| 1. |
- Andersson, Jonas, 1975-, et al.
(författare)
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Estimating Patient Organ Dosewith Computed Tomography: A Review of Present Methodologyand Required DICOM Information : A Joint Report ofAAPM Task Group 246 and the European Federationof Organizations for Medical Physics (EFOMP)
- 2019
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Rapport (refereegranskat)abstract
- The purpose of this report is (1) to summarize the current state of the art in estimating organ doses from CT examinations and (2) to outline a road map for standardized reporting of essential parameters necessary for estimation of organ doses from CT imaging in the DICOM standard. To address these purposes, the report includes a comprehensive discussion of (1) the various metrics, concepts, and methods that may be used to achieve estimates of patient organ dose and (2) the DICOM standard for CT.This Joint Report of the American Association of Physicists in Medicine (AAPM) Task Group 246 and the European Federation of Organizations for Medical Physics (EFOMP) contains three major sections and an appendix. Section 2 (with additional material in the appendix) provides a review of basic CT dosimetry metrics, their uses and limitations in the context of organ dosimetry, and the DICOM information currently associated with parameters that affect CT dose metrics and, consequently, organ dose estimates. Section 3 provides an overview of present and emerging organ dose estimation methods reported in the literature, e.g., for the lens of the eye, breast tissue, colon, and skin. Finally, the report concludes with section 4, which provides a discussion on the sources and magnitudes of uncertainty for different organ dose estimation methods.Ongoing efforts to facilitate routine standardized estimation of patient organ doses from CT are dependent, in large part, on the availability of the DICOM Radiation Dose Structured Report (RDSR), which provides a host of information pertinent to radiation dose calculations. This report, therefore, includes detailed information on DICOM header content in CT images and how it can be used in organ dose estimation. The RDSR markedly expands the abilities of the clinical medical physicist to estimate doses at the patient, device, and protocol level
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| 2. |
- Andersson, Jonas, 1975-, et al.
(författare)
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Estimation of patient skin dose in fluoroscopy : summary of a joint report by AAPM TG357 and EFOMP
- 2021
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Ingår i: Medical physics (Lancaster). - : John Wiley & Sons. - 0094-2405 .- 2473-4209. ; 48:7, s. e671-e696
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin.Materials and Methods: The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation.Results: The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed.Conclusions: The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.
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| 3. |
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| 4. |
- de Las Heras Gala, Hugo, et al.
(författare)
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Quality control in cone-beam computed tomography (CBCT): EFOMP-ESTRO-IAEA protocol
- 2017
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Rapport (refereegranskat)abstract
- Quality control of cone-beam computed tomography (CBCT) systems is an essential part of quality assurance to periodically check that quality requirements are met, reduce uncertainties and errors and reduce the likelihood of accidents and incidents. Radiation exposure levels must be measured to ensure that patient doses associated with CBCT examinations are kept as low as reasonably achievable consistent with the required diagnostic information. The main purpose of this document is to present procedures for quality control of CBCT systems used for dental, radiotherapy, interventional radiology and guided surgery applications.
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| 5. |
- de Las Heras Gala, Hugo, et al.
(författare)
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Quality control in cone-beam computed tomography (CBCT) EFOMP-ESTRO-IAEA protocol (summary report)
- 2017
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Ingår i: Physica medica (Testo stampato). - : Elsevier BV. - 1120-1797 .- 1724-191X. ; 39, s. 67-72
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the guideline presented in this article is to unify the test parameters for image quality evaluation and radiation output in all types of cone-beam computed tomography (CBCT) systems. The applications of CBCT spread over dental and interventional radiology, guided surgery and radiotherapy. The chosen tests provide the means to objectively evaluate the performance and monitor the constancy of the imaging chain. Experience from all involved associations has been collected to achieve a consensus that is rigorous and helpful for the practice. The guideline recommends to assess image quality in terms of uniformity, geometrical precision, voxel density values (or Hounsfield units where available), noise, low contrast resolution and spatial resolution measurements. These tests usually require the use of a phantom and evaluation software. Radiation output can be determined with a kerma-area product meter attached to the tube case. Alternatively, a solid state dosimeter attached to the flat panel and a simple geometric relationship can be used to calculate the dose to the isocentre. Summary tables including action levels and recommended frequencies for each test, as well as relevant references, are provided. If the radiation output or image quality deviates from expected values, or exceeds documented action levels for a given system, a more in depth system analysis (using conventional tests) and corrective maintenance work may be required.
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| 6. |
- de las Heras, Hugo, et al.
(författare)
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Quality control for cone beam CT devices: The EFOMP guidelines for assessing image quality and dose
- 2016
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Ingår i: ECR 2016.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Learning objectives: Learn about an objective, practical and unifying methodology for quality control of all cone beam CT (CBCT) modalities. Understand the choice and justification of the proposed tests Learn how to perform the tests on a routine basis.Background: Current guidelines for quality control of CBCT devices consider the available applications (dental, radiotherapy, interventional radiology and guided surgery) as different entities [1], [2]. However, the data acquisition and reconstruction methods are similar. Henceforth, the evaluation parameters for image quality and dose can be unified.Findings and procedure details: The parameters used for image quality assessment are uniformity, accuracy of density values (or Hounsfield units where appropriate), geometrical evaluation, noise, low-contrast resolution (including contrast-to-noise ratio) and high-contrast resolution. Detailed procedures using free software and commercially available test phantoms are described in the guidelines, which are currently under external review.Conclusion: These guidelines include the minimum tests that should be performed to ensure reliable, safe and consistent performance of CBCT devices. This minimum has been sought to guarantee compatibility with all manufacturers, all cone beam modalities and existing national and international documents.
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| 7. |
- Gennaro, Gisella, et al.
(författare)
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Quality Controls in Digital Mammography protocol of the EFOMP Mammo Working group
- 2018
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Ingår i: Physica Medica. - : Elsevier BV. - 1120-1797. ; 48, s. 55-64
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Tidskriftsartikel (refereegranskat)abstract
- This article aims to present the protocol on Quality Controls in Digital Mammography published online in 2015 by the European Federation of Organisations for Medical Physics (EFOMP) which was developed by a Task Force under the Mammo Working Group. The main objective of this protocol was to define a minimum set of easily implemented quality control tests on digital mammography systems that can be used to assure the performance of a system within a set and acceptable range. Detailed step-by-step instructions have been provided, limiting as much as possible any misinterpretations or variations by the person performing. It is intended that these tests be implemented as part of the daily routine of medical physicists and system users throughout Europe in a harmonised way so allowing results to be compared. In this paper the main characteristics of the protocol are illustrated, including examples, together with a brief summary of the contents of each chapter. Finally, instructions for the download of the full protocol and of the related software tools are provided.
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| 8. |
- Giorgi Rossi, Paolo, et al.
(författare)
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Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative
- 2021
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Ingår i: British Journal of Cancer. - : Springer. - 0007-0920 .- 1532-1827. ; 124:9, s. 1503-1512
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Forskningsöversikt (refereegranskat)abstract
- Background: Predicting the risk of recurrence and response to chemotherapy in women with early breast cancer is crucial to optimise adjuvant treatment. Despite the common practice of using multigene tests to predict recurrence, existing recommendations are inconsistent. Our aim was to formulate healthcare recommendations for the question “Should multigene tests be used in women who have early invasive breast cancer, hormone receptor-positive, HER2-negative, to guide the use of adjuvant chemotherapy?”Methods: The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG), a multidisciplinary guideline panel including experts and three patients, developed recommendations informed by systematic reviews of the evidence. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision frameworks were used. Four multigene tests were evaluated: the 21-gene recurrence score (21-RS), the 70-gene signature (70-GS), the PAM50 risk of recurrence score (PAM50-RORS), and the 12-gene molecular score (12-MS).Results: Five studies (2 marker-based design RCTs, two treatment interaction design RCTs and 1 pooled individual data analysis from observational studies) were included; no eligible studies on PAM50-RORS or 12-MS were identified and the GDG did not formulate recommendations for these tests.Conclusions: The ECIBC GDG suggests the use of the 21-RS for lymph node-negative women (conditional recommendation, very low certainty of evidence), recognising that benefits are probably larger in women at high risk of recurrence based on clinical characteristics. The ECIBC GDG suggests the use of the 70-GS for women at high clinical risk (conditional recommendation, low certainty of evidence), and recommends not using 70-GS in women at low clinical risk (strong recommendation, low certainty of evidence).
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| 9. |
- Muratov, Sergei, et al.
(författare)
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Monitoring and evaluation of breast cancer screening programmes : selecting candidate performance indicators
- 2020
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Ingår i: BMC Cancer. - : BioMed Central. - 1471-2407. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection.Methods: The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries.Results: A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers >20mm, cancers <= 10mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate.Conclusion: This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality.
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| 10. |
- Schunemann, Holger J., et al.
(författare)
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Methods for Development of the European Commission Initiative on Breast Cancer Guidelines Recommendations in the Era of Guideline Transparency
- 2019
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Ingår i: Annals of Internal Medicine. - : American College of Physicians. - 0003-4819 .- 1539-3704. ; 171:4, s. 273-280
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Tidskriftsartikel (refereegranskat)abstract
- Neither breast cancer prevention and early-detection programs, nor their outcomes, are uniform across Europe. This article describes the rationale, methods, and process for development of the European Commission ( EC) Initiative on Breast Cancer Screening and Diagnosis Guidelines. To be consistent with standards set by the Institute of Medicine and others, the EC followed 6 general principles. First, the EC selected, via an open call, a panel with broad representation of areas of expertise. Second, it ensured that all recommendations were supported by systematic reviews. Third, the EC separately considered important subgroups of women, included patient advocates in the guidelines development group, and focused on good communication to inform women's decisions. Fourth, EC rules on conflicts of interest were followed and the GRADE ( Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision frameworks were used to structure the process and minimize the influence of competing interests. Fifth, it focused its recommendations on outcomes that matter to women, and certainty of the evidence is rated for each. Sixth, the EC elicited stakeholder feedback to ensure that the recommendations remain up to date and relevant to practice. This article describes the approach and highlights ways of disseminating and adapting the recommendations both within and outside Europe, using innovative information technology tools.
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| 11. |
- Vano, Eliseo, et al.
(författare)
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Notifications and alerts in patient dose values for computed tomography and fluoroscopy-guided interventional procedures
- 2022
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Ingår i: European Radiology. - : Springer. - 0938-7994 .- 1432-1084. ; 32, s. 5525-5531
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Tidskriftsartikel (refereegranskat)abstract
- The terms "notifications" and "alerts" for medical exposures are used by several national and international organisations. Recommendations for CT scanners have been published by the American Association of Physicists in Medicine. Some interventional radiology societies as well as national authorities have also published dose notifications for fluoroscopy-guided interventional procedures. Notifications and alerts may also be useful for optimisation and to avoid unintended and accidental exposures. The main interest in using these values for high-dose procedures (CT and interventional) is to optimise imaging procedures, reducing the probability of stochastic effects and avoiding tissue reactions. Alerts in X-ray systems may be considered before procedures (as in CT), during procedures (in some interventional radiology systems), and after procedures, when the patient radiation dose results are known and processed. This review summarises the different uses of notifications and alerts to help in optimisation for CT and for fluoroscopy-guided interventional procedures as well as in the analysis of unintended and accidental medical exposures. The paper also includes cautions in setting the alert values and discusses the benefits of using patient dose management systems for the alerts, their registry and follow-up, and the differences between notifications, alerts, and trigger levels for individual procedures and the terms used for the collective approach, such as diagnostic reference levels.Key points:• Notifications and alerts on patient dose values for computed tomography (CT) and fluoroscopy-guided interventional procedures (FGIP) allow to improve radiation safety and contribute to the avoidance of radiation injuries and unintended and accidental exposures.• Alerts may be established before the imaging procedures (as in CT) or during and after the procedures as for FGIP.• Dose management systems should include notifications and alerts and their registry for the hospital quality programmes.
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