KEY POINTS
- ARTEMIS is a vendor-neutral, web-based workflow orchestration platform developed at University Hospital Southampton to coordinate radiotherapy planning across different clinical software systems. It combines a central DICOM data hub, an executable Business Process Model and Notation (BPMN) engine, modular automation plugins, and mandatory clinical review steps.
- Following clinical deployment in September 2023, ARTEMIS supported approximately 1,800 workflow executions during its first year. Monthly throughput increased from approximately 150 workflows during the initial pilot to 350 in version 3.2, reflecting both expanded functionality and increased platform adoption.
- The initial implementation included 28 site-specific AI-contouring pilot workflows across sites such as prostate, head and neck, and lung. Subsequent development consolidated these into more flexible workflows and expanded the platform to nine active BPMN workflows and eleven automation plugins, including automated independent dose checking, DICOM routing, clinical document generation and export.
- ARTEMIS integrated existing systems rather than replacing treatment planning or oncology information software. The architecture supported data exchange across platforms including RayStation, Pinnacle, Prosoma, MOSAIQ, MVision AI, Elements and Oncentra Brachy, using defined workflow stages for automated tasks and human review.
- In a workflow efficiency assessment involving 19 conventional MERLIN and 22 ARTEMIS independent dose-check executions, median planner interaction time decreased from 5.2 minutes (IQR 4.83–6.00) to 3.0 minutes (IQR 2.00–3.00). This represented a 42% reduction (p<0.001), largely through automation of data export, parameter entry, dose-check initiation and report generation.
- In an anonymous survey of 11 clinical users, 10 of 11 (91%) reported spending less time on repetitive tasks, while 7 of 11 (64%) found it easier to locate patient data. All respondents expected further automation to improve service quality, although feedback on workflow visibility was mixed and the sample represented only about 30% of invited staff.
- Clinical governance incorporated four deployment environments with independent testing, user acceptance procedures and formal clinical authorization before software release. The time-saving analysis covered only one specific workflow, while increased throughput cannot be attributed solely to improved efficiency because the platform's clinical scope expanded over time.
CLINICAL TAKEAWAY
ARTEMIS illustrates how radiotherapy departments can move beyond isolated scripts toward integrated, vendor-neutral automation that coordinates planning, documentation, independent checks and data transfer while preserving clinical oversight. Its measured reduction in manual interaction is promising, but successful implementation requires dedicated software maintenance, rigorous validation and evaluation of benefits across additional workflows and institutions.