Home' The Source : Quarter 1 Contents and track CT doses. It recommends that “hospitals consider the
options currently available, in the form of OEM open-source and
third-party commercial products.”
The report found 50 percent dose reduction is possible with
OEM processing technologies, but these technologies can cost
from $150,000 to $200,000. The report recommends supply chain
providers consider a third-party image processing system, with
almost as effective dose savings (40 percent) and at a much lower
cost of $50,000. While the OEM advanced-processing technologies
are designed to work only on select models, the third-party system
can be used on the majority of CT scanners.
ROI on CT Dose Reduction Software?
In evaluating vendors, HealthTrust is looking for evidence of an
increase in tube life from the reduction in dose. Responses from
OEMs have varied from “reduced dose does not extend tube life
as most tube failures are from bearings” to reduced CT dose “will
extend tube life by an estimated 20 percent.” One of the third-party
image system vendors responded with a white paper reporting that
“owners of CT systems observed that using low-dose protocols
significantly increased the number of scans, anywhere from 40
percent to as much as a factor of 4, well beyond the expected values
of the manufacturers.”
Annual CT service contracts can average as much as $165,000
per year—with the tube being the majority of that cost—but this
technology can provide a significant clinical benefit to patients by
reducing dose. If the service contract is renegotiated, the ROI would
be very short, especially for third-party image system products that
can be used on the majority of CT scanners (instead of select CT
models as is the case with some OEMs).
Potential Issues with Patient Throughput
Both OEMs and third-party image system software could have
an effect on patient throughput. Most post-processing at a reduced
dose will have minimal impact on patient throughput, adding only
one to five minutes per case. However, some products could take
approximately 15 minutes just to improve the image quality of a
low-dose image, which greatly extends the average time needed
to complete a multi-slice CT exam.
The Joint Commission’s Recommended Actions
In August 2011 The Joint Commission released a Sentinel Event
Alert related to radiation exposure and specific actions that hospitals
and imaging centers should take. The specific actions suggested by
The Joint Commission include:
• Use of imaging techniques other than CT, such as ultrasound
or magnetic resonance imaging (MRI), and collaboration between
radiologists and referring physicians about the appropriate use of
• Adherence to the Nuclear Regulatory Commission’s “As Low
as Reasonably Achievable” (ALARA) guidelines, as well as guide-
lines from the Society for Pediatric Radiology, American College
of Radiology and the Radiological Society of North America for
imaging for children and adults, respectively.
• Assurance by radiologists that the proper dosing protocol is
in place for the patient being treated and reviews of all dosing
protocols against the latest evidence are made either annually or
every two years.
• Expansion of the radiation safety officer’s role to explicitly
include patient safety as it relates to radiation and dosing, as well
as education on proper dosing and equipment usage for all physi-
cians and technologists who prescribe diagnostic radiation or use
diagnostic radiation equipment.
• Implementation of centralized quality and safety performance
monitoring of all diagnostic imaging equipment that may emit high
amounts of radiation cumulatively.
Radiation exposure will continue to be a patient safety issue.
Medical imaging vendors are improving both devices and software
to reduce and monitor patient dose during diagnostic and thera-
peutic procedures. However, it is ultimately the responsibility of
the clinical staff, both physician and technologist, to follow and
adhere to all guidelines to reduce and monitor radiation dose from
medical imaging procedures.
Find HealthTrust’s report on “Dose Reduction and Dose Monitoring
Features and Upgrades for CT Scanners and Angiography Systems”
and The Joint Commission Sentinel Event Alert on Radiation Exposure
on SCRUBS under the “MedTech” link.
[ SourceBook ]
The following HealthTrust vendors have products on contract that
monitor and reduce radiation exposure:
GE Healthcare (HealthTrust Contract #500043)
• GE Healthcare’s Optidose technologies can be used to deliver dose
reduction at the source. Optidose includes the following SmartTrack,
which keeps the X-ray beam tightly focused on the active detector
cells, SmartA 3D Dose Modulation, Color Coding for Kids, and DICOM
structured dose reports.
• Prior to starting the scan, Dose Check provides tools to notify and
alert the operator while setting the scan parameters as to whether the
estimated dose index is above user-defined notification values.
• ASiR helps clinicians achieve dose reductions while delivering
the diagnostic image quality needed for confident diagnosis. ASiR, a
projection-based iterative reconstruction technology, changes the dose
paradigm across many anatomies and patients.
• Ve o , the world’s first model-based iterative reconstruction product,
enables imaging under 1mSv with profound clarity.
22 The Source | First Quarter 2013
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