Approaches to Dose Reduction in Computed Tomography
Organizations need to manage dose across their institutions. Regional regulations sometimes require the dose applied to all patients to be documented. Other CT administrators like to have an overview as a basis for dose optimization. All of these requirements rely on the availability of dose data as well as adequately educated personal. This is then also the foundation for further optimizations regarding dose reduction.
DoseMAP - The Siemens CT Dose Management Program
Dose Structured Reports
On SOMATOM scanners, the reporting of established dose parameters such as Computed Tomography Dose Index (CTDI) and dose length product (DLP) has been implemented since 1990. For each exam, the information is available in the patient protocol, and can be viewed and archived after the scan.
Siemens provides the new Dose Structured Reports (Dose SR) for nearly all products within our CT portfolio.
Dose SR contains comprehensive data for each irradiation event, including the accumulated dose and basic information about the context of the exposure. One radiation event is defined as one continuous irradiation applied to a patient; for example, a CT topogram and the associated spiral scan are two separate events. The details include patient demographics, study information, imaging technique and geometry and all typical dose metrics (e.g., CTDIvol, DLP). The data is provided in electronic format that can be sent to any system which receives, stores or processes dose information, such as conventional PACS or workstations for further analysis.
Siemens Utilization Management
Siemens Utilization Management (UM) is a proactive service offering from Siemens UPTIME Services that provides system-specific usage data which have been collected electronically using Siemens Remote Service (SRS). Access to these detailed data enables customers to leverage their systems’ full potential. Customers receive extensive equipment utilization analyses and anonymous benchmark information about comparable systems at other facilities operating in similar environments, as well as dose information on a regular basis.
The reports are generated by the Siemens service organization and made available through personalized access to the LifeNet UPTIME Services Portal. This is Siemens’ secure web portal that gives customers the information they need to manage the productivity of their Siemens diagnostic equipment – anywhere internet access is available.
The Dose Report
The dose report is a feature of Utilization Management (UM) that keeps users aware of the data regarding total radiation exposure and dose usage on a monthly or a multi-monthly basis.
With UM, dose information can be accessed in all basic and advanced reports for SOMATOM Definition systems (from SW version syngo CT 2008B). It is an easy way to track system and dose utilization details at the point of care. With these reports, users can see if any specific values have been exceeded, indicating that a significant radiation dose has been administered.
With the new dose report, operators obtain an overview of the total number and the percentage split of all selected protocols, as well as the available dose information for the dedicated period. The relevant dose values for a CT examination are the CT dose index volume (CTDIvol) and the dose length product (DLP).
Key benefits for the user include:
- Visibility of dose usage data in a monthly or multi-monthly period; increased awareness of radiation exposure among clinicians
- Easy way to track system and dose utilization details at the point of care
- Increased ability to optimize clinical practice
- Need for dose details of specific procedures is satisfied
- Available in four languages (German, English, French, Spanish)
Through customized service agreements, Siemens UPTIME Services can offer almost unlimited options, from proven service modules and freely adaptable solutions to shared service options that support in-house staff in performing individual tasks themselves. More information is available at www.siemens.com/Performanceplans.
Dose Notification and Dose Alert
With Dose Notification values for CTDIvol and DLP can be defined that should not be exceeded. This has to be done separately for CT examinations in adults and children. National organizations such as BfS (Bundesamt für Strahlenschutz, Federal Office for Radiation Protection, Germany) and ACR (American College of Radiology, USA) provide recommendations1 on reference dose levels in terms of CTDIvol and DLP. If the planned setting for the exam would result in a CTDIvol or DLP higher than these predefined values for one scan a Dose notification message box will inform the user.
Dose Alert is another dose warning tool. Here the CTDIvol values are predefined for both, CT examinations of adults and children, when the system is shipped. According to recommendations by FDA (Food and Drug Administration, USA) these two values are set to 1000 mGy. These predefined values can be changed. In addition the definition of a DLP value is possible. A Dose Alert message box is displayed if the accumulated CTDIvol or the accumulated DLP, plus the estimated values for the next confirmed scan range, exceeds the corresponding Alert Value. A diagnostic reason and the user’s name have to be entered before the scan can be performed with these settings. In many countries functionalities like Dose Notification and Dose Alert will become mandatory in the near future.
1 Bfs: Bundesamt für Strahlenschutz (Bekanntmachung der aktualisierten diagnostischen Referenzwerte für diagnotische und interventionelle Röntgenuntersuchungen. Vom 22. Juni 2010)
ACR: American College of Radiology (CT Accreditation Program Requirements, Clinical Image Quality Guide, Amended 2014)
AAPM Working Group on Standardization of CT Nomenclature and Protocols: CT Dose Notifications and Alerts, April 16, 2014
FDA: Press announcement ”FDA working to prevent radiation overdoses during CT scans”, Nov 9, 2010
Dedicated trainings from Siemens that combine a focus on key technologies with applications in clinical practice.
Optimize CARE CT - Achieving the Right Dose
- Are you taking full advantage of the dose reduction technologies that are already on your scanners?
- Are these technologies utilized appropriately so that their benefits ultimately reach your patients?
- What tools or metrics are you using to track your dose performance?
- What programs do you have in place to ensure consistent awareness about appropriate use of medical radiation among your staff?
- How can you effectively instill standards and promote a safety culture which is necessary for the safe use of diagnostic radiation?
Take the next step to right dose management.
Siemens Healthcare Customer Services has developed an innovative dose-consultation service, Optimize CARE CT, that helps to minimize medical radiation in CT. Siemens Healthcare professionals work with customers on site to analyze baseline dose status as well as define and implement improvement measures.