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Submitted by  Tie Tjee, Evert Sanders, Arjen Becht, IHE The Netherlands
   Commenting on behalf of the organisation
Document Diagnostic Reference Levels in Medical Imaging
 
Dear authors, 

On behalf of the IHE (Integrating the Healthcare Enterprise) organisation of The Netherlands we would like to make the following comments: 

In the report we would like to see IT standards to exchange patient exposure information in a interoperable way, such as IHE REM, to be considered more adequately.
Page 44 line 29 says: "Exposure data recorded in the RDSR, MPPS or the DICOM header can be transmitted to the PACS." In our opinion, this sentence should be followed by: "Integrating the Healthcare Enterprise (IHE) has established a well accepted standard worklow to ensure interoperability among modalities, PACS, dose report systems and even national archives*."

Furthermore: 
- We strongly belief that DICOM RDSR should be described as the current standard, instead of mentioning MPPS and DICOM header on page 44. DICOM RDSR should be strongly emphasized as the recommended data collection mechanism, as opposed to legacy use of MPPS (or OCR of dose screens for that matter).
- The specification of RDSR as the mechanism in the IHE REM* profile should be described.
- The issue of consistent procedure code mapping during data collection should probably also be referred to.
- The future use of the R-RDSR for NM and PET as well as its incorporation in the new IHE REM-NM profile should be mentioned, since the report discusses PET and hybrid imaging.

On behalf of IHE The Netherlands, 
Tie Tjee, vendor chair
Evert Sanders, radiologist, user chair
Arjen Becht, medical physicist, IHE ambassador

* Ref: http://wiki.ihe.net/index.php/Radiation_Exposure_Monitoring