This is an educational abstract describing the recently released IHE Radiation Exposure Monitoring (REM) Profile from Integrating the Healthcare Enterprise. The purpose is to inform imaging informaticists of REM’s benefits and how to request it from commercial vendors.

Many regulations and guidelines (such as the European directive Euratom 97/43 and the American College of Radiology Dose Whitepaper) express the need for facilities to monitor radiation dose estimates for procedures they perform, and keep procedure doses As Low As Reasonably Achievable (ALARA). Such efforts are easier, and more likely to occur regularly, when dose estimates are provided electronically. The American College of Radiology created the Image Gently campaign in 2008 to help reduce exposure to pediatric patients undergoing Computed Tomography by minimizing exposure protocols.

The ability to centralize exposure information from multiple imaging modalities is a central tenet to building a quality management program that can effectively monitor patient exposure and provide protocoling feedback to the technologists.

Integrating the Healthcare Enterprise (IHE) at www.ihe.net is an initiative of professional societies to supervise and coordinate standards-based solutions to problems that span multiple vendor systems.

The IHE Radiation Exposure Monitoring (REM) Profile facilitates the collection and distribution of estimated patient radiation exposure information resulting from imaging procedures.

The IHE REM Profile is an implementation guide for vendors documenting how to support dose reporting using existing standards (DICOM SR Dose Reports). By following this guide and participating in IHE Connectathons, vendors can release products that will interoperate to provide an exposure monitoring pipeline.

Imaging modalities are required to export radiation exposure details in a standard format. Radiation reporting systems can periodically query these “dose objects” from an archive, or receive them directly from modalities. The reporting system is expected to perform relevant dose QA analyses and produce related reports. Dose reports can also be submitted to centralized registries, such as might be run by professional societies or national accreditation groups.

Dose details are recorded for each irradiation event, defined as one continuous irradiation applied to a patient. A CT scanogram and the associated helical scan are two separate events, as are two different presses of the fluoro pedal. Typically, one dose object is created at the end of each step of the procedure performed on the modality. That object collects all irradiation events from the procedure step and adds summary dose index values.

The Profile addresses CT, angiography, fluoroscopy, mammography, CR, DR, and plain X-ray. It does not yet address nuclear medicine (PET or SPECT), radiotherapy, or implanted seeds.

With automated methods, dose information can be collected and evaluated without imposing an administrative burden on staff members otherwise occupied with caring for patients.

Sites that are planning programs to monitor radiation exposure should review the profile for applicability, and consider requiring compliance with the IHE REM Profile in future purchases.

IHE Radiology Technical Framework Supplement - Radiation Exposure Monitoring