This article was orginally posted on DotMed.com on June 11, 2015
Atlantis would like to share it with you!
By Donald Elting, R.T. (CT) (MR)
Dir. of Operations at Hackensack Radiology Group
In any area of life, yet alone in healthcare, it is very unusual to find everyone in agreement on a topic.
To successfully achieve dose reduction, it must be a multi-faceted approach. Ordering physician education, in regard to proper exam ordering; technologist education, in order to limit scan range and radiation; dose protocol modification to limit radiation; and the implementation of image reconstruction software to improve image quality with reduced radiation.
At HRG, by employing this combination of best practices, we are at or below the lowest 25th percentile of radiation exposure examinations in the Dose Index Registry, a data registry allowing facilities to report and measure their CT dose indices against regional and national values.
The data submitted to the registry encompasses routine body and neuro exams in our practice including multiphase exams, CT angiography, CT Colonography and Lung screening .
Three key steps to successful dose reduction
First, it starts with education and awareness. Today, many physicians and technologists learn in school about the risks of radiation exposure and the proper precautions and techniques that are needed for their safety and the safety of the patient. Since dose has become a prominent topic, more is being done to address it in training programs.
As a technologist specializing in MR before becoming an administrator 15 years ago, it was not top of mind or part of our imaging protocol to approach the patient’s imaging exam from a dose perspective. Now, we make sure technologists know when an additional dose is necessary, or when they can appropriately lower dose and still achieve the necessary image quality. Most notably, besides the establishment of the Dose Registry, the American College of Radiology (ACR) launched national campaigns known as Image Wisely™ and Image Gently™ to promote technologists pledging to take precautions and utilize all available protections for the safety of staff and patients.
Secondly, patient positioning is vital. We use the best technique possible to keep the dose as low as possible. For example, we have been able to reduce dose for our CT cervical spine exams after changing our patient position. We ask patients to pull on a strap so that their shoulders are out of the way of the lower cervical spine. Now we only need enough dose to penetrate the neck and not the shoulders as well.
In a few other instances, we may actually increase the dose slightly, but to offset the potential need to have to call a patient back for a retake and a full additional exposure. It’s much better to assess the situation the first time properly and increase the dose a little bit if necessary than to have the patient come back another time.
Thirdly, utilizing technological improvements is paramount. That’s why we decided to implement SafeCT®, a universal 3D iterative image reconstruction system from Medic Vision that enables substantial signal-to-noise ratio (SNR) increase of CT images acquired on conventional scanners, regardless of exposure parameters.
HRG uses two scanners that send images to the SafeCT and then to the PACS for radiologists to read. It’s important to have radiologists who are willing to examine each and every protocol and are confident to share feedback and concerns to further improve the experience and safety for patients and staff.
The solution has also afforded us the ability to purchase only one product to service all of our existing CT scanners and avoid retrofitting them. That solution equated to a cost savings of about 50 percent and it was less than the cost to upgrade one of the existing scanners.
The advanced technology achieves low dose images at the high quality that is acceptable for our 35 radiologists on staff who perform twelve-thousand scans annually. The goal is not to increase patient volume simply because the facility is conscientious about low dose, but many patients do refer others to the facility because of that. Adopting a patient dose reduction program needs several key pieces to work successfully. The dose reduction software is one of those key pieces.
For any facility approaching dose reduction, it will take commitment, buy-in and diligence, but it is worth the effort for all involved. Our results speak for themselves. Employing a combination of best practices maintains HRG as a leading reputable provider of imaging services in its region.