In contrast to radiography and CT, complex RDSR reports are not always correctly and completely saved as DICOM objects in FGI and are not always correctly and completely evaluated by DMS providers. Various commercial dose management systems (DMSs) with varying characteristics are available today. Recording and processing of patient exposure was driven by the EU-BSS which requires member states of the European Union to ensure justification and optimisation of radiological procedures and store information on patient exposure for analysis and quality assurance. The DICOM image data therefore lack the dose contribution from fluoroscopy, which can easily exceed 50% of the total dose depending on the type of intervention. This is not the case with fluoroscopic procedures, as fluoroscopy scenes are usually not stored in the PACS. In radiography and CT, the exposure data can be extracted relatively reliable from the DICOM image data even without RDSR. Table 1 shows an excerpt of an angiography RDSR.
How to open mckesson pacs viewer for patients series#
This includes all exposure parameters for each fluoroscopic scene, all radiographic images or cine series with kV, mAs, geometrical parameters of C-arm, detector and more. Today DICOM RDSR is available in most new angiography systems and provides an easy solution to collect dose parameters. All of these recording methods allow only difficult analysis of the patient exposure.
Later, storage was provided together with the angiographic images in a picture archiving and communication system (PACS) as bitmap report. If appropriate, these are to be reported to the competent authorities as "unintended exposures" in accordance with the national implementation of the EU-BSS.Ībout 20 years ago, exposure parameters from FGI were usually recorded manually in a Radiology or Hospital Information System (RIS/HIS) or paper based. Furthermore, FGI are the procedures with the highest risk of deterministic effects. įor all aspects of quality assurance and dose management, the involvement of a medical physics expert (MPE) is therefore imperative in accordance with the European Directive 2013/59/EURATOM (EU-BSS), especially for procedures with a higher dose such as computed tomography (CT) or FGI. The DICOM radiation dose structured report (RDSR) is available in most new angiographic systems and enables a more detailed analysis of all exposure parameters from fluoroscopy and radiographic images or cine series.
Patient exposure in FGI depends on many patient, procedure and modality related parameters like kV, mAs, filtration, detector entrance dose rate, pulse rate, number of images, image processing, fluoroscopy time, geometric properties of the modality and field of view (FOV). in radiology, neuroradiology, cardiology or vascular surgery can be performed.
The following article essentially refers to stationary angiography systems on which complex interventions e.g. This dose information should not only be available after a procedure by means of the recorded exposure parameters, but also to the interventionalist during a FGI. It is therefore important in complex interventions with substantial radiation dose levels (SRDL) to be able to measure or estimate the patient dose. The reasons for this include the variety of modalities used and the wide range of interventional procedures. Patient exposure in fluoroscopically guided interventions (FGI) spans a wide dose range and can reach levels at which deterministic effects may occur.