There are three distinct steps that we see CT providers taking to reduce patient radiation exposure on their CT scanners today. Lets take a look at these actions.
As a result of a lot of publicity in the media about radiation dose, a higher level of education and training with respect to radiation hazards has started at facilities providing CT Scans. In addition to increased education and awareness, the ACR’s Sentinel Event also describes the need for periodic testing to ensure the CT operates within established guidelines for radiation emission. Finally, the ACR’s Sentinel Event describes the need to track, monitor and record dose profiles for both the patient and the CT device as well.
1. The actions described above have led most CT providers to also adopt “Smart CT Protocols” to ensure their existing CT scanners are meeting accreditation requirements. These Smart CT protocols include actions such as:
• First, determine if CT is the right study to solve the problem
• Perfect patient positioning at the center line of the CT table
• Reducing mAs as low as possible without negatively affecting diagnostic image quality
• Adjusting kVp on a per-patient basis according to the body mass index of the patient
• Re-Thinking how we deliver multi-phase scans and eliminating non-contrast enhanced scans when they do not add useful diagnostic information
• Scanning the minimum distance required to cover the organs in question
• Scanning at a pitch greater than one
While there are other steps taken in CT departments today to reduce radiation exposure, these are the most common. When the above steps are taken, dose can be effectively reduced by an average of approximately 30% without excessive image quality degradation. While the steps described above are effective in reducing patient exposure, they can take a considerable amount of the CT Technologists time and are not always effective for the CT exam being performed. When these measures are not effective, this can result in the re-scanning of the patient and in these cases, all benefits derived for the potential dose reduction are lost.
The question is often asked, “can we do a better job at reducing patient exposure using a more automated process that will work on all patients?” We will revisit this question later.
2. The second step we see most providers taking, again in concert with the suggestions made by the ACR through the Sentinel Event, is adopting a method for dose tracking, monitoring and recording.
Dose tracking at the patient level becomes part of the patients EMR, and will provide the patient with information regarding their lifetime cumulative radiation dose. Tracking at the CT (equipment) level helps to ensure that the specific CT is meeting or exceeding the ACR guidelines in terms of emitted dose for a given exam. Machine tracking alerts the radiation physicist or safety officer when a CT varies from accepted dose guidelines and allows them to have maintenance performed on the CT in a timely manner.
Today, the majority of CT providers are tracking, monitoring and recording dose manually, both at the patient and CT levels. This can be a cumbersome, time consuming task for the technologist and does not really provide the radiology manager with the depth of information they require to efficiently manage their department.
In 2012, the state of California was the first to mandate dose tracking. Texas followed suit in May of 2013 followed by Connecticut. Today, most CT providers feel that state mandates will continue much in the same way dense breast legislation has now affected the majority of states. Within the states that currently have mandates, most providers have still not purchased dose tracking solutions that are currently available. Most facilities are still tracking, monitoring and recording manually.
In 2013, the imaging marketplace saw a tremendous amount of interest in dose tracking solutions. As more states mandate tracking, we feel that the interest in these solutions will continue. Atlantis Worldwide invites you to consider Scannerside as a viable solution for your dose tracking, monitoring and recording needs.
3. The third and most impactful solution for CT dose savings is for the provider to add an Iterative Image Reconstruction (IR) solution. Adding an IR solution to your existing CT scanners is the single biggest step a provider can take to reduce patient radiation exposure from a CT examination. An IR solution enables the CT provider to reduce patient exposure by up to 80% depending on the type of scan. Iterative reconstruction can be applied on any CT study, and the resulting image quality looks and “feels” the same as if the acquisition was acquired at standard dose.
An IR solution is the best defense against over radiating a patient. Applying an IR solution to the scan protocol ensures that the data set will be acquired at the lowest dose possible, thus ensuring that you are adhering to both ALARA standards; Image Wisely and Image Gently. Utilizing an IR solution makes the technologist’s job easier. There is no need to consult with the radiologist to discuss altering kVp as a function of the patients BMI. There is no need to manually adjust mAs and no need to worry about the image quality as a result of changing these parameters. Iterative Reconstruction solutions are automatically applied to each scan resulting in consistent patient dose from procedure to procedure and at the same time standardizing image quality across your CT scanners.
So, why hasn’t every CT provider simply added an IR solution to their CT scanners? The answer is complex, but here are some of the reasons.
First, as we know, original equipment manufacturers only provide solutions for THEIR products. GE, Philips, Siemens and Toshiba do not make software or hardware applications that work on each other’s systems.
If you purchase a new CT scanner today from an OEM, you will be able to purchase an IR package from that vendor. The cost of the IR solution can range from approximately $125,000 to $200,000. All OEMs make an IR solution: GE offers ASIR and VEO; Siemens offers SAFIRE and IRIS; Toshiba offers AIDR 3D and Philips offers iDOSE. The problem with these products is that they only work on the “newest” CT scanners offered by the vendors. The likelihood is very low that your existing CT if it more than five years old, is compatible with the OEM IR solution.
Today hospitals usually have CTs from more than one vendor. It is not uncommon today for many hospitals to have purchased the outpatient imaging centers around them; or at least absorbed the radiologists and personnel in these outpatient facilities and incorporated them into their IDN, or now ACO. The result is that most facilities with multiple CTs have a variety of CTs of different ages and manufacturers. OEM IR solutions only work on one CT at a time, not on all CTs in the department or in your health care system.
Most importantly no one has the budget dollars available to replace “old” CTs every five years as they once did.
This all leads to a dilemma that many hospitals experience today. Lets say that you fit the profile above. You have multiple CTs of varying ages from more than one vendor. You just purchased a new CT that does in fact have an IR solution that significantly reduces patient dose, thus making the exam safer for the patient and healthcare professional alike.
It would be very beneficial for your hospital to be able to market the fact that you provide the “lowest patient radiation dose possible” on your newly acquired CT scanner. With a little patient education, it could in fact help HCAPHS scores for the hospital and if you are in an outpatient setting, low dose CT could also help with your CGCAPH scores.
Patients today are aware of and concerned about issues surrounding x-ray dose. When patients present for a CT examination, many of them will ask to be scanned on the “low dose” CT system you market. What if the low dose system is in use and in fact, scheduling has the patient slotted for the “standard dose” scanner? What if the patient presents at one of your facilities where the low dose CT is not located. You begin to understand the problem.
While many hospitals today have one or even maybe two “new” CTs with an IR solution, it is likely that not all of your CT’s will have low dose capabilities. For this reason, most hospitals today do not market the fact that they provide low dose CT scans to the patient populations they serve.
Even if you do have a new CT scanner offering an IR solution, and even if you have adopted and applied “Smart CT Protocols” on all of your other systems, you still cannot achieve the overall dose savings and standardized image quality you are looking for. What you may experience is volume decreases on your “old” CTs that do not have an IR solution. This can easily result in scheduling and utilization problems.
We all know that today, no one has the budget to go out and replace their older CTs for the purpose of adding an IR solution to achieve low dose scanning. As the Affordable Care Act rolls out, we all have to prepare to do more with less. We are all tasked with reducing costs while increasing the quality of our patient services. We are all looking at moving from an Integrated Delivery Network structure to an Accountable Care Organization. We are rapidly moving from a fee-for-service reimbursement model to a pay-for-value model.
All of these changes dramatically alter the paradigm in healthcare today. The bottom line is that access to capital for hospital departments is at an all time low. Specific to radiology, we must determine ways to EXTEND the useful life of our equipment and at the same time reduce the operating costs associated with owning equipment. Finally, we need to accomplish these goals while creating better patient outcomes.
What if there was an “add-on” Iterative Reconstruction solution available that would work on literally any CT regardless of the vendor who manufactured the machine? What if the IR solution could reduce dose by 50% or greater, could be applied to any CT acquisition that was automated and did not change the CT technologists workflow in any appreciable way? Finally, what if the solution was available at a cost far less than what the OEM’s charge on their newest systems? What if this IR solution was recommended by ECRI and in several papers presented at the RSNA in 2012 and 2013 achieved better images than OEM IR solutions?
The answer to the question above is that THERE IS an IR solution that meets the criteria mentioned above and more. The product is available today at a fraction of the cost of an OEM Iterative Reconstruction solution and it is called SafeCT.
As the Affordable Care Act becomes the law of the land, SafeCT is perfectly aligned to enable you to extend the useful life of your existing CT scanners, reduce your operating costs, provide better, more consistent CT examination outcomes and improve safety for your patients.
SafeCT is an Iterative Image Reconstruction solution that will work on any CT scanner from any vendor as long as the CT scanner has four (4) or more detector rows. The SafeCT solution resides in the PAC’s environment and can be scaled to work with any number of CT’s across geographic boundaries. SafeCT installs in three days with no CT downtime. SafeCT does not change the CT technologist’s workflow in any appreciable way. Finally, SafeCT is available at a fraction of the cost of the OEM IR solutions.
Atlantis Worldwide invites you to take a look at what may be the “best kept secret” in radiology today. Come and compare the OEM IR images to those created by SafeCT. You do not have to replace your “old” CT scanners in order to achieve low dose imaging capabilities! We know you will be pleasantly surprised!
Atlantis Worldwide will be at the RSNA, so if you are going to be there, please stop by. We are located in the South Building, Exhibit Hall A, booth number 2329. If you cannot attend the RSNA this year, please contact Jeff Weiss at Atlantis Worldwide for product information, a presentation or a quotation.