Deployingadosemanagementstrategyacrossmultiplesites

KatiaKatsariMedicalPhysicist

DisclosureInformationKatiaKatsari

CEORADProtectionServicesS.A.Consultantofaffidea (multinationalmedicalservicesprovider)

PresentationobjectivesI. UnderstandthechallengesofimplementingaDoseManagementStrategy

(DMS), indifferentlocations

I. LearnmoreaboutpracticalexamplesofDMS,implementedacrossmultiplesites

• CTmultislice ≥6detectorrows

• 6 countries

• 36 CTsites

• 3 CTmanufacturers

• 12 CTmodels

• 27 CTsystems withdosereductionalgorithms

DMSscope(1/2)

• 53 radiologists

• 70radiographers

• 11anatomicareas

• 29 CTprotocols

• 22.000 examinationsonaveragepermonth

DMSscope(2/2)

• Assigndosemanagementteams

• Assessexistingworkflow&doseawarenessculture

• Createacommunicationplan

• Setgoals&milestones

• Fosteradoseawarenessculture

• Usedosetracking,monitoring,analyzingsoftware

DMSRationale(1/2)

• Justification:dosealerts

• Standardization:QC,protocolsandpractice

• Optimization:CToperation, protocolsandpractice

• Reporting

• Dose benchmarking

• Implementbestpractices

DMSRationale(2/2)

HQSTEERINGCOMMITTEE

Sponsor

ProjectLeader

MedicalDoctor

MarketingLeader

ITLeader

LeanManagement

Leader

DMSTeamsCOUNTRYTEAM

ProjectLeader

ChiefRadiologist

ChiefRadiographer

ChiefMedicalPhysicist

SITETEAM

Radiologist

Radiographer

THIRDPARTIES

Applicationspecialists

Serviceproviders

Managementteams

• CreatestandardizedCTprotocolslist

• SetDRLsfor29protocols

• Set%targetsforstandarduseofprotocols,justificationofdosealerts,linkedprotocols,protocolscompliancetoDRLs

• Doseawarenessculture

• Dosebenchmarking

• Imagequalitytesting

• Goldprotocols

Goals

• Assessmentofdoseawarenessculturethroughquestionnaire

• Automaticalerts ofhighdoseexaminations

• Justification ofeachalert

• Monthlydoseteammeetings

• Continuingeducation forradiologists&radiographers

DoseAwarenessCulture

• Creationofcommunicationmaterial

• TargetgroupI:medicalcenters

• TargetgroupII:medicalpractitioners,patients

Communicationplan

RecordedCTDoseUnits

• ConnectCTsystemstodosetrackingsoftware

• Softwaretoolsto linksiteprotocolstostandardizedprotocols

• Softwaretoolstosetlocal dosereferencelevels

• Softwaretoolstomonitorandanalyzehighdosealertsandpatientcumulativedose

• Usedataconsolidationandstatisticalanalysistoolsforprotocoloptimizationanddosereduction

DoseTracking,Monitoring,Analysis

• MonthlyandannualqualitycontrolsofCTsystems

• Workflow

• CTprotocolslist

Standardization(1/2)

Standardization(2/2)STANDARDIZEDPROTOCOLS LISTPARAMETERS

Region/Anatomy

ProtocolName

ID ClinicalIndication

DiagnosticTask

NS ScanMode

ScanRange

BMI 75pCTDIDRL

75pDLPDRL

• Choosemost frequent protocols

• Link individual site CT protocols to above list

• Compare dosevaluestoDRL’s

• Adjust protocolparametersaccordingly

• ImageQualitytestingwithphantoms&blindstudies

Optimization

MONTHLYANDPERIODICDATA

%ofhighdoseexaminationsand%ofJustifiedalerts

%ofperformedexaminationswithStandardizedprotocols

%ofprotocolsOptimized

JSOReport

ProtocolsComparedtoDRLs

%DLPReduction

-29%

-19%

-34% -36%

-16%

COUNTRYA COUNTRYB COUNTRYC COUNTRYD COUNTRYE

%Optimization

60%52% 51% 50% 46%

COUNTRYA COUNTRYB COUNTRYC COUNTRYD COUNTRYE

%PROTOCOLp75(DLPANDCTDI)<DRL

DosebenchmarkingSINUSPROTOCOL

COUNTRY SYSTEM75%

CTDIvol(mGy)

75%DLP

(mGy.cm)

DRLCTDIvol (mGy)

DRLDLP(mGy.cm)

A CTScanner A– 64slice 3,10 43,33

13 190D CTscannerB– 64slicewith

dosereductionoption 4,29 75,75

E CTscannerC– 64slicewithdosereductionoption 7,06 108,02

C CTscannerD– 64 slice 10,96 176,51

• Countrylegislation&NHSrules

• Differencesinnationalmentalities&CTdoseperception

• CTdoseculturebetweenradiologistsofdifferentgenerations

• Workloaddifferencesbetweenprivate&publicsector

Challenges(1/2)

• Teamspiritandcollaboration

• AgreementonstandardizedCTprotocols&practices

• Clinicalandtechnicalassessment ofprotocols

• CTprotocolparameterscorrections toreducedose

Challenges(2/2)

“Wewouldliketoinformyouthat thelatestchangeswehaveappliedinHead,NeckandSino-nasalCTscanshaveaverygoodimagequality,whichisconsideredmuchbetterthanthepreviousimageprotocols.Wewouldliketothankyouverymuchandwewillkeepintouchforanyprotocolregulationsandchangeswemightneedinthefuture.”

Sincerelyyours,

Radiologist

“StandardizingCTprotocolsiskeybecase itmeansthatallcentersacrossallcountrieswilloperateinthesameway.ThatmeansIcanworkanywherethroughouttheorganization.”

Radiographer

Participantsfeedback

Withdedicatedteams,continuingeducation, standardization and

acleardosemanagementstrategy,

dosetrackingwillleadtodosereduction

Conclusion