Dzień dobry

Dose management in X-ray diagnostics

Ed McDonagh, The Royal Marsden

PJOMED 2021 Conference, Łódź, Poland
13th - 14th September 2021

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What is a dose management system?

Used for imaging of patients with ionising radiation

  • Records information about
    • the patient
    • the equipment
    • the exam
    • the exposure parameters and dose

Primary uses (1)

  • Population dose surveys
    • Representative doses
    • Dose reference levels
    • Contributing to national/international surveys

Primary uses (2)

  • Optimisation
    • Comparing between X-ray systems
    • Comparing to national/international
    • New equipment monitoring
    • New protocols
    • Technique monitoring
    • Imaging Optimisation Teams -
      practitioner, medical physics expert and radiographer (tecknik electroradiologii)

Primary uses (3)

  • Incident dose and risk estimates

Primary uses (4)

  • Estimates of skin dose

Secondary uses

  • Basic equipment usage stats
    • Differences between equipment
    • Time of day, day of week
  • Record of software versions etc

What is is not for...

  • (meaningless) Effective dose calculations
  • Cumulative dose tracking
  • Must not be part of justification process

Legal basis

EU Council Directive 2013/59/Euratom of 5 December 2013



Prawo atomowe (Dz. U. z 2019 r., poz. 1792), Rozdział 3a

Artykuł 56 - Optymalizacja

  • Member States must establish and review diagnostic reference levels for radiodiagnostic examinations, and where appropriate interventional radiology procedures Prawo atomowe Art. 33g.
  • Ensure that optimisation includes... assessment and evaluation of patient doses

Artykuł 57 - Obowiązki

  • The practitioner, medical physics expert and technik electroradiologii must take part in optimisation process
  • Patient should be provided with information on benefits and risks associated with radiation dose from the exposure Prawo atomowe Art. 33i. ust. 4.

Artykuł 60 - Sprzęt

For equipment installed after 6th February 2018:

  • 3. (e) Interventional radiology and CT must be able to transfer relevant parameters for assessing patient dose Prawo atomowe Art. 33k. ust. 4.
  • 3. (f) Other new radiodiagnostic equipment must be able to inform practitioner of relevant parameters for assessing patient dose, and where appropriate be able to transfer this information.

Artykuł 63 - Narażenia przypadkowe i niezamierzone

  • (c) Must have an appropriate system for record keeping and analysis of events involving or potentially involving accidental or unintended medical exposures Prawo atomowe Art. 7 ust. 2b pkt 3

Artykuł 64 - Szacowanie dawek dla ludności

  • Member states shall ensure that the distribution of individual dose estimates from medical exposures for radiodiagnostic and interventional radiology purposes is determined, taking into consideration where appropriate the distribution by age and gender of the exposed
OpenREM logo

What is OpenREM

  • Free, open source application for patient dose monitoring
  • Imports CT, planar X-ray, fluoroscopy and mammography data
  • Display of summary exposure data, with filtering and searching
  • Charts to visualise and explore the data
  • Skin dose maps for fluoroscopy using a simple geometric phantom
  • Export of data into spreadsheets, sorted and summarised

Importing dose data

Imports data from file or using DICOM networking

Radiation dose structured reports from all modalities

DICOM image header information from Radiography, Mammography, some CT

Additional height/weight data from csv

OpenREM web interface
CT filtered search page, with charts
Another chart - normalised histogram of DLP values for two systems
Detailed display of data for one CT exam
Detailed display of data for fluoroscopy, including skin dose map
Different export formats available, with or without patient information, for further analysis

How is it different?


Developed in the open - by the people who use it

Contributions welcome

Enables choices for data protection

Free, open source - GPLv3 licence

Hosted at in a git repository

Python, Django, pydicom, XlsxWriter, Celery, RabbitMQ, Docker, PixelMed and more

Coming in the next release...

Simplified Docker based installation

Upgrade of Python version and all the libraries

All new charts

Translations of docs and the interface

Lots of enhancements and bug-fixes

How do I get started?

The website:

The documentation:

The support forums: Google Groups

How do I get involved?

Bugs, feature requests:

Code fixes, enhancements - fork and pull request:

Developer docs:


Any questions?




@ed_mcdonagh | @_OpenREM

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