Feature | March 07, 2014 | Dave Fornell

Recording and Managing Radiation Dose

This article appeared as an introduction to a Comparison Chart on Radiation Dose Management in the March 2014 issue.

Better management of X-ray radiation doses starts with recording and tracking each exposure patients receive. Dose tracking has come to the forefront of medicine in recent years with the realization that medical imaging has doubled the public’s exposure to ionizing radiation since the 1980s, largely due to the rapid expansion of computed tomography (CT) and minimally invasive angiography procedures.

This fact, combined with popular media stories in recent years about patients receiving radiation burns from medical imaging and concerns about radiation exposure, has spurred California and Texas to legislate X-ray dose recording requirements for all patients. It is widely expected other states will follow suit and that dose guidelines based on exam protocol and patient size will eventually be specified by the American College of Radiology (ACR), based on data from its U.S. Dose Index Registry (DIR).

California’s law may set the standard for what will be expected in the future across the country. It mandates that all facilities providing CT scans be accredited. It also requires the documentation of the dose of each CT exam, annual verification of each dose by a medical physicist, and reporting dose errors to patients and physicians. Dose management software helps meet all of these requirements. 

Most medical professional organizations are now actively advocating dose reduction across medicine to improve patient safety through initiatives such as Image Wisely, Choosing Wisely, ALARA (as low as reasonably achievable) and quality assessment guidelines set by accreditation organizations. The Joint Commission recently released new accreditation standards for diagnostic imaging services, effective July 2014. Its main focus is reducing CT dose, with focus on recording and reviewing dose usage. 

The starting point for lowering dose at any facility begins with assessing how much dose is being administered, by tracking the dose and then comparing it to levels at other departments or facilities. This can help raise dose awareness and aid dose reduction education. The data can show areas where a facility is out of average ranges, possibly due to specific technologists turning up the dose for better image quality, use of older technology, scanners operating outside normal parameters or use of imaging protocols that might need revision.  

Basics of Recording Dose

The software is used to record the dose from numerous imaging modalities, which may include CT, angiography, fluoroscopy, standard X-ray, mammography and nuclear imaging. It can record dose-based industry standards, such as computed tomography dose index (CTDI), dose length product (DLP), tube current and exposure time. Some software also can record the type of exam protocol and the size of the patient for a more accurate dose estimate. 

Dose management software offers varying levels of dose information. Some offer patient dose so it can be included in their electronic medical record (EMR). Others might only record overall dose for radiology department management purposes. Other software breaks down radiation levels by technologist, machine, exam protocol and modality. This data might reside separately from other systems, or might be interfaced with PACS and EMRs.  

Due to the potential need to collect data from several modalities and imaging systems manufactured by different vendors, it is important the software is vendor-neutral. To facilitate this, Integrating the Healthcare Enterprise (IHE) created the radiation exposure monitoring (REM) software profile for easier IT integration. The profile defines programming for vendors so all radiation reporting is collected, evaluated, automated and exported in a similar manner. 

Vendors’ Software

Some PACS vendors are starting to incorporate dose reporting directly into their systems, but most software currently available is in the form of bolt-on modules that work with a PACS. Key vendors emerging in this area include Radimetrics, GE and Sectra, but there are others. 

Radimetrics, owned by Bayer Healthcare, offers the eXposure dose management software. It is a third-party solution that is resold by several PACS vendors, including Philips, Siemens and McKesson.

GE’s DoseWatch retrieves, tracks and reports the radiation dose administered and automatically organizes the data for hospital management to monitor. The system collects data by imaging device, the individual operator or protocol so it can easily identify dose outliers. The software offers a dose comparison analysis tool where users can compare doses between facilities, across systems and among protocols. Its most recent release at RSNA 2013 uses new log capabilities that can reduce the bandwidth requirement across the hospital network.

Sectra’s Web-based DoseTrack automatically collects, stores and monitors data from all connected modalities. Sectra is a certified ACR software partner, approved to submit a hospital’s dose data to the DIR.

PACSHealth’s DoseMonitor automates dose monitoring and reports. It can help ensure imaging exam consistency, maintain regulatory compliance and manage radiation dose at an enterprise level.

Aware Inc. offers the Aware REM Server to collect radiation exposure data based on the IHE’s REM profile to generate customized dosage estimation reports and upload data to the DIR. 

Selecting a Dose Management Solution  

When searching for a dose-monitoring solution, providers should make sure it integrates with other hospital IT systems for smooth operation into the daily routine.  To ensure intraoperability, key selection criteria should include industry-standard HL7 connections and IHE profile compliance. It also should offer the ability to make changes in other IT systems to create a uniform dataset across the hospital. Data collection should also be automated. 

Information provided should allow for comparison of dose levels among different equipment to help guide new purchase decisions, maintenance and utilization of low-dose equipment. Comparisons should also allow analysis of dose levels given by specific staff and departments. The system should allow dose alert thresholds to help identify potential problem areas. Systems also should allow diagnostic reference levels (DRLs) to identify unusually high radiation doses for imaging procedures. 

Related Content

Virtual Phantoms Inc. Releases VirtualDose-IR
Technology | Radiation Dose Management | August 07, 2017
Virtual Phantoms Inc. announced the release of VirtualDoseIR, a tool for assessing organ dose from interventional...
GE’s DoseWatch is a digital informatics solution that automatically collects, monitors and reports on radiation dose indices for diagnostic imaging exams
News | Radiation Dose Management | July 31, 2017
GE Healthcare announced that it has licensed computed tomography (CT) organ dosimetry technology developed at Duke...
Radiation dose tracking in medical imaging is helping increase patient safety by lower X-ray doses.
Feature | Radiation Dose Management | July 26, 2017 | Dave Fornell
Patient X-ray radiation exposure from medical imaging has been a hot topic in radiology the past few years and has pr
ACR Updates Radiation Oncology and Medical Physics Guidance With ASTRO and AAPM
News | Radiation Dose Management | July 19, 2017
July 19, 2017 — The American College of Radiology (ACR) recently collaborated with professional medical societies to
SafeCT-29 product suite
News | Radiation Dose Management | July 19, 2017
Medic Vision, a pioneer and US market leader in 3rd party XR-29 standard solutions, announced July 19 that it was...
Low Doses of Radiation Could Harm Cardiovascular Health
News | Radiation Dose Management | July 17, 2017
Ionizing radiation, such as X-rays, has a harmful effect on the cardiovascular system even at doses equivalent to...
RadNet Inc. Acquires Equity Stake in Medic Vision
News | Radiation Dose Management | June 21, 2017
June 21, 2017 — RadNet Inc. and Medic Vision Imaging Solutions Ltd.
Diagnostic Radiation Exposure Safe for Children, Experts State
News | Pediatric Imaging | June 21, 2017
In an article published in the June 2017 issue of The Journal of Nuclear Medicine, researchers assert that exposure to...
New Image Wisely Radiation Safety Case Discusses Child-Sizing CT Dose
News | Radiation Dose Management | June 19, 2017
The tenth special edition Image Wisely Radiation Safety Case is now available to help radiologists, imaging...
Versa

Image courtesy of Elekta

News | Radiation Therapy | June 13, 2017
Radiation therapy (RT) using high-energy particles, like X-rays or electron beams, is a common and critical component...
Overlay Init