title: Open-Source Radiation Exposure Extraction Engine (RE3) with Patient-Specific Outlier Detection.
abstract: We present an open-source, picture archiving and communication system (PACS)-integrated radiation exposure extraction engine (RE3) that provides study-, series-, and slice-specific data for automated monitoring of computed tomography (CT) radiation exposure. RE3 was built using open-source components and seamlessly integrates with the PACS. RE3 calculations of dose length product (DLP) from the Digital imaging and communications in medicine (DICOM) headers showed high agreement (R (2) = 0.99) with the vendor dose pages. For study-specific outlier detection, RE3 constructs robust, automatically updating multivariable regression models to predict DLP in the context of patient gender and age, scan length, water-equivalent diameter (D w), and scanned body volume (SBV). As proof of concept, the model was trained on 811 CT chest, abdomen + pelvis (CAP) exams and 29 outliers were detected. The continuous variables used in the outlier detection model were scan length (R (2)  = 0.45), D w (R (2) = 0.70), SBV (R (2) = 0.80), and age (R (2) = 0.01). The categorical variables were gender (male average 1182.7 ± 26.3 and female 1047.1 ± 26.9 mGy cm) and pediatric status (pediatric average 710.7 ± 73.6 mGy cm and adult 1134.5 ± 19.3 mGy cm).
authors.affiliation: National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Clinical Image Processing Service (CIPS), 10 Center Drive, Bethesda, MD, 20892-1182, USA.|University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Weisenthal
authors.affiliation: National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Clinical Image Processing Service (CIPS), 10 Center Drive, Bethesda, MD, 20892-1182, USA.
authors.forename: Les
authors.initials: L
authors.lastname: Folio
authors.affiliation: National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Clinical Image Processing Service (CIPS), 10 Center Drive, Bethesda, MD, 20892-1182, USA.
authors.forename: William
authors.initials: W
authors.lastname: Kovacs
authors.affiliation: National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Clinical Image Processing Service (CIPS), 10 Center Drive, Bethesda, MD, 20892-1182, USA.
authors.forename: Ari
authors.initials: A
authors.lastname: Seff
authors.affiliation: National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Clinical Image Processing Service (CIPS), 10 Center Drive, Bethesda, MD, 20892-1182, USA.
authors.forename: Vana
authors.initials: V
authors.lastname: Derderian
authors.affiliation: National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Clinical Image Processing Service (CIPS), 10 Center Drive, Bethesda, MD, 20892-1182, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Summers
authors.affiliation: National Institutes of Health, Clinical Center, Radiology and Imaging Sciences, Clinical Image Processing Service (CIPS), 10 Center Drive, Bethesda, MD, 20892-1182, USA. jyao@cc.nih.gov.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Yao
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control* / Q000706:statistics & numerical data; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D011873:Radiology Information Systems; D012044:Regression Analysis; D012737:Sex Factors; D012984:Software; D014057:Tomography, X-Ray Computed
keywords: Automated measurement; Clinical workflow; Computers in medicine; Data extraction; Data mining; Imaging informatics; Medical informatics applications; Open source; PACS implementation; PACS integration; Quality assurance; Quality control; Radiation dose; Software design; Statistical analysis