<scp>AAPM</scp>medical physics practice guideline 6.a.: Performance characteristics of radiation dose index monitoring systems

Gress, Dustin A.; Dickinson, R; Erwin, William D.; Jordan, David W.; Kobistek, Robert J.; Stevens, David B.; Supanich, Mark; Wang, Jia; Fairobent, Lynne

doi:10.1002/acm2.12089

Cited by 25 publications

(20 citation statements)

References 14 publications

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“…Since modern medical systems in interventional radiology and computed tomography must be able to transfer dose-related parameters to the examination records, dose-related parameters should be continuously recorded and systematically and clearly evaluated with the help of a dose management system [45,46]. As various studies have shown, this is essential for systematic protocol optimization and for a continuous comparison with national DRLs and local reference values [47 -49].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling

Schegerer

Loose²,

Heuser

et al. 2019

Fortschr Röntgenstr

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Purpose Recent developments in medical technology have broadened the spectrum of X-ray procedures and changed exposure practice in X-ray facilities. For this reason, diagnostic reference levels (DRLs) for diagnostic and interventional X-ray procedures were updated in 2016 and 2018, respectively. It is the aim of this paper to present the procedure for the update of the DRLs and to give advice on their practical application. Materials and Methods For the determination of DRLs, data from different independent sources that collect dose-relevant data from different facilities in Germany were considered. Seven different weight intervals were specified for classifying pediatric X-ray procedures. For each X-ray procedure considered, the 25th, 50th, and 75th percentile of the respective national distribution of the dose-relevant parameters were determined. Additionally, effective doses that correspond to the DRLs were estimated. Results In procedures with already existing DRLs before 2016, the values were lowered by circa 20 % on average. Numerous DRLs were established for the first time (9 for interventional procedures, 10 for CT examinations). Conclusion For dose optimizations even below the new national DRLs, the BfS recommends establishing local reference levels, using dose management software (particularly in CT and interventional radiology), adapting dose-relevant parameters of X-ray protocols to the individual patient size, and establishing internal radiation protection teams responsible for optimizing X-ray procedures in clinical practice. When applying good medical practice and using modern equipment, the median dose values of the nationwide dose distributions can not only be easily achieved but can even be undercut. Key Points: Citation Format

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Section: Discussionmentioning

confidence: 99%

Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling

Schegerer

Loose²,

Heuser

et al. 2019

Fortschr Röntgenstr

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“…With the introduction of PACS (Picture Archiving and Communication Systems) in radiology, several vendors have developed radiation dose index monitoring (RDIM) software, which collects dosimetric information from imaging studies and stores it in a relational database . RDIM systems are a powerful tool to identify accidental changes and outliers, and determine where optimization is needed.…”

Section: Introductionmentioning

confidence: 99%

Automatic calculation of patient size metrics in computed tomography: What level of computational accuracy do we need?

Sarmento

Mendes

Gouvêa

2017

J Applied Clin Med Phys

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ObjectivesTo compare the effectiveness of two different patient size metrics based on water equivalent diameter (D w), the mid‐scan water equivalent diameter D w_c, and the mean (average) water equivalent diameter in the imaged region, D w_ave, for automatic detection of accidental changes in computed tomography (CT) acquisition protocols.MethodsPatient biometric data (height and weight) were available from a previous survey for 80 adult chest examinations, and 119 adult single‐acquisition chest–abdomen–pelvis (CAP) examinations for two 16 slice scanners (GE LightSpeed and Toshiba Aquilion RXL) equipped with automatic tube current modulation (ATCM). D w_c and D w_ave were calculated from the archived CT images. Size‐specific dose estimates (SSDE) were obtained from volume CT dose index (CTDI vol), using the conversion factors for a patient diameter of D w_c.Results CTDI vol and SSDE correlate better with D w_ave than with D w_c. R‐squared values of linear fits to CTDI vol of CAP examinations were 0.81–0.89 for D w_c and 0.93–0.94 for D w_ave (SSDE: 0.69–080 for D w_c, 0.87–0.92 for D w_ave). Percentage differences between D w_c and D w_ave were −4 ± 4% for chest and +5 ± 4% for CAP examinations (in % of D w_ave). However, small D w variations translated as larger variations in CTDI vol for these ATCM systems (e.g., a 24% increase in D w doubled CTDI vol). The dependence of CTDI vol on D w_ave was similar for chest and CAP examinations performed with similar ATCM parameters, while use of D w_c resulted in a clear separation of the same data according to examination type. Maximum D w variation in the imaged region was 5.6 ± 1.6 cm for chest and 6.5 ± 1.4 cm for CAP examinations.Conclusions D w_ave is a better metric than D w_c for binning similar‐sized patients in dose comparison studies, despite the additional computational effort required for its calculation Therefore, when implementing automatic determination of D w for SSDE calculations, automatic calculation of D w_ave should be considered.

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“…Most DMS function from a server (physical, virtual or cloud-based) which is used for data capture, analyses, display of results, and distribution to other interfaced systems. With DMS, the data collection procedure is fully automated and it can be done in many ways using: OCR of the Dose Report images, analysis of the DICOM headers (both are useful mostly for older systems), DICOM-modality performed procedure step and analysis of the Radiation Dose Structured Report (RDSR) generated in all modern CT scanners [36,37]. Support for these RDSR objects appears in the DICOM Conformance Statement document of each CT scanner and other imaging modalities, which can be found on vendor websites [38].…”

Section: Dose Monitoring Systems: Operation Principlesmentioning

confidence: 99%

“…Therefore, the actual examination can be simulated in the phantom and calculate E, organ doses, and in some cases, even cancer risk estimates [57][58][59][60][61][62][63][64][65][66]. However, E values, organ doses and risk estimates reported within DMS should be used with caution, because apart from the inherent limitations of such calculations, in most cases they are not patient specific [36].…”

Section: Data Collection and Processingmentioning

confidence: 99%

Radiation dose monitoring in computed tomography: Status, options and limitations

et al. 2020

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In the last few years there has been an increasing interest on radiation dose to patients undergoing various diagnostic or therapeutic procedures with the use of ionizing radiation. Especially for CT examinations and interventional procedures, where it is known that patient doses are much higher than conventional radiography, new norms have been published that require to have appropriate radiation dose indices registered in the patient medical record. Because of these demands, dose monitoring has been recommended and adopted into many clinical practices as a routine procedure for every patient and every examination. Dedicated dose monitoring systems (DMS) that facilitate data collection and processing, statistical comparisons, reporting and management of radiation dose related information have been devised and are being used worldwide. In this review paper, a brief flashback to the reasons that necessitated dose monitoring in radiology will be first presented. Furthermore, since the focus of this manuscript is on CT, the CT dosimetry principles and metrics will be summarized. The limitations of these metrics will be also discussed, so that DMS users are aware of the semantics of the parameters shown in the DMS reports. The operation of DMS systems will be outlined to make users aware of functions, limitations, and available options of DMS systems. Furthermore, the usefulness of DMS systems as an optimization tool will be presented and discussed. Finally, information about the DMS solutions available in the market and relevant links will be presented.

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AAPMmedical physics practice guideline 6.a.: Performance characteristics of radiation dose index monitoring systems

Cited by 25 publications

References 14 publications

Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling

Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling

Automatic calculation of patient size metrics in computed tomography: What level of computational accuracy do we need?

Radiation dose monitoring in computed tomography: Status, options and limitations

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