# Enhancing cyberattack resiliency through the radiotherapy backup and recovery dashboard tool

## TL;DR

A new dashboard tool backs up radiotherapy data to help clinics quickly resume treatments after cyberattacks.

## Contribution

The RBRDT provides a novel backup and recovery system for radiotherapy data during cyberattacks.

## Key findings

- The RBRDT successfully backs up treatment data every 10 minutes and has processed thousands of records since May 2024.
- The dashboard enables rapid resumption of patient treatments by retrieving data from the RT-PACS during cyberattacks.
- The tool reduces reliance on the R&V system by storing relational data in an accessible RT-PACS.

## Abstract

Radiation Oncology departments impacted by recent cyberattacks were unable to access data backups or their Record and Verify (R&V) system and therefore faced challenges to resume patient treatments in a timely manner. We present a novel software tool that backs‐up critical radiotherapy treatment information and displays essential information for on‐treatment patients in an intuitive and accessible dashboard allowing clinics to continue radiotherapy treatments. The purpose of this report is to describe implementation details, challenges, and share open‐source code to facilitate radiation oncology clinics’ efforts to develop tools to improve cyberattack resiliency.

The Radiotherapy Backup and Recovery Dashboard Tool (RBRDT) performs daily backups of treatment information and relationships between DICOM‐RT objects from the R&V system and treatment planning system (TPS) to a Radiation Therapy Picture Archiving and Communication System (RT‐PACS). If the R&V system is inaccessible, the RBRDT accesses the backed‐up data in the RT‐PACS to create a dashboard containing critical treatment information for patients currently undergoing radiotherapy.

The RBRDT is successfully clinically implemented and generates backups to the RT‐PACS every 10 minutes. Since its implementation in May 2024, the RBRDT backed up over 80,000 RTRECORDS and moved 322 RTPLANS and 142 RTSTRUCTS to the RT‐PACS that were absent from this server caused by human error. The dashboard is generated nightly.

The RBRDT fills a critical gap in existing approaches for radiotherapy treatment data backup and restoration. All relational data is transferred to the RT‐PACS which is accessible during a cyberattack, reducing the reliance on the R&V system. The RBRDT retrieves connected data elements saved in separate locations. In the event of a cyberattack, this data is returned in a dashboard to rapidly resume patient treatments.