Katia Katsari1,2, Hugo Pasquier3, Milan Barati4, Pilar Pujadas3, Rowland O Illing5,6. 1. Affidea BV, Vijzelstraat 68, 1017, Amsterdam, HL, The Netherlands. kkatsari@icloud.com. 2. , Budapest, Hungary. kkatsari@icloud.com. 3. GE Healthcare, 283 Rue de la Minière, 78530, Buc, France. 4. Affidea St Margit Hospital, Bécsi út 132 B - Épület, Budapest, 1032, Hungary. 5. Affidea BV, Vijzelstraat 68, 1017, Amsterdam, HL, The Netherlands. 6. University College London, Gower Street, London, WC1E 6BT, UK.
Abstract
OBJECTIVES: Radiation dose index monitoring (RDIM) systems may help identify CT dose reduction opportunities, but variability and complexity of imaging procedures make consistent dose optimization and standardization a challenge. This study aimed to investigate the feasibility to standardize and optimize CT protocols through the implementation of a Dose Excellence Program within a European healthcare network. METHODS: The Dose Excellence Program consisted of a multidisciplinary team that developed standardized organizational adult CT protocols and thresholds for relevant radiation dose indices (RDIs). Baseline data were collected retrospectively from the RDIM (Phase I, 2015). Organization's protocols were implemented and monitored from the RDIM for deviations (Phase II, 2016). Following standardization, radiation dose optimization was initiated (Phase III, 2017). Data from the three most used protocols were retrospectively extracted and grouped by country for all phases. The mean number of series (RS) and RDIs were compared between phases and with organizational reference levels. A Mann-Whitney test was conducted; p < .05 was considered as significant. RESULTS: Data from 9588, 12638, and 6093 examinations were analyzed from General Chest, General Head, and Thorax/Abdomen/Pelvis (TAP) multiphase respectively. Overall, after Phase III, mean RS and CTDIvol p75 were below the organizational reference levels in all countries for the three protocols. The CTDIvol decreased by 45% in Switzerland (p < .00001), 32% in Turkey (p < .00001), and 28% in Switzerland (p = .0027) for General Chest, General Head, and TAP multiphase respectively. CONCLUSIONS: The implementation of a Dose Excellence Program within a large-scale healthcare organization allowed unifying protocols and optimizing radiation dose across countries. KEY POINTS: • Engaging a multidisciplinary team can enhance the use of an RDIM system for CT dose management in a multinational healthcare environment. • Deep dive of baseline data and standardization of CT practices by defining organizational clinical indication CT protocols with RPIDs is an essential step before optimization of radiation dose. • Following the implementation of the program, the mean RS and CTDIvol were below or equal to the organizational reference levels in all countries.
OBJECTIVES: Radiation dose index monitoring (RDIM) systems may help identify CT dose reduction opportunities, but variability and complexity of imaging procedures make consistent dose optimization and standardization a challenge. This study aimed to investigate the feasibility to standardize and optimize CT protocols through the implementation of a Dose Excellence Program within a European healthcare network. METHODS: The Dose Excellence Program consisted of a multidisciplinary team that developed standardized organizational adult CT protocols and thresholds for relevant radiation dose indices (RDIs). Baseline data were collected retrospectively from the RDIM (Phase I, 2015). Organization's protocols were implemented and monitored from the RDIM for deviations (Phase II, 2016). Following standardization, radiation dose optimization was initiated (Phase III, 2017). Data from the three most used protocols were retrospectively extracted and grouped by country for all phases. The mean number of series (RS) and RDIs were compared between phases and with organizational reference levels. A Mann-Whitney test was conducted; p < .05 was considered as significant. RESULTS: Data from 9588, 12638, and 6093 examinations were analyzed from General Chest, General Head, and Thorax/Abdomen/Pelvis (TAP) multiphase respectively. Overall, after Phase III, mean RS and CTDIvol p75 were below the organizational reference levels in all countries for the three protocols. The CTDIvol decreased by 45% in Switzerland (p < .00001), 32% in Turkey (p < .00001), and 28% in Switzerland (p = .0027) for General Chest, General Head, and TAP multiphase respectively. CONCLUSIONS: The implementation of a Dose Excellence Program within a large-scale healthcare organization allowed unifying protocols and optimizing radiation dose across countries. KEY POINTS: • Engaging a multidisciplinary team can enhance the use of an RDIM system for CT dose management in a multinational healthcare environment. • Deep dive of baseline data and standardization of CT practices by defining organizational clinical indication CT protocols with RPIDs is an essential step before optimization of radiation dose. • Following the implementation of the program, the mean RS and CTDIvol were below or equal to the organizational reference levels in all countries.
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Authors: Rebecca Smith-Bindman; Yifei Wang; Philip Chu; Robert Chung; Andrew J Einstein; Jonathan Balcombe; Mary Cocker; Marcos Das; Bradley N Delman; Michael Flynn; Robert Gould; Ryan K Lee; Thomas Yellen-Nelson; Sebastian Schindera; Anthony Seibert; Jay Starkey; Saravanabavaan Suntharalingam; Axel Wetter; Joachim E Wildberger; Diana L Miglioretti Journal: BMJ Date: 2019-01-02