Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience
Abstract
:1. Introduction
2. Materials and Methods
Study Design and Data Collection
3. Results
3.1. Dose Configuration and Features
3.2. Dose Notification Counts
3.3. Notification Studies
3.4. Radiographer Justifications
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Feature | CT Console (Prospective) | DOSE TQM (Retrospective) |
---|---|---|
NV can be entered for both CT dose quantities, CTDI and DLP | Yes | Yes |
Dose NV configured per series/phase | Per series/phase | Whole study |
Different NV values can be used depending on the series or phase | Yes | Yes (e.g., upper ACC/ACH and lower ACC/ACH) but for the whole study |
Statistical comparison to aid | No | Yes |
Patients’ accumulative dose history | No | Yes |
Allows dose alteration/reduction | Yes | No, it’s retrospective |
Positioning evaluation tool | No, limited scanners | Yes, very effective |
Credentials needed to override NV alerts | No | No |
Comparison using the same device, same study description, and even same protocol | No | Yes |
Common CT Exam | |
---|---|
CT Console (Prospective) | DOSE TQM (Retrospective) |
CT Abdomen/Pelvis + Contrast | CT Polytrauma |
CT Chest/Abdomen/Pelvis + Contrast | CT Brain Stroke With CTA |
CT Cardiac Angiogram | CT Abdomen/Pelvis + Contrast |
CT KUB (Kidney Ureter Bladder) | CT Chest/Abdomen/Pelvis + Contrast |
CT Chest/CT Chest + Contrast | CT Cardiac Angiogram |
CT Chest Pulmonary Angiogram | CT KUB (Kidney Ureter Bladder) |
CT Chest/CT Chest + Contrast | |
CT High Resolution |
Our Institutional Standardized Justifications | Radiographers’ Common Justifications | ||||
---|---|---|---|---|---|
CT System Console (Prospective) | DOSE TQM (Retrospective) | ||||
Actual or Suspected Justification | Justification | Notification Type | Justification | CT System Console (Prospective) | DOSE TQM (Retrospective) |
Urgent case “No time to write a justification note” | In the diagnosis reason window type 1 | CTDI | Off center > 15 mm; Patient size-obese; Pitch < 1 Hands down; High kV due to (beam hardening, non-typical scan, patient size, pitch, off center, hands down); Combined study | Patient size-obese | Patient size-obese |
Patient size-obese | Obese patient | DLP | High CTDI; High scan length | High scan length—added delay scan(s) | Off-center |
Off center | To include ROI (e.g., Knee/Ankle/Foot); External fixator; Difficult positioning (e.g., bulky patient, big abdomen, restless patient, trauma patient, uncooperative patient, etc.); Female patient positioned by male radiographer | High scan length—cover pathology | Blind scan (out of scout) | ||
High scan length | Due to patient height; To cover pathology; Radiologists request; Add delay scan (s); Repeated scan due to artifact (e.g., breathing, movement), technical error, etc. Combined study | High scan length—combined study | |||
Alternative positioning | Disoriented patient; Arms in the FOV | Alternative positioning—arms in the FOV | |||
Non-typical scan | Due to using: Dual energy; 4D-Care Dose Modulation; Pitch adjusted; Combined scan | Beam hardening—metallic implant | |||
Beam hardening | In case of: Metallic implant; Metallic ornament; External fixator Metallic item in FOV | Repeated—technical error |
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Dalah, E.Z.; Al Musfari, Y.M.; Ali, B.M.H.; Al Hammadi, A.A.; Beevi, H.A.A.; Jaber, M.I.; Al-Ali, A.A.; Alkharoossi, A.K.; Hashemi, F.H.A.; Alkhatib, F.M.; et al. Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience. Healthcare 2022, 10, 1970. https://doi.org/10.3390/healthcare10101970
Dalah EZ, Al Musfari YM, Ali BMH, Al Hammadi AA, Beevi HAA, Jaber MI, Al-Ali AA, Alkharoossi AK, Hashemi FHA, Alkhatib FM, et al. Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience. Healthcare. 2022; 10(10):1970. https://doi.org/10.3390/healthcare10101970
Chicago/Turabian StyleDalah, Entesar Zawam, Yousuf Mohammad Al Musfari, Badriya Mohd Hassan Ali, Anwaar Abdulrahim Al Hammadi, Hashim Abdul Azeez Beevi, Manal Ibrahim Jaber, Alyazya Akeel Al-Ali, Ayesha Khalid Alkharoossi, Fairooz Hussain Al Hashemi, Fatma Mahmood Alkhatib, and et al. 2022. "Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience" Healthcare 10, no. 10: 1970. https://doi.org/10.3390/healthcare10101970