Docstoc

MIIT - Radiation Dose Management

Document Sample
MIIT - Radiation Dose Management Powered By Docstoc
					      Managing Radiation Dose:
          IHE REM Profile


Kevin O’Donnell
Toshiba Medical Systems
Co-chair, IHE Radiology Planning Cmte
Member, DICOM Standards Cmte & WG-6
Member, MITA X-Ray Section
                   Motivation
      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
RSNA 2008                                          2
              Why Measure / Monitor


“I think patient                                “I think it’s
 dose is                                         getting
 improving.”                                     worse.”




    Managing in the presence of data is far better and easier
    than managing in its absence. – Robert Glass

RSNA 2008                                                  3
            Why Measure / Monitor

        Technology is constantly changing


        Technique is constantly evolving


        Understanding continues to improve




RSNA 2008                                    4
                Why 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
        Can we make the data readily available…

RSNA 2008                                                   5
             … A New IHE Profile

        What’s an IHE Profile?




RSNA 2008                          6
                      IHE in One Slide
      IHE helps vendors implement & test
      functions that span multiple systems

      Profiles are implementation guides
        how to use existing standards
        to address a specific problem scenario

      Connectathons are test events
        managed testing of Profile implementations

      IHE helps users purchase & integrate
      multi-system solutions
        list required IHE Profile support in RFPs

RSNA 2008                                             7
            IHE Connectathon
                           One Week;
                           70+ vendors;
                           350+ engineers;
                           Thousands
                           of tests;
                           Managed
                           process;
                           Find & resolve
                           issues.

                           Results @
                           www.ihe.net
RSNA 2008                              8
IHE Radiation Exposure Monitoring Profile
                                                                                                                     National Registry


                                                                                                                                          some text: #
                                                                                                                                          Numerical Details
                                                                                                                                           12.2 14.5
                               some text: #                                                                                           Numer11.8   7.6
                               Numerical Details                                                                                             14.5
                                                                                                                                       12.2 9.5 10.9
                                12.2 14.5
                                11.8   7.6                                                                                                9.5   10.9
                                 9.5 10.9




                                                                           some text: #
                                                                           Numerical Details
                                                                             text:
                                                                      some12.2 #14.5
                                                                      Numerical Details
                                                                            11.8    7.6                              Outlier: #
                                                                        text: #14.5
                                                                 some12.2 9.5 10.9
                                                                                                                     Performing Phys.
                                                                        11.8 Details
                                                                 Numerical 7.6
                                                                                                                     Over Target: 12.2%
                                                                   12.2 9.5 10.9
                                                                          14.5
                                                             some text: #                                            Outlier: #
                                                                   11.8    7.6
                                                             Numerical Details                                       Performing Phys.
                                                                    9.5 10.9
                                                              12.2 14.5                                              Over Target: 12.2%
                                                              11.8    7.6
                                                               9.5 10.9
                                                                                                 some text: #        Outlier: #
                                                                                                 Numerical Details   Performing Phys.
                                                                                                  12.2 14.5          Over Target: 12.2%
                                                                                                  11.8   7.6
                                                                                                   9.5 10.9
                     some text: #
                     Numerical Details
                      12.2
               some text: # 14.5
                      11.8   7.6
               Numerical Details
                       9.5
                12.2 14.5 10.9
                11.8   7.6
                 9.5 10.9




                                                                                               Dose Analysis
                                                   Archive                                      & Reporting
                        some text: #
                        Numerical Details
                         12.2 14.5
                         11.8   7.6
                          9.5 10.9




RSNA 2008                                                                                                                                                     9
                   A 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.

       Directly based on DICOM Dose Reports
       Creation, Collection, Distribution, Processing



RSNA 2008                                                   10
                  DICOM 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

RSNA 2008                                                  11
               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




RSNA 2008                                                       12
            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

RSNA 2008                                               13
                 What To Measure

      So many choices…
        Exposure, Dose, Dose Index, Estimated Dose,
         Effective Dose, Estimated Effective Dose, …
        CTDIw, CTDIvol, CTDI100, CTDIfreeair, …



      Solution:
        Collaborated with IEC Subcommittee 62B
        Established a baseline & a pipeline
        Upgrade when necessary


RSNA 2008                                              14
                 Key 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
       ftp://medical.nema.org/medical/dicom/final/cp874_ft.pdf
RSNA 2008                                                        15
            Other 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


RSNA 2008                                      16
                            DICOM CP 874

        Updated details for REM Implementers
             Will apply to 2009 Connectathon

        Minor adjustments to DICOM templates
               Require identification of irradiating system
               Require Target Region
               Optional references to persons who ordered / performed
               Code to differentiate interventional procedures from diagnostic
               etc.




RSNA 2008                                                                    17
              Creating SR Dose Reports

        Modalities
             CT, XR, XA, MX

        “Readers”
             CR, DX, Film Digitizers


        3rd Party Workstations


        RIS, PACS

RSNA 2008                                18
               Storing SR Dose Reports


        Usually stored in the Study folder
             Archive, Backup, Reconciliation
             Query / Retrieve


        Can be sent to other destinations




RSNA 2008                                       19
                  Using 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
             e.g. if Patient identified as pregnant post-facto


        Dose Mapping
             Store data in realtime from Modality to Mapping Workstation


RSNA 2008                                                                   20
                 Using 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

RSNA 2008                                                     21
      REM Profile: Actors & Transactions




RSNA 2008                                  22
     2009 Connectathon Participation

  Vendors Planning to Test IHE REM Profile


      GE                  CMI
      Siemens             Infimed
      Toshiba             Krucom


  Results will be posted:
   http://ihe.univ-rennes1.fr/con_result/

RSNA 2008                                    23
                        What to Ask For

        IHE
             Radiation Exposure Monitoring Profile (REM)
             Check Product: IHE Integration Statement


        DICOM
             X-ray Radiation Dose SR Storage
               •   CT Radiation Dose Template, or
               •   Projection X-Ray Radiation Dose Template
             Check Product: DICOM Conformance Statement



RSNA 2008                                                     24
                       Takeaway

    Start planning:
      How will this support your Radiation Safety Plan


    IHE REM Profile
      www.ihe.net
      www.ihe.net/Technical_Framework/index.cfm#radiology




RSNA 2008                                                    25
            Questions ?




RSNA 2008                 26
                               Timeline
        Nov. 2007
             DICOM CT Dose Reports published
             (DICOM Proj. X-Ray Dose Reports already published)

        June 2008
             IHE REM Profile published
             http://www.ihe.net/Technical_Framework

        Aug. 2008
             Vendors sign up to test REM Implementations

        Feb. 2009
             Connectathon Testing of REM Profile (Chicago)
             Results posted: http://ihe.univ-rennes1.fr/con_result/


RSNA 2008                                                              27
                              The IHE Process
                                                                                              RFP
Users                                                 Select
             Real-World                                IHE                                 (Profiles &
             Integration                             Profiles                                Actors)
              Problems




IHE                              IHE
        Standards               IHE
                               IHE
       Standards
      Standards              Integration
                            Integration        IHE                            IHE
                           Integration
                               Profiles                         Results
                              Profiles     Connectathons                  Demonstrations
         (DICOM,
        (DICOM,
                             Profiles
       (DICOM,
         HL7, etc)
        HL7, etc)
       HL7, etc)

                           IHE Technical
                            Framework

                                                                                               IHE
Vendors                               Product
                                                                                           Integration
                                                                                            Statement
                                      with IHE
                                                                                           (Profiles &
                                                                                             Actors)

 RSNA 2008                                                                                     28
  28

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:3/7/2012
language:
pages:28