Radiation Dosage Monitoring in CT

Was it just a few years ago that potential to reduce exposure was one of the benefits touted for adoption of multi-slice CT?  Then, in 2001, the FDA issued a Public Health Notification to emphasize the importance of keeping radiation doses during CT procedures as low as reasonably achievable (ALARA).  Concerns with monitoring patient radiation dosage in CT are rising, in part due to a general trend toward patient safety and in larger part due to concerns within the medical community that multi-detector CT technology may actually be increasing exposure. Massachusetts General Hospital radiologists have conducted studies and published in peer-reviewed journals findings that indicate the potential of upwards of 50% less radiation dosage is possible in some situations without any loss in image quality for interpretation.  The conclusion?  As demand for CT continues to grow and technology allows capture of an ever-increasing number of images, the need for standardized policies for optimum radiation efficiency will increase. How is this radiation dosage monitoring different than what a radiation safety officer (RSO) may already be providing?  An RSO can measure dosage for a sample of patients; however, CT protocols have evolved so much in the past few years that more medical input is needed for dose reduction.  More specificity is required, based on such factors as clinical indication, body region, patient size, and age. Radiologists can take the lead. The first step is to assess/measure: • Actual radiation dose with existent protocol • Redundancy in CT protocols that adds to image numbers and radiation dose •  Image quality with existent protocol – objective and subjective indicators such as noise, contrast, artifacts) The second step is to develop and implement policies, which may require additional education and training for all staff.  The last step is to monitor by: • Maintaining a “bad case” record • Randomly recording doses for cases For practices committed to the highest quality, standardized policies for optimum radiation efficiency are a natural next leap to continuously improving patient care.