1. 1 IHE Radiation Exposure Monitoring Profile some text: # Numerical Details 12.2 14.5 11.8 7.6 9.5 10.9 National Registry Archive Dose Information Reporter some text: # Numerical Details 12.2 14.5 11.8 7.6 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

2. 2 DICOM Dose Reports “SR Objects” – DICOM Structured Reports“SR Objects” – DICOM Structured Reports –Easily ingested (and regurgitated) by PACS Granularity : “Irradiation Event”Granularity : “Irradiation Event” –& Accumulated Dose over Study, Series Templates :Templates : –CT, Projection X-Ray (Mammo, Fluoro) –DR/CR, NM (WIP) Not yet addressed: RTNot yet addressed: RT

3. 3 Key Measurements CT DoseCT Dose –DLP, CTDIvol, kVP, mA, sec –Effective Dose [ Optional ] (Reference estimation method) Projection X-Ray DoseProjection X-Ray Dose –DAP, Dose@RP, kVP, mA, sec –Fluoro Dose, Fluoro Time Mammography DoseMammography Dose –AGD, Entrance Exposure@RP, kVP, mA, sec –Compression, Half Value Layer ftp://medical.nema.org/medical/dicom/2009/09_16pu.pdf

4. 4 Other Details in Dose SR Full Patient / Order / Study DetailsFull Patient / Order / Study Details Unique ID for each Irradiation EventUnique ID for each Irradiation Event Equipment ID, Ordering Doc, Performing TechEquipment ID, Ordering Doc, Performing Tech Patient Orientation, Anatomy ImagedPatient Orientation, Anatomy Imaged Imaging GeometryImaging Geometry X-Ray Filtering & Collimation DetailsX-Ray Filtering & Collimation Details Anode Target MaterialAnode Target Material Calibration, Phantom, Dosimeter, Patient ModelCalibration, Phantom, Dosimeter, Patient Model

5. 5 Creating SR Dose Reports ModalitiesModalities –CT, XA/XRF, X-Ray, Mammography “Readers”“Readers” –CR, DX, Film Digitizers –Note challenge if tube and detector don’t talk… 3 rd Party Workstations, Extractors3 rd Party Workstations, Extractors RIS, PACSRIS, PACS

6. 6 Storing SR Dose Reports Usually stored in the Study folderUsually stored in the Study folder –Archive, Backup, Reconciliation –Query / Retrieve Can be sent to other destinationsCan be sent to other destinations

7. 7 Using SR Dose Reports Possible applications: Radiation QARadiation QA –Periodically Query / Retrieve Reports from Archive –Set policies/standards and flag deviations –Set goals for improvement and track progress; –Implement protocol changes and compare difference in dose Patient Impact EvaluationPatient Impact Evaluation –e.g. if Patient identified as pregnant post-facto Dose MappingDose Mapping –Store data in realtime from Modality to Mapping Workstation

8. 8 Using SR Dose Reports National RegistriesNational Registries –Anonymize and submit Dose Reports to Registry –Compile Population Risk Estimations –Derive Dose Reference Levels (DRLs) –Provide Site-Site Comparisons Individual Dose RecordIndividual Dose Record –Collect Dose Reports over time Clinical TrialsClinical Trials –Collect Dose together with Images –Demonstrate both improved detection & reduced dose

9. 9 IHE Connectathon One Week; 85+ vendors; 400+ engineers; Thousands of tests; Managed process; Find & resolve issues. Results published.

10. 10 Connectathon Participation (Includes prior testing & January 2011 signups) Modalities CT: GE, Siemens, Toshiba, PhilipsCT: GE, Siemens, Toshiba, Philips XA: GE, Siemens, ToshibaXA: GE, Siemens, Toshiba Other: PET/CT (GE), XR (Swissray), Extractor (ETIAM)Other: PET/CT (GE), XR (Swissray), Extractor (ETIAM)PACS Agfa, GE, Softway, Karos, Aware, INFINITT, DCM4CHE, …Agfa, GE, Softway, Karos, Aware, INFINITT, DCM4CHE, … Dose Information Reporter Krucom, EDL, Aware, INFINITT, [U Penn]Krucom, EDL, Aware, INFINITT, [U Penn]Registry ACR, KrucomACR, Krucom http://connectathon-results.ihe.net

11. REM Demo @ RSNA IHE Booth S2852IHE Booth S2852 RSNA arranged for vendors to demonstrate the REM profileRSNA arranged for vendors to demonstrate the REM profile –Full walkthrough –Includes University of Pennsylvania Dose Dashboard & Reporting –Includes ACR Dose Registry Docent guided demo ~1 per hour throughout showDocent guided demo ~1 per hour throughout show Also demonstrating network-based inter-site image exchangeAlso demonstrating network-based inter-site image exchange –based in part on IHE XDS-I