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Providing Low-cost, Tailored & Unique Services to Community Hospitals and Radiology Groups

The Dose Index Registry (DIR) is a powerful, flexible tool from which facilities can learn a great deal.  The most common use is to use the DIR’s dose comparison reports identify dose reduction opportunities:  Never before have facilities been able to identify dose reduction opportunities so easily.

But, there is so much more to glean from the DIR if facilities work with someone who understands how to take advantage of the DIR’s data.  In our opinion, too many facilities spend thousands of dollars each year unnecessarily to purchase expensive third-party solutions when the information is readily available from the DIR for free or at a very low cost.  This article will describe one example of the unique, low-cost analyses Dose Registries Support Services offers its clients as they work to lower doses, increase patient safety, and improve their CT services:  Protocol Use (or in this case) Misuse.

Protocol Misuse:  While reviewing one facility’s DIR data we noted they used two different protocols for RPID22- CT Head wo Contrast; their names were HEAD_WO and Head Kyphotic_ExtendedFOV.  The Head_WO protocol uses the standard field of view while the kyphotic protocol uses a larger field of view (up to 500mm).

In our experience it is common for facilities to use a larger field of view to accommodate kyphotic patients whose kyphosis does not allow them to be positioned at isocenter.  These are typically elderly people whose kyphosis is due to osteoporosis-related compression fractures.  In these cases, technologists often use a larger field of view to image the head which is located some distance above isocenter thereby requiring a larger field of view to image.  Most technologists then reprocess the images to a normal field of view prior to sending the images for interpretation.  While patient friendly and appropriate when warranted, a larger field of view can significantly decrease mage resolution, and should be employed only when necessary.  In our experience, the need to use this technique occurs in the low single digit percentage of the time in most community-based facilities.

Protocol Use ExampleWhat concerned us after performing this analysis was that the Kyphotic protocol was used an astounding 51% of the time at this single facility!  See Table 1.   We summarized our findings in our report to the department manager.  Upon investigation it was found that one technologist used the kyphotic protocol exclusively whether the patient was kyphotic or not, reprocessing the images to the smaller FOV prior to sending the images for interpretation.  This practice was quickly stopped.

One of my next articles will discuss what Charts 1 & 2 below signify.  Anyone care to guess about what they represent and what their trend lines suggest?   Hint, if you are not doing your quality checks, you should.


Dose Registry Support Services provides personalized, tailored dose support services to facilities and radiologists.  This story represents but one creative, propriety analysis Dose Registry Support Services brings to its clients – an approach not generally provided by other solutions.  To learn more about Dose Registry Support Services’ cost effective solutions and how we can help your department improve its CT services contact us or visit

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