HOW TO MANAGE THE DOSE EFFECTIVELY ?
DMS
« RADIATION DOSE MONITOR »
Florent JAULT Product specialist
Arnaud LEGLANDChannel Partner Sales Manager Europe
2018, September
Agenda
• Technical overview
• Take care your patient
• Before
• End of exam
• Later
• Main features
• Practical case
How to manage the dose effectively ?
TECHNICALOVERVIEW
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Collect dose from most modalities
CT
Interventional radiology
Mammography
Even the oldest ones
External dosimeter
Ionizing chamber
Technical overview
Conventional radiology
Digital X ray
MR
Nuclear medicine
PETCT
SPECCT
Manually
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Modality integration, collection of dose data
DICOM RDSR (Radiation Dose Structured Report)
DICOM Dose SC (Secondary Capture)
DICOM MPPS (Modality Performed Procedure Step)
DICOM Header
External dosimeter
Manual entry of dose data
Technical overview
Blending
RDSR format
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******
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Technical overview
Secondary Capture + Dicom Header
RDSR format
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Web 2.0 interface
Accessible from anywhere
Customized access can be provided to different profiles (LDAP* supported)
No restriction to the number of users
Customize different templates
HIS/RIS connectivity
Automatic submission of HL7 and DICOM RDSR dose reports
Reception of HL7 messages (fusion, update, etc.)
PACS connectivity
Automatic downloading in DICOM Query/Retrieve of the patient’s dose history (even Screen Capture)
Automatic sending of dose reports to PACS in RDSR format
Webservices
Technical overview
*Lightweight Directory Access Protocol
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Flexible solution :
Dose data collected from
▪ modalities,
▪ PACS
▪ or both
PACS or RIS connectivity
Through Webservices, you can display/reach
▪ Alerts,
▪ Patient history,
▪ …
Technical overview
DMS
PACS/RIS/workstation
Modality
Dose data
Study
Before
End exam
After
TAKE CARE YOURPATIENT
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Involve your staff
D.M.S.
Dose manager
Physicists
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Involve your staff
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New European directives (February 2018)
Several tasks
Involve your staff
• No dose, without BMI • No dose, without reason of overexposure • No dose, without the right procedure
?
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Involve your staff
• No dose without BMI
No population filter Normal BMI
New European directives (February 2018)
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New European directives (February 2018)
We can automatically collect Weight and Height from
▪ RIS, PACS (via HL7)
▪ Modalities
▪ ( or at least manually in RDM )
If informations are previously in the database, RDM will show them.
Involve your staff
• No dose without BMI
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Involve your staff
• No dose, without reason of overexposure
New European directives (February 2018)
Respect of DRLs
Dose exceeds the 1st threshold
Dose exceeds the 2nd threshold
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Involve your staff
• No dose, without the right procedure
?
New European directives (February 2018)
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Involve your staff
(REAL TIME)
ALERTS MANAGEMENT
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Overall alerts with DRL’s (national or local)
Accuracy
Example of CT
Alerts management (Real time)
CT
Acquisition alert rules
• DLP (mGy.cm)
• CTDI (mGy)
• SSDE (mGy)
• Scanning length (mm)
• DLP Head 16 (mGy.cm)
• CTDI Head 16 (mGy)
• SSDE Head 16 (mGy)
• Scanning length Head 16 (mm)
• DLP Body 32 (mGy.cm)
• CTDI Body 32 (mGy)
• SSDE Body 32 (mGy)
• Scanning length Body 32 (mm)
Study alert rules
• E (mSv)
• DLP total (mGy.cm)
• Number of acquisitions
• DLP 16 total (mGy.cm)
• DLP 32 total (mGy.cm)
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Why so many possibilities ?
Alerts management (Real time)
Example of multiple traumatic injuries patient
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Why so many possibilities ?
Alerts management (Real time)
Example of CT UROGRAPHY with 3 phaseswithout injection
Arterial
Portal
1
2
3
1
1
2
2
3
3
1
2
3
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OVERALL
or ACCURACY
In different « fields »:
▪ « orientation », « acquisition protocol», « description »,« laterality » and « target region ».
You can add « conditions »:
▪ « starts with », « ends with », « contains » and « equals ».
2 times
▪ Complete dose management
Alerts management (Real time)
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You can categorize your alert rules by :
Alerts management (Real time)
Weight
Age
BMI
Sex
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Email alerts by :
Dose manager (Physicist, Radiologist, radographer, …)
Modalities
Hospital
…
Alerts management (Real time)
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For authorities :
Automatic templates
…
Dose for Authorities
(BEFORE)
ALERTS MANAGEMENT
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PATIENT ALERT RULES : DOSE HISTORY
Over a period from 1 day to 30 years:
Alerts on number of studies
• All examinations (global),
• CT,
• NM,
• IR,
• Xray,
• Mammography.
Alerts on amount of dose
• DLP,
• DAP,
• Air Kerma,
• Average glandular dose,
• MBq.
Alerts management (Before)
Worklist
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PATIENT ALERT RULES : DOSE HISTORY
Alerts management (Before)
PATIENT ALERT RULES
DOSE HISTORYSorted by modalities, by region
Region: HeadTotal Dose (MBq): 0
Total DLP (mGy.cm): 19814.35Total DLP 16 (mGy.cm): 18599.78
Total DLP 32 (mGy.cm): 1197.87E (mSv): 110.36
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PATIENT ALERT RULES : DOSE HISTORY
• Examples:
IR: Alert « above 5 Gy on 10 days » Monday Thursday Friday
1 Gy 2 Gy 3 Gy
6 Gy
Friday Monday
CT: Alert « above 2 CT in 3 days »
SaturdayWorklist :
Worklist
(AFTER)
ALERTS MANAGEMENT
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ORGAN DOSE in CT
Alerts management (After)
MonteCarlo Phantoms
Newborn
1 year
5 years
10 years
15 years
Pregnant 3 months
Pregnant 6 months
Pregnant 9 months
Thinness
Normal BMI
Overweight
Obesity level 1
Obesity level 2
Obesity level 3
Doses calculate according to ICRP 60 and 103
Fetal organ dose
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ORGAN DOSE and EFFICIENT DOSE in Nuclear Medicine
Hybrid Modality
PETCT – SPECCT
Adult and pediatric
Multi-injection
Alerts management (After)
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PEAK SKIN DOSE in Interventional Radiology
Validated
4 University Hospitals (adult and children)
6 physicists
Alerts management (After)
Mrs Hadid Lama - Physicist
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Other features …
SSDE
Automatic reports
Export files
Comparison module
…
Alerts management (After)
How do you
imagine a perfectDMS ?
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IRM
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IRM
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IRM