Jenifer Willmann Siegelman MD, MPH, Presenter: Consultant, Bayer AG

Marie Kate MacGregor MPH, Abstract Co-Author: Consultant, Bayer AG

Mark Patrick Supanich PhD, Abstract Co-Author: Research agreement, Siemens AG

Evaluate the effectiveness an organization-wide stewardship initiative based on a systematic evaluation of radiation dose using automated dose tracking software coupled with targeted interventions that included protocol modification, equipment replacement or software upgrades and operator training

Design: Retrospective, observational study of consecutive CT exams with a 3-month control,12 month intervention and 3-month follow-up period in a community health system.intervention: Periodic analysis of dose by protocol, equipment and operator using automated radiation dose capture software with built-in analytic tools provided the data for the intervention and confirmation of dose optimization. The optimization strategy engaged physicians, physicists, technologists, and hospital administrators and included equipment software upgrades, new equipment, changes in protocol parameters and training/retraining of technologists.Analysis: Pre- and post-intervention radiation dose (surrogate parameters CTDIvol, Dose Length Product (DLP) and Size Specific Dose Estimate (SSDE))  by protocol group was assessed and significance tested using an Analysis of Covariance on log transformed values.

Compared with control period, mean CTDIvol by protocol in the follow up period was reduced by 13% for all head exams and by 22% for all body exams.The difference in mean CTDIvol between the control and follow up period within all protocols was significant. Model R-squared values for analysis of covariance (ANCOVA) ranged from .03 to .68 and demonstrated equipment and gender as significant covariates.Low model R-squared values for the majority of tests indicated changes in protocol parameters and technique were likely contributors to dose reduction. Analysis of the difference in means pre- and post-intervention by equipment found dose reduction was significant for equipment that was not upgraded during the intervention and for equipment that was upgraded.

Systematic review of radiation dose by protocol and by patient demographics combined with an iterative process of image review, education, protocol modification and equipment upgrades resulted in a decrease in radiation exposure to a patient population

Tracking radiation dose by protocol and patient demographics provides information for ongoing, targeted quality improvement and quality control

Siegelman, J, MacGregor, M, Supanich, M, Monitoring and Controlling Patient Radiation Exposure from Computed Tomography at a Community Hospital Using a Collaborative, Data-driven Approach.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015992.html