Radiation Exposure Monitoring

Radiation Exposure Managment (REM) facilitates the collection and distribution of information about estimated patient radiation exposure resulting from imaging procedures.

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Summary

The REM Profile requires imaging modalities to export radiation exposure details in a standard format. Radiation reporting systems can either query for these "dose objects" periodically from an archive, or receive them directly from the modalities.

The profile also describes how radiation reporting systems can submit dose reports to centralized registries such as might be run by professional societies or national accreditation groups.

The radiation reporting system is expected to preform relevant dose QA analysis and produce related reports. The nature of such analysis and format of the reports is not considered a topic for standardization and is not covered in the profile.

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Benefits

In the vast majority of medical procedures involving radiation, the potential benefit to the patients’ health from the information gained far outweighs the small potential risk from being exposed to radiation, but the trade-off should not be overlooked. The technological mechanisms provided by this profile can facilitate a conscious evaluation of that trade-off.

Estimating radiation dose delivered to patients for medical purposes can facilitate a number of important activities:

• For facilities exposing patients to radiation, monitoring such exposures can help ensure their policies, procedures and protocols are adequate and being followed appropriately.
• For imaging physicians, monitoring such exposures can assist them in determining how changes in techniques and protocols impact radiation dose as well as image quality. This will enable them to maintain patient doses As Low As Reasonably Achievable (ALARA).
• For patients’ physicians, overall data provided from monitoring such exposures can help them determine (in consultation with the imaging physician) if the benefit from the diagnostic information provided by an individual examination (or additional examinations) outweigh any small risk that may be associated with the imaging exam.
• For medical physicists, having such post-procedure information available for individual patients may help them make essential patient-specific dose estimates for pregnant patients or patients exhibiting skin erythema as a result of long fluoroscopy examinations.
• For professional societies and regulatory agencies, a collection of exposure data can be useful when setting or reviewing radiation dose related guidelines. Many such groups have expressed a desire to establish standards of practice or dose reference levels based on a quantitative understanding of current practice, however they have found it prohibitively difficult to collect such data.
• For physicists and physicians, this kind of data can be vital to answering some of the fundamental scientific questions that remain and developing a more detailed understanding of the health impacts of radiation exposure and how it should be measured and managed.

Details

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The Radiation Exposure Monitoring Integration Profile specifies communications between systems generating reports of irradiation events (generally acquisition modalities and workstations) and systems which receive, store, or process those reports (generally local dose information management systems and/or national/regional dose registers). It defines how DICOM SR objects for CT and projection X-ray dose objects are created, stored, queried, retrieved, de-identified, and may be processed and displayed.

• Granularity is at the level of irradiation events (define)

An irradiation event is one continuous occurrence of irradiation being applied to a patient. A pulsed fluoro X-Ray acquisition, or a multi-slice helical CT scan are examples of single events; while a CT scanogram and the helical scan, or two different presses of the fluoro pedal, or simultaneous irradiation from two X-ray tubes are examples of separate events.

• Mention the modalities covered
• Mention the details recorded?
• Based on DICOM SR
• Expected that in most cases it will be stored in the study on the PACS
• Registry submissions are de-identified
• Submission uses Secure FTP

However, it is important to understand the technical and practical limitations of such dose monitoring and the reasons why the monitored values may not accurately provide the radiation dose administered to the patient: • The values provided by this tool are not “measurements” but only calculated estimates. • For computed tomography, “CTDI” is a dose estimate to a standard plastic phantom. Plastic is not human tissue. Therefore, the dose should not be represented as the dose received by the patient. • For planar or projection imaging, the recorded values may be exposure, skin dose or some other value that may not be patient’s body or organ dose. • It is inappropriate and inaccurate to add up dose estimates received by different parts of the body into a single cumulative value.

Despite such limitations, interest in monitoring radiation dose estimates is clearly expressed in such documents as the European directive Euratom 97/43 and the American College of Radiology Dose Whitepaper [1]. The profile is directly based on the work done by DICOM and the IEC to develop DICOM Dose objects appropriate for radiation dose monitoring. By profiling such automated methods, dose information can be collected and evaluated without imposing a significant administrative burden on staff otherwise occupied with caring for patients.

This Integration Profile specifies how details of radiation exposure resulting from imaging procedures are exchanged among the imaging systems, local dose information management systems and cross-institutional systems such as dose registers. The data flow in the profile is intended to facilitate recording individual procedure dose information, collecting dose data related to specific patients, and performing population analysis.

Use of the relevant DICOM objects (CT Dose SR, Projection X-Ray Dose SR) is clarified and constrained.

The Profile focuses on conveying the details of individual irradiation events. A proper radiation exposure management program at an imaging facility would involve a medical physicist and define such things as local policies, local reporting requirements, annual reviews, etc. Although this Profile is intended to facilitate such activities, it does not define such policies, reports or processing, or in itself constitute a radiation exposure management program.

The Profile addresses dose reporting for imaging procedures performed on CT and projection X-ray systems, including mammography. It does not currently address procedures such as nuclear medicine (PET or SPECT), radiotherapy, or implanted seeds. The Profile is intended to support quality assurance (QA) of the technical process (was the dose appropriate for the procedure performed). It is less suited to QA of the ordering process (was the procedure ordered/scheduled appropriate for the indications (appropriateness criteria)), or QA of the operational process (were any differences between the procedure scheduled and the procedure performed justified by the situation/equipment/patient and appropriately approved).

Systems Affected

• Modalities may create and transmit dose objects.
• PACS systems may store and manage dose objects.
• RIS, PACS or standalone Reporting Workstations may retrieve, process and analyze dose objects.
• Workstations may retrieve, display and possibly supplement dose objects.
• National or regional repositories may receive dose objects submitted by reporting systems at participating sites.

Actors & Transactions:

Specification

Profile Status: Trial Implementation

Documents: Radiation Exposure Monitoring Supplement

Underlying Standards:

• DICOM
• Secure FTP (TLS)

See Also

Related Profiles

• Scheduled Workflow [SWF] can help the modality properly identify the patient in the dose objects.
• Patient Information Reconciliation [PIR] can help the archive update the dose records when patient identifications are updated.
• Portable Data for Imaging [PDI] can store dose objects on media such as CDs.
• Import Reconciliation Workflow [IRWF] can fix patient ids, etc. of dose objects when importing.
• Reporting Workflow [RWF] could conceivably use dose objects as inputs to the reporting process in jurisdictions where dose details are included in the report.
• Simple Image & Numeric Reports [SINR] may include data copied from dose objects.
• Cross-enterprise Document Sharing for Imaging [XDS-I] can be used to share dose objects between sites over a network.

Consumer Information

The Radiation Exposure Monitoring FAQ answers typical questions about what the Profile does.

The Radiation Exposure Monitoring Purchasing describes considerations when purchasing equipment to deploy this Profile.

Implementer Information

The Radiation Exposure Monitoring Implementation provides additional information about implementing this Profile in software.

Reference Articles

This page is based on the Profile Template