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16 facilities (and growing) have made the switch

Lots of interest on our DoseID service at RSNA19, particularly from the physicist community who too often see their clients struggling to implement an effective program and/or have purchased expensive third-party systems that are, for all practical purposes, sitting on the shelf. The ACR’s DIR is all you need, and its (nearly) free. Contact me if you recognize yourself in the previous statement or want to learn how to leverage the DIR to implement an effective and Joint Commission compliant CT dose program. #JCAHO #ct

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Dose Registry Support Services Client Comment

I received this compliment from one of our client’s radiology managers this morning. “Thanks for all the information on this Mike.  I appreciate it!  I think this program is working well and has yielded some great dose reduction opportunities so far.  I also reviewed our dose incidents thoroughly with the JC physician surveyor recently and went really well.  I’m thinking it’s about time for us to schedule the next DIR work-group meeting as well.  Have a great weekend!”  Radiology Dept. Manager This multi-hospital health system was prepared to purchase a third-party platform at an annual cost across the system of between $80k to $100k each year. Instead, they are using our service which costs them less than 10% of what they nearly spent, and that is for all of the hospitals within their system. This means that, collectively, the health system is saving between $70k and $90k each year! Yet, they are have been able to make significant improvements reducing CT doses. If your facility is struggling to use your dose monitoring solution, or only using it to meet the Joint Commission’s Dose Incident reporting requirement, you are spending too much and/or getting too little. Dose Registry Support Services leverages your participation in the ACR’s Dose Index Registry to provide a comprehensive, joint commission compliant, and easy to understand dose optimization program.

Contact us to learn how we can lower your costs.  If you are attending RSNA and would like to meet at some point that week, let me know.

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NRDR DIR Report Format Change Webinar

Effective this reporting cycle (Q3 2019), the DIR changed its report formats. As of October, 2019 the quarterly DIR Aggregate Excel reports we have become accustomed to will no longer be produced. These reports will be replaced by data that is currently available in the corresponding Interactive Aggregate Reports. The DIR held a webinar October 29th describing the changes and giving an introduction on how to use the new reports. Here is a link to a recording of that webinar: Oct 29, 2019 ACR Dose Index Registry Webinar.

As we’ve written in other posts, we believe these are positive changes: The new Tableau-based reports have advantages that the fixed, hard-copy Excel worksheets did not have. Having used the Interactive Reports for some time now, we find them incredibly useful, but they are not without a learning curve.

The challenge: The new report format requires facilities to self-generate much of the information that was previously provided in the fixed report. Based on my experience, some facilities may find having to self-generate some of the reports inconvenient and somewhat confusing, at least without some guidance.

The first step for facilities to make this as easy as possible is to view the webinar at the link above. After that, if you are still finding it challenging, feel free to contact us. Dose Registry Support Services are here to help make the DIR simple to use and understand; and, we can do so at a fraction of the cost of the more expensive third-party applications (which themselves are complex and difficult to use and understand).

In our opinion, the DIR is one of the last, best bargains in healthcare. We’re here to help you make the most of it. If you are attending RSNA and would like to schedule a meeting, or if you would like to speak with us, send an email by clicking here: Dose Registry Support Services.

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Dose Reduction Success Stories

I want to share some exciting information concerning one of our client’s dose reduction successes. I recently completed an analysis of this site’s doses (Total CTDIvol) from 2013 through YTD 2019. This is interesting because during this time period the equipment did not change.

The chart below illustrates what can be accomplished using the ACR’s Dose Index Registry to lower doses over time. The blue column represents the baseline – the average Total CTDIvol for that RPID in 2013, the site’s first year it participated in the DIR. Each column to the right represents the average Total CTDIvol for each subsequent year for that RPID through Q3 2019.

Dose Reduction Successes: The first two sets of columns above show that this client, with our help, has reduced their average Total CTDIvol for their CT Chest studies in 2019 to less than 80% of what it was in 2013, and its average Total CTDIvol for their CT Brain w/o contrast studies in 2019 to about 60% of what they it was in 2013. The chart also shows that their average Total CTDIvol for their CT Neck, Aorta w/ Lower Extremity Angio, Lower Extremity w/o contrast, and IAC studies in 2019 are about 45%, 55%, 40%, and 50% lower, respectively, than they were in 2013. Overall, when reviewing the entirety of the work done at this site each year, the average Total CTDIvol per study in 2019 is about 75% of what it was in 2013.

This chart also illustrates the continuing focus this site placed on this project. Note that, with the exception of the CT Neck, most studies’ Total CTDIvol were reduced gradually. This is illustrative of the site’s continued and long term focus on dose reduction: The management and staff didn’t just look at the process as “one and done;” they looked at this as a long-term process, and continued to look for ways to optimize their doses.

In the end, this is their department’s success story. Using this information, the site is able to show that the radiology department is taking the lead on an important patient safety initiative, and get the recognition they deserve within their institution. Dose Registry Support’s role in this was not to do this work for them: Our role was to help staff understand the DIR, identify where the dose reduction opportunities were, and to point them in the right direction. At the end of the day, this process must be lead by the staff and management on site, working with their radiologists and medical physicists, in order to be successful. Without department/staff leadership, it can’t succeed.

If your site is struggling to use the DIR, Dose Registry Support Services can help. We can make the DIR easy and understandable, and do so at a very low cost. While nothing guarantees success – we are confident we can help those who are motivated and want to succeed.

Contact us for more information. If you are attending RSNA 2019 and would like to meet and discuss our services, we can do so.

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DIR Webinar Describing Dose Reporting Format Changes

Webinar: The DIR is hosting a webinar at 1:00 p.m. CDT on the 29th to review their new reporting formats. Dose Registry Support Services encourages DIR facilities to register for this webinar by clicking on the following link: https://attendee.gotowebinar.com/register/2608624724178001666

Details: Effective this reporting period, the NRDR has significantly changed the dose monitoring reports it provides to their enrolled facilities: The NRDR has replaced the hard-copy, color-coded Excel Aggregate Reports with a corresponding set of Interactive Aggregate Reports. The new, Tableau-based, Interactive Aggregate reports offers facilities unprecedented near real time and flexible access to their data in ways the fixed, hard-copy Excel worksheets simply could not.  These changes will alter the general nature of what facilities receive directly from the DIR and what facilities will be responsible for generating themselves.

Dose Registry Support Services believes these are positive changes: The new Tableau-based reports have advantages that the fixed, hard-copy Excel worksheets did not have (albeit the hard-copy reports were easy to understand and use).  Having used the Interactive Reports for some time now, we find them incredibly useful, but they are not without a learning curve.

The challenge: The new report format requires facilities to self-generate some of the reports the most useful reports that were previously compiled and sent directly to them. Some facilities may find having to self-generate some of the reports inconvenient and somewhat confusing, at least without some guidance.

Webinar: To that end, the DIR is hosting a webinar at 1:00 p.m. CDT on the 29th to review the new reports.  Dose Registry Support Services encourages its clients, customers, and friends to register and attend the webinar, by clicking on the link in the first paragraph above.

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Dose Registry Support Services: Are you looking for a CT Dose Monitoring solution or frustrated by the complexity of your current solution? Is your current solution confusing to the point of non-use? If so, please consider DoseID.

DoseID is an affordable, turn-key CT Dose Monitoring service for hospitals, health systems, imaging centers, and physician practices. Our DoseID service leverages your participation in the ACR’s Dose Index Registry to comply with TJC’s mandate to create Expected Dose Ranges for every study the identifies individual exams that exceed their expected range, and it does so with little daily impact on staff and without having to purchase more expensive third-party solutions.

  • Is your department struggling to understand or meet the Joint Commission’s requirement PI.02.01.01 requiring facilities to establish expected dose ranges for every CT exam, identify studies that exceeded the upper threshold, and then review and analyze CT dose incidents – incidents when the actual total dose exceeded your facility’s dose threshold for that exam? 
  • Did your facility purchase an expensive third-party platform only to discover it is too complex and difficult to use, often to the point it goes unused? 
  • If your facility purchased a third-party platform did it have to hire dedicated staff just to use it, or are you struggling to keep staff trained to use it?
  • Is your department still trying to meet this requirement on your own, but finding it difficult and time consuming? 
  • Is department management and/or staff frustrated with your current solution? 
  • Is your facility spending more than $4,000 per year?
  • Would you like a less expensive solution that actually provides you with actionable information your staff can use?

If you answered “yes” to any of the above questions take a look at our DoseID program.  We provide a yearly service at a cost less than many facilities spend in 1 to 3 months on other solutions, and we do most of the work for you.  No hardware or software to purchase; no upfront costs; and, no  long-term commitments. 

Our DoseID program is one of the most cost-effective and user-friendly CT dose optimization programs available designed to meet the Joint Commission’s dose incident identification requirements. 

We are able to do this because we leverage your participation in the ACR’s Dose Index Registry.   The DIR is a powerful tool, yet many facilities fail to grasp its utility or take advantage of it.  We help you leverage your participation in it to optimize your doses and meet TJC’s requirements, and do so at a fraction of the cost of other programs.   

Don’t misunderstand – the expensive third-party platforms are wonderful products, particularly for health systems with large budgets and the staff to use them.  I would never discourage anyone from purchasing them if they have the resources to purchase and use them. However, that is not the world many small to mid-sized community hospitals find themselves in today.  DoseID is designed to meet the needs of facilities that want an effective program, but one which is also affordable and easy to implement and understand.   

Our service requires no up-front costs, no hardware or software to buy, and there are no annual maintenance or support fees to pay. Because this is a service, we do the work for you and work directly with staff to identify dose reduction opportunities. Simple, but very effective. Click here to see what our customers are saying.

For more information visit www.doseregistry.com or email us by clicking here

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DoseID – Affordable Joint Commission Compliant CT Dose Monitoring Solution

Are you looking for a CT Dose Monitoring solution or frustrated by the complexity of your current solution? Is your current solution confusing to the point of non-use? If so, please consider DoseID.

DoseID is an affordable, turn-key CT Dose Monitoring service for hospitals, health systems, imaging centers, and physician practices. Our DoseID service leverages your participation in the ACR’s Dose Index Registry to comply with TJC’s mandate to create Expected Dose Ranges for every study the identifies individual exams that exceed their expected range, and it does so with little daily impact on staff and without having to purchase more expensive third-party solutions.

  • Is your department struggling to understand or meet the Joint Commission’s requirement PI.02.01.01 requiring facilities to establish expected dose ranges for every CT exam, identify studies that exceeded the upper threshold, and then review and analyze CT dose incidents – incidents when the actual total dose exceeded your facility’s dose threshold for that exam? 
  • Did your facility purchase an expensive third-party platform only to discover it is too complex and difficult to use, often to the point it goes unused? 
  • If your facility purchased a third-party platform did it have to hire dedicated staff just to use it, or are you struggling to keep staff trained to use it?
  • Is your department still trying to meet this requirement on your own, but finding it difficult and time consuming? 
  • Is department management and/or staff frustrated with your current solution? 
  • Is your facility spending more than $4,000 per year?
  • Would you like a less expensive solution that actually provides you with actionable information your staff can use?

If you answered “yes” to any of the above questions take a look at our DoseID program.  We provide a yearly service at a cost less than many facilities spend in 1 to 3 months on other solutions, and we do most of the work for you.  No hardware or software to purchase; no upfront costs; and, no  long-term commitments. 

Our DoseID program is one of the most cost-effective and user-friendly CT dose optimization programs available designed to meet the Joint Commission’s dose incident identification requirements. 

We are able to do this because we leverage your participation in the ACR’s Dose Index Registry.   The DIR is a powerful tool, yet many facilities fail to grasp its utility or take advantage of it.  We help you leverage your participation in it to optimize your doses and meet TJC’s requirements, and do so at a fraction of the cost of other programs.   

Don’t misunderstand – the expensive third-party platforms are wonderful products, particularly for health systems with large budgets and the staff to use them.  I would never discourage anyone from purchasing them if they have the resources to purchase and use them. However, that is not the world many small to mid-sized community hospitals find themselves in today.  DoseID is designed to meet the needs of facilities that want an effective program, but one which is also affordable and easy to implement and understand.   

Our service requires no up-front costs, no hardware or software to buy, and there are no annual maintenance or support fees to pay. Because this is a service, we do the work for you and work directly with staff to identify dose reduction opportunities. Simple, but very effective. Click here to see what our customers are saying.

For more information visit www.doseregistry.com or email us by clicking here

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Important Announcements Concerning the Dose Index Registry – Please Read If You Use the DIR

The NRDR has announced 3 important changes to the DIR

  1. The DIR is dropping support of Secondary Capture images as a means for cataloging doses and will accept only Radiation Dose Structured Reports (RDSRs) at some point in the near future;
  2. The DIR is retiring the following 3 Operational Reports and will, instead, make this information available in a recently added set of Interactive Reports due for release in July, 2019; and,
  3.  The DIR is hosting a webinar to  review the new Interactive Reports on June 27, 2019.

I have included the NRDR’s email announcing each change at the end of this email.   

Secondary Capture Discussion:

The first email copied below was sent to a facility which is currently using a CT platform which is not sending RDSRs to report doses, but is sending Secondary Capture images instead.  As you will see, the email asks that facilities switch to RDSRs by September 3, 2019.  It adds that scanners which send Secondary Capture Images in addition to RDSRs may continue to send secondary capture images, they just won’t be used. 

If your scanner is natively XR-29 compliant you should (or are able to be) sending RDSRs.  If your scanner is not XR-29 compliant and/or you purchased a third-party solution to achieve XR-29 compliance, you should speak your system’s service engineers and/or your third-party solution support desk as to whether or not you can send RDSRs. 

As the NRDR wrote in its email below, if you have barriers to sending RDSRs (MB: Or if you just have questions) they are happy to work with you.  Simply contact the National Radiology Data Registry support team at nrdrsupport@acr.org for assistance.  I’ve had many occasions to work with the Help Desk and have always found them very professional and helpful. 

Retiring of 3 Operational Reports and the Addition of several Interactive Reports

The second email copied below is the NRDR’s announcement of several reporting changes, specifically the retiring of the following Operational Reports:

  1. Dose Information by Exam;
  2. CTDIvol Over Time; and,
  3. Summary of Data Submitted.

These will be replaced by the following Interactive Reports

  1. CT Standardized Dose Index Reports: Exam Search
  2. CTDIvol Standardized Dose Index Reports: Scatterplot Over Time; and,
  3. CT Summary of Data Submitted.

I’ve used all three Operational Reports as well as their new Interactive Report counterparts and have found the new Interactive Reports superior to their older counterparts.  While change generally requires a learning curve, this learning curve is fairly short and intuitive.  One of the main benefits of the new reports is that they provide much more flexibility to design the report and obtain either overall or the limited data sets you are interested in reviewing on demand – by facility, by scanner, by RPID, by Exam Name, by data, etc.  Give it a try and spend an hour or so testing it out – I think you’ll like it. 

Interactive Report Webinar 

The third email below is the announcement of a webinar to review the new Interactive Report features.  The webinar, titled New DIR CT Interactive Reports Webinar, is scheduled for Jun 27, 2019 1:30 PM EDT.  Click here to register.

————————- NRDR Emails ————————-

Ending of Support for DIR Secondary Capture Email

Dear DIR Participant,

Thank you for your ongoing participation in the American College of Radiology’s (ACR) Dose Index Registry (DIR).  Your participation in the registry not only affects quality improvement at your own facility, but also establishes benchmarks that other facilities use for performance comparison and ultimately to reduce unnecessary patient radiation exposure across all participant sites. 

When we launched the DIR in 2011 few CT scanners were capable of generating Radiation Dose Structured Reports (RDSRs).  Therefore, we accepted exams directly from a RDSR as well as from secondary capture images (without RDSR).  In the years since the registry launch, and with the implementation of the XR-29 standard on CT scanners, most scanners submitting DIR data are now capable of producing RDSRs.  In addition, the secondary capture method has proven to be less effective than RDSR in terms of data quality, information processing time, and resource support requirements.  In response to the industry technology changes, and to the overall limitations of secondary capture, we would like to transition DIR support to RDSR submission only.  Consequently, we are requesting that all sites shift submission of all of their registry data to the RDSR format as soon as possible. 

Your site is one of several identified as sending secondary capture images without RDSRs in the past three months.  As such, we ask that you switch over to RDSR transmission by September 3, 2019.  Though we would prefer to receive the RDSR message exclusively, we can accept an accompanying secondary capture (it will not be processed) in the event your system mandates sending both. 

The continued success of the Dose Index Registry and the resulting improvement in radiological quality is dependent on active participation by sites such as yours.  We realize that making this change may result in modifications to your processes/systems with potential effort required by you.  ACR thanks you in advance for your willingness to consider this change.  If you have barriers to sending the RDSR we will be more than happy to work with you in an attempt to overcome these issues.  Please contact the National Radiology Data Registry support team at nrdrsupport@acr.org for assistance.

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Retiring of 3 Operational Reports and Addition of new Interactive Reports Email

Dear DIR User,

 In the beginning of July we will be retiring the following DIR Operational Reports: Dose Information by Exam, CTDIvol Over Time, and Summary of Data Submitted.  The same content in the Operational Report can be found in a corresponding Interactive Report. 

 Operational Report Interactive Report
Dose Information by Exam CT Standardized Dose Index Reports: Exam Search
CTDlvol Over Time CT Standardized Dose Index Reports: Scatterplot Over Time
Summary of Data Submitted CT Summary of Data Submitted

We have implemented Interactive Reports which allows users to query, filter, and navigate through data to identify patterns and gain insights on their data.  During the next few weeks, we encourage you to familiarize yourself with the Interactive Reports.  Included at the end of the email are links to articles outlining the use and content of these Interactive Reports.  We are also available at nrdrsupport@acr.org to answer any questions you may have about the reports.

DIR Interactive Reports

CT Standardized Dose Index Reports: Exam Search

CT Standardized Dose Index Reports: Scatterplot Over Time

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Webinar to Discuss New Interactive Reports Email

Dear DIR Participants,

 Please register for New DIR CT Interactive Reports Webinar on Jun 27, 2019 1:30 PM EDT at:

https://attendee.gotowebinar.com/register/4707038265377226754  

Our upcoming webinar will focus on the next set of Interactive Reports for the Dose Index Registry due for release in July, 2019. These reports will allow users to quickly identify which exam Short Names are outliers (compared to the entire registry) and drill-down to see both individual exams and long-term data trends. We’ll also cover new reports for downloading data in a format similar to the existing quarterly Excel reports.

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Joint Commission Annual Fluoro Training Requirements May Be Rescinded Soon

Thought you might find this interesting.  This was sent to me earlier today.  Looks like TJC will soon announce they are rescinding the annual fluoroscopy education requirements. Stay tuned!

Michael Bohl
Dose Registry Support Services

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Sent: Thursday, June 13, 2019 12:48 PM
To: Michael Bohl

Subject: TJC fluoro training

From a recent release:

(To be published in the August 2019 Perspectives)

Effective immediately, The Joint Commission is deleting Standard HR.01.05.03, element of performance (EP) 15 from the Ambulatory Care, Critical Access Hospital, Hospital, and Office-Based Surgery programs.

For reference, the text of the deleted EP is as follows:

Standard HR.01.05.03, EP 15: The  verifies and documents that individuals (including physicians, non-physicians, and ancillary personnel) who use fluoroscopic equipment participate in ongoing education that includes annual training on the following: 
 – Radiation dose optimization techniques and tools for pediatric and adult patients addressed in the Image Gently® and Image Wisely® campaigns 
 – Safe procedures for operation of the types of fluoroscopy equipment they will use 
 Note 1: Information on the Image Gently and Image Wisely initiatives can be found online at http://www.imagegently.organd http://www.imagewisely.org
 Note 2: This element of performance does not apply to fluoroscopy equipment used for therapeutic radiation treatment planning or delivery.

Since the launch of HR.01.05.03, EP 15 on January 1, 2019, The Joint Commission has determined through stakeholder and customer feedback that this requirement is redundant to other accreditation requirements and would be burdensome to conform with annually. Therefore, an annual training requirement will not be required, and an  assessment of staff and physician competency to provide fluoroscopy services will continue to be assessed during the on-site survey using accreditation standards that currently exist in the “Human Resources” and “Medical Staff” chapters.

This deletion will be posted on The Joint Commission website at https://www.jointcommission.org/standards_information/prepublication_standards.aspx. It will no longer be part of the Comprehensive Accreditation Manuals for the above programs as of the January 2020 E-dition® update and January 2020 hard copy publications.  

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Over 800 People Have Taken Our Free Fluoroscopy Training Course; Now Try Our DoseID Program

As of this week, since its publication in December, 2018 over 800 people have taken our free Fluoroscopic Dose Optimization: Tools and Techniques for Pediatric and Adult Patients course and received their certificate of completion.  This course is designed to meet The Joint Commission’s annual education training requirements for fluoroscopy users. If you or your staff took advantage of this, thanks, and I hope you found it useful. 

If you found our Fluoroscopy training course useful, you may want to take a look at our Joint Commission-compliant CT Dose Incident identification program – DoseID – a program designed to meet The Joint Commission’s requirement to identify dose incidents.

  • Is your department struggling to understand or meet the Joint Commission’s requirement PI.02.01.01 which requires facilities to
    • Establish expected dose ranges for every CT exam;
    • Identify studies that exceeded the upper threshold;
    • Review and analyze CT dose incidents – incidents when the actual total dose exceeded your facility’s dose threshold for that exam; and then,
    • Compare your dose incidents to an external benchmark? 
  • Did your facility purchase an expensive third-party platform only to discover it is too complex and difficult to use, often to the point it goes unused? 
  • If your facility purchased a third-party platform, did it have to hire dedicated staff just to use it, or are you struggling to keep staff trained on how to use it?
  • Is your department still trying to meet this requirement on your own, but finding it difficult and time consuming? 
  • Are your department managers and/or staff frustrated? 
  • Is your facility spending more than $4,000 per year?
  • Would you like a less expensive solution that actually provides you with actionable information your staff can use?

If you answered “yes” to any of the above questions take a look at Dose Registry Support Service’s DoseID program.  We provide a yearly service at a cost less than many facilities spend in 1 to 3 months on other solutions, and we do most of the work for you.  No hardware or software to purchase; no up front costs; and, no  long-term commitments. 

Our DoseID program is one of the most cost-effective and user-friendly CT dose optimization programs available designed to meet the Joint Commission’s dose incident identification requirements. 

We are able to do this because we leverage your participation in the ACR’s Dose Index Registry.   The DIR is a powerful tool, yet many facilities fail to grasp its utility or take advantage of it.  We help you leverage your participation in it to optimize your doses and meet TJC’s requirements, and do so at a fraction of the cost of other programs.   

Don’t misunderstand – the other third-party platforms are wonderful products, particularly for health systems with large budgets and the staff to use them.  We would never discourage any facility from purchasing one if they have the resources to do so.  However, that is not the world many small to mid-sized community hospitals find themselves in today.  We designed our product to meet the needs of facilities that want an effective program, but one which is also affordable and easy to implement and understand.   If this describes your facility, we may just be the solution you need.

Our service requires no up-front costs, no hardware or software to buy, and there are no annual maintenance or support fees to pay. Because this is a service, we do the work for you and work directly with staff to identify dose reduction opportunities. Simple, but very effective. Our customers will tell you exactly how well this is working for them.

For more information visit www.doseregistry.com or email us by clicking here

Michael Bohl, Founder & CEO
Dose Registry Support Services

 Bohl Radiologic Technologist Scholarship Fund
Mercy College of Health Sciences, Des Moines, IA
Please consider a donation – all donations matched 100%, doubling the impact

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Free Course: Fluoroscopic Dose Optimization: Tools and Techniques for Pediatric and Adult Patients

I created a course titled “Fluoroscopic Dose Optimization: Tools and Techniques for Pediatric and Adult Patient” and am making it available to anyone wishing to use it for free. The course is designed to meet The Joint Commission’s annual training requirement for physicians and technologists.

It covers and/or provides links to the following information:

• Radiation dose optimization techniques and tools for pediatric and adult patients addressed in the Image Gently® campaign; and,

• Safe procedures for operation of the types of fluoroscopy equipment they use.

Upon completion of this course the participant will receive a certificate of annual training for Joint Commission verification purposes.

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CT Dose Monitoring:  Are you frustrated by your current CT Dose Monitoring system? Is it difficult or hard to use? Dose Registry Support Services makes dose monitoring understandable and easy. We leverage your participation in the Dose Index Registry (DIR) to provide a cost effective, comprehensive and Joint Commission compliant dose program. No hardware or software to buy, no long-term commitments, and for the most part, we do the work for you and provide you with the information you need. Most facilities pay less than $5,000 per year, but derive benefits far in excess to what they are currently receiving from much more expensive systems. We make dose monitoring understandable and easy.