Since the awareness of the need for electronic recording and verification of radiotherapy treatments arose over 40 years ago [1 -3], radiation oncology information systems (ROIS) have evolved toward connecting and integrating information between different radiation treatment procedures [4]. ROIS can play an important role in utilizing modern radiotherapy techniques that have high complexity and involve a large amount of information because it is essential to share such information quickly and efficiently among medical staff. Han et al. [5] reported that the overall workload associated with radiation treatment procedures such as nursing, simulation, and treatment was reduced by 28.2% through the introduction of an electronic chart system.

One of the most widely used digital database formats is the relational database (RDB) proposed by Codd [6] in 1970. Since the RDB can effectively and intuitively manage a large amount of complex data using related tables and support data consistency and concurrency, this method is suitable for ROIS, which requires quick and accurate propagation of frequently updated treatment-related information. Although commercial radiotherapy platforms such as Aria^TM (Varian Medical Systems, Palo Alto, CA, USA) or Mosaiq^TM (Elekta Oncology Systems, Crawley, UK) already provide most ROIS functionality, their structures or functions cannot be rapidly customized to the needs of individual users, and the number of terminals in these platforms is limited. Therefore, they have limited capability to respond to the detailed requirements of individual departments.

This study aimed to suggest ROIS with an RDB structure that is effective for small radiation oncology departments using the cost-effective popular database software Access^TM (Microsoft, Redmond, WA, USA). Since the feasibility of ROIS developed using this general-purpose software has already been shown by Lim et al. [7], in this study, we focus on an RDB structure that is more sophisticated and optimized for radiotherapeutic workflow. The treatment parameters directly related to treatment-beam delivery, such as the monitor unit, gantry angle, and source-to-surface distance, are excluded from our ROIS because they are effectively displayed by existing treatment machine-operating platforms.

The workflow of our department from the reception of patients to follow-up is presented as an example in Fig. 1. The workflow was carefully analyzed for the design of our own ROIS structure.

Using Access^TM, we created eight relational tables containing their own data and designed three types of forms for displaying the queried data. Detailed explanations are provided in the rest of this section. We established three design requirements to build ROIS that were optimized for our departmental workflow as follows.

Fig. 4 shows the two chart forms designed in this study. One main chart contains most of the clinical data for a single patient, as shown in Fig. 4a, and the other chart is used by the reception staff to schedule examinations, as shown in Fig. 4c. The current clinical status and changes to the patient’s treatment plan can be easily identified in short order, and remarks are listed at the bottom of the chart. The chart also provides a viewing window to check the patient’s posture during CT simulation, and the history of radiation treatment can be easily reviewed by clicking the corresponding course number.

Fig. 5 shows two worklist forms as examples. The worklist form for planners contains three sub-lists for the start of daily treatment, issued orders/remarks, and the current status of planning, as shown in Fig. 5a. The issued list can help planners to respond quickly to the reported situation, and the planners can easily track or conduct the radiation treatment plans of different patients based on the other two lists. The worklist form shown in Fig. 5b provides a daily treatment list for each treatment room, such that therapists can identify their own schedules. We designed five different worklist forms for physicians, planners, reception staff, CT simulation staff, and therapists. Fig. 6 shows two calendar-style forms designed for displaying examination and CT simulation schedules. Since examination or treatment schedules may change frequently, a calendar form effective in managing the schedule information is necessary, especially for the reception staff. We noted that the worklist and calendar forms could offer complementary supports for identifying the task in each room.

In addition to the main functions described above, we introduce a login procedure to manage user-specific authority for clinical data security and develop detailed search and statistics functions through various data-filtering processes.

The possibility of communication errors among staff that may lead to clinical accidents has significantly decreased since the introduction of highly computerized ROIS databases. However, there is a possibility of communication errors in non-routine workflow based on sudden changes in the situation; in such cases, a fast and reliable channel for delivering information to related staff is essential. In this study, we developed ROIS that can exactly meet these requirements. All related staff can easily access additional short orders by physicians or sudden changes in the patient’s condition.

The biggest advantage of our ROIS is that it can be fully customized according to the requirements of individual departments, because the difficulty and cost of database development and maintenance using Access^TM are significantly lower than those of the existing database platforms. Therefore, users can achieve high work efficiency with a highly customized ROIS. For instance, the workload and probability of human errors can be minimized by automatic treatment scheduling (rather than manual writing).

The ROIS presented in this study have some limitations. First, Access^TM has limited data storage (approximately 2 GB) and a small number of connected users. Thus, our ROIS are difficult to use for radiation oncology departments beyond a certain size. Second, we believe that our system cannot be inherently connected or integrated with existing commercial operating systems for radiation treatment. Instead, it can be used in parallel with systems to maximize work efficiency.

We expect our ROIS design to inspire those who need to develop and manage an individual ROIS suitable for their radiation oncology departments at low cost.