
OCTOBER 25, 2011 • VOLUME 4 • NUMBER 5

Dose Management

UC Davis Medical Center Embarks on Journey to Reduce Dose by 20%

By Matthew Skoufalos

J. Anthony Seibert, PhD Dose management (including dose-reduction strategies) is a dominant topic of conversation throughout the imaging world. Cross-disciplinary efforts to resolve the issue are moving to the forefront of both vendor and provider dockets, spurred on not least by quality metrics that tie reimbursement rates to patient outcomes.

At UC Davis Medical Center in Sacramento, California, radiology professor J. Anthony Seibert, PhD, and his colleagues are working to lower the radiation dose that their patients receive by some 20%. It's an ambitious goal, but one that they believe is reasonable, with the implementation of statistical iterative reconstruction techniques, dose modulation, and geometry-based modeling.

The process goes well beyond CT, Seibert says, and is needed much more in interventional radiology, where per-patient radiation doses can exceed those of CT and even PET exams, in many cases. He cites the National Council on Radiation Protection & Measurements as having raised awareness of the overall impact of increased use of CT and nuclear-medicine procedures.

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All Aboard California’s Dose-reduction Locomotive

By Julie Ritzer Ross

Hospital In September 2010, California Gov Arnold Schwarzenegger signed into law a measure mandating that radiologists include dose-length product or volume CT dose index in all reports. Such a development probably spurred many imaging service providers to begin thinking about radiation-dose-reduction initiatives, but Providence Saint Joseph Medical Center (PSJMC), Burbank, California, was already ahead of this game, with plans for a comprehensive dose-reduction program under discussion.

Judy Fauria, MSHA, RT (M)(CT), is the hospital's director of imaging services. She notes that talk about devising a dose-reduction initiative kicked into gear when a Los Angeles, California-based hospital disclosed, in late 2009, 206 patients, over an 18-month period, had been exposed to eight times the normal radiation dose for their exams. "We knew then that it was time to be proactive," she says.

Currently in its infancy, PSJMC's dose-reduction initiative encompasses all areas of imaging that utilize ionizing radiation to produce an image. The safety principle of using doses as low as reasonable achievable (ALARA) and the Image Gently™ pediatric imaging guidelines are consistently followed under the program's umbrella. Among other precautions, ALARA protocols mean exposing patients to the lowest dose of radiation feasible for effective diagnostics and protecting patients from scatter radiation using lead aprons and shields.

Fauria and her colleagues also regularly engage in efforts to educate referring physicians about the ins and outs of radiation dose and the need to pursue dose reduction whenever feasible. She says, "We communicate with physicians to make them aware that for certain diagnoses, an MRI or ultrasound exam may be more appropriate for certain diagnoses," Fauria states

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Dose Reduction in Radiology: An Industrywide Initiative

By Cheryl Proval

Gregg Cretella There is no more compelling story in radiology today than the urgency with which organized radiology and imaging modality vendors have come together to address the issue of dose management in radiology. Yes, more work lies ahead, and significant challenges remain—but the swiftness and decisiveness with which providers and vendors have cooperated, and their accomplishments to date, might be unprecedented in the history of the specialty.

On the provider side, radiologists—worldwide—have adopted pediatric CT protocols that protect children from receiving adult-size radiation doses, under an initiative aggressively promoted by the Image Gently™ campaign. At the Image Gently Dose Summit held in St Louis, Missouri, in February 2010, the industry turned its attention to radiography and to the adoption of an international standard that will eliminate confusing and sometimes contradictory user interfaces on various acquisition devices and will smooth the way for technologists, administrators, and radiologists to monitor dose.

Gregg Cretella, manager, clinical science, FUJIFILM Medical Systems USA (Stamford, Connecticut), articulates the technical progress that has been made on the radiography front thus far, the challenges that lie ahead, and the significance of these advances in an interview with Radinformatics.com.

Radinformatics.com: Which organizations are involved in the initiative?
Cretella: The Alliance for Radiation Safety in Pediatric Imaging (with the Image Gently campaign) was probably the number-one driver, but also included in the list of associations would be the American Society of Radiologic Technologists (ASRT), the Medical Imaging and Technology Alliance (MITA), the American Association of Physicists in Medicine (AAPM), and the American College of Radiology (ACR). All of the CR and DR vendors participated in the Image Gently Summit, and Image Gently requested that all vendors move toward and adopt the international standard for exposure index, International Electrotechnical Commission (IEC) standard 62494-1. This was supported by the AAPM, and vendors were encouraged to begin the engineering work for adopting that standard.

Historically, each vendor had its own proprietary index. Sometimes, when the dose goes up, the exposure index goes up, but on other systems, when the dose goes up, the exposure index goes down. Also, the numerical values used to represent these exposure indices are usually different, vendor to vendor, so you can imagine the difficulties, in a multivendor facility, for a technologist, as he or she moves from system to system.

The whole idea behind adopting the international standard is this: Regardless of the systems the technologist is operating, they would all display and present to the technologist roughly the same information.

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D-EVO Line Adds Larger Wireless Detector
FUJIFILM, Stamford, Connecticut, has announced the commercial availability of a larger, 17 by 17-inch flat-panel wireless detector for its new D-EVO line. The new detector —the only wireless flat panel of its size sold in the United States—supplements the existing 14 by 17-inch wireless flat-panel detector. It features the company's patented irradiation side sampling technology, which enables technologists to take higher-quality images at a lower dose.