patient dose monitoring
DESCRIPTION
TRANSCRIPT
![Page 1: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/1.jpg)
, Total Quality Monitoring
MIDIALIS DE WOLF - GONZALEZ
![Page 2: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/2.jpg)
Pitch
2 www.qaelum.com - CONFIDENTIAL
• We are – an official high-tech spin-off company of the University of Leuven and the
University Hospitals of Leuven, Belgium
• We have – 15+ years of experience in quality assurance in medical imaging in radiology
• We are specialized in – remote and automated quality control in breast cancer screening programs
and innovative patient radiation dose monitoring
• ISO 13485 medical device manufacturer
![Page 3: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/3.jpg)
Background
3 www.qaelum.com - CONFIDENTIAL
• company structure – mix of
• private capital
• investment funds – Gemma-Frisius fund (KBC + BNP Paribas Fortis)
• university funds
– we bought all needed technology from the University of Leuven, no need for licensing
![Page 4: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/4.jpg)
Innovation and Incubation Center KULeuven
5 www.qaelum.com - CONFIDENTIAL
![Page 5: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/5.jpg)
Products
6
Patient dose monitoring
Clinical relevant patient radiation dose monitoring
QA Network
Consultancy
Centralized and automated quality assurance for any modality (strong focus on breast cancer screening)
- Breast cancer screening
- CT
- General radiology
- … Ad hoc
Stand alone applications to improve efficiency of Medical Physics Experts
and service engineers
- General Radiology
- CT
- Interventional Radiology
- Mammography
- Erica²
- BianQA Human observer performance experiments
Setup of image based clinical trials
![Page 6: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/6.jpg)
Installation base
7 www.qaelum.com - CONFIDENTIAL
• Mammography Quality Control Network – Flanders
• 150+ systems
– Canada (Ontario Breast Screening Programme) • 2014: 200 systems (DR/CR) (project: 25 systems)
– Austria • 2013: 220 systems (DR/CR) (project: 30 systems)
• Patient dose monitoring – +/- 1,000,000 studies – Non-exclusive collaboration agreement with FujiFilm Europe
![Page 7: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/7.jpg)
Installation base
8 www.qaelum.com - CONFIDENTIAL
• Standalone applications – MoniQA: Monitor Quality Assurance
• Mandatory in Ireland, Flanders, …
• Recommended by EUREF
– Erica²: Enhanced CDMAM analysis
– BianQA: Automated analysis of digital mammography phantom data
• Both mandatory in France
![Page 8: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/8.jpg)
Products
9
Patient dose monitoring
Clinical relevant patient radiation dose monitoring
Consultancy - General Radiology
- CT
- Interventional Radiology
- Mammography
www.qaelum.com - CONFIDENTIAL
![Page 9: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/9.jpg)
Why automated dose monitoring ?
10 www.qaelum.com - CONFIDENTIAL
• Dose monitoring is often a legal obligation • Constant monitoring tool to avoid (deliberate) system abuse • Reduces potential for human error • Save technologists / radiologists time • Enables the creation of more detailed reports • Insurance against the all-mighty patients • Benchmark tool between systems • Optimisation tool • Quality management project (cfr JCI, IRMER) • Independent tool to check manufacturer, service engineer
![Page 10: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/10.jpg)
11 www.qaelum.com - CONFIDENTIAL
CE IIb
Vendor
neutral
![Page 11: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/11.jpg)
Components
12 www.qaelum.com - CONFIDENTIAL
• Physical-technical QC – Are the devices working correctly from a physical-technical point of
view ?
• Patient radiaton dosimetry – At which level are our patient dose levels compared with DRLs / the
past / other devices / …. ?
• Managment QC – Do we manage and control the workflow and can we optimize it ?
• Clinical QC – Did the operator use the system correctly ?
![Page 12: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/12.jpg)
Components
13 www.qaelum.com - CONFIDENTIAL
• Physical-technical QC – Are the devices working correctly from a physical-technical point of
view ?
• Patient radiaton dosimetry – At which level are our patient dose levels compared with DRLs / the
past / other devices / …. ?
• Managment QC – Do we manage and control the workflow and can we optimize it ?
• Clinical QC – Did the operator use the system correctly ?
![Page 13: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/13.jpg)
Technical overview
14 www.qaelum.com - CONFIDENTIAL
VM Windows Server 2008
SQL Database (Oracle)
Data receiver Analysis engine
Integration webservice
Web application
Pre-configured Virtual Machine simplified installation
![Page 14: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/14.jpg)
Analysis engine / data receiver
15 www.qaelum.com - CONFIDENTIAL
![Page 15: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/15.jpg)
Database
16 www.qaelum.com - CONFIDENTIAL
![Page 16: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/16.jpg)
Total Quality Monitoring
17 www.qaelum.com - CONFIDENTIAL
![Page 17: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/17.jpg)
Typical workflow / easy setup
18 www.qaelum.com - CONFIDENTIAL
PACS
Warning Unknown
stationname Add device
Analysis engine
Send 1 study
![Page 18: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/18.jpg)
Typical workflow / easy setup
19 www.qaelum.com - CONFIDENTIAL
PACS Analysis engine
Send all studies
Known device Perform analysis
Database
Reporting Data overview
![Page 19: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/19.jpg)
Typical analysis
20 www.qaelum.com - CONFIDENTIAL
• Depending on modality, we use… – DICOM header information
– RDSR objects
– DoseReports (using vendor specific OCR modules)
– calculation of dose values using Dance method (makes it possible to compare systems - MG)
![Page 20: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/20.jpg)
Typical analysis
21 www.qaelum.com - CONFIDENTIAL
• We extract more than only dose information – Meta-data analysis system
• PACS – Picture Archive and Communications System
• DACS – Dose Archive and Communications System
• MACS – Meta-data Archive and Communications System
– Possibility to store stripped and anonymized DICOM header
DCM
![Page 21: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/21.jpg)
Potential extensions
22 www.qaelum.com - CONFIDENTIAL
![Page 22: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/22.jpg)
Optimisation chain
23 www.qaelum.com - CONFIDENTIAL
Pre-exam
During examination
Post-exam
Optimization & Reporting
![Page 23: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/23.jpg)
Pre - exam
![Page 24: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/24.jpg)
25 www.qaelum.com - CONFIDENTIAL
• At order entry
• Use the accumulated patient dose to decide on the used technology
• For specialists, radiologists, ….
• Possible to use webservice integration in workflow of specialist
• Future: pre-exam calculation of expected dose based on study, modality and patient specific parameters
Pre - exam
![Page 25: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/25.jpg)
26 www.qaelum.com - CONFIDENTIAL
• Several views possible (themeable, translated, …)
(only integrated browser needed)
Pre - exam
![Page 26: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/26.jpg)
During examination
![Page 27: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/27.jpg)
28 www.qaelum.com - CONFIDENTIAL
• Protocol management
• Key for successful dose and workflow optimization
• Collection of best practices
• Web access, so accessible from the room
• General information, contrast, exposure settings, reconstruction parameters, …
• Version tracking available / report
• Can also be used during the pre-exam phase to point patients to more optimized devices
During examination
![Page 28: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/28.jpg)
29 www.qaelum.com - CONFIDENTIAL
During examination
![Page 29: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/29.jpg)
30 www.qaelum.com - CONFIDENTIAL
During examination
![Page 30: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/30.jpg)
31 www.qaelum.com - CONFIDENTIAL
During examination
![Page 31: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/31.jpg)
32 www.qaelum.com - CONFIDENTIAL
During examination
![Page 32: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/32.jpg)
33 www.qaelum.com - CONFIDENTIAL
• Simplified creation of protocol database
• Future: management of other modalities
During examination
![Page 33: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/33.jpg)
34 www.qaelum.com - CONFIDENTIAL
• Simplified connection of BodyPartExamined codes with protocols, studydescriptions
• Possible inclusion of RadLex PlayBook codes
During examination
![Page 34: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/34.jpg)
Post - exam
![Page 35: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/35.jpg)
36 www.qaelum.com - CONFIDENTIAL
• Comparison of study specific results with statistical data
Post - exam
![Page 36: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/36.jpg)
37 www.qaelum.com - CONFIDENTIAL
• Warning system based on user defineable dose limits – Limits are based on
• used protocol
• Patient age
• Patient gender
– Limits are • send via e-mail, twitter
• stored in the database
• saved as XML files
• Warning system to inform on secondary treatment – ex. interventional procedures: generate warning when dose exceeds
certain level and follo-up treatment should start as soon as possible (treatment for burn wounds)
Post - exam
![Page 37: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/37.jpg)
38 www.qaelum.com - CONFIDENTIAL
• Integration of webservice in PACS for patient accumulated dose reporting (ex. FujiFilm PowerJacket)
Post - exam
![Page 38: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/38.jpg)
39 www.qaelum.com - CONFIDENTIAL
• Overview of patient specific studies Post - exam
![Page 39: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/39.jpg)
40 www.qaelum.com - CONFIDENTIAL
• Integrated tools
Post - exam future
![Page 40: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/40.jpg)
41 www.qaelum.com - CONFIDENTIAL
• Analysis of meta-data of 3rd party products • Visiana.com: BoneXpert
– Determine bone age from digital hand X-Ray
• Breast density measurements
Post - exam future
![Page 41: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/41.jpg)
Optimisation reporting
![Page 42: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/42.jpg)
43 www.qaelum.com - CONFIDENTIAL
• Look for trending in dose data
• Use of web application
• Quick data overview using user-configurable dashboards
Optimisation reporting
![Page 43: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/43.jpg)
44 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
![Page 44: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/44.jpg)
45 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
![Page 45: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/45.jpg)
46 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
![Page 46: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/46.jpg)
47 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
![Page 47: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/47.jpg)
48 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
![Page 48: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/48.jpg)
49 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
• From simple to complicated reports
• Possibility to define template layouts according to local legislation
![Page 49: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/49.jpg)
50 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
![Page 50: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/50.jpg)
51 www.qaelum.com - CONFIDENTIAL
Optimisation reporting
• Different user roles for different data access
• Possibility to export data to MS Excel compatible formats no vendor lock-in
![Page 51: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/51.jpg)
52 www.qaelum.com - CONFIDENTIAL
• localisation
Optimisation reporting
![Page 52: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/52.jpg)
Optimisation chain - TQM
53 www.qaelum.com - CONFIDENTIAL
Pre-exam
During examination
Post-exam
Optimization & Reporting
Physical – technical Quality Control
Clinical Quality Control
![Page 53: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/53.jpg)
Physical-technical Quality Control
54 www.qaelum.com - CONFIDENTIAL
• DR • detector artefact analysis (PMMA phantom / Cu filter)
• evaluate system stability
• tube management (based on accumulated tube loads) • (portable DR systems: fall analysis)
• CR • artefact analysis of Imaging Plate (IP) (comparison before and after cleaning)
• IP replacement detection based on amount of exposures
• IP sensitivity monitoring (plate ageing)
– optimal usage of RX rooms
![Page 54: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/54.jpg)
Clinical Quality Control
55 www.qaelum.com - CONFIDENTIAL
• In CT, simple dataset analysis – Analysis of …
• DoseReport / SR : for patient radiation dose monitoring • Topogram / scout : to create a small thumbnail for easy study
recognition
– Only 2 DICOM files
• Advanced dataset analysis – Receive all images and extract as much information as
possible
![Page 55: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/55.jpg)
Clinical Quality Control
56 www.qaelum.com - CONFIDENTIAL
• Analysis of every DICOM header of every original series
– Extraction of exposure information per slice
– Possibility to
• Evaluate influence of mAs or kV modulation techniques
• Evaluate used exposure parameters
![Page 56: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/56.jpg)
Clinical Quality Control
57 www.qaelum.com - CONFIDENTIAL
– Possibility to
• Evaluate influence of mAs or kV modulation techniques
![Page 57: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/57.jpg)
Clinical Quality Control
58 www.qaelum.com - CONFIDENTIAL
– Possibility to
• Evaluate potential scan overlap between series
• Overlap between consecutive series should be as small as possible
![Page 58: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/58.jpg)
Clinical Quality Control
59 www.qaelum.com - CONFIDENTIAL
– Possibility to
• Evaluate used used series and exposure parameters in combination with protocol management
• Example, method to optimize scan protocols – If in more than ex. 50% of the studies the parameters needs to
be modified, sign for
» optimization of protocol
» creation of new protocols
![Page 59: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/59.jpg)
Clinical Quality Control
60 www.qaelum.com - CONFIDENTIAL
– Possibility to
• Evaluate if the used protocol was intended to be used for this patient – Adult vs peadiatric protocols
– Warning when adult protocols are being used for peadiatric patients
![Page 60: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/60.jpg)
Clinical Quality Control
61 www.qaelum.com - CONFIDENTIAL
– Evaluate problem of patient positioning
• when using dose reduction techniques, it’s crucial that patients are positioned in the isocentre of the gantry – danger for dose increase instead of dose reduction
vertical horizontal
can be used as an alternative for missing
weight/length information
![Page 61: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/61.jpg)
Clinical Quality Control
62 www.qaelum.com - CONFIDENTIAL
– Evaluate problem of overscan in CT
• possibility to measure overscan and estimate superfluous dose
• fully automatic analysis method
![Page 62: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/62.jpg)
63 www.qaelum.com - CONFIDENTIAL
Thorax scan
Optimal scan limits
![Page 63: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/63.jpg)
64 www.qaelum.com - CONFIDENTIAL
Breasts: 0%
Lungs: 8.3%
Liver: 20%
Gallbladder: 50%
Pancreas: 50%
Intestines: 10%
Thyroid : 0%
Heart: 0% Spleen: 30%
Stomach: 25%
Kidneys: 33,3%
Uterus: 0%
Prostate Prostate: 0%
Scanned region
Optimal region
![Page 64: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/64.jpg)
Clinical Quality Control
65 www.qaelum.com - CONFIDENTIAL
– Evaluate problem of blind scanning in CT
![Page 65: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/65.jpg)
Clinical Quality Control
66 www.qaelum.com - CONFIDENTIAL
The patient becomes the phantom
![Page 66: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/66.jpg)
67 www.qaelum.com - CONFIDENTIAL
• Need for automated solution for patient dose monitoring
• Starting from an academic / medical physics background, Qaelum offers a vendor neutral and complete solution to monitor and optimize the quality and workflow in digital radiology departments, Total Quality Monitoring
• Next to advanced patient dose monitoring, this total solution includes novel types of quality control, ex. Clinical QC, and extensions to monitor the quality in general
![Page 67: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/67.jpg)
QUESTIONS & ANSWERS
Q…A 68 www.qaelum.com - CONFIDENTIAL
![Page 68: Patient Dose Monitoring](https://reader036.vdocuments.site/reader036/viewer/2022081716/54920d08ac795944288b468a/html5/thumbnails/68.jpg)
FOR YOU ATTENTION
THANK YOU
69 www.qaelum.com - CONFIDENTIAL