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CT dose optimization and its global impact on stakeholders

September 21, 2016
From the September 2016 issue of HealthCare Business News magazine

The specific actions resulting from this committee (or for facilities without a committee, from those individuals or groups guiding the CT dose optimization effort) can usually be grouped into the following five categories: new or upgraded CT imaging equipment; dose tracking and analysis software; administrative enhancements; staff training; and/or improved and expanded CT policies and procedures. I will address each of these categories individually, discussing the offerings that have developed and their appropriate application in an imaging department.

New or upgraded CT imaging equipment
Original equipment manufacturers (OEMs) have directed significant resources during the past decade on dose reduction and optimization improvements to their CT scanner hardware and software platforms. The ultimate result is more dose-efficient scanning generally, and more numerous and sophisticated dose-saving options on CT scanners.

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These advancements, while welcome from a radiation safety standpoint, in some cases increase the complexity of scanners, necessitating increased CT technologist training and CT protocol review, and customization in order to fully realize the benefits of the new technology. As such, while new or upgraded CT imaging equipment may permit a facility to potentially reach lower dose-to- image quality ratios, and may address the aforementioned NEMA requirements for facilities with older equipment, equipment improvements alone cannot produce optimized CT doses, nor can they address the vast majority of new requirements and imperatives in the current dose optimization framework. In some cases, new or upgraded equipment is neither necessary nor particularly helpful in reducing patient doses.

Frequently, better staff training to properly take advantage of CT dose reduction features on existing scanners, combined with protocol optimization, may contribute substantially more to dose reduction efforts than scanner upgrades.

Dose tracking and analysis software
Myriad dose tracking and analysis software systems have been introduced during the past decade. These programs have grown in capabilities, sophistication and complexity, and come in all different forms and at all different price points. While CT patient dose analysis (including identification of high or low outliers, comparison of patient doses over time, comparison of patient doses between scanners, comparison of patient doses between technologists, etc.) does not require dose tracking and analysis software, we have found in our dose optimization consulting practice at West Physics that for all but very small facilities with very limited CT patient volume, it is extremely difficult and time-consuming to perform dose tracking and analysis manually without the benefit of at least basic software. As such, in most quarters of the industry, such software is rapidly becoming a de rigueur part of a highly-functioning CT department’s toolset.

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