Feature | June 03, 2014 | Williette Nyanue

CT Dose: The Need For Management

This article appeared as an introduction to a Comparison Chart on CT Dose in the June 2014 issue.

Radiation dose management has come to the forefront of healthcare concerns with both patients and providers advocating for measures that will decrease and manage exposure. Research has shown that medical imaging has doubled the public’s exposure to ionizing radiation since the 1980s, and while this statistic includes fluoroscopy, angiography, mammography and standard X-ray, computed tomography (CT) has contributed the majority of the dose increase. 

The effects of increased exposure to ionizing radiation — burns, nausea, fatigue, cancer and even death — as well as increased media coverage on the issue, has led many states to pass legislation mandating that medical organizations record CT radiation dose to help track, assess and manage exposure more easily. Senate Bill 1237, passed in California, requires hospitals and clinics that use CT for diagnostics to record radiation dose administered during exams. The Texas Department of State Health Services also updated the Texas Administrative Code 289.227, requiring programs to record radiation output on all CT and fluoroscopy exams. Connecticut currently has a bill under committee review that would require CT radiation dose to be recorded in radiology reports. 

As radiation dose monitoring continues to become a requirement across the United States, manufacturers are supplying hospitals with the hardware and software needed to come under compliance and prepare for the future.  

Software to Help Lower CT Dose

Manufacturers are also integrating dose reduction techniques within CT systems. GE, Siemens and Philips each unveiled CT scanners that addressed low-dose scanning at the Radiological Society of North America’s (RSNA) 2013 annual meeting. GE’s Revolution CT featured the ASiR–V, the company’s next version of its iterative reconstruction CT technology. ASiR-V combines the speed of ASiR with the capabilities of Veo full model-based iterative reconstruction and is designed to significantly reduce dose relative to filtered back projection (FBP) for both body and head modes. The company said ASiR-V significantly improves low contrast detectability, spatial resolution and image noise, and has the capability to reduce low signal artifacts such as streak artifacts when compared to FBP. 

Siemens showcased two X-ray generators on the Somatom Force, which can be used at low voltage for low-dose scanning, as well as its Safire software, which further reduces dose. According to Siemens, these two technologies, working together, allow the Somatom Force to deliver half the amount of dose during lung scans when compared to other systems. 

Philips showed its iterative modeling technology, iterative model reconstruction (IMR), on the company’s newly unveiled IQon Spectral CT at RSNA. According to Philips, the company’s first iterative reconstruction technique allows physicians to achieve 60-80 percent lower dose and improve low-contrast detectability by 43-80 percent and lower image noise by 70-80 percent, relative to FBP. 

Late last year, Toshiba also integrated its advanced radiation dose reduction technology, Adaptive Iterative Dose Reduction 3D (AIDR 3D), onto all new Aquilion CT systems. AIDR 3D is Toshiba’s third-generation iterative dose reconstruction software, which incorporates significant system enhancements by reducing radiation dose compared with conventional scanning. The software uses a sophisticated algorithm that is designed to work in both the raw data and image data spaces, reducing noise while attempting to maintain image quality. 

CT Dose Tracking Software

Going hand-in-hand with lower-dose hardware and new reconstruction software is the ability to record and track dose. This helps set a baseline on dose at a facility and track it over time to see which imaging protocols need to be changed, which scanner operators are using higher than average dosages and which scanners might need to be replaced by newer technology.
In addition, the Joint Commission now requires CT dose
tracking software as part of its new rules for certification programs starting in July. 

GE Healthcare released the latest version of its DoseWatch software — which retrieves, tracks and reports radiation dose administered to patients during exams — at RSNA last December. In addition to information technology (IT) and interface enhancements, the latest version features a dose comparison analysis tool that allows users to compare dose between facilities, across systems and among protocols. The software has already proven to be beneficial. Jan Casselman, M.D., Ph.D., St. John’s Hospital, Belgium, said, “I believe that many would be surprised to see the impact that an effective dose management tool can have.” He stated that since St. John’s implemented its dose management program, which includes GE’s DoseWatch software, there has been a 30-40 percent reduction in CT dose. 

Other vendors include Sectra, PACSHealth and Aware Inc. Sectra showcased its DoseTrack Web-based software at RSNA 2013. An American College of Radiology (ACR) software partner, DoseTrack automatically collects, stores and monitors dose data from all modalities. DoseMonitor from PACSHealth automates dose monitoring and reports, helping to ensure exam consistency, maintain regulatory compliance and manage radiation dose from a single application. The AccuRad REM Server from Aware Inc. collects radiation exposure data based on Integrating the Healthcare Enterprise’s (IHE) radiation exposure monitoring (REM) profile to generate customized dosage estimation reports and upload data to the U.S. Data Index Registry (DIR).

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