Introduction to REM-NM: Radiation Exposure Monitoring for Nuclear Medicine

Introduction to REM-NM: Radiation Exposure Monitoring for Nuclear Medicine

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Description: Supports recording/reporting administered activity and estimated organ radiation dose due to Radiopharmaceutical administration. Includes automatic transmission of administered activity information from hot lab/injector systems to scanner. Regulatory bodies, professional societies, and institutions are interested in monitoring administered activity for NM and PET procedures.

 
Author: Jeff Pohlhammer, Charles Smith  | Visits: 360 | Page Views: 472
Domain:  Medicine Category: Equipment 
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Contents:
Introduction to REM-NM
Radiation Exposure Monitoring for Nuclear Medicine

Jeff Pohlhammer, Charles Smith

Agenda
• A Little History – The REM Profile
• Introduction of REM-NM Profile
• Features
• Functional Requirements
• Workflow Use Cases

• Dose Information Reporter and Dose Registry
• Connectathon Review

• Next Steps

REM-NM Profile
• New Radiology Profile; REM-NM.
• Supports recording/reporting administered activity and
estimated organ radiation dose due to Radiopharmaceutical
administration.
• Includes automatic transmission of administered activity
information from hot lab/injector systems to scanner.

Background – REM Profile
Regulatory bodies require reporting of X-Ray dose information



DICOM supports X-Ray dose via Structured Reports (RDSR)
IHE REM (Radiation Exposure Monitoring) based on the RDSR



REM Profile in use since 2009
All CTs shipped since 2013 support RDSR/REM

Background – REM Profile cont’d
Dose
Register

 [RAD-63] Submit Dose Information

Dose Info
Reporter
 [RAD-64] Query Dose Information
 [RAD-65] Retrieve Dose Information
Image
Archive

Image
Manager

 [RAD-64] Query Dose Information
 [RAD-65] Retrieve Dose Information

Dose Info
Consumer

 [RAD-62] Store Dose Information
 [RAD-10] Storage Commitment

Acquisition
Modality
 [RAD-62] Store Dose Information

REM-NM Profile


Regulatory bodies, professional societies, and institutions are
interested in monitoring administered activity for NM and PET
procedures. For example:









QIBA
ASNC - ImageGuide

DICOM has defined new Structured Report for NM/PET in 2013,
similar to CT.
REM-NM Profile provides a framework for managing reporting of
administered activity and estimated dose.
• PET imaging procedures.
• NM and SPECT imaging procedures.
• NM procedures that do not involve imaging.
REM-NM leverages infrastructure, actors, roles of REM.
Promotes quantitative imaging by providing accurate activity and
time information (e.g. QIBA)

REM-NM Profile Structure
Dose
Registry

 [RAD-63] Submit Dose Information

Dose Info
Reporter

Identical actors and roles
as in REM Profile

 [RAD-64] Query Dose Information
 [RAD-65] Retrieve Dose Information
Image
Archive

Image
Manager

 [RAD-64] Query Dose Information
 [RAD-65] Retrieve Dose Information

 [RAD-Z] Store
Radiopharmaceutical Dose
Information

Radiopharmaceutical
Activity Supplier

 [RAD-5] Query
Modality Worklist

Dose Info
Consumer

 [RAD-64] Query Dose
Information
 [RAD-65] Retrieve Dose
Information

Acquisition
Modality

 [RAD-8] Modality Images
Stored
 [RAD-10] Storage Commitment

DSS/Order
Filler
 [RAD-5] Query Modality Worklist

 [RAD-Z] Store Radiopharmaceutical Dose Information

Differs from REM Profile:
• RAS becomes source of
the Dose Report
• Acquisition Modality
only consumes reports
pulled from Image
Manager/Archive
• RAS and Modality pull
study info from Worklist

REM-NM High Level Requirements


Modality and RAS:





Hybrid Modalities (e.g. PET/CT)




Must support Consistent Time Profile
Must support Worklist Query transactions
Must support both REM and REM-NM

Use Cases:






General Imaging Procedure (Most Common)
Non-imaging Procedure
Simultaneous Administration and Imaging Procedure
Dose Information Reporter Pull-based Workflow
Dose Information Reporter Push-based Workflow

Use Case – General Imaging Procedure








The RAS (Hot lab) retrieves Worklist entry to get patient
demographics, order and procedure info.
Radiopharmaceutical is administered to patient.
RAS records amount of activity actually administered,
generates new Radiopharmaceutical Administration Event
UID.
RAS sends Dose Report (RRDSR) to archive (PACS).
When scan is set up, modality queries for the Dose Report
(using Study Instance UID) and extracts relevant information
(admin event UID, activity, date/time, pharmaceutical name,
etc., but might not include half-life or positron fraction).
Modality includes this info in images, and uses information
for decay correction, SUVs, etc.

Use Case – Continued

Dose Information Reporter and Dose Registry





IHE Technical Framework defines these as part of REM
Profile
In many organizations, a Dose Information Reporter will
collect Dose objects covering a particular period (e.g., today,
this week or last month), analyze them, compare to site
policy and generate summary reports.
All, or a sampled subset of the Dose objects might be
submitted to a National Registry to facilitate composing
population statistics and other research. Such Dose objects
will generally undergo a configurable de-identification
process prior to submission.

Example Dose Info Reporter Uses



Department QA (Process Control)
Patient Impact Evaluation


E.g. Assess impact to fetus when mother was determined to be
pregnant after the scan.

Example Dose Registry Uses







Population Dose and Dose Indicators
Dose Reference Levels
Site Benchmarking
Population Epidemiology
Clinical Trials
Longitudinal Patient Dose Record

IHE Europe 2017 Connectathon Review





1 RAS Actor
2 Image Archive Actors
1 Modality
2 Dose Information Consumers

Next Steps
• Vendors begin implementation
• Upcoming IHE Connectathons will continue to test
REM-NM
• Customers begin to include requirements for REMNM support in RfPs.
• Dose Registries plan to receive and analyze
Radiopharmaceutical Radiation Dose SRs.
• Raise awareness of the standard.