Supplement 191 Patient Radiation Dose Reporting PRDSR Supplement

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Supplement 191: Patient Radiation Dose Reporting (P-RDSR) Supplement is developed by DICOM Working Group

Supplement 191: Patient Radiation Dose Reporting (P-RDSR) Supplement is developed by DICOM Working Group 28 (WG-28 -Physics) 31 May 2016

Patient Radiation Dose SR (P-RDSR) • Current Radiation Dose SR contains only information about

Patient Radiation Dose SR (P-RDSR) • Current Radiation Dose SR contains only information about the x-ray system or information the x-ray system can determine, e. g. : • radiation output, geometry, x-ray source, detector system, etc. • Estimation of patient/organ dose requires knowledge of: • Radiation beam characteristics that interact with patient • Models of the patient/organs • Models of radiation interaction within the patient • Methods to do patient dose estimations are being developed and improved continuously • storage of these estimations in a different object would allow more versatile utilization of the data 31 May 2016 DICOM WG-28 / Supp 191 2

Patient Radiation Dose SR (P-RDSR) • Goals of the Patient Dose SR • Store

Patient Radiation Dose SR (P-RDSR) • Goals of the Patient Dose SR • Store the results of Patient Organ Dose calculations: – – • of a SINGLE procedure or MULTIPLE procedures including one or more modalities and procedure steps/phases of one or more organs by one or more calculation methods Exchange intermediate results with peers • Examples of modalities and procedures: Single modality, single procedure step • CT – internal organ dose (Stochastic) – eye dose (Deterministic) • XA/RF (one time point) – skin dose map (Deterministic) – internal organ dose (Stochastic) • Mammography – glandular dose (Stochastic) • Projection x-ray (CR/DX) – entrance skin dose (Deterministic) – internal organ dose (Stochastic) • NM/PET – internal organ dose (Stochastic) 31 May 2016 Multi-modality, single procedure step • SPECT and PET/CT – internal organ dose (Stochastic) Single modality, multi-procedure step • CT – internal organ dose (Stochastic) – eye dose (Deterministic) • XA/RF (multi time points being combined) – skin dose map (Deterministic) • XA localization / disgnostic plus intervention – skin dose map (Deterministic) – internal organ dose (Stochastic) • Mammography/Projection X-ray – Tomosynthesis DICOM WG-28 / Supp 191 3

Patient Radiation Dose SR (P-RDSR) Data flow – simple case Radiation Dose SR 1

Patient Radiation Dose SR (P-RDSR) Data flow – simple case Radiation Dose SR 1 Organ 1 Calculation Method 1 Patient Dose SR 1 Dose Estimate Group #1: • Organ 1 • RDSR Source 1 • Method 1 31 May 2016 DICOM WG-28 / Supp 191 4

Patient Radiation Dose SR (P-RDSR) One RDSR, multiple organs Radiation Dose SR 1 Organ

Patient Radiation Dose SR (P-RDSR) One RDSR, multiple organs Radiation Dose SR 1 Organ 1 Calculation Method 1 Patient Dose SR 1 Dose Estimate Group #1: • Organs 1, 2, 3 • RDSR Source 1 • Method 1 Organ 2 Organ 3 31 May 2016 DICOM WG-28 / Supp 191 5

Patient Radiation Dose SR (P-RDSR) Multiple RDSRs, multiple organs Radiation Dose SR 1 Radiation

Patient Radiation Dose SR (P-RDSR) Multiple RDSRs, multiple organs Radiation Dose SR 1 Radiation Dose SR 2 Organ 1 Calculation Method 1 Patient Dose SR 1 Dose Estimate Group #1: • Organs 1, 2, 3 • RDSR Source 1 • Method 1 Dose Estimate Group #2: • Organs 1, 2, 3 • RDSR Source 2 • Method 1 Organ 2 Or combining RDSRs: Dose Estimate Group #1: • Organs 1, 2, 3 • RDSR Sources 1, 2 • Method 1 Organ 3 31 May 2016 DICOM WG-28 / Supp 191 6

Patient Radiation Dose SR (P-RDSR) Multiple RDSRs, multiple organs, multiple methods Radiation Dose SR

Patient Radiation Dose SR (P-RDSR) Multiple RDSRs, multiple organs, multiple methods Radiation Dose SR 1 Radiation Dose SR 2 Organ 1 Organ 2 Calculation Method 1 Calculation Method 2 Organ 3 Patient Dose SR 1 Dose Estimate Group #1: • Organs 1, 2, 3 • RDSR Source 1 • Method 1 Dose Estimate Group #2: • Organs 1, 2, 3 • RDSR Source 2 • Method 1 Dose Estimate Group #3: • Organs 1, 2, 3 • RDSR Source 1 • Method 2 Dose Estimate Group #4: • Organs 1, 2, 3 • RDSR Source 2 • Method 2 Or combining RDSRs: Dose Estimate Group #1: • Organs 1, 2, 3 • RDSR Sources 1, 2 • Method 1 Dose Estimate Group #2: • Organs 1, 2, 3 • RDSR Sources 1, 2 • Method 2 31 May 2016 DICOM WG-28 / Supp 191 7

Patient Dose Determination: Data Flow Requirements Modality Frame of Reference (FOR) Modality Image Radiation

Patient Dose Determination: Data Flow Requirements Modality Frame of Reference (FOR) Modality Image Radiation Dose SR Radiation Exposure Information X-Ray Equipment - X-Ray exposure techniques - Table, Gantry Angle, Beam Geometry, collimation - Dose measure: CTDI, DAP, . . . Organ Dose Reporter System 31 May 2016 Signifies part of Supplement 191 Patient RDSR DICOM WG-28 / Supp 191 8

Patient Dose Determination: Data Flow Requirements Modality Frame of Reference (FOR) Modality Image Radiation

Patient Dose Determination: Data Flow Requirements Modality Frame of Reference (FOR) Modality Image Radiation Dose SR Radiation Exposure Information - X-Ray exposure techniques - Table, Gantry Angle, Beam Geometry, collimation - Dose measure: CTDI, DAP, . . . X-Ray Equipment Organ Dose Reporter System Patient Model FOR Equipment Information - Table dimension Attenuating material, … Registration IOD Patient Registration Information - 31 May 2016 Patient position on table Fiducials Registration matrix between Patient FOR and Equipment FOR Signifies part of Supplement 191 Patient RDSR DICOM WG-28 / Supp 191 9

Patient Dose Determination: Data Flow Requirements Modality Frame of Reference (FOR) Modality Image Radiation

Patient Dose Determination: Data Flow Requirements Modality Frame of Reference (FOR) Modality Image Radiation Dose SR Radiation Exposure Information - X-Ray exposure techniques - Table, Gantry Angle, Beam Geometry, collimation - Dose measure: CTDI, DAP, . . . X-Ray Equipment Patient Dose Surface 3 D map/view Organ Dose Reporter System Patient Model FOR Equipment Information - Table dimension Attenuating material, … Patient Dose 2 D view/map (e. g. isodose map) Patient Dose SR Registration IOD Patient Registration Information - 31 May 2016 Calculated data for documentation and reference to images and RDSR’s Patient position on table Fiducials Registration matrix between Patient FOR and Equipment FOR Signifies part of Supplement 191 Patient RDSR DICOM WG-28 / Supp 191 10

Registration between Patient Model and RDSR Case #1 Patient Images FOR X-Ray Images Radiation

Registration between Patient Model and RDSR Case #1 Patient Images FOR X-Ray Images Radiation Dose SR (RDSR) - Table, position - Gantry Angle - Beam Geometry, collimation X-Ray Equipment Registration matrix between: each RDSR FOR and - the Patient Model FOR Patient Model (3 D image) 31 May 2016 DICOM WG-28 / Supp 191 11

Registration between Patient Model and RDSR Case #2 FOR TABLE TOP HEAD Equipment Fiducials

Registration between Patient Model and RDSR Case #2 FOR TABLE TOP HEAD Equipment Fiducials Radiation Dose SR (RDSR) - Table position vs. Isocenter - Gantry Angle vs. Isocenter - Beam Geometry, collimation X-Ray Equipment Registration matrix between: - each RDSR Fiducial FOR and - the Patient Model FOR Patient Model (3 D image) 31 May 2016 DICOM WG-28 / Supp 191 12

Registration between Patient Model and RDSR Case #3 FOR TABLE TOP HEAD Equipment Fiducials

Registration between Patient Model and RDSR Case #3 FOR TABLE TOP HEAD Equipment Fiducials X-Ray Equipment Radiation Dose SR (RDSR) - Table position vs. Isocenter - Gantry Angle vs. Isocenter - Beam Geometry, collimation Registration FOR Registration matrix between: - each RDSR Fiducial FOR and - the Patient Fiducial FOR PATIENT TOP HEAD Patient Fiducials Note: the patient fiducials can be defined through a manual measurent on the actual patient landmarks, or through imagebased measurements of landmarks visible on the X-Ray images. 31 May 2016 DICOM WG-28 / Supp 191 13

Registration between Patient Model and RDSR Case #4 No X-Ray Images No Equipment Fiducials

Registration between Patient Model and RDSR Case #4 No X-Ray Images No Equipment Fiducials X-Ray Equipment Radiation Dose SR (RDSR) - Table position vs. Isocenter - Gantry Angle vs. Isocenter - Beam Geometry, collimation Registration Free Text Comment: E. g. “Distance from Patient Head to Table Top Head is 15 cm” No Patient Model 31 May 2016 DICOM WG-28 / Supp 191 14

Patient Radiation Dose SR (P-RDSR) Patient Dose SR IOD Templates TID prdsr. T 01

Patient Radiation Dose SR (P-RDSR) Patient Dose SR IOD Templates TID prdsr. T 01 Patient Radiation Dose TID 1002 Observer Context TID 1204 Language of Content Item and Descendants TID prdsr. T 02 Dose Estimate Group TID prdsr. T 04 Dose Estimate Methodology TID prdsr. T 05 Dose Estimate Parameters TID prdsr. T 03 Dose Estimate Representation 31 May 2016 DICOM WG-28 / Supp 191 15

Patient Radiation Dose SR: Detailed Structured Content 1 -N TID prdsr. T 01 Patient

Patient Radiation Dose SR: Detailed Structured Content 1 -N TID prdsr. T 01 Patient Radiation Dose 1 1 1 Patient Radiation Dose Report 1 -N TID 1204 Language of Content Item and Descendants TID 1002 Observer Context Ref. Source Radiation Dose SR Patient Dose Model 1 - Model Type - Radiation Transport Type - Model Reference 1 1 1 - Group Name - Source Category 1 TID prdsr. T 04 Dose Estimate Methodology Patient Model Demographics 1 1 TID ptdsr. T 02 Dose Estimate Group 1 1 Dose Estimate Methodology 1 -N X-Ray Beam Attenuator Information 1 1 Dose Estimate Group 1 1 -N 1 Legend: Template 1 Container Content Items 31 May 2016 1 -N TID prdsr. T 03 Dose Estimate Representation Organ Dose Information 1 -N 1 Ref. Fiducials Registration Ref. - Material Category - Equivalent Material - Equivalent Thickness - Description Registration with RDSR 1 - Registration Method Ref. - Fiducials Ref. - Registration 1 1 1 Radiation Dose Estimate Method Type Dose Estimate Parameters 1 -N Radiation Dose Estimation Parameter Distribution Model 1 1 Registration Method 1 - Radiation Transport Type - Model Reference TID prdsr. T 05 Dose Estimate Parameters - Organ Name - Absorbed Dose - Equivalent Dose - Uncertainty info 1 Attenuator Model Radiation Dose Estimate Method Dose Estimate Representation Model Age, sex, weight, height Registration with RDSR 1 1 -N Ref. Patient Model Data 1 -N DICOM WG-28 / Supp 191 Instance Ref. Organ 16

Author Contacts • • Donald Peck, donaldp@rad. hfh. edu (editor) Annalisa Trianni, trianni. annalisa@aoud.

Author Contacts • • Donald Peck, donaldp@rad. hfh. edu (editor) Annalisa Trianni, trianni. annalisa@aoud. sanita. fvg. it Heinz Blendinger, heinz. blendinger@siemens. com Francisco Sureda, francisco. sureda@med. ge. com Steve Massey, steve. massey@pacshealth. com Ioannis Sechopoulos, ioannis. sechopoulos@radboudumc. nl Ting Lu, ting. lu@bayer. com DICOM Secretariat: dicom@medicalimaging. org Thank you for your attention! 31 May 2016 DICOM WG-28 / Supp 191 17

Reporting Reporting Types Interpretative Reporting Investigative Reporting ReportingReporting Reporting Types Interpretative Reporting Investigative Reporting Reporting
Radiation definitions of activity dose and dose ratesRadiation definitions of activity dose and dose rates
Radiation definitions of activity dose and dose ratesRadiation definitions of activity dose and dose rates
Radiation therapy Radiation therapy Radiotherapy Radiation oncology RadiationRadiation therapy Radiation therapy Radiotherapy Radiation oncology Radiation
Radiation Ionising Radiation Ionising Radiation Alpha Radiation BetaRadiation Ionising Radiation Ionising Radiation Alpha Radiation Beta
Dose from Computed Tomography CT Patient Dose TubeDose from Computed Tomography CT Patient Dose Tube
ECE 191 Introduction to ECE 191 Fall 2016ECE 191 Introduction to ECE 191 Fall 2016
N 1 page 191 N 2 page 191N 1 page 191 N 2 page 191
INTERNSHIPS HSPM 191 A 191 B Dept ofINTERNSHIPS HSPM 191 A 191 B Dept of
Patient 1 Patient 3 Patient 5 Patient 6Patient 1 Patient 3 Patient 5 Patient 6
PROTECTION FROM RADIATION AND RADIATION DOSE RESPONSE WITHPROTECTION FROM RADIATION AND RADIATION DOSE RESPONSE WITH
Radiation and Reason Why radiation at modest doseRadiation and Reason Why radiation at modest dose
Patient Occupational radiation dose management Chapter 37 38Patient Occupational radiation dose management Chapter 37 38
Patient Occupational radiation dose management Chapter 37 38Patient Occupational radiation dose management Chapter 37 38
DOSE SPACING IN EARLY DOSE RESPONSE CLINICAL TRIALDOSE SPACING IN EARLY DOSE RESPONSE CLINICAL TRIAL
Topic Physics 2 a Dose and Dose equivelentTopic Physics 2 a Dose and Dose equivelent