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Med Phys. 2012 Aug;39(8):4726-32. doi: 10.1118/1.4736825.

Technical note: electronic chart checks in a paperless radiation therapy clinic.

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  • 1Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110, USA.



EcCk, which stands for Electronic Chart ChecK, is a computer software and database system. It was developed to improve quality and efficiency of patient chart checking in radiation oncology departments. The core concept is to automatically collect and analyze patient treatment data, and to report discrepancies and potential concerns.


EcCk consists of several different computer technologies, including relational database, DICOM, dynamic HTML, and image processing. Implemented in MATLAB and C#, EcCk processes patient data in DICOM, PDF, Microsoft Word, database, and Pinnacle native formats. Generated reports are stored on the storage server and indexed in the database. A standalone report-browser program is implemented to allow users to view reports on any computer in the department. Checks are performed according to predefined logical rules, and results are presented through color-coded reports in which discrepancies are summarized and highlighted. Users examine the reports and take appropriate actions. The core design is intended to automate human task and to improve the reliability of the performed tasks. The software is not intended to replace human audits but rather to aid as a decision support tool.


The software was successfully implemented in the clinical environment and has demonstrated the feasibility of automation of this common task with modern clinical tools. The software integrates multiple disconnected systems and successfully supports analysis of data in diverse formats.


While the human is the ultimate expert, EcCk has a significant potential to improve quality and efficiency of patient treatment record audits, and to allow verification of tasks that are not easily performed by humans. EcCk can potentially relieve human experts from simple and repetitive tasks, and allow them to work on other important tasks, and in the end to improve the quality and safety of radiation therapy treatments.

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