For all the benefits of medical diagnostic imaging, radiation exposure to both the patient and the operator remains a major safety concern. Various studies have illustrated the harmful effects of excess radiation dose, but much is still uncertain as to its precise impact.
New research suggests, however, that occupational radiation safety for radiologists has improved in recent years. The study, conducted by a team from the National Cancer Institute in Bethesda, Md., found that radiologists who graduated medical school after 1940 do not face increased mortality rates from radiation-related causes, including cancer and cerebrovascular disease. Researchers looked at records from the American Medical Association Physician Masterfile to compare cancer incidence and mortality rates of radiologists who graduated between 1916 and 2006 with psychiatrists (chosen as the control group because they were unlikely to have occupational radiation exposure). Male radiologists who graduated after 1940 were found to have lower incidences in both categories compared to psychiatrists.1
As studies like this seem to support safety efforts of the last few decades, a number of new solutions released in the past 12 months continue to expand dose monitoring capabilities and increase safety for staff and patients.
XR-29 and CT Dose
One of the most recent standards published related to occupational radiation safety in radiology is the XR-29 standard, released by the National Electrical Manufacturers Association (NEMA) in 2013. XR-29 focuses on optimizing radiation dose specifically for computed tomography (CT) and positron emission tomography (PET)/CT through four scanner features: DICOM Radiation Dose Structured Reports, CT Dose Check, automatic exposure controls, and pediatric and adult reference protocols. The mandates became effective Jan. 1 of this year.
In May, Medic Vision released third-party software to help make existing 4-, 8- and 16-slice scanners XR-29 compliant. SafeCT-29 analyzes dose data in real time and alerts the operator if the dose is too high. If so, the software automatically prevents the scan until the dose is either adjusted or confirmed and justified. All events and actions are recorded, logged and available for review and audit.
RamSoft introduced a new CT Dose Module in July, a cloud-based system that integrates with Scannerside dose software. The module pulls dose information directly from CT dose report screens and bookmarks the values directly into the radiology report; this helps streamline exam workflow and eliminate data entry errors. The module also helps evaluate usage protocols, compare dose rates against national averages and generate easy-to-read printouts for patients.
GE Healthcare released the DoseWatch Explore software — which tracks, analyzes and reports on practice-level CT dose data for GE’s CT systems —
at the 2015 Radiological Society of North America (RSNA) annual meeting. The Web-based, cloud-deployed solution provides an automated tool for dose data and analytics with no user-side IT integration required. DoseWatch Explore is part of GE’s Dose Excellence consulting program, where the company’s experts will help users create a dose team and customize a multi-step plan to reduce dose variation, manage risk, streamline reporting and enable quality imaging at the lowest dose possible.
Multimodality Dose Solutions
Cerner displayed an updated version of its Radnet RIS (radiology information system) at RSNA 2015. The system brings dose data into the Cerner Millennium electronic health record (EHR), including it in the technologist and radiologist workflow as well as the exam report. Users can also include historical dose information in the patient chart.
RSNA 2015 also saw the introduction of version 2.0 of Philips’ DoseWise Portal, now featuring an enhanced dashboard for patient dose data viewing. The second version also includes a peak skin dose reporting feature for fluoroscopy procedures and further integration with DoseAware Xtend for improved staff exposure data, bringing staff and patient dose data together into the user interface.
Siemens rolled out several new modules, or Protocols, for its teamplay cloud-based collaboration network at RSNA. Teamplay connects radiologists, physicians and patients around the globe with clinical data to streamline and enhance the decision-making process. The new Protocols include a dose function, which allows users to compare their current dose values against institutional and national reference values, or benchmark their performance against other facilities for similar exams. Images are called up using picture archiving and communication system (PACS) Web viewers, and all information is provided in a patient-centric view. Dose values are normalized by patient size.
SST Group’s RDM (Radiation Dosage Monitor) solution, also on display at RSNA 2015, employs a dose archive and communication system (DACS) to store and manage both current and historical patient dose data, including all captured diagnostic, interventional and image-guided surgical ionizing events. RDM is compatible across all imaging modalities from all manufacturers, with a browser-based user interface that collects data directly from the scanner for real-time monitoring and alerts.
1. Berrington de Gonzalez, A., Ntowe, E., Kitahara, C.M., et al. “Long-term Mortality in 43,763 U.S. Radiologists Compared with 64,990 U.S. Psychiatrists,” Radiology. Published online July 19, 2016. http://dx.doi.org/10.1148/radiol.2016152472. Accessed Aug. 6, 2016.