There is DOH working party which is looking at standardising radiation dose collation.
Excellent presentation by Niall.
Key points for options for automated radiation dose recording-- 1. Dose data sored in the DICOM header--poor " Can lead to problems if rejected images are deleted or there are multiple reconstructions of image data, e.g. CT. 2. MPPS message from the modality to RIS or PACS--poor Designed for workflow, not persistent archiving " Lacks complete dose details 3. DICOM Dose SR. " This is the preferred method. • SR Objects. " Easily ingested (and regurgitated) by PACS • Granularity " Accumulated dose over image, study & series • Can be templated to modality requirements"
Niall recommends IHE REM Profile adoption (which is based on DICOM SR). He advices all PACS & Modality procurements MUST put in IHE REM Profile as a requirement. Thanks to Niall & his working with DOH, I do think we have a national direction for automated radiation dose monitoring.
11.10 Automated recording of radiation dose from modalities—Dr. David Clunie (IHE)
David is renowned over the world for his work in DICOM standards. It is interesting that both Niall & David have exactly the same message for the NHS. IHE REM profile (DICOM Radiation Dose Structured Report--RDSR) is clearly the way forward.
The concluding slide is key--defining a way forward for new PACS & modality procurement/replacement & also suggesting a way of dealing with old modalities. "Infrastructure must support RDSR New & updated modalities: make RDSR Older modalities (and archive): OCR dose screens to make RDSR Ancient modalities: worth estimating from technique in image headers? Should be no need to record manually"
11.30 Role of PACS in radiation dose monitoring--Professor Mats Nilsson, Medical Radiation Physics Skane University Hospital, Sweden (Speaker Sponsored by Sectra)
We are grateful to Prof Mats Nilsson for sharing his experience of 7years of automatic dose monitoring. In his talk Prof Nilsson mentioned how with automated monitoring, it was easy to recognise that an old CT scanner was producing hugely excessive doses compared to the others --resulting in the leverage needed for it to be replaced.
Some'key'areas'of'use:' – Short and long term monitoring and follow up of patient doses' – Gives the referring physician access to the patient ́s previous dose history – Facilitates dose benchmarking within large X-ray departments or between hospitals' – Rapid feedback to radiologists and radiographers during optimization programs
There is likely to be some EU legislation in this regard too.
ND Comment--I do believe that radiation dose MUST be displayed somewhere. My view is that it should be displayed in PACS. REM complaint PACS should be able to store & display the radiation dose information in its database. 2013 Replacements--"Does the PACS support REM Profile? Is the PACS able to display the radiation dose information in the display area for radiologists/radiographer/clinical users to see?" I do not think this is unreasonable.
11.50 REM Profile(IHE) for populating a national dose Registry—Mr. Steve Massey--PACSHealth
This is the final & but very important presentation on Automatic Radiation Dose Monitoring from Steve. The whole purpose of recording dose information is to do something about it if there is a problem.
Key points from the slides:
"DICOM RDSR provides a standard way to capture all modalities and their respective dose indices!"
"Modality generates SR object! Object archived within PACS or VNA! Dose indices analysis and reporting system accesses archive for local needs! Dose system sends data to national registry!"
Summary of discussions from our 4 experts on Automatic Radiation Dose Monitoring. -Current process of manual dose recording on RIS/MPPS is sub-standard & NHS MUST move away from this. -Automatic Radiation Dose monitoring using RDSR is clearly the way forward. -Older Modalities will need "black boxes" to help send out standard dose information until they are replaced. -New modalities MUST support REM Profile of IHE -PACS/VNA must support REM profile -Any REM Dose Reporter will connect to a REM profile compliant PACS/VNA and send standardised dose information to National Registry for analysis. -Health Protection Agency MUST develop a National Dose Registry which conforms to REM Profile of IHE
As discussed in the meeting, it is also important that radiographers, radiologists & clinical users are also able to see the radiation dose exposure related to exams. PACS Display MUST have a data field to display the radiation dose from the exam, alongwith the other exam related information.
13:00 Direct OJEU vs. Framework Agreements-Mr. Tony Corkett (Amor)
Pros & Cons of OJEU & Framework is discussed by Tony. This is his summary Summary "• Frameworks are a very valuable tool • Work well for simpler or transactional processes or products • But in my opinion for complex system the ability of the Trust(s) to set out their own requirements, contract terms and conditions is the better route................... – if time and skills are available."
13:20 Insisting on Open Standards for PACS procurement –Mr. Malcolm Newbury (IHE-UK)
Must read presentation from Malcolm.
There is cost significant immendiate & future cost savings to be had by insisting on IHE Profiles in your procurement process.
13:20 Insisting on Open Standards for PACS procurement –Mr. Malcolm Newbury (IHE-UK) IHE-UK in Procurement.pdf (4486.0 k)
ND Comment---Traditional PACS was like buying a house with non-standard plug-points. Everytime you wanted to connect a TV/Fridge very expensive building work needs to happen or you bought expensive stuff from the house supplier. By including IHE Profiles in your procurement you are really really buying your house with standard plug-points You have a choice of what make of TV etc you buy.
13.40 Point to Point transfer of documents/Images using IHE Profiles (XDR etc)—Dr. Dave Harvey (IHE-UK)
Dave compares push & pull models of data sharing.
ND Comment--In England we have very closely seen both. 1. In 2002, LSP CDS was promoted by CFH/NPFIT as a means of sharing of images between organizations within a cluster. This was to be based on a pull model. This failed miserably. Dave states some reasons for failure of such pull models "Too many hurdles at once: • Technology • Responsibility • Scalability • Information Governance" 2. In 2008 or later IEP (which was initially come into being to support independent sector sharing with NHS) become the means of image sharing between NHS Trusts --based on a DICOM push model. The success of IEP today is evidence of a push model can work.
XDR-I is similar to DICOM push but more sophisticated. 1. uses common web protocols for transport of images (like email services etc) rather than transport which is radiology based only. 2. Uses XD* metadata thus making the metadata set consistent with radiology, non-radiology images, documents etc 3. including radiology reports with it as CDA or encapsulated pdf becomes simple
Where will we find it useful is transfer of images instead of medico-legal CDs, and in future it is likely to replace DICOM push links as there is an ability to attach reports & other documents with images.
ITK move towards adopting XD* metadata is very reassuring for NHS as this will bring about a model for a similar methodology for sending DICOM images & documents with similar common web protocols.
13.40 Point to Point transfer of documents/Images using IHE Profiles (XDR etc)—Dr. Dave Harvey (IHE-UK) Point to Point transfer.pdf (835.0 k)
14.15 RIS to RIS report transfer using XDR via IEP –Mr. Stephen Jessop (Burnbank)
Adoption of XDR can bring about a standardised method of transfer of reports from 1 RIS to another. Whilst IEP has been hugely successful in image transfer between hospitals--due to DICOM standard, report transfer between RISes has been a real problem.
The real problem is the reliance on HL7 messaging standard. We need to move from a message standard to a document standard for reports--CDA, encapsulated pdf, etc
RISes need to adopt doc standard --source & display PACS also need to support display of documents (currently most PACS receive reports as HL7 messages--NOT documents).
IEP adoption of XDR is a way forward towards global standards adoption.
13.55 CDA & XDR adaptors for legacy RISes—Mr. Michel Pawlitz (KarosHealth)
There is no doubt in my mind that the future is with a. XDS/XDS-I based VNA for an enterprise image & document management system--PULL method of sharing b. XDR/XDR-I is the future of point to point sharing of images & documents (DICOM, CDA & pdf formats are supported)--PUSH method of sharing.
DICOM & PACS did not happen in a day. Many of us remember the DICOM black boxes that were used for legacy non-DICOM modalities. In the same way Michel shows how XDS/XDR adaptors are already available off the shelf from innovative vendors to deal with legacy PACS, RIS etc. HL7v2 messages can be converted to CDA. Metadata can be attached to pdf doc for making encapsulated pdf for XDS/XDR transfers. As we look to a regional teleradiology solution, Legacy PACS from LSPs may need XDS-I/XDR-I adaptors.
This is an excellent presentation from Michel & is worthy a read. Thank you Michel for sending us the notes too.
15:00 Using mobile devices with RIS workflow--Mr. Richard Bulmer (Group Secretary)
I think use of mobile devices will continue to increase in NHS. 1. Tablet devices for doctors doing ward rounds 2. Tablet devices for radiographers in radiology departments 3. Kiosk type check-in for patients 4. Smart phone like devices for porters etc
PACS & RISes need to move to becoming hardware independent --"zero footprint"
Security of these devices against theft must be addressed with time.
15:00 Using mobile devices with RIS workflow--Mr. Richard Bulmer (Group Secretary) Presentation.pdf (145.5 k)
15: 20 Adapting legacy NHS software for mobile device use—the Challenges—digital pens, tablets, kiosks etc—Mr. Martin Peacock (Inflection Technologies)
Both Richard Bulmer's & Martin Peacock's presentations are excellent & complement one another. Whilst Richard talks about where we would use mobile workflow, Martin talks about what mobile devices are available & where they could be used.
Martin takes us through an interesting journey through mobile device use-tablet devices (i-pads etc), pda, location devices, & digital pens. I agree with Martin, there is a significant potential for use of digital pens with RIS-- 1. MRI safety questionnaire filled by patients 2. LMP forms etc
I think looking ahead this is where we will see mobile devices in use with RIS & PACS: 1. Self-check in by patients--kiosks 2. MRI safety questionaire/LMP forms--Digital pens 3. Radiographer workflow-tablets 4. Porters--Pda type devices 5. Ward-rounds--Tablets for PACS etc I think NHS Trusts as customers MUST put these in their requirements for their replacements
15.40 Lessons learned from deploying Zero-footprint Imaging Viewers—Mr. Genady Knizhnik (Agfa) Genady discusses the limitations of use of zero-footprint viewers over LOW bandwith networks esp with limitations of use of DICOM, WADO & XDS-I
16.00 ZeroFoot Image Viewers on Mobile Devices—Mr John Kingham (Carestream)
PACS on mobile devices is here. HTML5 & widespread use of ipad like tablet devices is key to this. Excellent presentation from John Kingham. Anyone replacing their PACS or RIS ensure you include mobile tablet device access within your specification. The technology is definitely here.
Neelam - thanks for the update from CSH's view on Zero Footprint Viewers. Vital Images is coming out with a great new one and a brand new one that may be as advanced as any is HealthAir. Exciting times ahead in this space.
Just to be clear. Our Group invites different vendors to talk about topics in a vendor neutral manner--about technology, standards etc. All speakers are clearly instructed to ensure this is not a sales pitch.
Most PACS suppliers or DICOM -GE, Sectra, Fujifilm, Agfa, Carestream, Vital, Siemens etc all support mobile tablet viewing. It is important NHS put it in their specifications for PACS replacements.
My apologies if I crossed some line I wasn't aware existed. Just to be clear, my firm doesn't sell or resell anything for any vendor (including GE, Fuji, Agfa, Siemens, etc). I see demos on every product under the sun and I get asked by countless hospitals about my view on the different vendors' products. If it's not kosher to give opinions in this forum please let me know and I'll take my proverbial ball and go elsewhere. Thanks.