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New Scanner Dose Review – A Unique DoseID Service

Generally speaking, today’s scanners are much more dose efficient than the ones they are replacing. When a site installs a new scanner I like to provide them with an overview of just how their doses changed so they can share their success within the institution.

One of my clients installed a new scanner a few months ago so I prepared my report for them. Their new scanner was imparting doses that were 30% to 80% lower than their previous scanner, depending upon the study group (RPID). That is, with the exception of one study – CT Brain. The doses for CT Brains were about 30% higher on the new scanner than they had been on the scanner they replaced. This seemed counter-intuitive to me so I decided to look into it a little further

My initial review found that CTDIvol was essentially identical between the two scanners. However, Total DLP was approximately 30% higher. The chart below plots both CTDIvol and Total DLP for CT Brain w/o Contrast studies for both the old scanner and the new scanner. Each dot represents a single study, and plots both the study’s CTDIvol and Total DLP. As you can see, the CTDIvol was consistent between scanners.  However, Total DLP was markedly higher on the new scanner.

CTDIvol essentially represents base scanner settings while DLP is based on CTDIvol, but then adds a scan length component (hence the name Dose Length Product).  Was it possible the protocol or some staff could be setting up the scans so they are scanning further (above and/or below) the desired area on the new scanner than they used to scan on the old one?  Were there other factors causing the increase?

To answer these question I ran the DIR’s Exam Detail Report which details the scan parameters of each irradiation event within a study, and includes data such as actual scan length, pitch factors used, kVp and scan rotation time.

The table below represents 3 studies from the old scanner in the top heavy-bordered section, and 3 studies from the new scanner in the lower heavy-bordered section. Each study is grouped using the same color-coding within each section.

The Exam Detail Report confirmed that the old and new scanner used approximately the same CTDIvol per study, but the new scanner’s Total DLP is approximately 30% higher than the scanner it replaced. It also showed that

  • The new scanner uses 3 irradiation events where the old scanner used 2 events
    • probably two scouts and one study acquisition event;
  • Scan length of the acquisition stage is longer on the new scanner;
  • Pitch is set to .625 on the new scanner (Spiral) and 1.0 on the old scanner (constant angle);
  • kVp is the same on both scanners; and,
  • Scan rotation is .75 seconds on the new scanner and 1 sec on the old scanner.

My role is not to recommend specific protocol changes. My role is to help facilities identify potential opportunities for dose reductions and point them in the right direction. To that end, I shared this information with the site so they could work with their radiologists, physicists, and application specialists to determine if there is an opportunity to reduce image dose while maintaining image quality. Perhaps the CT Brain protocol in use is the protocol this site wants and needs. But again, what struck me was that virtually ever other study group had significantly lower doses on the new scanner, except CT Brain. On that fact alone, I felt it was worth reviewing the exam details.

Given the information above, do you see a potential to reduce these doses? If so, where?

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Please keep Dose Registry Support Services in mind if you or your facility are looking for a low-cost, staff-friendly, and Joint Commission compliant dose monitoring solution. or more information visit www.doseregistry.com or email me by clicking here.  

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COVID-19 Impact Modeling Template for Radiology Groups and Imaging Centers

One of Radiology Executive’s primary responsibilities is to monitor and report on the financial health of their organizations. Given that many of imaging facilities and departments are ceasing to perform screening and other non-urgent imaging a Radiology group and Imaging Center cash flows could be seriously eroded. Some are reporting a 30% to 40% loss of volume, or more. Radiology executives should be modeling the near and mid-term impact these volume decreases have on cash flows at least through the end of the year. 

Historically, most community-based groups and physician owned imaging centers don’t retain a high level of cash reserves, which means they are exposed to sudden cash flow disruptions. Depending upon how long this COVID-19 related volume loss continues, Radiology groups and Imaging Centers could find themselves in a negative cash flow situation that erodes their cash reserves. 

Radiology groups and Imaging Centers need to take proactive steps to 1) understand the size of the potential impact; and 2) takes steps to ensure they have enough cash available to them to continue operations. 

I created a Cash Reserves Modeling template and am making it available here free of charge.

Click here to download. Instructions are included.

[A couple of people have asked if I provide consulting services to help them analyze their practice’s exposure. I am certainly willing to help in any way I am able. Click here to send me an email if you would like to discuss how I can help.]

The template allows users to estimate the impact anticipated revenue losses may have on group practices’ and imaging centers’ cash reserves across 5 different Scenarios. Users need to input historical revenues for both screening services and non-screening, historical expenses, and their current cash balance. The model allows users to enter different base loss percentages for Screening services (often 100% initially) and non-screening services (some are reporting up to a 30% to 40% loss in non-screening imaging services). The model uses varying “Recovery Rates” to create 5 different recovery Scenarios. Default recovery rates are provided. The template auto-calculates tables and a line chart based upon the variables entered.  

Please keep Dose Registry Support Services in mind if you or your facility are looking for a low-cost, staff-friendly, and Joint Commission compliant dose monitoring solution.

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DoseID: An affordable, effective, and staff friendly Dose Monitoring Solution

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 The Joint Commission’s requirements to create Expected Dose Ranges for every study and then identify individual exams that exceed their expected range; and, it does so with little daily impact on staff and without having to purchase an expensive third-party solution.

  • Does your current solution require you to pay large annual maintenance fees or have dedicated staff to operate it?
  • Is your current solution complex and difficult to use, often to the point it goes unused? 
  • Is department management and/or staff frustrated with your current solution? 
  • Is your department struggling to understand or meet the Joint Commission’s requirement 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? 
  • 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 one 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 DoseID 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 me by clicking here.  

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Free 2 CE course: “Using the DIR to Implement an Effective CT Dose Monitoring Program and Meet The Joint Commission’s Dose Incident Identification Requirements.”

I just published the FREE independent study course I wrote of earlier titled “Using the DIR to Implement an Effective CT Dose Monitoring Program and Meet The Joint Commission’s Dose Incident Identification Requirements. The course consists of a 100 minute video presentation followed by a 16 question exam.  Registered Radiologic Technologists successfully completing the course will earn 2 CE credits.  However, anyone interested may take the course without taking the exam.  The course is available at www.doseregistry.com

Click on the Course title in the Featured Course menu along the right border.

Note: Users wishing to enroll in the course should first create an account on the website, then login and enroll in the course.    

In this course, I share with you

  • Why dose monitoring is important;
  • 4 of the most useful DIR Reports and how to generate them, including the new Interactive reports;
  • Tips to make Exam Name mapping easier, including how to use the Bulk Mapping option;
  • Success stories others have had using this approach, which provides additional insight for using the DIR;
  • Advice on assigning User Roles; and,
  • How to use the DIR to meet TJC’s Dose Incident Requirement without the need for expensive third-party dose monitoring systems.

As you will hear, the Dose Index Registry is a powerful tool. We only need to understand how to use it and what it is telling us.  At the end of this course you will have enough information to implement an effective, low cost dose monitoring and optimization program at your facility.  My real objective is to have Radiologic Technologists BECOME LEADERS in dose reduction within their institution.  The success stories you will hear are technologist-generated success stories which, in many cases, were then broadly shared within their organizations. 

Please share this with your management and technical staff if they would like to learn more about how to use the Dose Index Registry to reduce CT doses and implement a low-cost, yet effective CT dose optimization program and/or meet TJC’s Dose Incident Identification requirements, or simply want free CE.  If  you are a member of a state chapter or national association feel free to share it with them as well.  The course if free for all. 

Sincerely,
Mike Bohl
Dose Registry Support Servicers
mbohl@doseregistry.com

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About the speaker:  Michael Bohl founded Dose Registry Support Services in 2015 to support Radiology Departments’ use of the Dose Index Registry to optimize doses and meet The Joint Commission’s mandate to identify and review Dose Incidents.  Mr. Bohl is a nationally recognized speaker and has extensive experience in radiology group, imaging center, and hospital management.  He has authored several articles, including an article titled Meeting The Joint Commission’s Dose Incident Identification and External Benchmarking Requirements Using the ACR’s Dose Index Registry published in the August 2016 edition of the Journal of the American College of Radiology.  For more information see Mr. Bohl’s LinkedIn profile, visit www.doseregistry.com, or email us by clicking here.

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Coming March 2nd: FREE 2 CE Course – Using the Dose Index Registry . . .

Just a quick note announcing a FREE independent study course Dose Registry Support Services is making available to anyone interested (beginning March 2, 2020).   The course is titled “Using the DIR to Implement an Effective CT Dose Monitoring Program and Meet The Joint Commission’s Dose Incident Identification Requirements.”  

The course is comprised of a 100 minute video presentation followed by a 16 question exam, and is approved by the ASRT for 2 CE credits. The course will be available at www.doseregistry.com on March 2nd.  Users should create an account on the website, then login and enroll in the course.    

Please share this with your management and/or technical staff if they are interested in the Dose Index Registry or simply want free CE. 

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About this course: In this course, we share with you

  • Why dose monitoring is important;
  • 4 of the most useful DIR Reports and how to generate them, including the new Interactive reports;
  • Tips to make Exam Name mapping easier, including how to use the Bulk Mapping option;
  • Success stories others have had using this approach, which provides additional insight for using the DIR;
  • Advice on assigning User Roles; and,
  • How to use the DIR to meet TJC’s Dose Incident Requirement without the need for expensive third-party dose monitoring systems.

About the speaker:  Mike Bohl founded Dose Registry Support Services in 2015 in order to support Radiology Departments’ use of the Dose Index Registry to optimize doses and meet The Joint Commission’s mandate to identify and review Dose Incidents.  Mr. Bohl is a nationally recognized speaker and has extensive experience in radiology group and imaging center management.  He has authored several articles, including an article titled Meeting The Joint Commission’s Dose Incident Identification and External Benchmarking Requirements Using the ACR’s Dose Index Registry published in the August 2016 edition of the Journal of the American College of Radiology.  For more information visit www.doseregistry.com, or email us by clicking here.

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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.