Implementation of a computed tomography dose management program across a multinational healthcare organization

Evaluating the impact of dose monitoring software alerts on radiation dose reduction in computed tomography: A systematic review

INTRODUCTION

Radiation Dose Monitoring Software (DMS) tools have been developed to monitor doses and alert computed tomography (CT) users of high radiation exposure. However, the causal factors for alerts and the impact of DMS in dose optimisation are poorly understood.

AIM

This review aims to identify high-dose CT examinations triggering alerts and their determinants, and to assess if the alerts from DMS help to reduce CT dose levels.

METHODS

To identify relevant articles published to December 2023, an electronic search of Medline, Scopus, CINAHL, Embase, and the Web of Science was undertaken. Reference lists of published articles were also assessed to identify further articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was employed to evaluate articles for relevance. Articles were included if they used the DMS tool to detect high-dose events that issued alerts in CT and were published in English.

RESULTS

The search resulted in 83 articles, of which, nine were included after a thorough screening process. High dose alerts most often occurred in CT chest, CT head/brain, CT Chest/abdomen/pelvis, and CT abdomen/pelvis with alert percentages ranging from 1.45% to 10.21%, 1.54% to 4.18%, 4.48% to 6.60%, and 4.47% respectively. Alerts were mainly triggered by overweight patients, scan repetition, miscentering of the patients, extra CT study added, orthopaedic hardware in the scanning area and scanning beyond the desire anatomy. Most of the studies reviewed show that DMS tools played a role in reducing the number of high-dose events that trigger alerts.

CONCLUSION

DMS tools are valuable in automatically identifying high-dose CT protocols, enabling quick investigation and dose optimisation. The high-dose events occurred due to patient and technical factors, which can be mitigated through proper monitoring and investment in both technological resources and staff training.

Radiation dose management system in computed tomography procedures: a systematic review

A systematic literature review was carried out to explore articles that reported the use of radiation dose management systems (RDMSs) in computed tomography (CT). The preferred reporting items for systematic review and meta-analysis flow chart were used to screen articles in PubMed, EBSCOhost, Web of Science, SCOPUS and Cochrane Library. A total of 1041 articles were retrieved and screened. After evaluation against criteria, 38 articles were selected and synthesised narratively. The results revealed that several RDMSs have been used in CT. The review also indicated that the use of RDMSs has promoted the implementation of diagnostic reference levels for dose optimisation. A RDMS, such as DoseWatch, is associated with compatibility challenges and failure in data transmission, while manual RDMSs are cumbersome and prone to data entry errors. Thus, a robust automated RDMS that is compatible with the different CT systems would provide efficient CT dose management.

Impact of abdominal imaging on the diagnosis of acute pancreatitis in patients with painless lipase elevation

Abdominal pain is considered a cardinal feature of acute pancreatitis (AP), and abdominal imaging is only required to diagnose AP when the pain is atypical, or serum enzyme elevation does not match the clinical picture. While painless lipase elevation is being increasingly associated with worse outcomes in various diseases, the diagnostic approach to such elevation is so-far unclear. We thus aimed to learn the impact of pain on the diagnosis of AP.

METHODS

All patients presenting to the Mayo Clinic Arizona Hospital emergency department with a serum lipase ≥3x upper limit of normal between April 2016 and January 2020 were prospectively followed. Their charts were reviewed for the nature of pain, serum lipase levels on presentation, abdominal imaging, and whether a diagnosis of AP was made. Chronic pancreatitis was excluded.

RESULTS

Among 320 patients, 85 (26.5%) had painless lipase elevation. These patients had abdominal imaging less often (56/85, 66%) than in those with abdominal pain (201/235, 83%; p = 0.001). The diagnosis of AP increased overall from 31/63 (49%) without imaging to 198/257 (77%) with imaging (P < 0.001). Imaging increased the diagnosis of AP in patients with painless lipase elevation from 2/29 (7%) without imaging to 16/56 (29%; p = 0.025) among those who were imaged.

CONCLUSIONS

Painless lipase elevation >3-fold the upper limit of normal is common in emergency department patients. 1/3 to 1/4 of these may have AP. Abdominal imaging increases the diagnosis of AP in patients with painless lipase elevation. Therefore, abdominal imaging in such patients may help detect AP that otherwise eludes diagnosis.