F-FDG-PET after surgery of pancreatic cancer. Methods Sixteen pre-surgery patients with either proven or suspected primary pancreatic cancer underwent 18F-FDG-PET/CT. The pathologically confirmation found out 13 malignancy in all cases. According to pathological findings, the stroma of tumors were quantitatively classified in 3 types (Scirrhous type: abundant stroma, Intermediate type: a type intermediate between the scirrhous type and the medullary type, and Medullary type: scanty stroma). We evaluated the correlation between the amount of tumor stroma and each 3 indexes, SUVmax, SUVpeak10 and SUVstroma. SUVstroma was calculated by the following equation: SUVstroma =1- [SUVpeak10] / [SUVmax] 18F-FDG accumulates in tumor cells but does not accumulate so much in stromal cells. The tumor with abundant stroma might be low SUVpeak10, so SUVstroma might be high. Because the tumor cell avidly accumulates 18F-FDG but stroma does not so much. Each 3 indexes of SUV (SUVmax, SUVpeak10 and SUVstroma) were statistically compared with 3 types of stroma classification using the Mann-Whitney's U test. The overall survival (OS) was calculated using Kaplan-Meier method by SUVs found statistically-significant with Mann-Whitney's U test. Results There was no patient with Medullary type in our cases. Statistically-significant difference was observed between Scirrhous type and Intermediate type in SUVstroma (p0.3 had markedly lower OS rate than those with SUVstroma, EANM'13 - Annual Congress of the European Association of Nuclear Medicine

The Patient Location Tracking Query (PLQ) is the IHE integration profile in order to find the location of patient only in a hospital, not for cross-referencing between multiple hospitals. In Japan, it is common for elderly patients to consult multiple departments in one hospital visit. To find the location of patients quickly is very important for productivity and use of resources in a hospital. We analyzed the workflow of patients and defined three actors and two transactions for PLQ integration profile. In order to collect the location of patients, multiple systems must provide the location into central management system. We proposed PLQ for the better patient care in hospitals. We believe that by using this PLQ profile hospital staffs are able to utilize the resource more efficiently., １４ｔｈ World Congress on Medical and Health Informatics

Our hospital started the charged particle therapy since 1996. New institutions for charged particle therapy are planned in the world. Our hospital are accepting many visitors from those newly planned medical institutions and having many opportunities to provide with the training to them. Based upon our experiences, we have developed the radiation oncology teaching files system for charged particle therapy. We adopted the PowerPoint of Microsoft as a basic framework of our teaching files system. By using our export function of the viewer any physician can create teaching files easily and effectively. Now our teaching file system has 33 cases for clinical and physics contents. We expect that we can improve the safety and accuracy of charged particle therapy by using our teaching files system substantially., MEDINFO2013

This paper describes the mechanical properties of an inorganic oil absorbent hardener which absorbs a part of asphalt in asphalt paving mixtures at high temperature. The inorganic oil absorbent hardener improves the plastic flow resistance of asphalt paving mixtures without lowering workability and crack-resistance.

アスファルト混合物中のアスファルトの一部を吸油材によって吸収させることによって, 混合物の施工性やひび割れ抵抗性を低下させることなく耐流動性を高める工法について研究した. 本文は, 工法のねらい, そのための吸油材の目標性状, 吸油材の原材料の選定理由と製造方法, 吸油材の物理的性質, アスファルト混合物への吸油材の適正添加率, および混合物への添加による耐流動性改善効果, その他の性質に及ぼす影響について検討した結果を述べたものである.

91例の登録されたstage Aの前立腺癌のうちstage A1 33例, stage A2 47例計80例について統計的観察を行った. 1)Stage A1のPSAの陽性率は18.5%, A2では53.8%であった. 2)進行した例はA1で1例3.0%, A2で2例4.3%であった.癌死例はA1症例ではなく, A2症例で1例認めた.前立腺全摘術はA2症例の5例(10.6%)に行われた. 3)5年生存率はA1では97.0%, A2では88.6%であり, 両者に有意差はなかった. 4)Stage A症例中でPSAが異常値を示した症例のTNN分類によるT1cに相当する症例はA1で4例, A2で21例あった, In 39 hospitals in the Tokai region of Japan, 815 cases with prostatic cancer were registered between 1988 and 1991, 91 of which (13.3%) were diagnosed as stage A. Eighty cases of stage A cancer were subclassified into stage A1 (33 cases) or stage A2 (47 cases). A detailed investigation was performed on these 80 subclassified cases with respect to tumor markers, treatment methods and prognosis. The tumor marker, prostate specific antigen (PSA) was positive in 18.5% of the A1 cases and 53.8% of the A2 cases. Endocrine therapy was administered in 45.5% of the A1 and 78.7% of the A2 cases. There was 1 (3.0%) case of progression in the stage A1 group, and 2 cases in stage A2 group. The 5-year survival rate was 97.0% for stage A1 and 88.6% for stage A2. The prognosis of prostatic cancer in stage A was fairly good in both the A1 and A2 subclasses in our series.

Objective FDG-PET provides quantitative information regarding the tumor glucose metabolism which is useful for the clinical diagnosis of tumor diseases. It is said that the amount of tumor stroma correlates with prognosis of patients with cancer. FDG accumulates in cancer cells but does not accumulate so much in stroma tissues. So cancer tissue with abundant stroma might show relatively lower accumulation of FDG than that with scanty stroma. We estimated the amount of tumor stroma with FDG-PET (STRpet), and evaluated prognosis of patients using STRpet after surgery of pancreatic cancer. Methods Sixteen pre-surgery patients with either proven or suspected primary pancreatic cancer underwent FDG- PET/CT. The pathologically confirmation found out 13 malignancy in all cases. The STRpet in tumor was evaluated for the 13 cases with the following equation: STRpet = [Mean value of spherical VOI of 10mm in radius with SUVmax in the center of it] / [SUVmax] The tumor with abundant stroma might be low STRpet, because the tumor cell accumulates FDG avidly but stroma does not so much. According to pathological findings, the stroma of tumors (STRpatho) were quantitatively classified in the following 3 types (Scirrhous type: abundant stroma, Intermediate type: a type intermediate between the scirrhous type and the medullary type, and Medullary type: scanty stroma). The STRpet were statistically compared with STRpatho using the Mann-Whitney's U test. The 1-year disease- free survival (DFS) and overall survival (OS) for STRPEt and STRpatho were calculated using Kaplan-Meier method. Results There is no patient with Medullary type in our cases. Statistically-significant difference was observed in STRpet between Scirrhous type and Intermediate type (p, Annual Congress of the European Association of Nuclear Medicine

1.Purpose/Objectives National Institute of Radiological Sciences (NIRS) is a hospital which specialized in radiotherapy and is located at Chiba in Japan. NIRS started charged particle therapy since in 1994 and treated over 6,500 cases up to March 2012. We have managed and operated multiple systems such as the Electronic Medical Record system / Computerized Physician Order Entry system (EMR/CPOE), the radiology information system(RIS), clinical database system, the Picture Archiving and Communication System (PACS) and the charged particle therapy management system (TMS). The purpose to improve the interoperability, communicate function between the EMR/CPOE system, the radiology information system and the radiation oncology department system was implemented. 2.Materials/Methods To implement the cooperation between the EMR/CPOE system and the charged particle therapy management system , we have adopted the ESI(Enterprise Schedule workflow) integration profile which is proposed by Radiation Oncology Domain of the IHE. We have deployed Order Placer(OP) Actor of ESI to the EMR/CPOE system and Treatment Management System(TMS) Actor to the charged particle therapy management system. As a method of communication between systems, we adopted the nine transactions necessary for the workflow of our hospital. Since the treatment planning CT device and creating fixture operation are under the control of the radiology department information system, those order informations published by TMS would be in process of notification and the radiology department information system notify the performed information to TMS was necessary. 3.Results We are referring to the SWF (Scheduled Workflow) integration profile which is proposed by the Radiation Domain of the IHE, and we have implemented its functions. We have selected the route via the EMR/CPOE system to work the CT order information from radiology department information system (RIS)/TMS to TMS/ radiology department information system (RIS) .We used HL7 message for communication between these systems. 4.Conclusions We are able to implement a system with the EMR/CPOE system and charged particle therapy management system by the standards. There is a merit of this method even if these systems such as the EMR/CPOE system or charged particle therapy management system or manufactures are updated, it keeps interoperability. We desire this implementation would be collected as extended function of ESI which IHE-RO has been proposed., ASTRO2012

Purpose Image reconstruction for most nuro-transmission PET scan data is performed by FBP because of a positive bias caused by the noise propagation in OS-EM algorithm. A positive bias affects the estimation of binding potential (BP) calculated from radioactive concentrations of reference regions and target region in nuroreceptor binding assay. To suppress the noise propagation in OS-EM algorithm, the hybrid wavelet shrinkage (HWS) filter is developed. In this study, we performed the phantom study to evaluate the effect of HWS filter on noise propagation in OS-EM algorithm. \nMaterials and Methods Phantom studies are performed by SET-3000GCT/X (shimadzu corp). To evaluate the effect of the HWS filter, we planned the some phantom study. IEC body phantom filled with 18F (activity concentration ratios relative to background of 4:1) are used for evaluation of image quality. A pool phantom filled with 18F (11.4kBq/ml) is scanned by dynamic scan mode for evaluation the quantification of PET image. Prior to emission scans, a transmission scan (6min) for attenuation correction with a 137Cs point source with a BGO transmission detector ring coaxially attached to the GSO emission detector ring. Reconstruction parameters of PET images are follows; FBP with Gaussian filter 5.0mm, OS-EM, OS-EM with HWS filter (OS-EMw). Iteration numbers in OS-EM algorithm are varied from 1 to 100 to evaluate the noise propagation. \nResults In pool phantom study, a positive bias at low count rate is shown in PET images reconstructed by OS-EM algorithm, while any biases are not shown in images reconstructed by FBP and OS-EMw algorithm. The N10 values are diverged due to noise propagation in OS-EM algorithm while N10 values calculated from PET image reconstructed by OS-EMw algorithm are convergence at the point of 10 iterations in IEC body phantom study. Similarly, the Q10 values are diverged depends on iteration number in OS-EM algorithm while that of OS-EMw has fast convergence. Furthermore, these results indicate that OS-EMw has the fast convergence of pixel number and suppress the noise propagation. \nConclusion According to our study, OS-EMw has fast convergence and suppresses the noise propagation in OS-EM algorithm. These results show that HWS filter can be a standard de-noising method for nuro-recptor PET imaging with OS-EM algorithm., Annual Congress of the European Association of Nuclear Medicine

In Japan, we have experienced the particle therapy for more than 30 years. The Japan Clinical Study Group of Particle Therapy (JCPT) studied the achievements of the Japanese particle therapy from 1979 to 2011. The study group covered the all particle therapy institutions. The aim of the paper is to disclose the status of Japanese particle therapy and to analyze the change of the number of the therapy. The number of particle therapy treatment from 1979 to 2011 reached 18,269. Each annual number of particle therapy was 520 (244 proton:p, 276 carbon:c) in 2002, 794 (474 p, 320 c) in 2003, 1082 (699 p, 383 c) in 2004, 1276 (803 p, 473 c) in 2005, 1453 (827 p, 626 c) in 2006, 1712 (923 p, 789 c) in 2007, 1712 (781 p, 931 c) in 2008, 2233 (1278 p, 955 c) in 2009, 2469 (1421p, 1048c) in 2010 and 2884 (1757p, 1127c) in 2011. The number of patients according to the primary lesion ranged 452 (347 p, 105 c) for CNS tumors, 2568 (1419 p, 1149 c) for Head and Neck tumors, 2093 (1172 p, 921 c) for lung tumors, 613 (524 p, 89 c) for upper digestive organ tumors, 2833 (2012 p, 821 c) for liver tumors, 519 (328 p, 191 c) for pancreas tumors, 305 (113 p, 192 c) for gynecological tumors, 4689 (3013 p, 1676 c) for prostate tumors, 1313 (311 p, 1002 c) for bone and soft tissue tumors, 483 (142 p, 341 c) for recurrent rectal tumors and 2386 (793 p, 1593 c) for other or unclassified tumors. The major target was a prostate cancer. This paper reports the activity of Japanese particle therapy for 33 years. We think that the analysis of the particle therapy is very important for the radiation oncology. We will be able to realize the desirable co-operation between the JCPT hospitals and establish the Japanese database concerned with the proton and carbon ion therapy., ASTRO's 54th Annual Meeting

[Purpose] Our hospital started the charged particle therapy since 1996, after the world's first development of Heavy Ion Medical Accelerator in Chiba (HIMAC). We have been obtaining the many clinical results, and the number of patients has exceeded 6,100 cases by December 2011. At the same time, we recognize another mission of us. We should promote the spread of medical knowledge, increasing standardization of radiation treatments and education of the professionals in conjunction with the charged particle therapy, which we have been experiencing. Recently the constructions of new institutions for charged particle therapy are in their courses, not only in Japan, as well as all over the world. Our hospital are accepting many visitors as medical doctors, radiologists, and physicists from those newly planned medical institutions worldwide and having many opportunities to provide with the training to them, for instance, regarding radiation therapy planning. Based upon our experiences, we have developed the prototype of the radiation oncology teaching files system for charged particle therapy. \n[Methods] We adopted the PowerPoint of Microsoft as a basic framework of our teaching files system. The teaching physicians who are in charge of the selection and produce of the contents of the teaching files are familiar with the PowerPoint through daily usages for the conference and/or the clinical report. These physicians are able to edit and prepare the following information in PowerPoint by themselves. Clinical history, stage and condition of the disease, treatment plan, dose distribution, follow-up information, effect/side-effect of the radiation therapy, the assessment of the treatment and key images are prepared. The method of image viewing is as follows. When users clicks the key images on PowerPoint, a "control file'', containing index information linked to the DICOM images is called internally. The DICOM image viewer (produced by TechMatrix Corporation), which is related to the "control file'', starts up and automatically load and show the images based upon index information described in the "control file''. At the same time, the image layout, annotation and presentation state are recorded into the "control file'' as well, which creators originally intended to show. Being the initial view evoked as a starting point, users can access to the all DICOM images of studies by normal operation like paging and window level manipulation. It was used to be needed for experts to insert the execution command of viewer and file path information to the related DICOM files into each PowerPoint page. After the version-up of the viewer system, the process to define the relationship between PowerPoint and contents DICOM files has become much easier as follows; Step1) Contents creators just layout images in the viewer, Step2) Just click the contents export icon. Only those operations in the viewer can export "control file'' which contains information about image files and layout. At the same time, the viewer creates new PowerPoint file, in which key image is attached automatically, keeping the link with the image files exported above. [Results] We have made 11 cases for teaching files contents along with the following organs group, (1) head and neck, (2) skull base, (3) lung (2 cases), (4) liver, (5) musculoskeletal (sarcoma and sacral chordoma), (6) prostate, (7) kidney and (8) rectum (2 cases). All patients' privacy information is eliminated in the process of production of teaching files. Even DICOM tags containing privacy information (patient name, disease entity and institution name etc.) are automatically replaced with unique code in this system. Users can select their interest disease from the menu, and easily review the images and explanation of each case. We have succeeded to decrease the contents production time and effort since teaching staff can select case images and attach them into a PowerPoint file by themselves. Before the system installation, each content production time ranged from 3 to 6 hours. After the introduction of this mechanism, we can finish creating control file in 15 to 30 minutes. \n[Conclusion] We have developed the teaching files system that enablers easy editing and anonymization. By using our export function of the viewer any physician can create teaching files easily and effectively. We are now adding new cases into our teaching files which we have applied charged particle therapy and showing the points to notice through the process of radiation therapies. We expect that we can improve the safety and accuracy of charged particle therapy by using our teaching files system substantially., CARS2012

Purpose: National Institute of Radiological Sciences (NIRS) is a hospital located in Chiba and a single radiation department which has 100 beds and 200 outpatients daily. The diagnosis specialized in the radiation/particle therapy. In 1961, radiation therapy by X rays was begun at NIRS. In addition, charged particle therapy (carbon ion) was begun in 1994, and over 6,500 examples were treated by January, 2012. We have multiple systems such as electronic medical Record systems (EMR), radiology information systems (RIS), laboratory information system (LIS), Picture Archiving and Communication system (PACS), and charged particle therapy treatment management system (TMS). Each system cooperates in a patient demographics information and order information which ordered by CPOE system and realizes a normal use work flow. Our electric medical system and charged particle therapy treatment management system will be updated in March, 2012. We aim to improve interoperability; we report management system that provides linkage between the charged particle therapy treatment management system and electronic medical records system. Methods: To develop this mechanism, we adopted the ESI (Enterprise Schedule workflow) integration profile which proposed by radiation oncology domain of IHE. IHE (Integrating the Healthcare Enterprise) is the international project. IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical need in support of optimal patient care. Enterprise Schedule Integration Profile involves the exchange of Schedule, Order, and Results information between Electrical Medical systems and Radiation Oncology treatment management systems. ESI integration profile has 2 actors as follows: 1) Order Placer (OP), 2) Treatment Management System (TMS). Results: As a communication procedure between two systems, We adopted nine transactions as follows: 1)Create Radiotherapy Parent Order, 2) Create Radiotherapy Delivery Child Order, 3) Modify Radiotherapy Delivery Child Order, 4)Cancel Radiotherapy Delivery Child Order, 5)Update Radiotherapy Delivery Child Order Status, 6)Update Radiotherapy Parent Order Status, 7) Cancel Radiotherapy Parent Order, 8) Unsolicited Create Radiotherapy Parent Order, 9)Unsolicited Cancel Radiotherapy Parent Order. And we developed a new transaction that notifies Radiology Information system of CT order information via electric medical record system from particle therapy treatment management system. Conclusion: We have built the system which cooperated with the EMR and TMS by a standard method. There is merit in what compatibility can keep when either of an EMR and TMS is updated in the future., ESTRO31