Managing Radiation Dose: Managing Radiation Dose: IHE REM Profile IHE REM Profile Kevin O’Donnell Kevin O’Donnell Toshiba Medical Systems Toshiba Medical Systems Co-chair, IHE Radiology Planning Co-chair, IHE Radiology Planning Cmte Cmte Member, DICOM Standards Cmte & WG- Member, DICOM Standards Cmte & WG- 6 6 Member, MITA X-Ray Section Member, MITA X-Ray Section
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Managing Radiation Dose: IHE REM Profile Kevin O’Donnell Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte Member, DICOM Standards Cmte & WG-6.
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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
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National Registry
Archive
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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
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