CT Radiation Dose Optimization and Tracking Program at a Large Quaternary-Care Health Care System.

PURPOSE The authors report the implementation and outcomes of a CT radiation dose optimization and tracking program at a large quaternary-care health care system. METHODS A committee reviewed, optimized, and released standardized imaging protocols for the most common CT examinations across the health system. Volume CT dose index and dose-length product (DLP) diagnostic reference levels (DRLs) were established, with the goal of decreasing the percentage of outliers (CT scans with DLPs greater than the established DRLs) to <5% of tracked CT examinations. Baseline radiation dose data were manually extracted for 5% of total examinations. A semiautomated process to analyze all DLP data was then implemented to monitor outliers. RESULTS The baseline percentage of outliers was slightly higher than 10% for pediatric scans but nearly 26.5% for adult scans. Over the first year, after standardized protocols were distributed, the percentage of outliers decreased for pediatric brain (from 22% to 6%), adult brain (from 23% to 3%), and adult chest (from 22% to 11%) examinations. Over the next 2 years, after the dose-tracking program was implemented, the percentage of outliers decreased for adult (brain, from 3% to 1%; chest, from 11% to 1%; abdomen, from 24% to 1%) and pediatric (brain, from 6% to 2%; chest, from 11% to 0%; abdomen, from 7% to 1%) examinations. CONCLUSIONS The reported CT protocol optimization and dose-tracking program enabled a sustainable reduction in the proportion of CT examinations being performed above established DRLs from as high as 26% to <1% over a period of 2 years.

[1]  D. Brenner,et al.  Computed tomography--an increasing source of radiation exposure. , 2007, The New England journal of medicine.

[2]  Ehsan Samei,et al.  Dose index analytics: more than a low number. , 2014, Journal of the American College of Radiology : JACR.

[3]  M Wintermark,et al.  FDA Investigates the Safety of Brain Perfusion CT , 2010, American Journal of Neuroradiology.

[4]  John O. Johnson,et al.  CT imaging: radiation risk reduction--real-life experience in a metropolitan outpatient imaging network. , 2012, Journal of the American College of Radiology : JACR.

[5]  Madan M. Rehani,et al.  Continuous monitoring of CT dose indexes at Dubai Hospital. , 2013, AJR. American journal of roentgenology.

[6]  Donald L. Miller,et al.  Clinical implementation of the National Electrical Manufacturers Association CT Dose Check standard at ACR Dose Index Registry sites. , 2014, Journal of the American College of Radiology : JACR.

[7]  N. Obuchowski,et al.  Detection of urolithiasis: comparison of 100% tube exposure images reconstructed with filtered back projection and 50% tube exposure images reconstructed with sinogram-affirmed iterative reconstruction. , 2014, Radiology.

[8]  K. Bis,et al.  A comprehensive approach to CT radiation dose reduction: one institution's experience. , 2011, AJR. American journal of roentgenology.

[9]  Dustin A Gress,et al.  Radiology stewardship and quality improvement: the process and costs of implementing a CT radiation dose optimization committee in a medium-sized community hospital system. , 2013, Journal of the American College of Radiology : JACR.

[10]  J. Lewin,et al.  Events that have shaped the quality movement in radiology. , 2012, Journal of the American College of Radiology : JACR.

[11]  Nancy A Obuchowski,et al.  Effect of reduced radiation exposure and iterative reconstruction on detection of low-contrast low-attenuation lesions in an anthropomorphic liver phantom: an 18-reader study. , 2014, Radiology.

[12]  M. Kalra,et al.  Pointers for optimizing radiation dose in head CT protocols. , 2011, Journal of the American College of Radiology : JACR.

[13]  Katherine P Andriole,et al.  IT tools will be critical in helping reduce radiation exposure from medical imaging. , 2009, Journal of the American College of Radiology : JACR.

[14]  Richard L Morin,et al.  CT protocol review and optimization. , 2014, Journal of the American College of Radiology : JACR.

[15]  Sheila Weinmann,et al.  Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. , 2012, JAMA.

[16]  N. Obuchowski,et al.  Dose reduction for abdominal and pelvic MDCT after change to graduated weight-based protocol for selecting quality reference tube current, peak kilovoltage, and slice collimation. , 2013, AJR. American journal of roentgenology.

[17]  N. Obuchowski,et al.  Effect of altering automatic exposure control settings and quality reference mAs on radiation dose, image quality, and diagnostic efficacy in MDCT enterography of active inflammatory Crohn's disease. , 2010, AJR. American journal of roentgenology.

[18]  M. Kalra,et al.  Pointers for optimizing radiation dose in abdominal CT protocols. , 2011, Journal of the American College of Radiology : JACR.

[19]  Michael F McNitt-Gray,et al.  AAPM Medical Physics Practice Guideline 1.a: CT Protocol Management and Review Practice Guideline , 2013, Journal of applied clinical medical physics.

[20]  John O Johnson,et al.  A community hospital's experience with an effective, affordable, and easily implemented CT radiation dose reduction initiative. , 2013, Journal of the American College of Radiology : JACR.