This superb article emphasizes the very high importance of a team approach when undertaking CT dose management.
In this article, the authors discuss how awareness of dose and risks of medical imaging by patients can facilitate shared decision making and reduce unnecessary radiation exposure.
Kalpana M. Kanal, Ph.D., a medical physicist, professor and section chief in diagnostic physics in the Department of Radiology at the University of Washington School of Medicine, Seattle, and colleagues examined actual patient data from the American College of Radiology (ACR) CT Dose Index Registry to develop size-based DRLs that enable healthcare facilities to compare their patient doses with national benchmarks and more effectively optimize CT protocols for the wide range of patient sizes they examine.
The use of DRLs have shown to reduce overall dose and the range of doses observed in clinical practice.
Dr. Kanal’s research is published here in Radiology.
This landmark work is very helpful in benchmarking CT dose levels. It will be widely cited, I predict. Congratulations, Kalpana!
Kalpana M. Kanal, Ph.D.
In this article, the research conducted by University of Washington Radiology Fellow Dr. Achille Mileto and colleagues highlight the importance of dose monitoring, but also the challenges: “Successful efforts to reduce overall radiation doses may actually direct attention away from other critical pieces of information that have so far been underappreciated, namely the widespread variability in global radiation dose values across clinical operation volumes.” … “These data may provide a foundation for the future development of best-practice guidelines for patient-specific radiation dose monitoring.”
Dr. Achille Mileto from the University of Washington
“We are kind of obsessed with radiation dose reduction, but I think we should keep in our minds the concept of radiation dose optimization, which means trying to adjust the dose to the specific clinical task,” Mileto said. “With technology we are reducing the dose, but we are increasing the room for variability. This is great if you are consistently reducing the dose, but we really want to understand what’s going on in terms of variability. So I think the main lesson is to try to develop best-practice guidelines for patient-specific radiation dose monitoring. I think basically the scenario in the near-term future will be to create some kind of shared library for radiation doses.”
To quote the American Association of Physicists in Medicine:
- The risk from medical diagnostic radiation in doses below 50 mSv as a single dose or 100 mSv as a cumulative dose is too small to be measured and may be non-existent.
This comprehensive article demonstrates the importance of CT dose monitoring and utilizing strategies to achieve ALARA (as low as reasonably achievable) doses while maintaining image quality for optimal clinical diagnosis. The authors also describe how the use of technology can improve the radiation dose efficiency of CT scanners.
Guest blog by Kalpana M. Kanal, PhD, Director of Diagnostic Physics Section and Associate Professor in the Department of Radiology at University of Washington
At the AHRA conference in Las Vegas recently, Dr. Pizzutiello, a medical physicist, discussed the complexity of CT radiation management and monitoring in diagnostic imaging. With the growing use of CT exams being performed and radiation dose in CT being a hot topic in the radiology community, it is imperative to monitor radiation dose from the CT exams as well as observe trends over time. Regulations now require that CT dose has to be documented and available on demand, CT protocols be revisited on an annual basis and incidents with high dose CT exams be reviewed. Several states around the US have CT regulations or are in the process of regulation implementation. It is a monumental task to monitor and manage dose, especially for large hospitals.
There are several dose management software products available that can help in managing the dose. Dose management is, however, a team effort and it is not possible to do this effectively without a team of radiologists, technologists, and medical physicists participating in this important task.
At our institution, we have been managing dose using a commercial product, Dose Watch (General Electric Healthcare) and also have a radiation safety committee within the department to review dose trends and make intelligent decisions based on our dose data. We have also been participating in the ACR CT Dose Index Registry since its inception and review our trends and benchmark values to our peer institutions. This is definitely a good idea if one is unaware of dose trends at their institution and how it compares to others around the nation.
Dose monitoring is complex but a necessary patient safety tool and, if well planned, can be accomplished and maintained with the help of dedicated professionals who understand the importance of the task.