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Annual Scientific Meeting of the Canadian Organization of Medical Physicists — July 9–12, 2014, The Banff Centre, Banff, Alberta, Canada

Practical considerations for transitioning to a new TPS

Replacing a treatment planning system in a radiation oncology department is one of those projects that looks straightforward on a project timeline and becomes far more complex once the first patient is on the new couch. The platform itself handles beam modelling, optimisation and dose calculation, but the switch reshapes daily routines, dose reporting, plan review culture and the way a multidisciplinary team communicates. In Australia, where centres stretch from Perth to Cairns and small regional units often rely on remote physics support, the move carries its own geographic and workforce pressures that larger overseas networks may not share.

This overview draws on the practical lessons shared during the scientific programme and informal discussions at COMP 2014 in Banff. It is written for clinical medical physicists, radiotherapy engineers and department leaders who are weighing vendor selection, budgeting cycles or the timing of a migration. The focus stays on the unglamorous decisions that decide whether a transition builds confidence or quietly erodes it.

Clinical workflow and staff readiness

The most visible impact of a new TPS lands in the clinic, not the server room. Radiation oncologists see different plan templates, therapists navigate updated approval screens, and nurses respond to patients asking why the printed summary looks different. Centres in Sydney and Melbourne that have recently completed migrations often describe the first fortnight as the hardest, because the people using the system are still mentally translating between old and new conventions. Building realistic transition timelines means acknowledging that a trained physicist is not yet a fluent operator, and a fluent operator is not yet a confident teacher.

Practical steps that help include shadowing on the outgoing system in the final weeks, photographing common plan approval screens for quick reference, and scheduling brief daily huddles for the first month. Departments at major Australian centres such as the Peter MacCallum Cancer Centre and Royal Brisbane and Women's Hospital have published workflow checklists that other sites adapt for their own staffing models. Holding a soft launch with a small patient cohort, rather than a department-wide cutover, lets the core physics group absorb the first wave of questions before general release.

Data migration and validation

Every TPS holds years of institutional memory: approved plans, prior treatment records, benchmark cases and locally configured beam models. Moving that data is rarely a clean copy operation. Vendor migration tools vary in how they handle proprietary tags, custom structures and naming conventions. A staged migration, beginning with archived cases, then current patients, and finally a working library, lets the physics team detect and document anomalies before clinical care depends on the results.

Validation has to cover three layers. The first is the integrity of migrated plan data, including structure names, dose grids and fractionation patterns. The second is dose calculation equivalence, where recalculated plans on the new system should agree with the legacy platform within agreed tolerances for a representative sample of techniques. The third layer, often forgotten in the rush, is the integrity of plan comments and approval workflows, which influence how reviewers sign off. Clinical audits from AHPRA-registered services in Queensland and New South Wales have highlighted this layer as a common source of complaints following a switch.

Training and competency assessment

Competency in the new platform needs to be documented, not assumed. A structured programme gives staff a clear path from supervised use to independent practice, and gives department managers a defensible record when regulators or accreditors ask who is authorised to operate the system. The Australasian College of Physical Scientists and Engineers in Medicine has long emphasised competency frameworks for emerging technologies, and migration projects are a natural place to apply them.

Key milestones worth tracking include:

  • Completion of vendor training modules with documented assessment scores
  • Independent creation of a benchmark plan set covering IMRT, VMAT and electron techniques
  • Peer-reviewed plan checks on at least five live cases per technique
  • Competency sign-off by a certified medical physicist for each operator
  • Annual refresher assessment linked to the department quality programme

Treating training as a recurring cost rather than a one-off expense helps sustain confidence. Staff turnover, vendor updates and the arrival of new techniques all erode competence quickly if there is no scheduled review.

Commissioning and quality assurance

Commissioning is the engineering heart of a TPS migration, and the part where shortcuts are most expensive later. The aim is to verify that the system delivers clinically acceptable dose calculations across the full range of techniques the department intends to use, and that the beam model behaves predictably at the edges of clinical relevance. Many sites pull in extra physics time during commissioning, and recognise that the workload is not linear: a few intense weeks followed by a long tail of fine adjustments.

A working commissioning checklist typically includes:

  • Baseline beam data measurement against the new model across all clinical energies
  • End-to-end testing with phantoms and detectors in standard and non-standard geometries
  • Comparison of calculated and measured dose for reference plans across treatment sites
  • Verification of small field and dynamic delivery performance where relevant
  • Stress testing of network storage, archive retrieval and DICOM interoperability
  • Acceptance criteria documented before any patient is planned on the new system

International regulatory frameworks influence what documentation a centre must keep. The Therapeutic Goods Administration in Australia, Health Canada and the FDA each set their own expectations for evidence of validation, and centres with cross-border research collaborations often align their commissioning records with the strictest applicable standard. A useful side-by-side look at the new Health Canada regulations for medical devices is available through this regulatory overview, which departments have found handy when clarifying international documentation expectations.

Regulatory and documentation requirements

A TPS is a regulated medical device, and switching platforms touches several layers of compliance. In Australia, departments must consider the requirements of the TGA for software as a medical device, the expectations of state-based health departments, and the standards used by accrediting bodies such as the Australian Council on Healthcare Standards. The transition window itself is a peak risk period, and the documentation assembled during commissioning often becomes the evidence pack that an auditor asks for in a follow-up review.

Internal records should capture who authorised the switch, what training was completed before the cutover, how deviations were managed in the first weeks, and how complaints or near-misses were reviewed. Many centres keep a transition register that sits alongside the routine quality manual, so that a future inspector can trace decisions back to the people who made them. For sites operating in multiple jurisdictions, including visiting consultants who treat across the Tasman or work with New Zealand colleagues, harmonising records early avoids duplicate paperwork later.

Managing change and communication

Technical quality alone does not carry a migration through. People need to know what is changing, why, when and how it affects their day. Communication plans that start before vendor selection and continue past clinical go-live tend to handle the rough patches better than plans that begin a week before the cutover. Regular updates to referring specialists, allied health colleagues and administrative staff prevent the small surprises that erode trust.

A practical sequence includes early engagement with consumer representatives or patient advisory groups, especially for centres that produce printed treatment summaries in languages other than English. Australian sites serving diverse communities in western Sydney, south-east Melbourne or northern Adelaide have found that translation review takes longer than expected, and that early input improves the final product. A risk register for the transition, reviewed weekly with executive sponsors, keeps attention on the issues that matter and away from the ones that simply feel loud.

The COMP organising committee welcomes questions from delegates who are working through these decisions and from centres that would like to share their own migration experience with the wider medical physics community. Anyone planning a transition, or already in the middle of one, can reach the organising team for follow-up discussions or to suggest topics for future meetings.