Beyond IPEM 91 Dexa
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Paul Charnock presenting at Beyond IPEM 91 on DEXA: The Forgotten Survey
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Beyond IPEM 91 Dexa
- 1. Dexa – The forgotten Survey Paul Charnock, Fergus Dunn, James Lowe IRS Ltd, Liverpool
- 2. • Should Level B QA be performed on Dexa? • Who does anything on Dexa? • Should guidance on QA & methods be included in any update to IPEM 91? Questions for the Audience
- 3. • Dual (Energy) X-ray Absorbtiometry – Osteoporosis – Bone Mineral Density determination • Patient dose ~0.01 to 0.1mSv • But... – (From IRR99) any practice involving medical exposure of patient should have a suitable QA programme QA in Dexa
- 4. • QA Guidance IPEM 91 (prev. IPEM 77) – No Dexa • Should it be included? • Is there any guidance available? QA in Dexa
- 5. • Commissioning & QA for Dexa (Sheahan et al, RPD 2005) • QA/Acceptance Testing of Dexa (Larkin et al, RPD 2008) • Patient doses in bone mineral densitometry (Huda et al, BJR 1996) QA in Dexa
- 6. QA in Dexa Manufacturer / Model Units GE Lunar Prodigy 4 Hologic Discovery QDR 7 DMS Stratos DR 1 12
- 7. • Scatter dose • Reference Dose • Patient Dose • BMD • Field Size • HVL • Cone/Fan Size QA in Dexa
- 8. • BMD Level A QA use a local, manufacturer specific phantom Measure BMD for (usually) spine, plot against a baseline Sometimes results clear, sometimes simple PASS/FAIL QA in Dexa
- 9. QA in Dexa
- 10. • BMD Level B – Take pelvis image of standard phantom QA in Dexa
- 11. QA in Dexa
- 12. QA in Dexa
- 13. • Reference Dose – Some systems display a dose – Some are DAP, others (assumed) ESD – One unit displays mrem – How to measure? QA in Dexa
- 14. QA in Dexa Model Measured Dose Displayed Dose WBED Lunar Prodigy Pro 131.8 µGy 146 (no units) 2.3 µSv Lunar Prodigy Pro 200.2 µGy 146 (no units) 3.4 µSv Discovery QDR 70.9 µGy No displayed 1.2 µSv Discovery QDR 79.9 µGy No displayed 1.4 µSv Discovery QDR 72.35 µGy No displayed 1.2 µSv Stratos DR 50.3 µGy No displayed 0.86 µSv QDR 4500W 208.9 µGy 3.5 cGycm2 3.6 µSv Discovery Wi 173.4 µGy 3.5 cGycm2 3.0 µSv Discovery Wi 151.9 µGy 3.5 cGycm2 2.6 µSv Lunar Prodigy 68.56 µGy 3.7 mrem?? 1.2 µSv
- 15. • Field Size – LBD equivalent – Image a cassette (could use detector, gafchromic film etc) – Is radiation constrained to the stated area? • Issues? – If no bone detected, some systems stop QA in Dexa
- 16. QA in Dexa Field size given is 10 cm by 15 cm
- 17. QA in Dexa Scan field is given as 180 mm by 180 mm Scan actually stops at 160 mm by 160 mm
- 18. • BMD Baseline is easy – Some systems allow simple comparison with previous survey, even 1 yr later – Supplements local QA • Field size also easy – Result show good indication Conclusions
- 19. • Dose indication – Variable results – Would like to discuss methodology • Patient Dose – Can establish a baseline – Conversion factors may not be appropriate • HVL – Only at commissioning – Only possible with Al Conclusions
- 20. • Should Level B QA be performed on Dexa? • Yes • Who else does anything on Dexa? • Send method / results to: paulcharnock@irs-limited.com ipem.evidence.based.qa@gmail.com • Should guidance on testing be included in any update to IPEM 91? Questions for the Audience
Editor's Notes
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp
- To begin with look at life cycle diagram from IPEM 91 Want to keep equipment in clinical use as long as equipment is effective Purpose of clinical use is to answer clinical question – ie sufficient image quality with doses alarp