Professional Documents
Culture Documents
Joseph Adams
Background
In 1980, the average American had a medical radiation dose of 0.54 mSv. By 2006, that amount increased 600 percent, to 3.2 mSv per capita. The worldwide average background radiation dose is estimated at 2.4 mSv per year (RSNA, 2008).
Background cont.
The amount of imaging orders, in particular CT, has grown exponentially
Easily performed Provide quick diagnostic interpretation Provide reassurance of nothing overlooked
Too often, advanced imaging exams are ordered even when they are not appropriate for patient symptoms
Background cont.
In addition to incurring unnecessary exams, increased healthcare costs, and resource burdening, patients are exposed to increasing amounts of radiation. While advanced imaging provides tremendous benefits as diagnostic tools, careful consideration of exam appropriateness is important. The benefits usually outweigh the risks. However, as patients undergo numerous exams, the balance shifts and cumulative risks manifest.
Objective
Maintain patient doses As Low As Reasonably Achievable (ALARA) through the use of Computerized Decision Support.
Avoid unnecessary or repetitive studies Compare benefits vs risk of exams that utilize ionizing radiation (CT) and alternatives (MRI, Ultrasound, etc.) Tailor exam based upon individual patient
Current State
As of 2007, no standard exists for acquiring, evaluating, and archiving radiation dose information. No federal requirements exist in the US for monitoring or reporting lifetime cumulative radiation dose for patients.
(Colang, Killion, & Vano, 2007) (Colang, Killion, & Vano, 2007)
Installed base of CT equipment has limited capabilities with respect to capturing dose information, but newer releases are starting to supply the proper SR dose report. There are a few radiology-specific CDS which address exam appropriateness criteria such as Nuances RadPort
(Clunie, 2009)
Source: http://wiki.ihe.net/index.php?title=Radiation_Exposure_Monitoring
ACR DIR
American College of Radiology Dose Index Registry (DIR)
Collect and provide feedback on dose estimate information from various modalities. A pilot program focusing on CT that allows participants to compare average CTDIvol and DLP values across facilities is currently in progress.
CTDIvol represents the radiation dose of a single CT slice DLP is measure of total radiation exposure for the whole series of images DLP = CTDIvol x irradiated length
Source: http://www.nuance.com/healthcare/pdf/ds_healthcare_radport.pdf
Key Systems
Ordering
EHR CPOE Central Scheduling
Clinical Content
Imaging modalities Therapeutic Devices
System Integration
Ordering
Ordering
Source: http://www.aapm.org/meetings/2010CTS/documents/0830_Brink_AAPM_CT_Dose_Summit_4_29-2010.pdf
US and MR are more appropriate than CT for RLQ pain in pregnant woman
Source: http://www.aapm.org/meetings/2010CTS/documents/0830_Brink_AAPM_CT_Dose_Summit_4_29-2010.pdf
Protocol
Modality Worklist
Image Acquisition
Interpretation
Documentation
Conclusion
Limitations Further Considerations