Dose monitoring should deliver many benefits, but it’s proving hard to sell to NHS trusts. Kim Thomas reports on EHI ahead of the annual meeting of the UK Imaging Informatics Group this autumn.
Hospitals should set radiation doses in CT scans to the lowest possible levels, because of the increased cancer risk to patients.
That was one of the key recommendations of a report issued in August by the government’s Committee on Medical Aspects of Radiation in the Environment.
The issue of radiation risk is not a new one, but it is the focus of increasing concern, as use of medical imaging grows. In 2012-13, NHS hospitals in England carried out 4.7m CT scans: an increase of 167% in ten years.
Working towards a working party
At the annual meeting of the Imaging Informatics Group at EHI Live 2013, the Department of Health announced that it was planning to set up a working party on radiation dose monitoring, with the longer-term aim of creating a national dose registry.
The announcement was in response to the new European directive on radiation monitoring, which requires member states to carry out national monitoring of patient radiation dose.
Once the directive is passed into law, every trust will have to collect patient dose data and make it centrally available. In practice, this already happens in England, though it’s generally done by manually entering dosage into a database.
A dose registry will automate the process, so trusts will have to use modalities that can produce dose data in the format of a DICOM structured report, which will then be collected by the central database.
Some trusts, however, are already going one step further and purchasing automated dose monitoring software that collates dose data from scanning equipment and presents it visually, making it simple to see how much radiation dose patients are receiving.
A good thing but a hard sell
Dose monitoring software isn’t necessary to comply with the legislation; but it does offer benefits for individual trusts and may, if adopted widely, provide collective benefits for radiology.
The more trusts that implement dose monitoring, the more data is gathered; making it possible to carry out benchmarking and standardisation of radiation dosage.
HSS, which sells PACSHealth’s DoseMonitor product as an additional module to CRIS, its radiology information system, is about to carry out its first implementations, including one at North West London Hospitals NHS Trust.
Dose monitoring is not just about gaining a broad picture of radiation dose, though. One of the benefits offered by the software is its ability to identify outliers, such as a piece of equipment or an operator regularly delivering too high a dosage to patients.
The ability to integrate dose data with other applications can also lead to a better picture of departmental practice as a whole.
Marc Newman, clinical business manager at Wellbeing, which supplies the HSS product, says that the integration of dose monitoring software with the HSS RIS has increased the accuracy of information held in the RIS.
This makes it possible to identify areas where more training is needed, where equipment might need to be recalibrated, or where there are bottlenecks in workflow.
Time will show the real benefits
Some of the bigger benefits will only become apparent after hospitals have been using dose monitoring software for several months.
The more data a trust collects, the more it is able to work to bring the dose level down, and the easier it will be to identify anomalies and outliers, such as a new radiographer joining the trust and not setting the protocols correctly.
At the same time, as more trusts adopt dose monitoring software – it will be increasingly possible to benchmark performance against other trusts by sharing dose data.
This will enable all trusts to improve practice – and help England maintain its position as a world leader in keeping radiation dose low.
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