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.

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

2. Pen tablet
Mouse 2

3. Computer Science
RO
TPS
Human Computer Interface
Mouse 3

4. Eclipse Version 8.9
Contouring
Targets
&
Organ
At Risk
3D View
3D View
4

5. Repetitive Stress Injury
5

6. Modifications in Mouse
6

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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10. Contouring with Mouse
Tamplate for Mouse
10

11. Contouring with Pen Tablet
Tamplate for Pen Tablet
11

12. Contouring with both
12

13. Table 1.-Volumes
Volume Contour by Mouse Contour by Pen Tablet
Opt Opt Eye_ Eye_ Opt Opt Eye_ Eye_
CT Scan BS N_Lt N_Rt Lt Rt BS N_Lt N_Rt Lt Rt
1 20.15 0.39 0.57 8.08 8.59 21.81 0.46 0.49 8.78 7.78
2 31.26 0.59 0.84 10.67 10.27 30.47 0.88 1.10 10.59 9.60
3 33.97 0.62 0.66 9.91 9.83 30.82 0.42 0.57 9.47 9.39
4 26.31 0.43 0.48 9.43 9.73 21.89 0.60 0.35 9.72 9.63
5 21.78 0.45 0.61 10.29 11.3 19.28 0.54 0.46 10.52 10.29
6 20.07 0.36 0.51 9.55 8.82 20.43 0.48 0.39 9.20 9.00
7 22.03 0.23 0.25 9.92 9.74 21.83 0.45 0.43 9.57 9.90
8 21.41 0.40 0.31 8.64 8.72 20.68 0.54 0.45 8.19 8.61
9 29.81 0.64 0.44 9.91 10.26 27.04 0.53 0.52 10.44 10.04
10 18.14 0.53 0.48 9.11 9.28 18.67 0.41 0.53 9.17 9.43
Average 24.49 0.46 0.51 9.55 9.65 23.29 0.53 0.52 9.56 9.36

14. Table 2- Time taken.
CT
Total Time Time diff.
scan Time Mo Time PT Time diff.
(sec) (sec) (Sec)
no
1 4m 23s 263 2m 32s 152 1m 51s 111
2 4m 32s 272 2m 21s 141 2m 11s 131
3 5m 52s 352 2m 52s 172 3m 0s 180
4 4m 42s 282 2m 34s 154 2m 8s 128
5 5m 54s 354 2m 51s 171 3m 3s 183
6 4m 46s 286 2m 33s 153 2m 13s 133
7 4m 53s 293 2m 15s 135 2m 38s 158
8 4m 18s 258 2m 42s 162 1m 36s 96
9 4m 49s 289 2m 37s 157 2m 12s 132
10 4m 15s 255 2m 25s 145 1m 50s 110
Tot. 48m 24s 2904 25m 42s 1542 22m 42s 1362

15. Tab.3-No. of slices contoured
Volume Contour by Mouse Contour by Pen Tablet
Opt Opt Eye_ Eye_ Opt Opt Eye_ Eye_
CT Scan BS N_Lt N_Rt Lt Rt BS N_Lt N_Rt Lt Rt
1 15 3 3 9 9 16 2 3 10 9
2 19 3 3 9 10 18 3 3 10 9
3 18 3 3 9 9 18 3 3 9 9
4 17 3 Total slice Contoured
3 9 9 16 3 3 10 10
5 17 3 3 10 12 17 3 2 11 12
6 16 3 slice by slice 842
3 10 10 16 3 3 10 9
7 18 3 2 11 11 18 3 3 10 10
8 17 3 2 9 9 17 3 3 9 10
9 17 2 3 10 10 16 3 3 10 10
10 15 2 3 10 10 15 2 3 10 11
Average 169 28 28 96 99 167 28 29 99 99

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.
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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