Benefits and limitations for the use of radiation dose management systems in medical imaging. practical experience in a university hospital

2022 ◽  
Author(s):  
Eliseo Vano PhD ◽  
José M Fernández ◽  
José I. Ten ◽  
Roberto M. Sanchez
Keyword(s):  
Medical Imaging ◽  
Radiation Dose ◽  
Practical Experience ◽  
Patient Dose ◽  
Public Hospitals ◽  
University Hospital ◽  
Management Systems ◽  
Clinical Indication ◽  
High Dose ◽  
Dose Management

Objectives: Radiation dose management systems (DMS) are currently to help improve radiation protection in medical imaging and interventions. This study presents our experience using a homemade DMS called DOLQA (Dose On-Line for Quality Assurance). Methods: Our DMS is connected to 14 X-ray systems in a university hospital linked to the central data repository of a large network of 16 public hospitals in the Autonomous Community of Madrid, with 6.7 million inhabitants. The system allows us to manage individual patient dose data and groups of procedures with the same clinical indications, and compare them with diagnostic reference levels (DRLs). The system can also help to prioritize optimisation actions. Results: This study includes results of imaging examinations from 2020, with 3,7601 procedures and 28,6471 radiation events included in the radiation dose structured reports (RDSR), for computed tomography (CT), interventional procedures, positron emission tomography-CT (PET-CT) and mammography. Conclusions: The benefits of the system include: automatic registration and management of patient doses, creation of dose reports for patients, information on recurrent examinations, high dose alerts, and help to define optimisation actions. The system requires the support of medical physicists and implication of radiologists and radiographers. DMSs must undergo periodic quality controls and audit reports must be drawn up and submitted to the hospital’s quality committee. The drawbacks of DMSs include the need for continuous external support (medical physics experts, radiologists, radiographers, technical services of imaging equipment and hospital informatics services) and the need to include data on clinical indication for the imaging procedures. Advances in knowledge: DMS perform automatic management of radiation doses, produces patient dose reports, and registers high dose alerts to suggest optimisation actions. Benefits and limitations are derived from the practical experience in a large university hospital.

scholarly journals Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019535 ◽  
Author(s):  
Jorge Vilar-Palop ◽  
Ildefonso Hernandez-Aguado ◽  
María Pastor-Valero ◽  
José Vilar ◽  
Isabel González-Alvarez ◽  
...  
Keyword(s):  
Medical Imaging ◽  
Radiation Dose ◽  
Clinical Information ◽  
Public Hospitals ◽  
Secondary Outcome ◽  
X Rays ◽  
Effective Radiation Dose ◽  
Cross Sectional ◽  
Imaging Test ◽  
Effective Radiation

ObjectivesTo determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated.DesignCross-sectional retrospective study.SettingTwo Spanish public tertiary hospitals.Participants2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded.Primary and secondary outcome measuresFive outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category.ResultsApproximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays.ConclusionThere was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.

KERMA-based radiation dose management system for real-time patient dose measurement

2016 ◽  
Vol 69 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Kyo-Tae Kim ◽  
Ye-Ji Heo ◽  
Kyung-Min Oh ◽  
Sang-Hee Nam ◽  
Sang-Sik Kang ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Real Time ◽  
Management System ◽  
Patient Dose ◽  
Dose Measurement ◽  
Dose Management

scholarly journals [P007] Patient dose management systems. Our experience in the CT department

2018 ◽  
Vol 52 ◽  
pp. 101
Author(s):  
Virginia Tsapaki ◽  
Niki Fitousi ◽  
Dimitrios Niotis ◽  
Chariklia Triantopoulou ◽  
Petros Maniatis
Keyword(s):  
Patient Dose ◽  
Management Systems ◽  
Dose Management

scholarly journals Probability of receiving a high cumulative radiation dose and primary clinical indication of CT examinations: a 5-year observational cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041883
Author(s):  
Cécile R L P N Jeukens ◽  
Hub Boere ◽  
Bart A J M Wagemans ◽  
Patty J Nelemans ◽  
Estelle C Nijssen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Radiation Dose ◽  
Effective Dose ◽  
Observational Cohort Study ◽  
Clinical Indication ◽  
Secondary Outcome ◽  
High Dose ◽  
High Radiation ◽  
High Radiation Dose ◽  
Observational Cohort

ObjectiveHigh radiation exposure is a concern because of the association with cancer. The objective was to determine the probability of receiving a high radiation dose from CT (from one or more examinations within a 5-year period) and to assess the clinical context by evaluating clinical indications in the high-dose patient group.DesignObservational cohort study. Effective radiation dose received from one or more CT examinations within a predefined 5-year calendar period was assessed for each patient.SettingHospital setting.ParticipantsAll patients undergoing a diagnostic CT examination between July 2013 and July 2018 at the Maastricht University Medical Center.Primary and secondary outcome measuresThe primary outcome was the probability of receiving a high effective dose, defined as ≥100 mSv, from one or more CT examinations within 5 years as derived from a time-to-event analysis. Secondary outcomes were the clinical indication for the initial scan of patients receiving a high effective dose.Results100 672 CT examinations were performed among 49 978 patients including 482 (1%) who received a high radiation dose. The estimated probability of a high effective dose from a single examination is low (0.002% (95% CI 0.00% to 0.01%)). The 4.5-year probability of receiving a high cumulative effective dose was 1.9% (95% CI 1.6% to 2.2%) for women and 1.5% (95% CI 1.3% to 1.7%) for men. The probability was highest in age categories between 51 and 74 years. A total of 2711 (5.5%) of patients underwent more than six CT examinations, and the probability of receiving a high effective dose was 16%. Among patients who received a high effective dose, most indications (80%) were oncology related.ConclusionsThe probability of receiving a high radiation dose from CT examinations is small but not negligible. In the majority (80%) of high effective dose receiving patients, the indication for the initial CT scan was oncology related.

scholarly journals How to Measure/Calculate Radiation Dose in Patients?

2021 ◽  
Author(s):  
Reinhard Loose ◽  
Michael Wucherer
Keyword(s):  
Radiation Dose ◽  
Digital Imaging ◽  
Adverse Reactions ◽  
Management Systems ◽  
Skin Dose ◽  
Skin Injuries ◽  
Threshold Doses ◽  
Dose Management ◽  
Dose Levels ◽  
Peak Skin Dose

AbstractPatients in fluoroscopically guided interventions (FGI) may be exposed to substantial radiation dose levels (SRDL). The most commonly reported adverse reactions are skin injuries with erythema or necrosis. It is therefore important for the interventional radiologist to know deterministic effects with their threshold doses. If possible all relevant modality parameters should be displayed on the interventionalists screen. Dosimetric parameters should be displayed in digital imaging and communications in medicine (DICOM) units and stored as DICOM Radiation Dose Structured Report (RDSR). The peak skin dose (PSD) is the most relevant risk parameter for skin injuries. Dose management systems (DMS) help optimising radiation exposure of patients. However, their calculation of skin dose maps is only available after a FGI. Therefore, dose maps and PSD should preferably be calculated and displayed in real time by the modality.

scholarly journals Patient Dose Management: Focus on Practical Actions

2016 ◽  
Vol 31 (Suppl 1) ◽  
pp. S45 ◽  
Author(s):  
Michael Yong Park ◽  
Seung Eun Jung
Keyword(s):  
Patient Dose ◽  
Dose Management

Use of magnetic resonance venography for inferior petrosal sinus sampling

2021 ◽  
pp. 112972982199726
Author(s):  
Kikutaro Tokairin ◽  
Toshiya Osanai ◽  
Noriyuki Fujima ◽  
Kinya Ishizaka ◽  
Hiroaki Motegi ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Radiation Dose ◽  
Interventional Procedure ◽  
Anatomical Variations ◽  
Magnetic Resonance Venography ◽  
University Hospital ◽  
Inferior Petrosal Sinus ◽  
Success Rates ◽  
Intravenous Catheter ◽  
Patient Demographics

Background: Inferior petrosal sinus (IPS) sampling (IPSS) is a transvenous interventional procedure performed to diagnose Cushing’s disease. The reported IPSS failure rate is approximately 10% because IPS catheter delivery is conducted blindly and is challenging because of IPS anatomical variations. This study aimed to evaluate the usefulness of preprocedural magnetic resonance venography (MRV) for assessing IPS access routes before IPSS. Methods: Nineteen consecutive patients who underwent IPSS at a single university hospital in Japan were retrospectively studied. A preprocedural MRV protocol optimized to visualize the IPS before IPSS was established and utilized in the eight most recent cases. An IPSS procedure was considered successful when bilateral IPS catheterization was accomplished. Patient demographics, IPSS success rate, and radiation dose required during IPSS were compared between two groups: MRV group ( N = 8) and no-MRV group ( N = 11) before IPSS. Results: There were no significant differences in age, sex, and IPSS success rates between the groups. The average radiation dose was 663.6 ± 246.8 (SD) mGy and 981.7 ± 389.5 (SD) mGy in the MRV group and no-MRV group, respectively. Thus, there was a significant reduction in radiation exposure in the MRV group ( p = 0.044). Catheterization of the left IPS was unsuccessful in only one patient in the MRV group owing to IPS hypoplasty, as found on the MRV. Conclusions: Hypoplastic IPSs occur in patients and can complicate IPSS. Preprocedural MRV assessment is useful for understanding venous anatomy and preventing unnecessary intravenous catheter manipulation during IPSS, which involves blind manipulation around the IPS.

scholarly journals High-dose radiation associated with improved survival in IDH-wildtype low-grade glioma

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shuai Liu ◽  
Yanwei Liu ◽  
Guanzhang Li ◽  
Jin Feng ◽  
Li Chen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
Radiation Dose ◽  
Frontal Lobe ◽  
Low Grade Glioma ◽  
Molecular Characteristics ◽  
High Dose ◽  
Low Grade ◽  
Multivariate Survival ◽  
Dose Radiation

Abstract Background As molecular advances have deepened the knowledge on low-grade glioma (LGG), we investigated the effect of higher radiation dose on the survival of IDH-wildtype (IDHwt) LGG. Methods In the current study, 52 IDHwt LGG patients who received radiotherapy were enrolled from the Chinese Glioma Genome Atlas dataset. Radiation doses > 54 Gy were defined as high-dose, whereas doses ≤ 54 Gy were defined as low-dose. We performed univariate and multivariate survival analyses to examine the prognostic role of high-dose radiotherapy. Results In total, the radiation dose ranged from 48.6 Gy to 61.2 Gy, with a median of 55.8 Gy, and 31 patients were grouped into high-dose radiation. Univariate survival analysis indicated that high-dose radiotherapy (p = 0.015), tumors located in the frontal lobe (p = 0.009), and pathology of astrocytoma (p = 0.037) were significantly prognostic factors for overall survival. In multivariate survival analysis, high-dose radiotherapy (p = 0.028) and tumors located in the frontal lobe (p = 0.016) were independently associated with better overall survival. Conclusions In conclusion, high-dose radiotherapy independently improved the survival of IDHwt LGG. This can guide treatments for glioma with known molecular characteristics.

Hematologic Toxicity of High-Dose Iodine-131–Metaiodobenzylguanidine Therapy for Advanced Neuroblastoma

2004 ◽  
Vol 22 (12) ◽  
pp. 2452-2460 ◽  
Author(s):  
Steven G. DuBois ◽  
Julia Messina ◽  
John M. Maris ◽  
John Huberty ◽  
David V. Glidden ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Radiation Dose ◽  
Red Cells ◽  
Whole Body ◽  
High Dose ◽  
Hematologic Toxicity ◽  
Severe Thrombocytopenia ◽  
Hematopoietic Stem ◽  
Iodine 131 ◽  
Mibg Therapy

Purpose Iodine-131–metaiodobenzylguanidine (131I-MIBG) has been shown to be active against refractory neuroblastoma. The primary toxicity of 131I-MIBG is myelosuppression, which might necessitate autologous hematopoietic stem-cell transplantation (AHSCT). The goal of this study was to determine risk factors for myelosuppression and the need for AHSCT after 131I-MIBG treatment. Patients and Methods Fifty-three patients with refractory or relapsed neuroblastoma were treated with 18 mCi/kg 131I-MIBG on a phase I/II protocol. The median whole-body radiation dose was 2.92 Gy. Results Almost all patients required at least one platelet (96%) or red cell (91%) transfusion and most patients (79%) developed neutropenia (< 0.5 × 103/μL). Patients reached platelet nadir earlier than neutrophil nadir (P < .0001). Earlier platelet nadir correlated with bone marrow tumor, more extensive bone involvement, higher whole-body radiation dose, and longer time from diagnosis to 131I-MIBG therapy (P ≤ .04). In patients who did not require AHSCT, bone marrow disease predicted longer periods of neutropenia and platelet transfusion dependence (P ≤ .03). Nineteen patients (36%) received AHSCT for prolonged myelosuppression. Of patients who received AHSCT, 100% recovered neutrophils, 73% recovered red cells, and 60% recovered platelets. Failure to recover red cells or platelets correlated with higher whole-body radiation dose (P ≤ .04). Conclusion These results demonstrate the substantial hematotoxicity associated with high-dose 131I-MIBG therapy, with severe thrombocytopenia an early and nearly universal finding. Bone marrow tumor at time of treatment was the most useful predictor of hematotoxicity, whereas whole-body radiation dose was the most useful predictor of failure to recover platelets after AHSCT.

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