Successfully reported this slideshow.

Reference Values in Diagnostic Radiology Application and Impact

283 views

Published on

  • Be the first to comment

  • Be the first to like this

Reference Values in Diagnostic Radiology Application and Impact

  1. 1. SENTINEL (SAFETY AND EFFICACY FOR NEW TECHNIQUES AND IMAGING USING NEW EQUIPMENT TO SUPPORT EUROPEAN LEGISLATION ) 22 Partners 17 member states 3 accession states
  2. 2. Background EU • Health care equates to 8.4% of GDP • Radiology is 10% of revenue expenditure • Radiology equipment is 15% of capital expenditure • In the UK this equates to 15,000,000,000 euros
  3. 3. Background SENTINEL European Union • Population 457,000,000 • 180,000,000 radiology examinations per year • Population exposure 220,000 man Sv
  4. 4. Background SENTINEL • 90% of all patient examinations • 60% of collective dose • 50% of man-made sources of radiation
  5. 5. Background SENTINEL EU CA • Public concern about radiation in general • Public want safe X-ray examinations • Are all examinations justified
  6. 6. Technology Driven Revolution in Radiology Introduction of new technology (computing) and imaging devices (digital) in radiology and nuclear medicine. These must be safe
  7. 7. Main Objectives SENTINEL • Address efficacy and safety issues in all digital diagnostic examinations and nuclear medicine • Particular emphasis on high dose procedures and sensitive groups
  8. 8. Objectives SENTINEL • Establish physical and clinical image quality criteria and link the two • Establish reference levels for new procedures, particularly for interventional radiology and cardiology
  9. 9. Objectives SENTINEL • Develop good practice guidelines for new digital imaging equipment and procedures • Develop training courses and supporting material • Identify ethical concerns
  10. 10. Functional Performance and Standards • Investigate image quality indices and referral criteria • Equipment performance surveys • IEC/CEN/CENELEC
  11. 11. Efficacy and Safety Cardiology and Interventional Radiology • Develop functional performance standards • Patient dose surveys • Optimisation studies • Use of DICOM (digital imaging and communications in medicine) header for surveys and QA
  12. 12. DICOM Header • DICOM header contains information on the procedure and dosimetry • Accurate dosimetry requires extra calculations and calibration. • Important differences between the different modalities and different X- ray systems.
  13. 13. Use of DICOM Header • On-line patient dosimetry requires significant interaction with the industry to clarify the data contained in the header • Transfer of this information to data bases still not fully solved • Dosimetry survey performed by a PC linked to the hospital RIS/PACS system • IEC developing a dosimetry standard following SENTINEL request
  14. 14. DICOM HEADER (contains useful information for QA, audit and patient dosimetry) Siemens Axiom FD important DICOM tags (0018,0040) : Cine Rate : 30 (0018,0060) : KVP : 97 (0018,1030) : Protocol Name : Reg (0018,1110) : Distance Source to Detector : 947 (0018,1111) : Distance Source to Patient : 798 (0018,1150) : Exposure Time : 786 (0018,1151) : X-ray Tube Current : 271 (0018,1154) : Average Pulse Width : 6.5 (0018,115E) : Image Area Dose Product : 1839 (0018,1162) : Intensifier Size : 160 (0018,1190) : Focal Spot(s) : 0.4 (0018,1510) : Positioner Primary Angle : 0 (0018,1511) : Positioner Secondary Angle : 0 (0018,1702) : Collimator Left Vertical Edge : 0 (0018,1704) : Collimator Right Vertical Edge: 1023 (0018,1706) : Collimator Upper Horizontal Ed: 0 (0018,1708) : Collimator Lower Horizontal Ed: 1023
  15. 15. Computed radiography (CR) Digital radiography with flat detector (DR) Relevant DICOM tags GE Chest flat panel (0008,0020) : Study Date : 27/01/03 (0008,0030) : Study Time : 10:31:12 (0008,0033) : Image Time : 10:32:43 (0008,0068) : Presentation Intent Type : FOR PRESENTATION (0008,103E) : Series Description : TORAX (0010,0020) : Patient ID : 795607 (0010,0040) : Patient's Sex : F (0010,1010) : Patient's Age : 085Y (0018,0015) : Body Part Examined : (0018,0060) : KVP : 125 (0018,1150) : Exposure Time : 5 (0018,1151) : X-ray Tube Current : 250 (0018,1153) : Exposure in uAs : 1400 (0018,115E) : Image Area Dose Product : 0.83557 (0018,1190) : Focal Spot(s) : 0.6 (0018,1405) : Relative X-ray Exposure : 61 (0018,7060) : Exposure Control Mode : AUTOMATIC (0018,7062) : Exposure Control Mode Descript: AEC_left_and_right_cells (0028,0010) : Rows : 2022 (0028,0011) : Columns : 2022 (0028,0100) : Bits Allocated : 16 (0028,0101) : Bits Stored : 14 (0008,0020) : Study Date : 04/12/2003 (0008,0022) : Acquisition Date : 04/12/2003 (0008,0060) : Modality : CR (0008,0070) : Manufacturer : AGFA (0008,0080) : Institution Name : HCSC (0008,1010) : Station Name : ADCC2 (0008,103E) : Series Description : lumbar AP (0010,1010) : Patient's Age : 020Y (0018,0015) : Body Part Examined : LSPINE (0018,1004) : Plate ID : U13-35 (0018,1401) : Acquisition Device Processing : 60025Ia712Ra (0018,1403) : Cassette Size : 35CMX43CM (0018,1404) : Exposures on Plate : 342 (0018,5101) : View Position : AP (0018,6000) : Sensitivity : 4.00000000E+02 (0019,1010) : Image processing parameters : MENU=60025 CC=0 MC=3.00 EC=0.00 LR=2.00 NR=4.00 (0019,1013) : Sensitometry name : NK5 (0019,1015) : Dose monitoring list : 1.54 (0020,0013) : Image Number : 1 (0020,1002) : Images in Acquisition : 1 (0028,0010) : Rows : 3730 (0028,0011) : Columns : 3062 (0028,0100) : Bits Allocated : 16 (0028,0101) : Bits Stored : 12 (0028,0102) : High Bit : 11
  16. 16. 2. DICOM header information is extracted 1. Images are received 4. ALARMS are displayed 3. COMPARISON with reference values
  17. 17. What Parameters are audited • Patient entrance dose (entrance air kerma). • Dose area product (collimation). • Radiographic technique (e.g. appropriate kVp). • Appropriate use of the AEC.
  18. 18. What Parameters are audited • Flat panel detector temperature. • Number of series, number of images per series, kV, mA, ms and total number of images per procedure. • Exposure index and post-processing parameters (for CR). • Repeated images (retakes). • Image quality (basic evaluation).
  19. 19. A total of 3,506 paediatric patients have been selected for the dose evaluations 0 <1 years sample size 1 < 5 years sample size 10 < 15 years sample size Chest without bucky 1180 309 92 Chest with bucky 0 181 363 Abdomen 93 30 150 Pelvis 254 128 137 TOTAL sample 5 <10 years sample size 69 122 1724 799 342 641 143 255
  20. 20. Standardisation • Direct Input to Industry both through Representation and as working participants in Standardisation Bodies • Brings research results directly to bear on Equipment Design Process and Industry thinking
  21. 21. Formal Collaboration with IEC • Acceptance Testing/Commissioning/QA • Long term differences and lack of trust between industry engineers, end user physicists, et al. • Criteria for Acceptability of Equipment in Europe under MED • Major Achievement: Meeting (Oct 2007) between SENTINEL and IEC Industry representatives agreed to work approach and common issues
  22. 22. Efficacy and Safety in Mammography Screening • Digital mammography • Risk/benefit studies • Tissue sampling techniques
  23. 23. Efficacy and Safety in Mammography Screening
  24. 24. Efficacy and Safety in Mammography Screening
  25. 25. Defining Aspects of Radiation Protection • Relatively strong science base • Developed mainly outside medicine, but is used mainly within medicine • Employs arcane impenetrable language invented and protected by Physicists • Inept in Social and Political Sciences (Note EU Medico Legal Survey) • Global Industry and Local Health Care Provision
  26. 26. Ethics Issues in Radiology • Identified a problem for Radiation Protection arising from a shift in dominant values in society since ICRP 26 and 60 • Ethicists will not solve the problems for us, but help us identify and formulate them • Training essential to produce ethically sensitive and competent professions. Presently weak in this area.
  27. 27. Examples of Areas • Right to Life • Right to Bodily Integrity • Individual Choice • Consent • Equality • Equity • Special Needs • Ageism • Trust of Authority • Trust in Professions
  28. 28. Some Issues Identified • Major Issues around Justification • Philosophical assumptions underlying ICRP Recommendations need re-examining • Pregnancy Issues • Medico Legal Issues • Population Screening Issues • Issues around consent, authorisation, power of attorney, personal choice, self referral etc. • Non Transparent Language for Discourse, particularly Quantities and Units
  29. 29. Pregnancy • Basis for Recommendations • Diversity of Practice throughout Community • Widespread high dose procedures need a more consistent approach • Patient Consent?
  30. 30. Non Medical Exposures • Exposures not primarily MEDICAL; Common Feature is lack of Medical Indication. Include: • Medico Legal, • Security, • Evidential • Commercial health screening, • Art
  31. 31. Training Guidelines • Training needs identified • Training syllabus developed • Dissemination to member states via a series of training courses
  32. 32. Summary • Safer, more effective procedures and examinations using new technology • Greater public acceptance of medical uses of radiation • Safer, more cost effective health care
  33. 33. Radiology Can Be Decorative!
  34. 34. ---- Or Threatening
  35. 35. Is It Ethical ? Is It Safe ? Is It Justified ?

×