Ajit H Goenka1, Frank Dong2, Bonnie Wildman2, Katie Hulme2, Paul Johnson2, Brian R Herts3. 1. Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio. 2. Section of Medical Physics, Imaging Institute, Cleveland Clinic, Cleveland, Ohio. 3. Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: hertsb@ccf.org.
Abstract
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.
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.
Authors: Joshua Demb; Philip Chu; Thomas Nelson; David Hall; Anthony Seibert; Ramit Lamba; John Boone; Mayil Krishnam; Christopher Cagnon; Maryam Bostani; Robert Gould; Diana Miglioretti; Rebecca Smith-Bindman Journal: JAMA Intern Med Date: 2017-06-01 Impact factor: 21.873