Achieving Joint Commission Regulatory Compliance: Quality Improvement Process for CT Protocol Review and Dose Alert Reduction

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.

A Holistic Approach to CT Protocol and Dose Management

PURPOSE

Challenges from administrative support, scanners' heterogeneity, patient size variation, and protocol mapping hinder CT protocol and dose management. We present a holistic approach to overcome these challenges.

METHODS

A dose tracking software was selected with two key requirements: intelligent protocol mapping and customizable dose threshold settings according to the patient size. A multifaceted workflow was carefully implemented. It included patient size-dependent dose thresholds for e-mail alerts, a base protocol archive on a website with a unified format using an in-house developed reformat software upon protocol export, prompt dose alert follow-up, and well-controlled protocol changes. The thresholds were iteratively updated following protocol changes or review of dose statistics. The program outcome was evaluated using 11 protocols from January 2020 to May 2023 (N = 148,678) in comparison to ACR's achievable dose (AD) and dose reference levels (DRLs).

RESULTS

The 75th percentile dose data were lower than the ACR's DRL on average, ranging from -4.9% to -36%. The median doses were in a range of -23% to 19% on average in comparison with the ACR's AD. The median value from pulmonary embolism scans initially showed 36% higher than the AD but was gradually reduced to nearly 3% lower than the AD. The percentage of unjustified alerted cases decreased from 80% in first half year of 2020 to 17% in the first 5 months of 2023.

CONCLUSIONS

The results showed that our holistic approach to protocol and dose management has been effective. The impact to practice has been prompt and sustainable.

Achieving CT Regulatory Compliance: A Comprehensive and Continuous Quality Improvement Approach

Computed tomography (CT) represents one of the largest sources of radiation exposure to the public in the United States. Regulatory requirements now mandate dose tracking for all exams and investigation of dose events that exceed set dose thresholds. Radiology practices are tasked with ensuring quality control and optimizing patient CT exam doses while maintaining diagnostic efficacy. Meeting regulatory requirements necessitates the development of an effective quality program in CT. This review provides a template for accreditation compliant quality control and CT dose optimization. The following paper summarizes a large health system approach for establishing a quality program in CT and discusses successes, challenges, and future needs.