what ihe delivers 1 radiation exposure monitoring: ihe rem profile kevin odonnell toshiba medical...
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1 What IHE Delivers
Radiation Exposure Monitoring:Radiation Exposure Monitoring:IHE REM ProfileIHE REM Profile
Kevin O’DonnellKevin O’Donnell
Toshiba Medical SystemsToshiba Medical Systems
Co-chair, IHE Radiology Planning CmteCo-chair, IHE Radiology Planning Cmte
2IHE 2008 Webinar SeriesIHE 2008 Webinar Series
MotivationMotivation
X-Ray based imaging can provide tremendously useful information
Patient Dose is an important consideration
Potential benefit >> potential risk
… but the risk should still be managed
3IHE 2008 Webinar SeriesIHE 2008 Webinar Series
Why Measure / MonitorWhy Measure / Monitor
“I think patientdose is improving.”
“I think it’sgetting worse.”
Managing in the presence of data is far better and easier than managing in its absence. – Robert Glass
4IHE 2008 Webinar SeriesIHE 2008 Webinar Series
Why Measure / MonitorWhy Measure / Monitor
Technology is constantly changing
Technique is constantly evolving
Understanding continues to improve
5IHE 2008 Webinar SeriesIHE 2008 Webinar Series
Why Measure / MonitorWhy Measure / Monitor
ALARA Guidelines for Physicians (Patient Dose) As Low As Reasonably Achievable
Patient Dose < = Reasonably Achievable Dose
A < = B
Should be easy / automatic / routine
Why isn’t the data readily available…
6IHE 2008 Webinar SeriesIHE 2008 Webinar Series
A New IHE ProfileA New IHE Profile
IHE Radiation Exposure Monitoring Profile Integration of systems reporting dose and systems
which receive, store, or process those reports Modalities, PACS, RIS, Workstations, Registries
Facilitate compliance with Euratom 97/43,ACR Guidelines, etc.
DICOM Dose Reports Creation, Collection, Distribution, Processing
7IHE 2008 Webinar SeriesIHE 2008 Webinar Series
DICOM Dose ReportsDICOM Dose Reports
“SR Objects” – DICOM Structured Reports Easily ingested (and regurgitated) by PACS
Granularity : “Irradiation Event” + Accumulated Dose over Study, Series
Templates: CT, Projection X-Ray (Mammo, Fluoro)
Not addressed: NM, RT
8IHE 2008 Webinar SeriesIHE 2008 Webinar Series
What about using MPPS?What about using MPPS?
Modality Performed Procedure Steps Status messages back to RIS / PACS
Transient Information designed for workflow; not persistent archiving
Lacks complete dose details
9IHE 2008 Webinar SeriesIHE 2008 Webinar Series
What about Image Headers?What about Image Headers?
Mostly Exposure details (for interpretation)
No image; no dose deleted due to quality / patient motion
More images; more dose extra reconstructions; post-processing
Lacks complete dose details
10IHE 2008 Webinar SeriesIHE 2008 Webinar Series
What To MeasureWhat To Measure
So many choices… Exposure, Dose, Dose Index, Estimated Dose,
Effective Dose, Estimated Effective Dose, … CTDIw, CTDIvol, CTDI100, CTDIfreeair, …
Solution: Collaborate with IEC Subcommittee 62B Establish a baseline & a pipeline Upgrade when necessary
11IHE 2008 Webinar SeriesIHE 2008 Webinar Series
Key MeasurementsKey Measurements
CT Dose DLP, CTDIvol, kVP, mA, sec Effective Dose [ Optional ]
(Reference estimation method)
Projection X-Ray Dose DAP, Dose@RP, kVP, mA, sec Fluoro Dose, Fluoro Time
Mammography Dose AGD, Entrance Exposure @ RP, kVP, mA, sec Compression, Half Value Layer
ftp://medical.nema.org/medical/dicom/2008/08_16pu.pdf
12IHE 2008 Webinar SeriesIHE 2008 Webinar Series
Other Details in Dose SROther Details in Dose SR
Full Patient / Order / Study Details
Unique ID for each Irradiation Event
Equipment ID
Patient Position, Anatomy imaged
Imaging Geometry (projection)
Collimation
X-Ray Filters, Anode Target Material
Calibration, Phantom, Dosimeter
13IHE 2008 Webinar SeriesIHE 2008 Webinar Series
Creating SR Dose ReportsCreating SR Dose Reports
Modalities CT, XR, XA, MX
“Readers” CR, DX, Film Digitizers
3rd Party Workstations
RIS, PACS
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Storing SR Dose ReportsStoring SR Dose Reports
Usually stored in the Study folder Archive, Backup, Reconciliation Query / Retrieve
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Using SR Dose ReportsUsing SR Dose Reports
Possible applications:
Radiation QA Periodically Query / Retrieve Reports from Archive Set policies/standards and flag deviations Set goals for improvement and track; Implement protocol changes and compare difference in dose
Patient Impact Evaluation Patient identified as pregnant post-facto
Dose Mapping Store data in realtime from Modality to Mapping Workstation
16IHE 2008 Webinar SeriesIHE 2008 Webinar Series
Using SR Dose ReportsUsing SR Dose Reports
National Registries Anonymize and submit Dose Reports to Register Compile Population Risk Estimations Derive Dose Reference Levels Provide Site-Site Comparisons
Individual Dose Record Collect Dose Reports over time
Clinical Trials Collect Dose together with Images Demonstrate both improved detection &
reduced dose
17IHE 2008 Webinar SeriesIHE 2008 Webinar Series
DICOM CP 874DICOM CP 874
Affects REM Will apply to 2009 Connectathon
DICOM is making minor template adjustments References to persons who ordered / performed Require Target Region Require identification of irradiating system Add Phantom/QA Flag etc.
Details/updates will be posted next to the IHE Profile download
18IHE 2008 Webinar SeriesIHE 2008 Webinar Series
REM Profile: Actors & TransactionsREM Profile: Actors & Transactions