EFOMP Workshop Dose management systems and repositories March

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Organisation of dose management systems and repositories for radiation protection and biomedical research: Possibilities and limitations of current implementations and standards Bernard Gibaud Medi. CIS, LTSI, U 1099 Inserm Faculté de médecine, Rennes bernard. gibaud@univ-rennes 1. fr

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Overview • Introduction • Current Standards – DICOM objects supporting the exchange of dose information – IHE profiles for dose management • Discussion of limitations – potential use of semantic technologies • Conclusion

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Introduction • Dose management systems and dose registries are acutely needed to support activities in the domain of radiation protection • Utilization of these systems is highly dependent on – standard information models of dosimetric information and related communication standards – implementation guidelines (such as IHE profiles)

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Communication needs Equipment causing radiation exposure Dose Management Dose Registry Estimation of resulting dose Intra-institutional dose management Cross-institutional Dose management

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna DICOM Standard • The DICOM standard defined several objects relevant to the domain of radiation protection – Two objects focused on dose recording • Projection X-Ray Radiation Dose Structured Report (2004) • CT Radiation Dose Structured Report (2007) – One focused on Radiopharmaceutical dose reporting • Radiopharmaceutical Radiation Dose Structured Report (2013) – One focused on Organ doses • Patient Radiation Dose Structured Report (2017)

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna DICOM Structured Reporting • All the previous objects are based on DICOM Structured reporting, a methodology to describe the structure of documents – – based on a tree-structure made of nodes (content items) connected by relationships specified in templates 1 1. 1. 1 1. 2. 1. 1 1. 3. 1

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Basic Structure of SR Types of Content items • • • CONTAINER TEXT CODE NUM DATETIME UIDREF IMAGE COMPOSITE SCOORD Types of Relationships • • • CONTAINS HAS OBS CONTEXT HAS CONCEPT MOD HAS PROPERTIES INFERRED FROM SELECTED FROM

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna CT Radiation Dose SR

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Structure of SR templates 1 1 b 2 3 4 5 6 7 8

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna CT Radiation Dose SR • Contains CT dose indices, which denote radiation that would be absorbed by a plastic phantom – Computed Tomography Dose Index: CTDIvol (m. Gy) – Dose x Length Product: DLP (m. Gy. cm) – Effective Dose (m. Sv) (optional) • The CT radiation dose SR mentions – DLP total, i. e. accumulated at a certain level: e. g. Study, Performed procedure Step, Series – CTDIvol , DLP, Effective Dose and Size-Specific Dose Estimation per irradiation event (i. e. acquisition), together with detailed image acquisition parameters (geometry, characteristics of X-Ray source)

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna CT Irradiation Event Data Target region … Exposure time Scanning length (…) Nominal single collimation width • Pitch factor • For each X-ray source • • • – KVP, Max X-Ray tube current, X-Ray tube current • • Mean CTDIvol CTDIw phantom type DLP Effective dose – Measurement method • Size specific dose estimation – Measurement method

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Projection X-Ray Radiation Dose SR • Dedicated to Projection X-ray devices, e. g. – Fluoroscopy systems – Biplane angio systems – Mammography systems – Cassette-based systems • Similar scope of accumulation – In biplane systems, accumulated dose values kept separate for each plane

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Projection X-Ray Radiation Dose SR

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Projection X-Ray Radiation Dose SR • Contains – Dose x Area Product (m. Gy. m 2) – Dose at reference point (RP) total (Gy) • The Projection X-Ray radiation dose SR mentions – Dose total, i. e. accumulated at a certain level: e. g. Study, Performed procedure Step – Exposure index , Dose (RP) and Average glandular dose per irradiation event (i. e. acquisition), together with image acquisition parameters

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Radiopharmaceutical Radiation Dose SR

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Radiopharmaceutical Radiation Dose SR • Radiopharmaceutical administration event data – Radiopharmaceutical agent and Radionuclide – Radiopharmaceutical specific activity (Bq/mmol) – Administered activity (MBq) and volume (cm 3) • Organ dose (Optional) – For each organ • Organ dose (m. Gy) • and related organ dose reference authority (e. g. ICRP publications, OLINDA, MIRDOSE) • Radiopharmaceutical administration patient characteristics (Optional) – Age, sex – Patient height, weight, body surface area – Glucose (mmol/l), serum creatinine(mg/dl), fasting, hydration

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Patient Radiation Dose SR • Specified in DICOM Supplement 191 (2017) • Concerns estimated radiation dose to a patient, focusing on the following sources of exposure – Projection X-Ray device (Fluoro, mammo, angio, etc) – CT device – Radiopharmaceutical administration (diagnostic and therapeutic) • Out of scope: Occupational radiation exposures, dose from external beam therapy, ion beam therapy, brachytherapy

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Patient Radiation Dose SR

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Patient Radiation Dose SR: Radiation Dose Estimate • Radiation dose estimate representation – (Ref to Images or SR) – List of organs • Radiation dose estimate methodology – (Ref to Radiation Dose SR or Radiopharm. Admin. SR) – Patient radiation dose model data – Radiation Dose estimate method (e. g. Monte Carlo, tabular algo. , analytical algo. , empirical algo. ) • Organ radiation dose information – For each organ • Organ • Absorbed radiation dose (max, min, mean, mode median) • Equivalent radiation dose (max, min, mean, mode median)

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Radiation Exposure Monitoring (REM) Integration profile (IHE) Transmission using regular DICOM services (Storage, Q & R, DICOMweb) Dose Register [RAD-63] Submit Dose Information Dose Info Reporter Image Archive Acquisition Modality ê [RAD-64] Query Dose Information ê [RAD-65] Retrieve Dose Information Image Manager ç [RAD-64] Query Dose Information ç [RAD-65] Retrieve Dose Information [RAD-62] Store Dose Information [RAD-10] Storage Commitment [RAD-62] Store Dose Information Dose Info Consumer

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Discussion • DICOM Radiation Dose SR and DICOM exchange services well-adapted to communication with Dose Management Systems and Registries • Communication in the context of research may requires additional capabilities – New methods, new parameters, new dosimetric quantities

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Development semantic repository for images and dosimetric data • Developed in the context of the MEDIRAD project (2017 2021) – EURATOM Grant Agreement N° 755523 • Image and Radiation Dose Bio. Bank (IRDBB) – a PACS database (for DICOM images and Radiation Dose SR) – complemented with a semantic (i. e. ontology-based) repository

MEDIRAD Project Imaging and Radiation Dose Biobank (IRDBB) Client applications DICOM-data CT images RF images Dose SR SR image report internet IRDBB Web Server Processing of DICOM File Set Descriptors Non-DICOM data Organ Doses Imaging biomarkers and related provenance data (in adhoc XML-based format) PACS CT images RF images Dose SR SR image report Ontologies RDF data - image metadata - dose values - clinical indication - imaging biomarkers Processing of Non. DICOM File Set Descriptors Metadata repository RDF Triple store File container Database

EFOMP Workshop: Dose management systems and repositories, March 2, ECR 2018, Vienna Conclusion • Standards exist for communicating / reporting radiation dose information (DICOM radiation dose SR, IHE REM profile) • For research applications, semantic technologies may bring additional capabilities thanks to the use of ontologies in the definition of managed data