Region-wide dose monitoring increases patient safety

The number of CT, nuclear, angiography, and fluoroscopy examinations is rapidly growing within diagnostic imaging. This growth also entails a risk for patients of overexposure to radiation, which can induce cancer. Healthcare providers and radiation safety agencies are now focused on this issue.

A novel idea

However, automatic radiation dose monitoring is not a new topic in Region Skåne—it has been on the agenda since 2003. The project to develop and implement a dose monitoring solution in the region’s hospitals was initiated by Mats Nilsson, a professor in the Department of Medical Radiation Physics at Skåne University Hospital in Malmö, Sweden. He saw the need for a more efficient and widespread collection of dose data from different modalities, with the purpose of optimizing dose levels and thereby increasing patient safety. When the project was initiated in 2003, the regulatory demands on dose registration only included mobile modalities, and it was from these modalities only that the region continuously, and manually, collected dose data. But Mats Nilsson wanted to paint a bigger picture. What if you could automatically register dose data from all modalities? The idea was certainly novel. No such solution was in place anywhere else in the world. The idea was well-received and a project was initiated to realize it. The solution was created in close customer-vendor collaboration.

Swedish Healthcare IT Award

One year later, the first version of the radiation dose monitoring solution was ready and in 2008, the solution won the prestigious Swedish Healthcare IT Award. This was the starting point of what is now Sectra DoseTrack. Region Skåne now collects dose data from some 100 modalities, including modalities that support the DICOM MPPS standard as well as SR Dose objects. This ensures that modality protocols are adequate and that processes are being followed to achieve doses “as low as reasonably achievable” (ALARA).

Optimizing dose levels

With the data at hand, Region Skåne started comparing the dose levels of various hospitals in the region, the different modalities, and the performance of specific modalities over time. This made it possible to identify modalities where settings required optimization, where processes could be improved or modalities should be replaced.

“Optimizing CT dose levels is on the very top of my priority list,” says Peter Leander, Regional Chief Medical Officer at Region Skåne.

Although the advantages of implementing Sectra DoseTrack have been clear, Region Skåne is still experiencing challenges. Mats Nilsson shares some of his advice:

“When working across an entire region as we do, standardization is crucial for efficient follow-up. You must have clear routines in place. Which exams can be reported together, and which should have separate exam codes? How do you name modalities and how, and in which, DICOM tag should the exam code be stored?”

Warning for abnormal dose levels

Sectra DoseTrack is also used to identify incidents where a specific patient has received an abnormal dose level. Thresholds are set in the system and if an exam exceeds those values, the system provides notification. This enables proper follow-up and is increasing patient safety throughout the region.

Increasing dose awareness throughout the healthcare chain

Optimizing modality dose levels is definitely an important part of managing the risks associated with dose. But both Peter Leander and Mats Nilsson emphasize the importance of increasing dose awareness among physicists, radiologists, referring clinicians and possibly even patients. The understanding of dose levels for different examinations and the impact of dose levels on patient safety need to increase.

“The first step toward increasing awareness and interest in dose levels is simply visualizing it throughout the organization. Dose history information needs to be readily available in the order management system for the referring clinicians—in the RIS for the radiographers, and in the PACS for radiologists.”

“Even if it’s just a number together with the image or patient record, it will have a positive impact,” Peter Leander concludes.