EuroSafe Imaging 2020
Action 4 - Dose management systems, Computer applications, Radiation physics, Radioprotection / Radiation dose, Catheter arteriography, Conventional radiography, CT, Computer Applications-General, Radiation effects, Radiation safety, Quality assurance, Not applicable
R. W. Loose, E. Vano, P. Mildenberger, V. Tsapaki, D. Caramella, J. Sjöberg, G. Paulo, A. Torresin, S. Schindera
Description of activity and work performed
The WG had one meeting at ECR March 2019 and one online meeting in October 2019 to discuss structure and contents of a planned ESR publication (white paper). Three DMS vendor companies joined the March meeting in Vienna.
The initial step was the selection of the most relevant topics to fulfil the objectives of the WG:
- Classification of basic (minimal requirements), advanced and high end features of DMS
- Pathways of dose data between HIS, RIS, PACS and modalities (Fig. 3)
- Unique and harmonised classification of procedures
- Selection of relevant dose parameters (in cooperation with WG on “Dosimetry for imaging in clinical practice”)
- Definition of trigger levels for notification and alerts
- Numerical and graphical reporting of DMS output for QA, benchmarking etc.
- Dosimetric information for the practitioner and referrer.
- The role of long term dose tracking and the use of effective dose
- Special aspects in IR like skin dose and skin dose mapping
Dose management is a comprehensive term, including dose recording, dose reporting, dose tracking and dose monitoring. Less than 10 years ago, manufacturers started to offer software systems for dose management. These systems receive dosimetric and other technical or patient related parameters from individual modalities like computed radiography (CR), digital radiography (DX), CT, radio fluoroscopy (RF), mammography (MG) and X-ray angiography (XA) either through analysis of DICOM headers or Radiation Dose Structured Reports (RDSR). Other techniques like bitmap dose reports or modality performed procedure step (MPPS) are outdated and should not be used in future. Analysis of these data over a longer time scale provides information that are helpful in terms of radiation protection, optimisation, quality management, exposure analysis of individual patients and reporting of specific events. It should be noted that some vendors, contrary to the recommendations of ICRP, attempt to calculate effective doses for individual patients without alerting on the large uncertainties of these estimations . Tracking of cumulative exposures in terms of ED over a longer time scale may help to investigate the proper justification of some high dose procedures.
An essential prerequisite for the introduction of a DMS is a uniform classification of procedures to be performed. Without such a classification, a number of requirements, such as the provision of dosimetric data to authorities for establishing DRLs or benchmarking between different modalities or institutions are not possible. Such a classification is part of the EuroSafe iGuide project  using the RadLex Playbook .