The radical increase in patient exposure to radiation from medical imaging over the last two decades has created great concerns about its inherent risks. Today, one of the highest priorities on many hospital agendas is to break this trend by achieving improved control of the radiation exposure to their patients.
The collection and monitoring of patient radiation dose is currently limited or non-existent in many imaging facilities which has provoked reaction by government agencies and state legislatures to establish laws and programs to collect and report on dose. There is no doubt that this has led the medical imaging community to take action to comply with these initiatives and gain a better control of the radiation exposure to their patients.
ACR’s Dose Index Registry
ACR’s Dose Index Registry (DIR), a prominent data registry in the United States, allows facilities to compare their computed tomography (CT) dose indices to regional and national values. Information related to dose indices for all CT exams is collected, anonymized, transmitted, and stored in this data repository. Every six months, institutions receive feedback reports comparing their results (by body part and exam type) against aggregate values in an attempt to provide hospitals a way of benchmarking dose values. Unfortunately, the external comparison itself is not enough; appropriate action must be taken from within the facility to reduce and achieve better control of radiation exposure to make sure laws and the ALARA (as low as reasonably achievable) dose principals are followed.
Utilizing a Dose Monitoring Solution
When an outlier in dose values for a specific procedure is identified in a feedback report, the next step is to determine the underlying reason for the deviation. The focus must move from external comparison to internal investigation.
“Utilizing a dose monitoring solution is the most efficient way to collect and visualize the huge volume of data concerned with dose reporting,” said Ian Judd, product manager for Sectra DoseTrack. “Any solution should accept data from multiple sources such as EMR, RIS, modalities and PACS and provide analytical tools to allow for drill-down into details about the specific procedure and the underlying cause for exceptions.”
He said it is only by gathering data from multiple sources within the imaging arena that an effective dose reduction methodology can be implemented. When this is accomplished, appropriate dose reducing actions including adjusting protocols, configuring modalities and providing additional training to staff will be successful.
“A dose monitoring solution should allow for comparisons on multiple levels such as between X-ray equipment, staff, and departments to determine the reason why each exposure occurred,” Judd said. “Without the ability to look at the complete patient journey from initial referral to the finalized report, the customer will never truly be able to manage patient dose. The actual dose received is a single moment in time, however, there are many other key touch points in the care of the patient, which if not also analyzed, will never allow true dose reduction to be achieved.
He said a dose tracking system provides confirmation and confidence in operating a quality, professional service. This confidence and proof can then be used to improve confidence in the level of service to referring clinicians and patients.
Both the Joint Commission (JCAHO) and U.S. Food and Drug Administration (FDA) have provided recommendations on capturing and transmitting dose information in the patient’s electronic medical record (EMR) as well as to a national dose registry.[2,3] Synergies can be achieved by utilizing a dose monitoring solution as a centralized portal to collect and send dose data to EMR’s and the DIR.
Participating in the DIR provides an excellent path for imaging institutions to receive external feedback on how they perform against other facilities. However, without corrective action, that feedback is of limited value. By utilizing a dose monitoring solution, the institution can leverage the feedback from the DIR to internally investigate the underlying reasons for outliers. Only then, can appropriate actions be taken to reduce the overall radiation exposure to patients.
Editor's note: The author Simon Häger is a Sectra DoseTrack team member.
1. The American College of Radiology, "Dose Index Registry," 23 10 2013. [Online]. Available: http://www.acr.org/Quality-Safety/National-Radiology-Data-Registry/Dose-Index-Registry.
2. The Joint Commission on Accreditation of Health Organizations, "Sentinel Event Alert 47," The Joint Commission on Accreditation of Health Organizations, 2011.
3. U.S. Food and Drug Administration, "Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging," U.S. Food and Drug Administration, 9 2 2010. [Online]. Available: http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm200085.htm?sms_ss=email. [Accessed 23 10 2013].