RNSA 2017: Enterprise radiation dose management

Nicole Murphy, MS, a medical physicist at Northwestern Memorial Hospital in Chicago, and Christina Sammet, PhD, research assistant professor of Radiology at the Northwestern Feinberg School of Medicine and medical physicist at Ann and Robert H. Lurie Children's Hospital of Chicago, targeted three main objectives in relation to radiation dose management at RSNA 2017.

The pair's interactive session, sponsored by the Associated Sciences Consortium, was entitled "Enterprise Radiation Dose Management." It covered three areas of discussion about managing radiation dosage:

  • Understanding the roles and responsibilities of the enterprise radiation dose management committee.
  • Implementing a radiation dose monitoring program that satisfies regulatory requirements.
  • Developing a radiation risk management policy that specifies follow-up and optimization procedures.

Sammet asserted that radiologists must use a multitude of sources to determine when to take appropriate action and when to contact a patient. She explained these sources include radiation dose management software to indicate when to send alerts, institutional knowledge, peer reviewed journals, retrospective reviews of PACS systems or utilizing a radiologist surveillance program, for example.  

Her suggestion was that once a team has radiation dose management alerts, that notification is then passed along to a medical physicist or lead technologist. That person is then responsible for determining whether the alert is a safety or quality event.

"A safety event would be something where there was an anomaly in the way the system was used that there's really a process problem that you need to fix," Sammet said. "An example would be you were running a biopsy on a CT scan and somebody forgot to use the biopsy mode. [Instead,] they used the diagnostic mode, which led to a very high dose. That's something you need to figure out how to not make it happen again."

Quality events are, according to Sammet, "things that you couldn't proactively improve, but they're not necessarily things that require immediate and sustained follow up."

The event is then triaged into a quality workflow or a safety event reporting system, which Sammet suggested to use due to its private workspace to evaluate safety events without compromising it to legal parties. In terms of contacting the patient, Sammet advised that practices have some sort of pre-planned criteria to help justify when to make that decision.

However, radiation dose isn't the only risk in medical imaging that radiologists and patients should consider, according to Murphy and Sammet.

According to her Sammet, there are additional risks that can affect radiation management, including:

  • Motion can disrupt an image more than in a CT scan.
  • Especially in the case of pediatric MRI, finding the balance between radiation exposure or anesthesia.
  • Misdiagnosing a patient due to under quality images.

Murphy and Sammet then initiated their interactive portion of the session. The colleagues presented various data sets correlated to radiation dose, the size of a patient, etc. Attendees were able to see the image projected on screen and circle on their phones where they thought were noticeable or dangerous looking trends or patterns of radiation dose.

According to Sammet, this type of data that she and Murphy used in their interactive session helps to implement new policies for determining when to act and specially what to do in the case of radiation dose management, which can vary based on institution and the model and type of imaging scanners.