Measuring Radiation Dose

Dose tracking software allows hospitals and imaging centers to track levels of radiation used by exam type protocol. It can flag technologists who are using higher than required doses who may benefit from additional ALARA training. Theradiation dose trackingsystems also can help track the amount of radiation a patient has received over time.

Cynthia McCollough, Ph.D., director ofMayo Clinic’s Computed Tomography (CT) Clinical Innovation Center,spoke with阿根廷vs乌拉圭直播(ITN) at theRadiological Society of North America’s (RSNA) 2021 annual meeting on how CT dose tracking software works, and offered advice to centers that record this patient level and device information.

Imaging Exam Guidelines

There have been great strides with new detector technologies anditerative reconstruction尽量降低辐射剂量。In addition to dose reduction, dose tracking is also a topic that has been discussed for many years.

McCollough said that there are a number of manufacturers that will tag onto aPACS systemor get output directly from the devices to record the delivered scanner dose, then run calculations to try to apply that dose to a human model. “Not all of them are validated in the literature,” she stated. “So, it’s good for quality assurance, if you see outliers, to dig in and find out what’s going on that wasn’t understood.”

It is the position of theAmerican Association of Physicists in Medicine(AAPM), theAmerican College of Radiology(ACR), and theHealth Physics Society(HPS) that the decision to perform a medical imaging exam should be based on clinical grounds, including the information available from prior imaging results, and not on the dose from prior imaging-related radiation exposures. In August 2021, the collective groups put out a statement cautioning people about sharing that information without guidelines, because it’s not standardized.

Image Wiselyhas endorsed the joint statement, which clarifies the evidence-based position and consensus of the organizations that medical imaging exams should be ordered for clinical reasons, and that exam ordering should not be based on past radiation exposures.

“This joint statement is a powerful confirmation of the medical radiological community’s commitment to providing the right exam, for the right patient, at the right time,” saidDiana Litmanovich, M.D., FNASCI, and Image Wisely co-chair, in a written statement. Beth Schueler, Ph.D., FAAPM, FACR, and Image Wisely co-chair, added, “The community invests so much in providing tools for appropriate exam ordering. Tracking dose indices is an important component of quality assurance and process optimization in radiology, but incorporating past radiation exposures into medical imaging exam ordering is inappropriate.”

This statement has also been endorsed by theAmerican Society for Radiation Oncology(ASTRO), TheAssociation for Medical Imaging Management(AHRA), theRadiological Society of North America(RSNA), theSociety for Cardiovascular Computed Tomography(SCCT) and theSociety of Nuclear Medicine and Molecular Imaging(SNMMI).

Quality Assurance

Dose tracking remains an important aspect of quality patient care. “I think that without data, you can’t do good quality assurance,” stressed McCollough. “You don’t know if for some reason you have one particular technologist who had a misunderstanding or miscommunication, and that one person, every time they scan and deliver the dose, it’s twice as high as everyone else in the practice. If you don’t have numbers, you can’t find those things and improve quality. But on an absolute scale in terms of medical decision making, I think that the dose numbers should take a very low priority. It is all about justification.”

She went on to state that theInternational Commission on Radiological Protection(ICRP) has always taken the premise that you don’t put a dose limit on in medical situations. “Just like if a patient comes in the emergency department and is in pain, you give them morphine if they need it, even though they may have risks for addiction. As long as medicine, and physicians, have the final say, then checking doses is okay. But it shouldn’t decide or make decisions for physicians.”

View the Radiation Dose Management Comparison Chart