Implementation of a computed tomography dose management program across a multinational healthcare organization.

OBJECTIVES: Radiation dose index monitoring (RDIM) systems may help identify CT dose reduction opportunities, but variability and complexity of imaging procedures make consistent dose optimization and standardization a challenge. This study aimed to investigate the feasibility to standardize and optimize CT protocols through the implementation of a Dose Excellence Program within a European healthcare network. METHODS: The Dose Excellence Program consisted of a multidisciplinary team that developed standardized organizational adult CT protocols and thresholds for relevant radiation dose indices (RDIs). Baseline data were collected retrospectively from the RDIM (Phase I, 2015). Organization's protocols were implemented and monitored from the RDIM for deviations (Phase II, 2016). Following standardization, radiation dose optimization was initiated (Phase III, 2017). Data from the three most used protocols were retrospectively extracted and grouped by country for all phases. The mean number of series (RS) and RDIs were compared between phases and with organizational reference levels. A Mann-Whitney test was conducted; p < .05 was considered as significant. RESULTS: Data from 9588, 12638, and 6093 examinations were analyzed from General Chest, General Head, and Thorax/Abdomen/Pelvis (TAP) multiphase respectively. Overall, after Phase III, mean RS and CTDIvol p75 were below the organizational reference levels in all countries for the three protocols. The CTDIvol decreased by 45% in Switzerland (p < .00001), 32% in Turkey (p < .00001), and 28% in Switzerland (p = .0027) for General Chest, General Head, and TAP multiphase respectively. CONCLUSIONS: The implementation of a Dose Excellence Program within a large-scale healthcare organization allowed unifying protocols and optimizing radiation dose across countries. KEY POINTS: • Engaging a multidisciplinary team can enhance the use of an RDIM system for CT dose management in a multinational healthcare environment. • Deep dive of baseline data and standardization of CT practices by defining organizational clinical indication CT protocols with RPIDs is an essential step before optimization of radiation dose. • Following the implementation of the program, the mean RS and CTDIvol were below or equal to the organizational reference levels in all countries.

Lead exposure in clinical imaging - The elephant in the room.

PURPOSE: Radiation Protection Apparel (RPA) is used during diagnostic imaging and interventional procedures to minimise incidental radiation exposure. The majority of RPA in use are lead-containing, which has until now been considered safe. A recent single-centre study has demonstrated that the external surface of 63 % of RPA was contaminated with lead dust. The purpose of this study was to reproduce this investigation with a larger sample size across Europe and assess whether decontamination procedures were possible. METHOD: The routine RPA Quality Control (QC) process was adapted to include lead dust contamination tests and decontamination if present. The presence of lead dust was determined using a commercially available colorimetric method. RPA that failed initial QC or could not be decontaminated were removed from use. RESULTS: From June to October 2019, 728 RPA from 85 imaging centres from five countries underwent initial QC. Of these, 712 were tested for lead dust contamination which was present on 162 (23 %). Following cleaning, 85 (12 %) remained contaminated and were removed from use. Linear regression analysis shows a significant correlation between type of RPA and contamination, (p = 0.0015). There was no correlation between contamination and imaging department, year of manufacture, country and RPA condition (p-values 0.98, 0.90, 0.94 and 0.14 respectively). CONCLUSIONS: Lead dust contamination is present on 23 % of RPA that would pass routine QC procedures. Approximately half were not amenable to decontamination and were removed from use. Procedures were introduced for the routine handling of RPA, and updated QC steps for assessment and cleaning. Lead-free RPA should be considered.