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Managing Radiation Dose: IHE REM Profile

Learn about the IHE Radiation Exposure Monitoring Profile for integrating systems to optimize dose management in medical imaging. Understand the importance of measuring and monitoring patient dose for improved healthcare outcomes and safety.

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Managing Radiation Dose: IHE REM Profile

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  1. Managing Radiation Dose:IHE REM Profile Kevin O’DonnellToshiba Medical Systems Co-chair, IHE Radiology Planning CmteMember, DICOM Standards Cmte & WG-6Member, MITA X-Ray Section

  2. 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

  3. Why 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

  4. Why Measure / Monitor • Technology is constantly changing • Technique is constantly evolving • Understanding continues to improve

  5. 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…

  6. … A New IHE Profile • What’s an IHE Profile?

  7. 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

  8. IHE Connectathon One Week; 70+ vendors; 350+ engineers; Thousandsof tests; Managed process; Find & resolve issues. Results @www.ihe.net

  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 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 IHE Radiation Exposure Monitoring Profile National Registry 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 Outlier: # Performing Phys. Over Target: 12.2% Dose Analysis & Reporting Archive

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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.

  18. Creating SR Dose Reports • Modalities • CT, XR, XA, MX • “Readers” • CR, DX, Film Digitizers • 3rd Party Workstations • RIS, PACS

  19. Storing SR Dose Reports • Usually stored in the Study folder • Archive, Backup, Reconciliation • Query / Retrieve • Can be sent to other destinations

  20. 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

  21. 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

  22. REM Profile: Actors & Transactions

  23. 2009 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

  24. 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

  25. 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

  26. Questions ?

  27. 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/

  28. The IHE Process Standards (DICOM,HL7, etc) IHE Integration Profiles Standards (DICOM,HL7, etc) IHE Integration Profiles Standards (DICOM,HL7, etc) IHE Integration Profiles IHE Technical Framework Real-World Integration Problems RFP (Profiles & Actors) Users Select IHE Profiles IHE Results IHE Connectathons IHE Demonstrations IHE Integration Statement (Profiles & Actors) Vendors Product with IHE

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