Cumulative Radiation Dose Recording and Monitoring: Are We … · 2013. 12. 3. · Pediatric...
Transcript of Cumulative Radiation Dose Recording and Monitoring: Are We … · 2013. 12. 3. · Pediatric...
Donald P. Frush, MD
No Disclosures
Cumulative Radiation Dose Recording and Monitoring:
Are We Ready?
National Medical Radiation
Tracking: Regulatory Requirements
There are none…..
Sodickson et al Radiology 2009; 251
• 33% > 5 CTs • 5% 22-132
Retrospective: CT Examinations
________________ • 15% ED > 100 mSv • 4% 250 -1375 mSv • 1% >399 mSv
• 0.2% of enrollees >20 mSv � Fazel 2009 NEJM 361
• SAH: mean dose 12.8 Gy (max 36.1 Gy) � Moskowitz 2010 Am J Neuroradiol 31
• Other investigations: � Chronic illness (Stein 2010 JACR 7 ) � Emergency setting (Griffey and Sodickson 2009 AJR
192) � Pediatric cardiology (Ait-Ali 2010 Heart 96) � Oncology: max 642 mSv (Ahmed 2010 Pediatrics 126)
Imaging Examination Radiation
“...13 fold variation in CT dose”
(although…a far greater evil is
having no variation).
“I am contacting you to ask about the radiation exposure my son has had when having a CT angiogram … Can I make the
radiation exposure request or does his physician need to? Here is my son’s
information and the date of his CT angiogram. I am wanting to get his radiation
exposure in a file for his health history. Thank you for your time. ”
September 11th, 2011
But we really don’t know if there is a risk with low level exposures…
….true, bit doesn’t matter.
If we don’t control this, someone will for us
We have a responsibility to
know individual and cumulative (CT) dose, and what this does or doesn’t signify…
patients
colleagues regulatory organizations
Tidal Poole Software http://www.tidalpool.ca/radiationpassport/index.html
What is a Botswanan pula? 1,218,060 pulas?
http://www.netcarshow.com/ferrari/2003-360_challenge_stradale/800x600/wallpaper_01.htm
= $180,000 US
= 1,218,060 P (Botswana)
Cumulative Dose
Cumulative radiation record, … but also more accurate dose estimations and
significance of these estimations:
- Reference levels - Age/gender appropriate risks
Pediatric CT Dose Estimation
AAPM TG 204 reportApril 2011
http://www.aapm.org/pubs/reports/RPT_204.pdf
• Consensus development • Simple • Meaningful • Consistent
– across specialties – across geographies
• Commutable • Protected • Electronic medical record
Cumulative Dose
Must become automated…
• Track individual patient doses, and • Track institutional dose profile
Courtesy Olav Christianson, RAIL
Optical Character Recognition
Courtesy Olav Christianson, RAIL
Duke Rad Tracker
Dose and Risk Calculations
TT
Tw HE ���average over gender and age groups
Effective Dose (ICRP 103)
Risk Index
TT
Tr HR ���
Brenner, Br J Radiol 81, 521-523 (2008) Courtesy Ehsan Samei, PhD
(BEIR VII)
tissue-, gender-, and age-specific
*q in units of cases /10,000 exposed /mGy-cm Courtesy of Dr. Xiang Li
Duke Rad Tracker: 20 Yr Old k (mSv/mGy-cm) q (cases/10,000 exposed/mGy-cm)
gender
averaged* male female
chest-abdomen-pelvis 0.018 0.016 0.032
chest 0.025 0.018 0.051
abdomen-pelvis 0.018 0.017 0.028
abdomen 0.023 0.018 0.037
pelvis 0.011 0.016 0.013
adrenals 0.026 0.021 0.030
liver 0.026 0.019 0.044
kidneys 0.020 0.017 0.022
liver to kidneys 0.024 0.018 0.039
kidneys to bladder 0.015 0.017 0.019
head 0.0014 0.0013 0.0018neck 0.0051 0.0043 0.0109
head and neck 0.0034 0.0030 0.0067
* Per its definition, effective dose was calculated using gender-averaged organ dose values.
Courtesy Olav Christianson, RAIL
Duke Rad Tracker: QA/QI
Challenges: denham article • Types of procedures
– diagnostic – interventional
• All ages? • What should be recorded?
– procedure? – units: ED? Organ dose? CTDI/DLP? – risk indices?
• How archived? – in report?
• Who is responsible?
Cumulative Dose
• Responsibility for monitoring? • Will it change practice? • Will it change quality of care?
Will it Change Practice?
We don’t order studies… change must involve referring
healthcare providers
Cumulative Dose
Sistrom et al. Radiology 2009; 251: 147
Available at Point of Care??
CT dose 10 mSv Risk est. = xx Prior CTs = yy
April 2009
• if accountability is a component of quality, • if we are a major stakeholder, • if information is meaningful and available, …. then yes
Will it change quality of care? …
Recording Radiation Dose:
Cumulative CT Radiation Record