Striking a Balance

The ACR Dose Index Registry® helps hospitals retain scan quality while successfully lowering radiation dose.striking a balance

There can be a fine line between maintaining the quality of an image and lowering radiation dose for patients. One solution for establishing this equilibrium is ACR’s Dose Index Registry® (DIR).

By collecting information related to dose indices for CT exams from around the country and storing it in a database, facilities that use the DIR can compare their CT dose indices to regional and national values. Two hospitals — Women & Children’s Hospital of Buffalo, the regional center in Western New York for specialized pediatric care and part of the Kaleida Health System, and St. Dominic-Jackson Memorial Hospital in Jackson, Miss. — are each using the DIR in unique ways to strike a balance between dose and quality.

Pediatric Radiation Safety

Kaleida Health, the largest health care provider network in Western New York, has taken a major step forward in ensuring pediatric patients receive the lowest radiation dose possible while still providing high-quality scans. Valerie Cronin, manager of imaging services for Women & Children’s Hospital of Buffalo, believes that pediatric radiation safety is a critical mandate for the entire radiology community. “There is a lot of literature stressing the importance of dose reduction in pediatric patients,” says Cronin. “Radiation safety is particularly important for children because they have a lifetime of potentially needing imaging in front of them.”

Until the advent of the DIR, however, optimizing pediatric CT radiation dose presented a significant challenge because hospitals were not able to compare their dose indices to those of other children’s hospitals across the United States. When Women & Children’s Hospital of Buffalo learned about the DIR, it quickly signed on to participate and began submitting its CT dose data to the directory. It also formed a Dose Reduction Committee to evaluate the DIR reports and compare the hospital’s dose indices to national standards.

Taking this team approach to dose reduction brought different perspectives and background levels of expertise into the same room, Cronin observes. The committee includes a lead CT technologist, radiation safety officer, quality radiologist, quality technologist, medical physicist, and department manager. Each committee member is able to contribute a unique perspective to tackling a shared problem. In particular, the facility realized that the inclusion of the medical physicist was important to bring the technical expertise required to optimize CT protocols.

Optimizing CT Scans

The committee’s first assessment of comparative information was enlightening. After a review of DIR reports for June–December 2011, they quickly recognized that their hospital’s radiation dose indices for CTs of the abdomen for pediatric patients were higher than national standards. And they took immediate steps to optimize radiation dose, including both protocol changes and implementation of new technology.

The group discovered that the dose reduction software tool installed on their scanner was not being used optimally, which was the hospital’s most immediate opportunity for dose reduction. After an extensive discussion with the staff physicist, the committee recommended that the hospital implement optimized protocols. A second step in the process was to standardize protocols by making the changes necessary and training all staff members on the new procedures.

Although there was a sense of urgency concerning the changes that needed to be made, the actual transition was not a rushed one. Since accuracy and quality should not be compromised, Cronin emphasizes the importance of a phased approach to making changes. “The plan of action was to review the DIR data as soon as it became available, to identify our outliers to national standards (such as CT scans of the abdomen), and not to change too much too fast,” she states. “If you do that then you don’t know what contributed to the reduction. You don’t know if it was the implementation of dose reduction software or the changing of the protocols.”

St. Dominic-Jackson Memorial Hospital in Jackson, Miss., is another participant in the DIR that successfully managed patient dose by analyzing and applying the results of their data. To read about their unique approach, visit

By Amena Hassan

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