Radiation Exposure Monitoring (REM) is a framework developed by

Integrating the Healthcare Enterprise Integrating the Healthcare Enterprise (IHE) is a non-profit organization based in the US state of Illinois. It sponsors an initiative by the healthcare industry to improve the way computer systems share information. IHE was established in 1998 b ...

(IHE), for utilizing existing

technical standard A technical standard is an established norm or requirement for a repeatable technical task which is applied to a common and repeated use of rules, conditions, guidelines or characteristics for products or related processes and production methods, ...

s, such as DICOM, to provide information about the dose delivered to patients in

radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...

procedures, in an

interoperable Interoperability is a characteristic of a product or system to work with other products or systems. While the term was initially defined for information technology or systems engineering services to allow for information exchange, a broader defi ...

format. Ready access to dose information aids medical staff, including

radiographer Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialize in the imaging of human anatomy for the diagnosis and treatment of pathology. Radi ...

radiologist Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiatio ...

s and

medical physicist A medical physicist is a health professional with specialist education and training in the concepts and techniques of applying physics in medicine and competent to practice independently in one or more of the subfields (specialties) of medical physi ...

s, in the

radiation protection Radiation protection, also known as radiological protection, is defined by the International Atomic Energy Agency (IAEA) as "The protection of people from harmful effects of exposure to ionizing radiation, and the means for achieving this". Expos ...

goal of reducing doses to a level "as low as reasonably practicable".

Collecting and using dose data

A challenge in automating the reporting of

radiation exposure Radiation is a moving form of energy, classified into ionizing and non-ionizing type. Ionizing radiation is further categorized into electromagnetic radiation (without matter) and particulate radiation (with matter). Electromagnetic radiation con ...

estimations has traditionally been a function of whether the record of dose provided by a manufacturer is persistent (i.e. stored electronically) or transient (i.e. displayed on a read-out). Many current radiology devices provide only transient records, either in the form of human-readable dose screens that require manual intervention (i.e. pencil and paper) to permanently capture the patient exposure, or else in the equally perishable data generated by a modality-performed procedure step (MPPS) created to help manage the scheduling system. MPPS is insufficient, having a limited ability to encode complex data, and no options for long-term storage or queries. Newer scanners are able to create DICOM radiation dose structured reports (RDSRs) alongside the images themselves. REM addresses perishable dose data by creating a persistent record that can be sent to a central repository, and then queried and analyzed by health information systems for either a specific patient's history or for analysis of radiation exposure levels among patient groups, platforms, or clinical operations. RDSRs, and the use of the IHE REM framework are part of the

IEC The International Electrotechnical Commission (IEC; in French: ''Commission électrotechnique internationale'') is an international standards organization that prepares and publishes international standards for all electrical, electronic and r ...

61910 standard.

Standards and Integrating the Healthcare Enterprise (IHE)

(IHE) is an initiative by

healthcare professional A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...

s and industry to improve the way computer systems in healthcare share information. IHE "Integration Profiles" are designed make systems easier to implement and integrate, and help care providers use information more effectively. IHE Integration Profiles describe clinical information management use cases and specify how to use existing standards (

HL7 Health Level Seven or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. These standards focus on the application layer, which is "la ...

, DICOM, etc.) to address them. Systems that implement integration profiles solve interoperability problems. For equipment vendors, Integration Profiles are implementation guides. For healthcare providers, Integration Profiles are shorthand for integration requirements in purchasing documents. Integration Statements tell customers the IHE Profiles supported by a specific release of a specific product. The REM Profile enables imaging modalities to export radiation exposure estimation details in a standard format. Radiation reporting systems can either query for these "dose objects" periodically from an archive, or receive them directly from the modalities. The radiation reporting system is expected to perform relevant dose QA analysis and produce related reports. The analysis methods and report format are not considered topics for standardization and are not covered in the profile. The profile also describes how radiation reporting systems can submit dose estimation reports to centralized registries such as might be run by professional societies or national accreditation groups. In the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...

, the

American College of Radiology The American College of Radiology (ACR), founded in 1923, is a professional medical society representing nearly 40,000 diagnostic radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians and medical physicists. ...

DIR is one such registry. By profiling automated methods, the profile allows dose information to be collected and evaluated without imposing a significant administrative burden on staff otherwise occupied with caring for patients. In addition to supporting profile

quality assurance Quality assurance (QA) is the term used in both manufacturing and service industries to describe the systematic efforts taken to ensure that the product(s) delivered to customer(s) meet with the contractual and other agreed upon performance, design ...

(QA) of the technical process at the local facility, (e.g. determining if the dose was appropriate for the procedure performed), the profile also supports population analysis performed by national registries. Compliant software products are capable of de-identifying and submitting dose reports to a national dose register securely, making it relatively simple for groups such as ACR to collect and process dose data from across the country once they have recruited participating sites.

Challenges

Fluoroscopy monitoring

Most

fluoroscopic Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal anatomy, structure and ...

x-ray equipment can provide an estimate of the cumulative dose that would have resulted to a point on the skin if the x-ray beam was stationary during the complete procedure. Such an estimate is derived from the fluoroscopic technique factors and the total exposure time, including any image recording, or from built-in dosimetry systems. However, these systems, known as

dose area product Dose area product (DAP) is a quantity used in assessing the radiation risk from diagnostic X-ray examinations and interventional procedures. It is defined as the absorbed dose multiplied by the area irradiated, expressed in gray- centimetres squared ...

meters (DAP meters), do not directly provide skin dose information without further knowledge of the sizes of the x-ray beam during the entire procedure. The relationship between cumulative skin dose and peak skin dose is highly variable, as has been demonstrated in a number of publications.

Limitations of dose monitoring

According to IHE, "It is important to understand the technical and practical limitations of dose monitoring and the reasons why the monitored values may not accurately provide the radiation dose administered to the patient": # The values provided by this tool are not "measurements" but only calculated estimates. # For computed tomography, "CTDI" is a dose estimate to a standard

plastic Plastics are a wide range of synthetic or semi-synthetic materials that use polymers as a main ingredient. Their plasticity makes it possible for plastics to be moulded, extruded or pressed into solid objects of various shapes. This adaptab ...

phantom. Plastic is not human tissue. Therefore, the dose should not be represented as the dose received by the patient. # For planar or projection imaging, the recorded values may be exposure, skin dose or some other value that may not be patient's body or organ dose. # It is inappropriate and inaccurate to add up dose estimates received by different parts of the body into a single cumulative value. Despite such limitations, interest in monitoring radiation dose estimates is clearly expressed in such documents as the

Europe Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...

an directive

Euratom The European Atomic Energy Community (EAEC or Euratom) is an international organisation established by the Euratom Treaty on 25 March 1957 with the original purpose of creating a specialist market for nuclear power in Europe, by developing nucl ...

97/43 and the American College of Radiology Dose Whitepaper.ACR White Paper on Radiation Dose in Medicine
/ref>

References

{{reflist