Long-Term Experience with CT Dose Monitoring: Implementation, Optimization and Outcome
Abstract
Purpose
This presentation shares insights gained over 6 years of implementing a dose monitoring software for Computed Tomography (CT) exams across a large, multi-campus hospital. By sharing our experience, we aim to help other institutions in achieving a smoother and more efficient software implementation, ultimately enabling faster protocol optimization and patient dose reduction.
Methods
The initial phase of a dose monitoring system optimization involved proper configuration of all hardware and alert thresholds to ensure comprehensive exam monitoring. This included verifying that all imaging units transmitted the Radiation Dose Structured Report (RDSR) to the Picture Archiving Communication System (PACS) upon exam completion, and that all study descriptions were correctly mapped to their corresponding Study Common Name (SCN). Once the system configuration was completed, the monitoring phase began. All alerts were reviewed and analyzed for trends, allowing targeted efforts toward protocol optimization and/or staff training initiatives. Alert thresholds were initially based on published recommendations from recognized professional organizations and regulatory agencies, and subsequently, fined tuned to reflect site-specific conditions.
Results
Over the 6-year period, more than 60 protocols were optimized. Protocol modifications included adjustments on parameters such as the pitch, kVp, dose curve configuration, Computed Tomography Dose Index (CTDIvol) phantom size as well as multiple manufacturer-specific dose modulation settings. The software also identified opportunities for staff training to reduce avoidable increase in patient dose related to patient positioning, over-ranging or other technical factors.
Conclusion
A dose monitoring software is an effective tool when properly configured and consistently utilized to identify areas requiring optimization. Since implementation, numerous protocols have been refined, and staff training was instituted resulting in patient dose reduction while maintaining optimal image quality.