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Radiation Exposure Monitoring(REM) Profile
Kevin O’DonnellToshiba Medical Research Inst. - USACo-chair, IHE Radiology Planning Cmte
IHE Radiology
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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 risk should be managed responsibly
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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
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IHE Radiation Exposure Monitoring ProfileIHE Radiation Exposure Monitoring Profile
some text: #Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9
National Registry
ArchiveDose Information
Reporter
some text: #Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9
Outlier: #Performing Phys.Over Target: 12.2%
Outlier: #Performing Phys.Over Target: 12.2%
Outlier: #Performing Phys.Over Target: 12.2%
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
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
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
Numer 12.2 14.5 9.5 10.9
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REM Profile: Actors & TransactionsREM Profile: Actors & Transactions
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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)– DR/CR
• Not yet addressed: NM, RT
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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/2009/09_16pu.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, Ordering Doc, Performing Tech
• Patient Position, Anatomy imaged• Imaging Geometry (projection)
• Collimation• X-Ray Filters, Anode Target Material• Calibration, Phantom, Dosimeter
DICOM SR TemplateDICOM SR Template
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Creating SR Dose ReportsCreating SR Dose Reports• Modalities– CT, XA/XRF, X-Ray, Mammography
• “Readers”– CR, DX, Film Digitizers– Note challenge if tube and detector don’t talk…
• 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 ReportsPossible 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
IHE REM Changes• Final Text CPs
– CP195 - Internationalize Series Description (RAD-62)– CP197 - Replace Register with Registry– CP198 - Remove weakening of DICOMDIR (RAD-63)
• Almost Final Text CPs– CP196 - REM De-identification (RAD-63)– CP199 - Patient Longitudinal Record Use Case– CP200 - Alternative Submission Transport Mechanisms (RAD-63)– CP203 - Require Irradiation Event UID in Images– CP204 - Record Patient Characteristics in Dose Reports
( See www.ihe.net/Technical_Framework/ )
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DICOM SR ChangesDICOM SR Changes• Incorporated CPs
– Use DICOM 2009 PS3.16 – incorporates CP-874 and more
• Final Text CPs– CP-957 – Add CT Exposure Modulation Type– CP-963 – Add DateTime Started to Irradiation Event
• WIP CPs– CP-1063 – Clean-up Dose Reports– CP-1065 – Improve Device Identification– CP-1068 – CT Scan Location– CP-1070 – Additional Codes for Dose Information Source– CP-1075 – CT Dose for Constant Angle Acquisitions– CP-1076 – Fix participant relationship in TID1020– CP-1077 – CR Dose Report
( See dclunie.com/dicom-status/status.html )15
Profile Overviews:Profile Overviews:wiki.ihe.net/index.php?title=Profiles
Profile Specs.:Profile Specs.:www.ihe.net/Technical_Framework
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Why not use Image Headers?Why not use 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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Why not use MPPS?Why not use MPPS?
• Modality Performed Procedure Steps– Status messages back to RIS / PACS
• Transient Information– designed for workflow; not persistent archiving
• Lacks complete dose details