1. ProKnow
  2. Patient Module
  3. Primary Submodules (Left Tabs)

Patient — Browse

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Kyle Burnett
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The patient browse tab is useful for managing the patient object hierarchy. You can perform various actions on patient objects by entering edit mode and selecting them in the Browse tab.

Accessing the Patient Browse Tab

When you access a patient, the Browse tab will be activated by default. The majority of the screen is devoted to the patient viewer, where you can examine the active image set, structure set, and dose. On the left is the browse sidebar, which contains the hierarchy of patient objects. These objects can be activated by double-clicking the object you wish to activate. This operation will also activate all of the object's ancestors in the hierarchy. Eyeball icons are aligned to the right of the sidebar and can be used to toggle the visibility of entities.

In addition to allowing you to view, activate, and manage patient objects, the Browse tab also displays useful DICOM Alerts that have been identified by ProKnow DS. These DICOM Alerts are displayed as a blue information icon or an orange warning icon to the right of a particular object, as shown in the following screenshot:

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By moving your mouse over the associated DICOM Alert, you can inspect the details of the alert.

Updating the Patient Hierarchy

Note: You must have the Update Patients permission on a patient to update the patient hierarchy.

CAUTION: It is important to perform appropriate validation anytime you update the patient hierarchy to ensure that the new associations are valid.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.

  2. Use the object handles on the left of each row to drag an object and its children to the desired position in the hierarchy.

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  3. Drop the object(s) into place.

NOTE: ProKnow allows you to re-associate any object to any valid parent (i.e., structure set with any image set; plan with any structure set or image set; or dose with any plan, structure set, or image set). However, ProKnow will display an appropriate DICOM Alert if it detects any of the following situations: (1) if a parent and child object do not share the same DICOM Frame of Reference, (2) if a structure set is associated with a different image set than originally specified in DICOM, (3) if a plan is associated directly with an image set, (4) if a plan is associated with a different structure set than originally specified in DICOM, (5) if a dose is associated directly with an image set or structure set, or (6) if a dose entity is associated with a different plan than originally specified in DICOM.

Editing Labels

Note: You must have the Update Patients permission on a patient to edit patient object labels.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. If you wish to re-label several objects with the same name, select those objects by toggling the checkbox aligned to the right of the sidebar. Otherwise, check the object you wish to rename.
  3. In the Available Actions menu, choose the Edit Patient Object Labels... option, and enter a new label name for the selected object(s).
  4. Press the Save button to save your changes.

Object Label Defaults

  • For Image Sets and RT Dose, the default description is determined by the 'Series Description' (0008,103E) tag.
  • For Structure Sets, ProKnow looks first to the 'Structure Set Name' (3006,0004) tag, then the 'Structure Set Label' (3006,0002) tag, then the 'Series Description' (0008,103E) tag.
  • For RT Plans, ProKnow looks first to the 'RT Plan Name' (300A,0003) tag, then the 'RT Plan Label' (300A,0002) tag, then the 'Series Description' (0008,103E) tag.

Creating a Structure Set

Note: You must have the Update Patients permission on a patient to create a new structure set for the patient.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. Select a single image set on which you wish to create the structures.
  3. In the Available Actions menu, choose the Create Structure Set... option.
  4. Enter a Name for the new structure set.
  5. Select a Structure Set Template to initialize the structure set with the structures configured in the template, or leave as None to create an empty structure set.
  6. Press the Create button to create the structure set.

Running Auto-Segmentation

Note: You must have the Create Patient Tasks permission on a patient to create run auto-segmentation to create a new structure set using auto-segmentation for the patient. You must also have an Auto-Segmentation license to create a structure set using auto-segmentation.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. Select a single image set on which to run auto-segmentation.
  3. In the Available Actions menu, choose the Run Auto-Segmentation... option.
  4. Select the Algorithm from the list of algorithms configured for the workspace.
  5. Enter a Description for the new structure set.
  6. Optional: Select a structure set Template. When processing the auto-segmentation result, the system will apply a structure set template by comparing the structures in the result to the list of structures defined in the template. The system will initialize an empty structure for each structure defined in the template that does not exist in the auto-segmentation result, using the type and color specified in the template.
  7. Place a check mark next to the algorithm-defined structures that should be included in the result structure set.
  8. Remove a check mark next to the algorithm-defined structures that should not be included in the result structure set.
  9. Enter the Desired Structure Name for each structure. Use the undo button to revert the name back to the name defined by the algorithm.
  10. Choose the Color for each structure. Use the undo button to revert the color back to the color defined by the algorithm.
  11. Press Run to invoke the auto-segmentation algorithm.

Copying a Structure Set

Note: You must have the Create Patient Tasks permission on a patient to copy a structure set for the patient.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. Select a single structure set to copy.
  3. In the Available Actions menu, choose the Copy Structure Set... option.
  4. Enter a description for the new structure set.
  5. Press the Copy button to copy the structure set.

Merging Structure Sets

Note: You must have the Create Patient Tasks permission on a patient to merge structure sets for the patient.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. Select two or more structure sets in the same frame of reference to merge.
  3. In the Available Actions menu, choose the Merge Structure Set... option, and enter a name for the new structure set.
  4. If there is more than one parent image set from the selected structure sets, choose the Primary Image Set. This will become the parent object ob the merged structure set.
  5. Check the Delete after merge checkboxes for the structure sets you wish to delete once the merge operation is complete.
  6. Press the Merge button to create a merged structure set.

Note

  • A structure set cannot be selected for deletion after merge if it has child plan or dose objects.
  • Structure sets cannot be merged when one or more of the selected structure sets are not in the same frame of reference.

Creating a Plan

Note: You must have the Update Patients permission on a patient to create a plan for the patient.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. Select a single image set, structure set, or dose. If an image set or structure set is selected, the plan will be created under that image set or structure set. If a dose is selected, the plan will be created as the parent object of the selected dose. Plans may not be created from doses that already belong under a plan object.
  3. In the Available Actions menu, choose the Create Plan... option, and enter a name for the new plan.
  4. Press the Create button to create the plan.

NOTE: ProKnow allows you to create plan objects for the purpose of defining prescriptions, which can be useful when analyzing patients planned with different dose references. Please note that ProKnow does not provide any capabilities to design or simulate plans (i.e., it is not a Treatment Planning System). Additionally, plans created within ProKnow are not able to be exported as DICOM.

Composite Dose Objects

Note: You must have the Create Patient Tasks permission on a patient to create a composite dose for the patient.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. Select one or more dose objects to composite.
  3. In the Available Actions menu, choose the Composite Dose Objects... option, and enter a name for the new dose.
  4. The composite dose tree defaults to an "Add" operation with the each of the selected doses as operands. For more complex operations, use the following tools to change the dose tree according to your needs.
    1. Add a new dose or operation by selecting one from the Add dose or operation... select box.
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    2. Change a dose or operation by clicking on the name of the dose or operation and making a selection from the select box.
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    3. Delete a dose or operation by clicking on the trash icon for the dose or operation.
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    4. For doses or operations requiring an SRO, select an SRO from the select box.
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    5. For doses or operations, set a scale factor as a fraction.
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    6. Move a dose or operation by dragging and dropping into place.
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  5. Press the Create button to create the composite dose.

Reference Dose Grid

The reference dose grid for an operation is indicated by a green star in the composition tree. The reference dose grid is used to determine the study and parent object of the result dose. In addition, the result dose will always be in the same frame of reference as the reference dose grid.

The result dose grid geometry and resolution will also be based on the reference dose grid. The composition process begins with a dose grid that is aligned with, and has the same resolution as, the reference dose grid. It then grows or shrinks the dose grid geometry to ensure that all dose grids are encapsulated in the resulting grid (i.e., the resulting grid geometry represents the union of the geometry of all operands). Finally, it will attempt to refine the resulting dose grid geometry if the composition algorithm detects that refinement may increase accuracy of the final result. Please note that any refinement is performed such that the voxel centers of the reference dose grid will always be represented in the final dose grid (i.e., it adds rows, columns, and planes between the voxel centers). This process occurs locally within each mathematical operation based on the first operand, and then overall based on the reference dose grid.

0 Gy

For addition and multiplication operations, a dose value of 0 Gy in an operand is treated exactly as you might expect. That is, the sum of the dose value d and 0 is, of course, d. Similarly, for multiplication, the product of the dose value d and 0 is 0. For division, there are two scenarios involving a dose of 0 Gy: a dose value of 0 in the dividend and a dose value of 0 in the divisor. In both of these scenarios (and, by extension, the 0/0 scenario), the resulting dose value will be 0.

Units

The result of a composite dose will always be in the units of Gy. Each time you make a change to the composite dose operation, ProKnow DS checks the formula you have provided to ensure that there are consistent units in the operands of each addition operation and that the final dose is Gy. If your formula does not pass this check, a warning and confirmation will be presented under the composite dose tree. Check the box to acknowledge the warning and then press the Create button to submit the composite dose task.

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Deleting Patient Objects

Note: You must have the Delete Patients permission on a patient to delete patient objects for the patient.

CAUTION: Deleting patients objects is an irreversible action, so use caution.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. Select one or more patient objects to delete.
  3. In the Available Actions menu, choose the Delete Patient Objects... option.
  4. Press the Confirm button to delete the data.

Forcing a Frame of Reference

Note: You must have the Update Patients permission on a patient to force a frame of reference for the patient.

CAUTION: The Force Frame of Reference tool allows you to force the currently active objects into a consistent frame of reference. Please note that the frame of reference indicates the unique coordinate system of each patient object. By forcing consistency (i.e., overriding the default values) you take full responsibility for ensuring that the objects are in the same coordinate system. In addition, this operation will permanently override the frames of reference for the selected patient objects and is an irreversible action, so use extreme caution.

  1. With the Browse tab activated, press the Edit button at the top of the sidebar.
  2. The Force Frame of Reference... option will be available if there is one or more active patient objects with a different frame of reference than the primary image set.
  3. In the Available Actions menu, choose the Force Frame of Reference... option, which will open the Force Frame of Reference dialog.
  4. The Force Frame of Reference dialog lists the active patient objects and indicates which items have a different frame of reference from the primary image set (indicated by a warning triangle). By default, all active patient objects that have a different frame of reference will be selected, however, you may deselect specific items if desired.
  5. Once you have selected the active objects that you wish to force into the consistent frame of reference, click the confirmation checkbox and press the Apply button to apply the changes.

Monitoring Patient Tasks

Note: You must have the Read Patient Tasks permission on a patient to monitor patient tasks for the patient.

Once a patient task has been submitted (e.g., producing a composite dose), the task will show up in the Tasks panel at the bottom of the Browse sidebar. Once the task has been completed, the patient object hierarchy will be updated automatically, and the task will disappear from the list after about a minute. Completed tasks are denoted by a green checkmark icon to the left of the task while failed tasks are denoted by a red triangular icon. Completed and failed tasks may be cleared from display by clicking on the trash icon located to the right of the task row.

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