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The Management of Imaging Procedure Dose 4: National, International & Local Perspectives

R Morin

M Rehani

K O'Donnell

R Morin1*, M Rehani2*, K O'Donnell3*, (1) Mayo Clinic, Jacksonville, FL, (2) European Society of Radiology, Vienna, (3) Toshiba Medical Research Institute - USA, Inc., Pacifica, CA

WE-G-144-1 Wednesday 4:30PM - 6:00PM Room: 144

Richard Morin: The American College of Radiology Dose Index Registry

The American College of Radiology Dose Index Registry, part of the ACR National Radiology Data Registry, provides the infrastructure platform for institutions, hospitals, and clinics to report dose indices from Computed Tomography (CT) clinical exams by body part / exam type, and allows those facilities to compare their CT dose indices to regional and national values through periodic feedback reports. This presentation describes the current state of the registry, how the data can be used to establish national benchmarks, to improve patient safety through identification of outlier protocols, and to demonstrate how participation in the registry can be part of a professional Maintenance of Certification effort.

Learning Objectives:
1) Understand how registries perform.
2) Understand the way in which registries have altered physician behavior and improve patient care.
3) Identify the parameters involved in optimizing radiation dose in clinical practice.
4) Apply this knowledge by participating in a dose index registry and utilizing these techniques in Maintenance of Certification.

Madan Rehani: The International Perspective on Recording and Reporting Dose

There are no common regulations valid for all of Europe, but there are a number of initiatives and concepts in place which originated here. Among these are primarily the generation of conversion coefficients k for estimating values of the effective dose E from the dose length product (DLP) by E = k*DLP and the concept of dose reference levels (DRL). DRLs for radiological examinations in the European Union were demanded by law in 2000. DRL values are considered advisory and aim at identifying practices with dose levels exceeding the 75 percentile level of reference distributions. Member states have installed the concepts and specific values to different degrees. A drawback is that both the values of k and DRL relate to CTDI and DLP. There is no major debate regarding the validity of the computed tomography dose index (CTDI) because it is mostly considered as a tool for scanner acceptance and constancy testing. Its use for that purpose is undisputed. More accurate measures for patient dose are still to be established in an international consensus. The lecture will review the above concepts and will point to both strengths and weaknesses.

Learning Objectives:
1) Understand that CTDI is merely a technical concept for scanner acceptance and constancy testing, but not a measure for patient dose.
2) Learn about concepts for patient- and scanner-specific patient dose estimates.
3) Learn about the concept of diagnostic reference levels and its strengths and weaknesses.

Kevin O'Donnell: Informatics Tools for Recording/Tracking Dose

Informatics tools are available to assist in the recording and tracking of patient radiation doses, and notification to system operators about potentially high dose settings prior to scanning a patient. This presentation describes the DICOM Radiation Dose Structured Report (RDSR), its characteristics, and modality-specific information contained in the RDSR object. Coordinating the capture and management of such objects can be accomplished with the Integrating the Healthcare Enterprise Radiation Exposure Monitoring (REM) profile. These topics, in addition to how to incorporate of legacy system dose reporting into the RDSR, as well as how to set up the new "Dose Check" standard on CT scanners are presented.

Learning Objectives:
1) Understand how DICOM Radiation Dose SR (RDSR) captures procedure dose information, the modalities and details covered.
2) Understand how the IHE Radiation Exposure Monitoring Profile (REM) coordinates the capture and management of RDSR objects and how it can be applied in a radiology practice.
3) Understand how "CT dose screens" from legacy scanners can be ported into RDSR.
4) Understand how to apply the pre-scan dose pop-ups on the CT console specified in the MITA CT Dose Check (XR-25) standard.
5) Understand how to specify the above standards & features when purchasing and integrating radiology systems.

Funding Support, Disclosures, and Conflict of Interest: Kevin O'Donnell, Toshiba America Medical Systems

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