Medical Physicist Assistant, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
Chair, Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
J Am Coll Radiol. 2024 Jul;21(7):1058-1066. doi: 10.1016/j.jacr.2024.01.008. Epub 2024 Jan 28.
Challenges from administrative support, scanners' heterogeneity, patient size variation, and protocol mapping hinder CT protocol and dose management. We present a holistic approach to overcome these challenges.
A dose tracking software was selected with two key requirements: intelligent protocol mapping and customizable dose threshold settings according to the patient size. A multifaceted workflow was carefully implemented. It included patient size-dependent dose thresholds for e-mail alerts, a base protocol archive on a website with a unified format using an in-house developed reformat software upon protocol export, prompt dose alert follow-up, and well-controlled protocol changes. The thresholds were iteratively updated following protocol changes or review of dose statistics. The program outcome was evaluated using 11 protocols from January 2020 to May 2023 (N = 148,678) in comparison to ACR's achievable dose (AD) and dose reference levels (DRLs).
The 75th percentile dose data were lower than the ACR's DRL on average, ranging from -4.9% to -36%. The median doses were in a range of -23% to 19% on average in comparison with the ACR's AD. The median value from pulmonary embolism scans initially showed 36% higher than the AD but was gradually reduced to nearly 3% lower than the AD. The percentage of unjustified alerted cases decreased from 80% in first half year of 2020 to 17% in the first 5 months of 2023.
The results showed that our holistic approach to protocol and dose management has been effective. The impact to practice has been prompt and sustainable.
行政支持、扫描仪的异质性、患者体型变化以及方案映射方面的挑战，给 CT 方案和剂量管理带来了阻碍。我们提出了一种整体方法来克服这些挑战。
选择了一种具有两个关键要求的剂量跟踪软件：智能方案映射和根据患者体型定制剂量阈值设置。精心实施了多方面的工作流程。它包括根据患者体型为电子邮件警报设置剂量阈值、在网站上建立一个具有统一格式的基本方案档案，该格式可使用内部开发的重新格式化软件在导出方案后进行转换、及时跟进剂量警报、以及对方案进行严格控制的更改。根据方案更改或剂量统计数据的审查，迭代更新阈值。使用 2020 年 1 月至 2023 年 5 月的 11 个方案（N = 148678），以及与 ACR 的可实现剂量（AD）和剂量参考水平（DRL）进行比较，评估了该程序的结果。
75 百分位数剂量数据平均低于 ACR 的 DRL，范围从-4.9%到-36%。与 ACR 的 AD 相比，中位数剂量的范围平均在-23%至 19%之间。最初，肺栓塞扫描的中位数显示比 AD 高 36%，但逐渐降低到比 AD 低近 3%。不合理警报病例的百分比从 2020 年上半年的 80%下降到 2023 年 5 个月的 17%。
结果表明，我们对方案和剂量管理的整体方法是有效的。对实践的影响是及时和可持续的。
