This presentation shows that for a Radiation oncologist who is doing 3DCRT and IMRT at their center with mouse, they can reduce their contouring time with help of pen tablets easily and more effectively .This is first study in India about comparison of mouse with pen tablet. The Cost of this pen tablet is Rs 4000 to 6000 only. This can be easily purchased at anywhere. ... When surgeons want to reduce their operative time why cant a radiation oncologist can reduce his contouring time by using pen tablet in place of mouse.
This presentation was made at AROICON 2012 at Kolkata on 30th Nov 2012, abstract is published in 3rd supplementary issue of JCRT Nov 2012. In Proferred Oral Paper Category in Hall C awarded first Prize.
About my center
My center has started in Jan 2011. in last two years we have treated more than 600 patients so far. With more then 120 Patients for IMRT. Since last 300 patients we are treating everyone through 3DCRT and IMRT only . hence by this our centre is one of very few center in India where all radiotherapy practice is done through 3DCRT and IMRT. Radiation oncologist makes all the contouring and medical physicist are planning on contouring. That,s why this concept of pen tablet was given to me for making me efficient in contouring and to relief me from pain in wrist joint,
Its my request to all radiation oncologist of India to kindly one time use this device for their contouring hours and see that pen based input device are far better then mouse.
DR Surendra Singh Solanki MD
Consultant, Radiation Oncologist
BA Smt L C Parikh Cancer Centre
Navsari, Gujarat.
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Pen tablet vs mouse for Contouring OAR and targets
1. Presenter & Main Author - Dr. Surendra Singh Solanki1 MD
Co- Authors - M. Loganathan,2 R. Swathika,2
1Radiation Oncologist, 2Medical Physicists,
“BA” Smt. Lilaben Chimanlal Parikh Cancer Centre,
Navsari, Gujarat, India
Date of presentation- 30Nov 2012-Kolkata
AROICON 2012- Kolkata 1
7. Aim of the Study
In the era of sophisticated treatment planning, all radiation
oncologists have to spend much of their time with
treatment planning systems to contour the targets and
organ at risks.
Most common used device for human computer interface is
mouse (Mo).
To replace mouse a new device is available in the market
known as Pen Tablet (PT) from Wacom or i-ball.
This study was done to find out the effectiveness of these
devices on a TPS for volume and Time taken for
contouring.
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8. Material and Methods
10 patients original CT scans in the Eclipse Treatment
Planning System (version 8.9) at our centre were
selected on which IMRT treatment was already
delivered in this year.
All CT scans do have 3 mm inter-slice distance.
A total of five organs were contoured separately with
both devices on each CT scan.
Organs were Eyes (left and right), Optic Nerves (left
and right) and Brain Stem.
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9. Material and Methods.
Time was calculated with stop watch for contouring all
five organs in one CT scan by both devices.
Volumes of organs were measured on TPS and
compared between both devices.
During contouring of Organ by right hand through
Mouse, the middle figure was using the central scroll
of mouse to move CT slices up and down and while
contouring with pen Tablet by right hand, left hand
was using mouse scroll button for up and down
movements.
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16. Results
The average volumes of Organs were as follows.
Brainstem (Mo-24.29 cc: PT-23.29cc), Optic Nerve Left
(Mo-0.46 cc: PT-0.53 cc), Optic Nerve Right (Mo-0.51
cc: PT-0.53 cc), Eye Left (Mo-9.55 cc: PT-9.56 cc), Eye
Right (Mo-9.65 cc: PT-9.36 cc).
Average time taken for contouring of all five organs by
mouse in ten CT scans was 4 min 50 seconds (290 + 35
seconds) while time taken by Pen Tablet was 2 min 25
seconds (154 + 12 seconds).
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17. Results
The total time spent by contouring of all CT scan by
mouse was 48 min 24 seconds and by PT was 25 min
42 seconds.
Hence the total time gain for these small volumes was
22 min 42 seconds.
17
18. Conclusion
The volumes of organs contoured by both devices are
nearly similar.
The smoothness in contouring is far superior in pen
tablet as compared to mouse.
The time utilization is better with Pen tablet as shown
by this study which is nearly half as compared to
mouse.
Pen Tablet can be used in contouring for effectively
utilizing the limited time available with radiation
oncologist during treatment planning in any busy
centre.
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19. Practical Working of mouse Vs pen
tablet
Discussion of difference.
Basic working- Ergonomics
Mouse – point –line -point fashion
Pen tablet –point-point constant working
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20. Take home message
Pen tablet effectively uses limited time with more
smoothness.
2 Dimensional EBRT 3D Conformal EBRT
2D Pic -Curtsey- Prof. Dr O. P Singh, GMC Bhopal. 20
21. Future of Radiation Contouring
Curtsey -Dr Martin Fuss MD , Oregon Health & Science University , Portland, USA.
And Wacom Cintiq 21
22. My Pen Tablet- from i-Ball.
My Pen tablet
> 300 patients are treated with help of contouring done by this pen tablet.
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23. My Personal Experience
1. With mouse Contouring targets + OAR –Slice
by Slice- 4 to 6 hours.
2. With pen tablet Contouring targets + OAR –
Slice by Slice- 2 to 3 hours
3. With pen tablet Contouring Target + OAR- 2th
or 3rd slice contouring and interpolation then=
45 minutes to 1.5 hours.
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24. Treated > 600 patients in two years
Established since Jan 2011 24
Hinweis der Redaktion
Right now I am utilising mouse and pen tablet simultaneously for this presentation
The developments in computer science have given Radiation oncologists a platform to evolve themselves from 2Dimentional Radiation practice to three dimensional Conformal radiotherapy.The whole interaction between radiation oncologist and treatment planning system is done through one human computer interface known as mouse.
Dictionary meaning of contouring is to outline the organ, or structure For a Radiation oncologist this is most important step in the planning process other then clinical planning on x ray or ct simulator.. This process is well executed with help of mouse on TPS by contouring slice by slice and combining all contours will give 3D view.
But there are certain drawbacks of excess utilization of mouse. It can give repetitive stress injury to index finger, wrist, arm and shoulder. I am sure those radiation oncologist in the audience who have tried to make their work fast with mouse must have experienced this sort of injury.
After understanding of ergonomics of human use, the technical enhancements in human computer interface have given many modifications in mouse. Pen tablet is one of them which is more ergonomically suited to human anatomy. This is mouse in form of pen which is mostly used for drawing on computers.
The Aim of this comparative study is to find effectiveness of mouse verses pen tablet by utilising volume and time as criteria.
At our centre we practice 3DCRT and IMRT for radiation therapy.We have selected ten patients IMRT CT scan with 3mm inter slice distance. We have chosen five organs both eyes, both optic nerves and brain stem as organs to be contoured by mouse and pen tablet separately slice by slice.
Time taken by both devices was calculated by stop watch. Volumes of all organs were found on TPS and compared.No of slices used for each organ was noted.
A structural template for mouse and pen tablet was made and introduced in context window in eclipse.This is contouring from mouse.
This slice shows contouring of pen tablet
And now slices shows fusion of mouse and pen tablet contours.
The tabulation of volumes. Head on comparison of volumes of respective organs are nearly similar. The Average volumes are also nearly similar.
But the time taken by both devices differ drastically. The mouse has taken 4 to 5 minutes for contouring all five organs where as pen tablet has taken 2 to 3 minutes only.The addition of time taken by both devices can clearly show that time utilizes by pen tablet(25 min 42 sec) is nearly half in comparison to mouse (48 min 24 sec.)
Tabulation of no of slices contoured per organ. The total slices contoured were 842.
This is the result of our study volumes are similar.
Timeutilised is better with pen tablet.
The conclusions- the volumes of organs contoured were nearly similar, smoothness is superior in pen tablet, I am explaining in next slide. and Time utilised is better with pen tablet which effectively uses limited time.
Let me explain practically with both devices.The contouring with mouse is done as deposition of points around a organ. And all these points are joined by a line. Where as contouring with pen tablet is deposition of points along with direction pen tablet movement. That’s why the smoothness is contouring by pen tablet is superior to mouse.
Take home message : Pen tablet effectively uses limited time with more smoothness.We all radiation oncologist have evolved from outer skin marking in 2D era to internal organ contouring 3D through mouse. this transformation from 2D to 3D has taken much of our time in contouring. Its my humble request to all radiation oncologist of India to kindly use pen tablet or similar device in future to effectively utilize your limited time.
In future we will be able to contour directly on the Computer screen with help pen based input device.
This is my pen tablet from I ball. Because of it, We are able to completed full contouring of > 300 patients at our centre.
Thanks a lot from me and my whole radiation therapy team at BaSmt LC Parikh cancer centre Navsari Gujarat.