how to manage the dose effectively - alphatron medical · 20 overall alerts with drl’s (national...

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

4

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

5

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

********

6

******

**

Technical overview

Secondary Capture + Dicom Header

RDSR format

********

7

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

8

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

10

Involve your staff

D.M.S.

Dose manager

Physicists

11

Involve your staff

12

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

?

13

Involve your staff

• No dose without BMI

No population filter Normal BMI

New European directives (February 2018)

14

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

15

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

17

Involve your staff

• No dose, without the right procedure

?

New European directives (February 2018)

18

Involve your staff

(REAL TIME)

ALERTS MANAGEMENT

20

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

22

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)

24

You can categorize your alert rules by :

Alerts management (Real time)

Weight

Age

BMI

Sex

25

Email alerts by :

Dose manager (Physicist, Radiologist, radographer, …)

Modalities

Hospital

…

Alerts management (Real time)

26

For authorities :

Automatic templates

…

Dose for Authorities

(BEFORE)

ALERTS MANAGEMENT

28

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

29

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

33

ORGAN DOSE and EFFICIENT DOSE in Nuclear Medicine

Hybrid Modality

PETCT – SPECCT

Adult and pediatric

Multi-injection

Alerts management (After)

35

PEAK SKIN DOSE in Interventional Radiology

Validated

4 University Hospitals (adult and children)

6 physicists

Alerts management (After)

Mrs Hadid Lama - Physicist

36

Other features …

SSDE

Automatic reports

Export files

Comparison module

…

Alerts management (After)

How do you

imagine a perfectDMS ?

44

IRM

45

IRM

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IRM