RSNA: Integrating tools to help reduce rad exposure, how IT can help
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Current modalities make it difficult to report dose data because the devices are constantly changing, techniques are evolving and understanding radiation dose and dose reporting is improving, said Kevin O’Donnell, senior research and development manager at the Toshiba Medical Research Institute in Calif.
“It should be easy and routine to obtain this dose information,” O’Donnell said; however, the reporting of dose is no walk in the park. O’Donnell urged that a new IHE profile that spans system-to-system and site-to-site is necessary to attain and monitor dose information.
IHE profiles are standards-based solutions that address various problems—how to access radiology information, audit trail and node authentication (ATNA), among others—in the radiology sector. The IHE solutions have been integrated into radiology-based information systems.
But, O'Donnell said we must first find out how the existing standards can best be utilized to address a specific radiation dose problem. Downloading all the images stored in a facility's PACS for one month and analyzing the data is not feasible, but utilizing new and improved tools and registries such as IHE REM profiles can facilitate data collection and make the process more efficient.
IHE radiation exposure monitoring profiles creates DICOM dose objects (SR dose) and creates radiation dose structure reports (RDSR). These reports are extracted into an archiving system (PACS) to create a single storage space for facility-wide collected dose data.
In addition, O’Donnell said that using a dose information reporter can query and retrieve data on a daily, weekly, monthly “or two weeks before [the Joint Commission] shows up” basis, which than extracts these data and runs a report.
To add on to these tools, the American College of Radiology (ACR) also has begun looking at the reporting of dose reference levels to get a good picture of the current dose trends and basic practices of radiation dose emittance around the country. However, when the initiative first started, O’Donnell said that it was a manual collection process that was unable to span to different sites. This made it difficult to create a system-wide portrait of radiation dose.
“DICOM reports are easily ingested and regurgitated by the PACS,” said O’Donnell. He said that the granularity of the reports helps to provide “in addition to the accumulated dose over the study and the series, also a breakdown of an irradiation event.”
The reports include data from single irradiation events—when the x-ray tube is turned on or off—such as each time a pedal push is recorded during angiography or when spiral radiation is used. This provides detailed information and analysis.
O’Donnell said these initiatives and tools may trump image headers or modality-performed procedure steps (MPPS), which lack dose detail and create “transient information,” due to the fact that they are designed for workflow enhancements, not archiving.
“It’s useful information but it’s not a complete set of dose details and trying to fit it all would be difficult. ... This wasn’t designed as an achievable object,” offered O’Donnell.
In the future, O’Donnell said the goal is to incorporate radiation QA, which will allow reports to be periodically queried, retrieved and split by certain characteristics such as doctor, imaging exam and even exam room. In addition, radiation QA would allow sites to set policies and standards so that reports could track deviations from said policies on radiation dose. These would also allow facilities to set goals for improvement and allow them to track the progress of goals—such as attempting to achieve a 20 percent reduction in radiation within one year.
While O’Donnell said that “reporting is great," it captures things after the fact. He asked, "What can we do in real-time?”
For one, facilities can util.ize the Medical Imaging Technology Alliance (MITA) dose check initiative (referred to as Standard XR-25), which is a software tool that can be downloaded to perform a CT dose check.
With use of the tool, technicians are warned when a sequence has the potential to exceed the site-set radiation dose standards. Pop-up notifications tell technologists when the current scan may exceed certain radiation values and will create an audit trail including the predicted dose, notification value, date/time and reason for the exam.
O’Donnell said that reference dose law values should also be used to identify “what’s good, what’s bad, what’s reasonable and what’s unreasonable,” in terms of the proper level of radiation dose emitted, which he offered is still “an open area for discussion.”
As for the take home message, O’Donnell said that REM profiles can automate data collection and be a useful component to track on-site radiation dose; however, he said that this is “not a site radiation safety program in a box.”
Just because you turn on the feature doesn’t mean you are there. He said that this is the “first-third of what you need to do. Then you need to understand the numbers and data and make use of them.”