2011 Victorian CTTG Monash

ARPANSA MDCT Updates: 

ARPANSA MDCT Updates Anthony Wallace, Manager, Diagnostic Imaging & Nuclear Medicine Section, ARPANSA anthony.wallace@arpansa.gov.au

Topics: 

Topics National, State & Territory regulatory environment ARPANSA NDRL survey Clinically useful dosimetry Recent propositions from Brenner Effective Dose applied to individuals Organ dose development necessity Radiation Dose Structured Reports Future developments eHealth and individual dose histories Radiation Oncology imaging RDSR as a national dose survey tool

Australian Regulatory Environment: 

Australian Regulatory Environment

Radiation Codes & Safety Guides: 

Radiation Codes & Safety Guides 4 NDRP RPS 6 Medical Code RPS 14 Safety Guides 2008 RPS 14.1 2008 RPS 14.2 2008 RPS 14.3 2004 2008 http://www.arpansa.gov.au/Publications/codes/rps.cfm

Direct & Indirect Regulatory Drivers: 

Direct & Indirect Regulatory Drivers 5 ARPANSA Code of Practice Local Regulatory Requirements Medicare Practice Accreditation (DIAS)

Codes & Safety Guides - DRLs: 

Codes & Safety Guides - DRLs 6 Diagnostic reference levels 3.1.8 The Responsible Person must establish a program to ensure that radiation doses administered to a patient for diagnostic purposes are: ( a) periodically compared with diagnostic reference levels ( DRLs) for diagnostic procedures for which DRLs have been established in Australia; and ( b) if DRLs are consistently exceeded, reviewed to determine whether radiation protection has been optimized .

ARPANSA NDRL Survey: 

ARPANSA NDRL Survey

The Rationale: 

The Rationale We want the data per scanned habitus You want a practice report per protocol You can use the report to assist in dose optimization To achieve this; Each protocol should be specific Don’t mix multiple phases, contrast with non-contrast, etc Dose modulation is problematic, mAs is indicative

Slide 9: 

www.arpansa.gov.au NDRL Link

Practice Registrations.....so far: 

Practice Registrations.....so far State/Territory Number ACT 4 NSW 7 NT 0 QLD 3 SA 0 TAS 0 VIC 5 WA 9

Clinically Useful Dosimetry: 

Clinically Useful Dosimetry

The Old, Tried & True Standards: 

The Old, Tried & True Standards CTDI Air , Weighted, Volume (mGy) DLP (mGy.cm) mSv/mGy.cm conversion tables If you don’t know what these are and how they are applied to patient dosimetry You should be having a serious look at yourself

The Effective Dose Dilemma: 

The Effective Dose Dilemma California has recently legislated as mandatory that all CT patients must be told the effective dose of the procedure and its consequent risk for them The fact that effective dose is a statistical population risk construct and cannot be applied to the individual didn’t seem to carry much weight A knee jerk response to CT dose sensitivity Don’t think it couldn’t happen here

If Not Effective Dose……..?: 

If Not Effective Dose……..? Effective dose is an inappropriate dose risk metric for the individual More accurate radiation risk assessments should be constructed from an organ dose assessment Individual radiosensitivities – normal distribution? Individual organ dose radiosensitivities Heterogeneous dose distributions Need a real time, platform embedded organ dose calculator for reasonable risk assessment

Age Dependent Dosimetry Risk: 

Age Dependent Dosimetry Risk Hall, Pediatric Radiology, (2002) Vol.32

Prof. David Brenner Postulates: 

Prof. David Brenner Postulates Supports the increased radiosensitivities of paediatrics, but Proposes that there is an inverse relationship between age at exposure and expression of detriment An outcome of Bystander effects

Bystander Effect: 

Bystander Effect

Age related Cancer Mortality: 

Age related Cancer Mortality Cancer incidence still primarily expressed in late middle age and older but if exposed at younger age there will be an increased expression of detriment from those exposures

Radiation Dose Structured Reports: 

Radiation Dose Structured Reports

Radiation Dose Structured Report: 

Radiation Dose Structured Report

RDSR – General Use: 

RDSR – General Use

RDSR – General Use: 

RDSR – General Use

RDSR – Key Measurements: 

RDSR – Key Measurements

RDSR – More Details: 

RDSR – More Details

RDSR – Creating Reports: 

RDSR – Creating Reports

RDSR – Applications I: 

RDSR – Applications I

RDSR – Applications 2: 

RDSR – Applications 2

RDSR - Wrap-up: 

RDSR - Wrap-up Multi-modality application Available now on newer platforms or latest software upgrades Check with your vendor Little or no PACS/RIS software integration 3 – 5 year full roll out Direct IP to IP address connectivity Vendor software to generate spreadsheet reports

Future Developments: 

Future Developments

eHealth: 

eHealth Combined with RDSR could be an answer for developing an individual dose record for PCEHR (personally controlled electronic health record) Need to start discussing with eHealth /NEHTA now for it to gain some traction on a busy and expanding agenda

Radiation Oncology Imaging: 

Radiation Oncology Imaging Improved sophistication and accuracy of treatment beam delivery IMRT MLC Rotational Recognition of regional organ radiosensitivities Serial vs. parallel functioning Improved targeting requires a greater dependence on diagnostic imaging

Where’s The Throttle Point(s)?: 

Where’s The Throttle Point(s)? 49 Referrer Knowledge Radiologist as Gatekeeper Optimized Acquisition

ARPANSA Preferred Outcomes: 

ARPANSA Preferred Outcomes 50

The End: 

The End