Rationale and Objectives
Radiation exposure from medical imaging has received increasing attention in recent years. Ongoing calls to report radiation doses received during radiology studies as a means of recording cumulative exposure and identifying rare over-exposures have culminated in the State of California passing a mandatory reporting requirement effective July 1, 2012. Herein we describe a radiology housestaff-led quality improvement project to track radiation dose reporting a full year prior to state reporting mandates using a template-driven reporting system and our results over the first 12 months of its implementation.
Materials and Methods
Effective July 2011, all radiology trainees were instructed to use a standard computed tomography (CT) report template that included a CT dose measurement derived from dose information routinely displayed on our picture archiving and communication system. Consecutive reports from July 1, 2011, to June 30, 2012, of patients who underwent CT examinations at our institution were then retrospectively reviewed. Compliance of each study with the reporting requirement was assessed based on the presence or absence of a radiation dose statement within the finalized report.
Results
A total of 36,217 eligible consecutive CT reports were identified within the review period. Of these, 91.9% reported the radiation dose for the examination, greatly exceeding the initial goal of 80% compliance with the dose reporting requirement.
Conclusion
Successful reporting of CT radiation doses resulted from template-driven reporting, readily accessible calculation tools to facilitate dose calculation, and minimization of reporting burden on the radiologist a full year prior to state regulatory mandates.
The use of computed tomography (CT) in clinical medicine has dramatically increased since its inception in the 1970s, and its subsequent integration into routine patient care is widely considered among the most important advances in medicine. CT now accounts for approximately 15% of all medical imaging and up to 70% of the total medical radiation dose in the pediatric population . Despite the tremendous importance of CT as a diagnostic modality, there is rising awareness of the potential risks of radiation-induced carcinogenesis with numerous reports in the literature estimating the incidence of malignancy resulting from CT imaging . A few high-profile examples of severe overexposure have further heightened awareness of medical radiation among providers and the public at large .
The response to rising radiation exposure from imaging has been multifaceted. The American College of Radiology and other radiologic societies have initiated pediatric and adult specific dose reduction campaigns ( Image Gently and Image Wisely , respectively) in addition to Society of Pediatric Radiology–sponsored As Low As Reasonably Achievables conferences, American College of Radiology accreditation programs, and the American Society of Radiologic Technologists professional development course titled “Pediatric Body CT: Techniques and Tactics.” Parallel efforts to decrease unnecessary medical imaging include recent efforts by the US Food and Drug Administration, which in 2010 launched the Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging .
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Materials and methods
Dose Reporting
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Tools to Assist the Radiologist and Implementation
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Study Design
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Statistical Analysis
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Results
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Table 1
Total Dose Reporting by Month in the 2011–2012 Academic Year
Month Not Reported Reported Total (%) July 328 2560 88.6 August 252 3016 92.3 September 238 2742 92.0 October 223 2911 92.9 November 177 2734 93.9 December 172 2660 93.9 January 179 2941 94.3 February 148 2842 95.1 March 165 3061 94.9 April 259 2622 91.0 May 452 2626 85.3 June 329 2580 88.7 Total 2922 33295 91.9
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Discussion
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Conclusion
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References
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