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Alfonso Martínez Responsable de Dosis de GE Healthcare
2 / GE Title or job number /
10/2/2012
SEEIC – Septiembre2012
2
3 / GE Title or job number /
10/2/2012
Fuentes de irradiación rayos X
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10/2/2012
Medical Radiation Portfolio Medical Device Imaging (X-Ray)
Computed Tomography (CT)
Interventional
Surgery
Mammography
Bone Densitometry
Radioscopy, Fluoroscopy
PET (hybrid with CT)
NM (hybrid with CT)
Medical Device Imaging (non-X-Ray)
PET (non-hybrid)
NM (non-hybrid)
Radiopharmaceuticals
Cyclotrons (radiopharm. production) Non-Medical Device
Pre-Clinical x-ray device
Medical Device Therapeutic
Oncology Seeds
Rad. Therapy
Relative Dose Levels
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10/2/2012
Joint Position Statement - April 2012
Representative Data Only 5
La IAEA (International Atomic Energy Agency) acaba de divulgar un comunicado de gran importancia en cuanto a las sugerencias que propone, y que impactan de forma notable en la futura regulación de la gestión de dosis. Los puntos más importantes son:
1. Tracking of radiological procedures is useful.
2. Tracking is of particular interest for CT, interventional procedures and some nuclear medicine examinations that involve relatively higher doses.
3. Countries should consider including necessary provisions in their national requirements for patient radiation exposure tracking. Implementation must comply with relevant national privacy and confidentiality regulations
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1. Tests that don’t use ionizing radiation when appropriate
2. Appropriateness review processes based on ACR’s Appropriateness Criteria
Right Test
3. Follow NRC ALARA guidelines
4. Follow Image Gently & Image Wisely guidelines
5. Reference doses for high volume & high dose exams
6. Proper protocols are in place
7. Regular protocol reviews & updates
8. Investigation processes in place
9. Dose recorded with radiology reports
Right Dose
10. Protocol management process
11. Patient and staff protective risk reduction policies
12. Expanded role for radiation safety officer
13. Process for radiation safety competency assessment and training for staff
Effective Processes
14. Organization-wide audit of all equipment with system for QA and safety performance monitoring
15. Annual/bi-annual testing by a qualified medical physicist test all diagnostic
16. Process to ensure all QA & maintenance per manufacturer’s instructions are completed
17. Invest in technologies that optimize or reduce dose
Safe Technology
Source: Joint Commission, Sentinel Event Alert, Issue 47, August 24, 2011
Please see the Sentinel Event Alert for the complete list of 21
recommendations
21 recommendations Joint Commision
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10/2/2012
¿Donde estamos hoy en la gestion de dosis?
Entender la causa de la variación
Optimizar dosis vs. calidad de imagen Identificar Examenes con alta dosis
Representative Data Only 7
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DoseWatch: gestion integral de dosis
Assess and Improve
Balance Image Quality and
Dose
Improve Patient Care and
Minimize Risk
8
• Multi-modality, multi-manufacturer
data collection and archiving
• Integrated with hospital information system
• Integrated statistical analysis
• View dose history by patient, anatomical
region and modality
• Data & analyses to guide radiologists &
physicists in optimizing protocols
• Exam and dose alerts
• On-site protocol optimization support
• Complete site dose reports
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Integraciones en un proyecto
Representative Data Only 9
Modalidades DI. Mediante DICOM MPPS y SR para obtener información de dosis de pacientes.
RIS. Mediante el Dicom Worklist podremos consultar que pacientes vienen a realizarse estudios.
Historia Clínica Electrónica. Integrando el informe de dosis de forma que complete el historial del paciente.
Sistema de petición de pruebas. De forma que el médico peticionario pueda consultar el informe de dosis del paciente y actuar en consecuencia.
Sistema de Información Global. De forma que se pueda obtener información de dosis en la población y comparar actividades.
GE cuenta con un equipo dedicado exclusivamente a integraciones en Sistemas de Información Clínicos
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10/2/2012
Recorramos el camino juntos
• Web
• Multimodalidad
• Multifabricante
• Alarma de dosis
• Historial de dosis
• Integrado con HIS
• Continuidad de la inversión
• Equipo de desarrollo
• Una versión anual
• Software de Calidad
• Soporte Local
• Equipo de Integración
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Total DLP
784 mGy.cm
464 mGy.cm Median
Pr. Parizel UZA
Antwerp , Belgium
The use of DoseWatch, which allows to analyze our practice and our
protocols, is of great value in helping radiologists and CT technologists to
identify sub-optimal scanning protocols, to improve parameter settings,
and reduce patient radiation dose.
” “
Collect data
Modify practice
Adapt protocol
Follow dose level
mGy.cm
timeline
CT Scan of the Brain The facility
UZA
Antwerpen , Belgium
Modalities connected
Two 64-slice LightSpeed
VCT scanners
Installation date
12/30/2011
Results
Decrease of 41% of DLP on
CT scan of the brain
Study submitted to RSNA
DoseWatch* a dose management solution
*Trademarks of General Electric company
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10/2/2012
DoseWatch helps you to find the right balance of image quality and dose
Before optimization After optimization
Protocol: BRAIN
DLP: 817,02 mGy.cm
CTDI: 47,02 mGy
Protocol: BRAIN Low Dose
DLP: 454,55 mGy.cm
CTDI: 23,53 mGy
FEMALE
34 years old
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10/2/2012
Dr. C.Delgoffe
DoseWatch expertise allowed us to optimize our Lumbar Spine protocol resulting in lower dose
while keeping pretty good image quality… When we got ASIR in July, this also considerably
reduced the dose. DoseWatch gave us the necessary visibility to monitor and reduce dose.
” “
Collect data
Modify practice
Adapt protocol
Follow dose level
CT Scan of Lumbar Spine The facility
Centre d’imagerie Jacques
Callot
Nancy, France
Modalities connected
Two CT
Installation date
06/17/2011
Results
Average of DLP decreased
from 1450 mGy.cm to 725
mGy.cm
Centre d’imagerie Jacques Callot
(SOLIME)
DoseWatch* a dose management solution
*Trademarks of General Electric company
Optimization based on DoseWatch analysis Installation of ASIR*
Total DLP Jan 2012
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DoseWatch helps you to find the right balance of image quality and dose
Initial conditions After optimization
DLP: 603.14 mGy.cm
CTDI: 20.4 mGy
ASIR technology
FEMALE
51 years old
59kg – 1.67m
BMI : 21.2
DLP: 966.86 mGy.cm
CTDI: 39.5 mGy
MALE
40 years old
80kg – 1.83m
BMI : 23.6
MALE
67 years old
68kg – 1.72m
BMI : 22.9
DLP: 1049.12
mGy.cm
CTDI: 47.5 mGy
