Radiation Dose Monitoring: Beyond CT

Tessa S. Cook, MD PhD University of Pennsylvania

Radiation Dose Monitoring: Beyond CT

Tessa S. Cook, MD PhD University of Pennsylvania

Radiation Dose Monitoring: CT and Beyond

Tessa S. Cook, MD PhD University of Pennsylvania

My Experience

• Financial disclosures – None

• Principal developer of

RADIANCE – Freely available, open-

source dose monitoring system for CT

– Available since 2010

What’s the data? How do I access

it?

What’s relevant? How do I present

it? To whom?

What does my state require?

What does Joint Commission

require?

Discussion Points

Radiation Exposure Monitoring

REM Rads

Techs Physicists

IT

• More than just installing some software and checking a box

• The personal element is critical!

Practical Considerations

Cost

Setup

Features

Collected parameters

Data review

Cost/Setup

Software

Hardware/Networking

Maintenance/Support

Upgrades

Features

• Modalities • Alerts • Dose indices tracked • Protocol management • Utilization analysis • DIR or other registry link

Comparison of Dose Monitoring Tools

Modalities Other Features

Health Devices (ECRI Institute, 2012)

• CT: kVp, mAs, CTDIvol, DLP • Fluoro/XA: ESD, DAP • CR/DR: EI • Nuclear medicine: mCi, conversion to

mSv • Conversion to organ dose?

Different Modalities, Different Indices

• Image-based dose sheet • RDSR • DICOM headers • Text reports

• …and that’s just in Radiology! • What about the other imaging-rich

specialties?

Where’s the Data?

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http://www.neurosurgery-blog.com/

http://usa.healthcare.siemens.com/

REM Management & Review

Scheduled review

Dose indices

Protocols Registry benchmarks

• The lesson is simple: look at the data – it helps you improve!

Examples of Successful Interventions

Interesting Things You Might Learn

• Old protocols still in use • Default protocols settings unexpectedly

modified • Vendor updates change protocols • Challenges to culture change at your

facility • Opportunities for dose reduction at every

step of the imaging process

Reporting CT Dose Indices

✓ • Transparency • Accountability • Education

✗ • Meaning • Anxiety • Misuse

Reporting CT Dose Indices

July 2012 May 2013

July 1, 2014

http://www.acr.org/News-Publications/News/News-Articles/2014/ACR/20140516-The-Joint-Commission-Postpones-July-2014-Implementation-of-Diagnostic-Imaging-Standards

http://www.jointcommission.org/standards_information/prepublication_standards.aspx

• Diagnostic Imaging Services Requirements

http://www.radiologybusiness.com/topics/technology-management/medicare-pay-5-less-ct-scans-acquired-non-compliant-technology

Summary

• Many reasons to do dose monitoring • Many tools available at different levels of

complexity, cost, capability • Look at the data and use it wisely • The software doesn’t do all the work –

form a committee to take responsibility and act on the data

Thank You!