Health Imaging & IT - April 2008 - (Page 14)

Cracking Down on CT Radiation Dose Control automatically vary radiation depending on patient size.” Overall, vendors have been very supportive regarding the control of radiation dose. Efforts such as making dosage information available in their DICOM header have helped to increase physician awareness. More can be done, however. “I think that there should be automated systems that make sure that the radiation that is delivered is the least that is feasible,” says Daniel Rosenthal, MD, associate radiologist-in-chief at Massachusetts General Hospital. He would like to see all CT scanners be obligated to report radiation doses in a unified, uniform system so doses can be compared. That would be particularly valuable in follow-up situations, for example, where the recent radiation exposure would allow for a second scan of equal quality at a lower dose. Imaging is a victim of its own success, to some degree. “Imaging has gotten so spectacular, it’s hard for clinicians not to order an imaging study,” says Rosenthal. Redundant and unnecessary exams really need to be controlled, however. “This sort of promiscuous ordering of imaging studies is probably not in patients’ interest.” Aside from the large CT system vendors working on imaging techniques that reduce radiation exposure while maintaining high image quality, smaller companies also are making inroads on radiation dose control. Rosenthal helped developed RadPort, ‘Child-size the Dose’ now distributed by Dictaphone. RadPort helps radiologists determine which exams should be ordered based on a patient’s symptoms. It is based on a set of 1,100 rules that were developed (from the original 200 that the American College of Radiology uses) by Massachusetts General Hospital. RadPort is helping to reduce the number of inappropriate exams that are ordered, and make sure the right exams are ordered the first time so problems can be diagnosed sooner, treatment can begin sooner and patients aren’t exposed to unnecessary amounts of radiation. In addition, RadPort prequalifies exams for insurance coverage, so it helps eliminate problems on the payor end of things as well. RadPort’s decision support is an effort to increase the appropriateness with which x-ray exams are used, says Rosenthal. A user selects an exam, enters one or more reasons for the exam and then the system feeds back a score to help the user rate the appropriateness of the study and determine whether it is highly indicated. RadPort also offers comparative scores for other, similar exams, some of which do not involve radiation at all. RadPort takes a very complex calculation and reduces it to a series of rules that will not always be right, Rosenthal admits. “We’ve tried to apply an algorithmic approach, with understanding by users that this is for general case. There will be exceptions.” Once users are accustomed to the system, it results in “very distinct changes in practice initially,” he says. Users first find the system indicating a high rate of use The image campaign of exams it considers inappropriate. Over time, that usually drops to among the new guidelines of the image gently campaign launched by the about 2 percent of all exams. gently alliance for Radiation safety in pediatric imaging are: › significanTly Reduce, or “child-size,” the amount of radiation used › do noT oveR-scan › Scan only when necessary › Scan only the indicated region › Scan once; multi phase scanning (pre-and post contrast, delayed exams) is rarely helpful › Be a Team playeR › Involve medical physicists to monitor pediatric CT techniques › Involve technologists to optimize scanning For more details, visit: ImageGently.org and www.ajronline.org/cgi/content/full/190/2/273. To develop CT protocols for children, visit: www.pedrad.org/associations/5364/files/ donald frush, Md, chair of the american College of radiology Pediatric imaging Commission, with a patient at the duke university Medical Center in durham, nC. 14 Health Imaging & IT | april 2008 Healthimaging.com http://ImageGently.org http://www.ajronline.org/cgi/content/full/190/2/273 http://www.pedrad.org/associations/5364/files/ http://Healthimaging.com

Table of Contents Feed for the Digital Edition of Health Imaging & IT - April 2008

Health Imaging & IT - April 2008 Contents On the Web The Enterprise News Update Cracking Down: CT Radiation Dose 3D Rendering: Options Galore Thinking Thin-Client Modality Review Ergonomics & Design Special Section: Storage Strategies Imaging Tools Technology Outlook People & Technology Technology Review IT Trends Reader's Resource Stat Sheet

Health Imaging & IT - April 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.