- Email: [email protected]
Dose Optimisation Team – A practical implementation
166
S. Cournane et al. / Physica Medica 52 (2018) 165–182
Dose Optimisation Team – A practical implementation Aibhilinn McHugh, Patricia Egan
result has been very positive with improved analysis of scanner performance and improved efficiency of routine CT QA.
Beacon Hospital, Ireland E-mail address: [email protected]
https://doi.org/10.1016/j.ejmp.2018.06.018
With the advent of the transposition of the new Basic Safety Standard into Irish Law there is an imperative on all health providers using ionising radiation to record, provide and optimise radiation dose to patients and accordingly to staff. Radiation dose management tools (RDMT), such as DoseWatch, Radimetrics, etc., are beneficial in aiding Medical Physics Experts on a day to day basis responding to individual patient doses (micro level) and Radiation Protection Advisors will use it on a population based perspective (macro level). In our hospital, GE DoseWatch is installed on Cath Labs, IR, CT and DR (high dose or high-volume modalities). We have recently replaced all of these systems and the RDMT has proved effective for establishing Dose Optimization Teams (DOT), comprising physics, radiologists and radiographers to set dose alert levels and to highlight opportunities for dose reduction. This study will show the advantages of a RDMT over a manual entry system and what that means for both patients and staff exposure, over time. This study reviews the effectiveness of DOTs. This study is undertaken over the past few months for the most frequent scans, using several modalities and results are then reviewed in conjunction with reports such as the COMARE 16th Report and SIR Guidelines 2009. We also undertook a holistic review of patient and staff doses in the Cath Lab, in concurrence with a recent position document published by the EHRA, regarding staff with reproductive potential and during pregnancy.
A review of the effects of exposure parameters on DAP and ESD on fluoroscopy X-rays systems Andrew Moran, Louise Bowden, Colm Saidlear
https://doi.org/10.1016/j.ejmp.2018.06.017
Automating routine CT image quality analysis from a virtual server Patrick Monnelly, John Cronin, Peter Woulfe Galway Clinic, Ireland E-mail address: [email protected]
Temple Street Children’s University Hospital, Ireland E-mail address: [email protected] During fluoroscopic and interventional procedures, radiographers monitor and record patient DAP/ESD values, from which local DRLs can be established. DRLs are used as a guide for dose optimisation for different imaging modalities. However the relevance of DRLs in paediatric fluoroscopic procedures is questionable. Different factors, e.g. pulse rate, magnification, etc. enable radiographers to optimise the radiation dose received by the patient. This is especially important in paediatric radiology, were optimal exposure is of utmost importance. The fundamental aim of this work is to provide adequate information to radiographers of the effects different parameters have to the DAP and ESD values on the various fluoroscopy systems in the hospital. Two mobile and one fixed fluoroscopy system were studied. Results indicate that at higher pulse rates, the increase in DAP and ESD rates when going from one pulse rate to another vary across the different systems, with one system increasing by up to 160%. Results also showed a decrease in DAP values of up to 30% when changing from full field to higher magnification settings while the ESD rates increased by up to 16%. A comprehensive investigation is presented here of the effects the varying parameters have on DAP and ESD values. Information sheets are being developed for the respective unit to improve the radiographer’s understanding of the systems. This will subsequently provide more confidence in their decisions with real time dose optimisation during complex procedures, which will be in line with image gently protocols and the new BSS. https://doi.org/10.1016/j.ejmp.2018.06.019
Routine QA is an effective approach to monitoring CT performance over time, it consists of a series of image quality checks which give the physicist the ability to detect suboptimal or declining performance and initiate corrective actions. This contributes to high quality images that improve the likelihood for correct diagnosis and ultimately contributes to quality patient care. With the clear importance of routine CT QA the drawback lies in the tedious and time consuming image analysis measurements, likewise in busy radiology departments it can be difficult schedule time for QA on the CT. In response to these problems we have developed and introduced an effectively automated QA computer program that automatically executes image quality analysis. The QA program platform is hosted on a virtual server and was scripted in-house using a combination of MatLab, PowerShell and ConQuest DICOM Server. With the introduction of this QA program, the routine CT QA procedure has been compressed down to scanning the QA phantom and exporting the study straight from the console via a dedicated Physics DICOM node. The QA program automatically begins image analysis then saves results, archives images and emails the user with the outcome of the analysis. With the introduction of this QA program we have observed a significant reduction in scanner downtime, an increase in the number of images analysed and improved consistency of measurements. The overall
Use of real-time electronic Silicon diode extremity dose detectors; towards optimising monitoring and radiopharmacy technique Seán Cournane, Dani Maguire, Lucian Harris, Claire Kenneally, Jackie McCavana, Julie Lucey St. Vincent’s University Hospital, Ireland E-mail address: [email protected] Extremity radiation doses are typically monitored using ring dosimeters worn at the base of the palmar side of the index finger. This measurement does not represent the maximum extremity doses received; however, fingertip dose can be estimated by multiplying by a factor of 3, as recommended by ICRP. Indeed, the literature reports a considerable factor range, between 1.5 and 7 and, furthermore, there is debate as to whether the non-dominant or dominant index finger should be monitored. Ring dosimeters provide monthly dose information but do not provide shorter term data which may inform on radiopharmacy technique optimisation. Accordingly, using ED3 Si diode Hp(0.07) electronic dosimeters, this study sought to establish optimum ring dosimeter placement, oper-
S. Cournane et al. / Physica Medica 52 (2018) 165–182
Dose Optimisation Team – A practical implementation Aibhilinn McHugh, Patricia Egan
result has been very positive with improved analysis of scanner performance and improved efficiency of routine CT QA.
Beacon Hospital, Ireland E-mail address: [email protected]
https://doi.org/10.1016/j.ejmp.2018.06.018
With the advent of the transposition of the new Basic Safety Standard into Irish Law there is an imperative on all health providers using ionising radiation to record, provide and optimise radiation dose to patients and accordingly to staff. Radiation dose management tools (RDMT), such as DoseWatch, Radimetrics, etc., are beneficial in aiding Medical Physics Experts on a day to day basis responding to individual patient doses (micro level) and Radiation Protection Advisors will use it on a population based perspective (macro level). In our hospital, GE DoseWatch is installed on Cath Labs, IR, CT and DR (high dose or high-volume modalities). We have recently replaced all of these systems and the RDMT has proved effective for establishing Dose Optimization Teams (DOT), comprising physics, radiologists and radiographers to set dose alert levels and to highlight opportunities for dose reduction. This study will show the advantages of a RDMT over a manual entry system and what that means for both patients and staff exposure, over time. This study reviews the effectiveness of DOTs. This study is undertaken over the past few months for the most frequent scans, using several modalities and results are then reviewed in conjunction with reports such as the COMARE 16th Report and SIR Guidelines 2009. We also undertook a holistic review of patient and staff doses in the Cath Lab, in concurrence with a recent position document published by the EHRA, regarding staff with reproductive potential and during pregnancy.
A review of the effects of exposure parameters on DAP and ESD on fluoroscopy X-rays systems Andrew Moran, Louise Bowden, Colm Saidlear
https://doi.org/10.1016/j.ejmp.2018.06.017
Automating routine CT image quality analysis from a virtual server Patrick Monnelly, John Cronin, Peter Woulfe Galway Clinic, Ireland E-mail address: [email protected]
Temple Street Children’s University Hospital, Ireland E-mail address: [email protected] During fluoroscopic and interventional procedures, radiographers monitor and record patient DAP/ESD values, from which local DRLs can be established. DRLs are used as a guide for dose optimisation for different imaging modalities. However the relevance of DRLs in paediatric fluoroscopic procedures is questionable. Different factors, e.g. pulse rate, magnification, etc. enable radiographers to optimise the radiation dose received by the patient. This is especially important in paediatric radiology, were optimal exposure is of utmost importance. The fundamental aim of this work is to provide adequate information to radiographers of the effects different parameters have to the DAP and ESD values on the various fluoroscopy systems in the hospital. Two mobile and one fixed fluoroscopy system were studied. Results indicate that at higher pulse rates, the increase in DAP and ESD rates when going from one pulse rate to another vary across the different systems, with one system increasing by up to 160%. Results also showed a decrease in DAP values of up to 30% when changing from full field to higher magnification settings while the ESD rates increased by up to 16%. A comprehensive investigation is presented here of the effects the varying parameters have on DAP and ESD values. Information sheets are being developed for the respective unit to improve the radiographer’s understanding of the systems. This will subsequently provide more confidence in their decisions with real time dose optimisation during complex procedures, which will be in line with image gently protocols and the new BSS. https://doi.org/10.1016/j.ejmp.2018.06.019
Routine QA is an effective approach to monitoring CT performance over time, it consists of a series of image quality checks which give the physicist the ability to detect suboptimal or declining performance and initiate corrective actions. This contributes to high quality images that improve the likelihood for correct diagnosis and ultimately contributes to quality patient care. With the clear importance of routine CT QA the drawback lies in the tedious and time consuming image analysis measurements, likewise in busy radiology departments it can be difficult schedule time for QA on the CT. In response to these problems we have developed and introduced an effectively automated QA computer program that automatically executes image quality analysis. The QA program platform is hosted on a virtual server and was scripted in-house using a combination of MatLab, PowerShell and ConQuest DICOM Server. With the introduction of this QA program, the routine CT QA procedure has been compressed down to scanning the QA phantom and exporting the study straight from the console via a dedicated Physics DICOM node. The QA program automatically begins image analysis then saves results, archives images and emails the user with the outcome of the analysis. With the introduction of this QA program we have observed a significant reduction in scanner downtime, an increase in the number of images analysed and improved consistency of measurements. The overall
Use of real-time electronic Silicon diode extremity dose detectors; towards optimising monitoring and radiopharmacy technique Seán Cournane, Dani Maguire, Lucian Harris, Claire Kenneally, Jackie McCavana, Julie Lucey St. Vincent’s University Hospital, Ireland E-mail address: [email protected] Extremity radiation doses are typically monitored using ring dosimeters worn at the base of the palmar side of the index finger. This measurement does not represent the maximum extremity doses received; however, fingertip dose can be estimated by multiplying by a factor of 3, as recommended by ICRP. Indeed, the literature reports a considerable factor range, between 1.5 and 7 and, furthermore, there is debate as to whether the non-dominant or dominant index finger should be monitored. Ring dosimeters provide monthly dose information but do not provide shorter term data which may inform on radiopharmacy technique optimisation. Accordingly, using ED3 Si diode Hp(0.07) electronic dosimeters, this study sought to establish optimum ring dosimeter placement, oper-