Dose tracking: Put it on my card

Smart card technology could be used to easily track the radiation doses patients receive from medical imaging studies, according to an article detailing the process of a prototype smart card system published in the April issue of the American Journal of Roentgenology.

“Like the ATM or credit card, the card acts as a secure unique ‘token’ rather than having cash, credit, or dose data on the card,” wrote Madan M. Rehani, PhD, of the International Atomic Energy Agency (IAEA) in Vienna, and Joseph F. Kushi, of Aware, a Bedford, Mass.-based healthcare software company. “The system provides the requested radiation history report, which then can be printed or sent by e-mail to the patient.”

The IAEA has been working on a smart card project for five years, recently naming it SmartCard/SmartRadTrack because of the focus on the process of tracking rather than cumulative dose, explained the authors.

“The common notion that the purpose of tracking is to estimate the cumulative radiation dose is not correct, because utilization of information from tracking can be very useful even without consideration of the cumulative exposure, as has been found in case reports of the experience of dose tracking,” wrote Rehani and Kushi.

SmartCard/SmartRadTrack requires patients to carry smart cards with unique identifiers, which are read at imaging facilities to retrieve medical records. Information gathered includes radiologic exams and dose information when included as part of the DICOM header or structured dose report file. The system also supports the conversion of CT dose in dose-length product to effective dose, according to the authors.

“This information can be used for assessing appropriateness of the next examination according to clinical information, as required by safety standards and guidelines,” wrote Rehani and Kushi.

They added that because clinicians are not familiar with radiation dose quantities, it will be up to imaging experts to educate others on how to use the information. “The system can provide guidance, but we are of the opinion that a medical physicist should take into account radiation doses from different radiologic examinations, which are in different units (normally in reference dose quantities), calculate effective dose or organ doses, and provide meaningful information that can be communicated to the patient. Providing dose figures to the patient at the first instance may lead to potential misinterpretation.”