The healthcare industry has an abiding interest in dose limits. These limits form the norm for health safety in the use of radiation for diagnostic procedures. With a pre-established exposure boundary, a patient receives radiation dose within a range of parameters during diagnostic examinations, general screening procedures, or therapy. For instance, the effective radiation dose for an adult spine X-ray procedure is approximately 1.5 millisievert (mSv) which is comparable to 6 months of natural background radiation.
How do radiologists determine the dose a patient receives? In a simplistic view, it would be the image quality. The dose needs to be within a ‘reasonable standard’ to achieve the clinical objectives. However, an accurate standard does not exist. But in its place are optimization tools like Diagnostic Reference Levels (DRLs), entrance surface dose (ESD), effective dose (E), computed tomography (CT) dose index CTDI(vol) and dose-length product (DLP). Naturally, due to the lack of or insufficient global or federal directives, there are differing views on the use of these measures as the ideal dose that can apply to a whole patient population. The use of DRL is common in radiology units and the most acceptable dose limit in the medical practice as of today.
While the DRL and E parameters act as a guideline, several studies have confirmed large variations in the dose administered to patients of similar procedures. Healthcare networks are looking at a gaping hole that needs an urgent fix. So, how should a healthcare provider approach this situation? How should hospitals track dose levels both at an individual patient level as well as the possibly alarming trends at an organizational level? Would a cohesive system that oversees and audits these practices work? Along with DRLs, can healthcare providers look at their datasets and evaluate their median reference point? There is a crucial need for a new set of protocols.
To establish the organization-specific protocols, I recommend these three granular controls to achieve the clinical objectives while at the same time succeeding in improving the safety of dose administration:
- Set dose reference guidelines at an organizational level for the recommended dose for a patient in a year and specific examination procedure types. The guidelines act as a dose limit standard for the hospital to achieve without compromising on the required level of clinical image quality.
- Track the dose levels of every procedure across the hospital network. By slicing and dicing this historical dataset, you can infer if the dose levels are higher than the guideline. You can then evaluate which procedure needs more optimization; whether it needs to be at an operator level, device level, examination type, or the facility level for the DRL violations.
- Track dose levels at the individual patient level to see if there are patients who have been exposed to radiation higher than the guideline set over a specific time interval.
By getting granular with both the historical patient dose and imaging equipment datasets, the dose audit system will embrace these key areas:
Identifying at-risk procedures for highest dose violations. Instead of relying on gut-feel or worse, static data, isolating procedures by a facility that does not consistently meet the dose reference values helps the operating management focus on providing the required training to radiologists to meet standards.
Safeguarding against device initiated inappropriate dose levels. In scenarios, where, for instance, a CT scanner is inappropriately dispensing an incorrect CTDI(vol )dose level, machine data provides the real context to course correct and fix the anomaly in the affected modality.
Moving to a proactive dose reduction levels. By analyzing historical trends in dose usage in intra-hospital variations in similar imaging procedures, we could discover that reducing the dose to acceptable levels can produce the same image quality without the higher dose levels that were previously administered.
As I conclude my thoughts on this very challenging area of the diagnostic practice, I am ever so enthusiastic that patient safety is taking center stage through such discussions and that my peers to are having today. In the many discussions I have on our dose analysis tool, hospital leaders share my enthusiasm and are equally determined to account for the variations in patient demographics and attribute to take their facilities to higher levels of individual patient radiation safety than it is today.
Do you think we can work together and establish a patient audit system on radiation dose? I invite you to schedule a short 10 min demo, where I will walk you through case studies of these challenges we are solving in hospital networks across the world.
- Download the Leveraging AI and Machine Learning to Maximize Machine Uptime and Utilization ebook
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- Blog: ROI and Business Impact of Glassbeam Clinsights™ for Healthcare Providers
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