1. What IHE Delivers 1 Radiation Exposure Monitoring: IHE REM Profile Kevin ODonnell Toshiba Medical Systems Co-chair, IHE Radiology Planning Cmte

2. IHE 2008 Webinar Series 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. IHE 2008 Webinar Series 3 Why Measure / Monitor I think patient dose is improving. I think its getting worse. Managing in the presence of data is far better and easier than managing in its absence. – Robert Glass

4. IHE 2008 Webinar Series 4 Why Measure / Monitor Technology is constantly changing Technique is constantly evolving Understanding continues to improve

5. IHE 2008 Webinar Series 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 Why isnt the data readily available…

6. IHE 2008 Webinar Series 6 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. DICOM Dose Reports Creation, Collection, Distribution, Processing

7. IHE 2008 Webinar Series 7 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

8. IHE 2008 Webinar Series 8 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

9. IHE 2008 Webinar Series 9 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

10. IHE 2008 Webinar Series 10 What To Measure So many choices… Exposure, Dose, Dose Index, Estimated Dose, Effective Dose, Estimated Effective Dose, … CTDI w, CTDI vol, CTDI 100, CTDI freeair, … Solution: Collaborate with IEC Subcommittee 62B Establish a baseline & a pipeline Upgrade when necessary

11. IHE 2008 Webinar Series 11 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

12. IHE 2008 Webinar Series 12 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

13. IHE 2008 Webinar Series 13 Creating SR Dose Reports Modalities CT, XR, XA, MX Readers CR, DX, Film Digitizers 3 rd Party Workstations RIS, PACS

14. IHE 2008 Webinar Series 14 Storing SR Dose Reports Usually stored in the Study folder Archive, Backup, Reconciliation Query / Retrieve

15. IHE 2008 Webinar Series 15 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 Patient identified as pregnant post-facto Dose Mapping Store data in realtime from Modality to Mapping Workstation

16. IHE 2008 Webinar Series 16 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

17. IHE 2008 Webinar Series 17 DICOM CP 874 Affects REM Will apply to 2009 Connectathon DICOM is making minor template adjustments References to persons who ordered / performed Require Target Region Require identification of irradiating system Add Phantom/QA Flag etc. Details/updates will be posted next to the IHE Profile download

18. IHE 2008 Webinar Series 18 REM Profile: Actors & Transactions