Managing Radiation Dose: IHE REM Profile Kevin O’Donnell Toshiba Medical Systems Co-chair, IHE...
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Transcript of Managing Radiation Dose: IHE REM Profile Kevin O’Donnell Toshiba Medical Systems Co-chair, IHE...
Managing Radiation Dose:Managing Radiation Dose:IHE REM ProfileIHE REM Profile
Kevin O’DonnellKevin O’DonnellToshiba Medical SystemsToshiba Medical Systems
Co-chair, IHE Radiology Planning CmteCo-chair, IHE Radiology Planning CmteMember, DICOM Standards Cmte & WG-6Member, DICOM Standards Cmte & WG-6Member, MITA X-Ray SectionMember, MITA X-Ray Section
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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
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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
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Why Measure / MonitorWhy Measure / Monitor
Technology is constantly changing
Technique is constantly evolving
Understanding continues to improve
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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
Can we make the data readily available…
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… … A New IHE ProfileA New IHE Profile
What’s an IHE Profile?
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IHE in One SlideIHE 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
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IHE ConnectathonIHE Connectathon
One Week;
70+ vendors;
350+ engineers;
Thousandsof tests;
Managed process;
Find & resolve issues.
Results @www.ihe.net
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IHE Radiation Exposure Monitoring Profile
some text: #Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9
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some text: #Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9
some text: #Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9
some text: #Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9
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National Registry
Archive
some text: #Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9
Numer 12.2 14.5 9.5 10.9
Dose Analysis& Reporting
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Outlier: #Performing Phys.Over Target: 12.2%
Outlier: #Performing Phys.Over Target: 12.2%
Outlier: #Performing Phys.Over Target: 12.2%
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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.
Directly based on DICOM Dose Reports Creation, Collection, Distribution, Processing
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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
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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
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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
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What To MeasureWhat 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
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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
ftp://medical.nema.org/medical/dicom/final/cp874_ft.pdf
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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
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DICOM CP 874DICOM 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.
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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
Can be sent to other destinations
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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 e.g. if Patient identified as pregnant post-facto
Dose Mapping Store data in realtime from Modality to Mapping Workstation
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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
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REM Profile: Actors & TransactionsREM Profile: Actors & Transactions
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2009 Connectathon Participation2009 Connectathon Participation
Vendors Planning to Test IHE REM Profile
GE
Siemens
Toshiba
Results will be posted: http://ihe.univ-rennes1.fr/con_result/
CMI
Infimed
Krucom
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What to Ask ForWhat 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
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TakeawayTakeaway
Start planning: How will this support your Radiation Safety Plan
IHE REM Profile www.ihe.net www.ihe.net/Technical_Framework/index.cfm#radiology
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Questions ?Questions ?
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TimelineTimeline
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/
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Users
IHE
Vendors
RFP
(Profiles &Actors)
Standards
(DICOM,HL7, etc)
Standards
(DICOM,HL7, etc)
Standards
(DICOM,HL7, etc)
IHEIntegrationStatement
(Profiles &Actors)
Results
SelectIHE
Profiles
IHEIntegration
Profiles
IHEIntegration
Profiles
IHEIntegration
Profiles
IHE TechnicalFramework
Productwith IHE
IHEConnectathons
IHEDemonstrations
Real-World
Integration
Problems
The IHE ProcessThe IHE Process