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Dose Registry Support Services: What we do and why you should consider using our services

Dose Registry Support Services is founded on two premises:

  1. Radiology departments should lead their facility’s dose reduction efforts;
  2. Facilities need and want effective solutions at a reasonable cost.

Our service is designed to achieve both.  I developed this service for a health system in the mid-west.  We enrolled some of their facilities in the DIR in 2013 and had excellent success reducing doses.

As the health system searched for solutions to TJC’s dose monitoring and incident identification requirements, it found plenty of companies willing to sell them very expensive solutions.  We heard stories then, and still do today, about how many of those same facilities struggled to use them.  Some have hired dedicated staff, increasing their costs even more.  That is all well and good, particularly if the facility is a large health system with significant resources.  However, that is not the world within which many of community-based facilities find themselves.  Most community-based facilities need and want effective solutions at a reasonable cost.  That is why I developed my program of using the facility’s DIR to do essentially the same thing.  This mid-west health system estimated that our DoseID program is saving them $80,000 to $100,000 per year.  And, best of all, it works well.

If you are unsatisfied with your current dose reduction efforts and/or dose monitoring platform, or your staff is challenged to understand and/or use the DIR, continue reading.  Dose Registry Support Services can provide you with a program that works and is tailored to your specific needs – a program that supports you and your staff, keeps radiology at the center of the dose reduction efforts within your organization, and is extremely cost-effective with no long-term commitments.

Best of all, there is nothing to purchase up front and no long-term commitments.  If you were to decide you no longer need our services, we simply stop.

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Dose Registry Support Services offers two distinct services:

  1. DIR support
    1. DIR set-up advice;
    2. Exam name mapping and maintenance; and/or
    3. Result review and recommendations.
  2. TJC compliance (Dose ID)
    1. Establishment of Expected Dose Ranges for every scanner protocol; and,
    2. Identification of Dose Incidents (e.g., identify studies that exceeded their expected range).

DIR support:  Our DIR support service (#1 above) is essentially an ala carte service – the client chooses what they would like Dose Registry Support Services to do for them and what it will do themselves.  Some facilities want Dose Registry Support Services to perform all DIR-related work, including mapping, remapping, and report review, while others may want to perform these tasks themselves, with us acting as advisors.

One of our goals is to teach local staff how to use the DIR so they can eventually perform the mappings and reviews after becoming comfortable with the process.  Some facilities find their staff needs some guidance initially, but as they become more comfortable they are able to perform some or all of the tasks themselves.  Others find it cost-effective to have us do most of the maintenance and initial review work.

Dose ID:  Our Dose ID service (#2 above) provides a turn-key solution for meeting TJC’s requirement to establish dose ranges for every protocol and then identify any study whose total dose exceeded its expected range.  We calculate expected ranges tailored to your facility by using your DIR data; expected ranges for TJC purposes are not based other facilities whose doses may have a completely different profile.  This means we calculate dose incidents that truly represent studies that are abnormally high for your facility.  The best part is that staff’s daily workflow remains unaltered.

Distance:  Distance is not an issue:  Our services can easily be provided remotely through email and video teleconferencing.  Having said that, if a facility would like to set up an on-site meeting initially, or meet semi-annually or annually, we are able to arrange it.

Contracts:  The best news is that there is nothing to purchase up front and no long-term commitments.  If you were to decide you no longer need our services, we simply stop.

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Dose Registry Support Services Success Stories

Here are recent examples of the successes two of our sites reported to their radiation safety committees.

This first example is a chart showing one facility’s average monthly Total DLP for its Chest Angio studies from early 2016 through Q1 2018.  Overall, this site reduced its average Total DLP for its Chest Angio studies by 38%.  Note the stepwise dose reduction.

chestangio

The second example shows how another site reduced its Total CTDIvol for Routine Neck studies by 67%.  Each point in the chart below represents an actual study.  Perhaps even more striking is the remarkable reduction in inter-study variability in recorded Total CTDIvol.

routineneck

Unlike some other dose monitoring and reduction solutions that are confusing and complicated to use, and leave you largely on your own after installation, Dose Registry Support Services works directly and personally with staff to identify and investigate dose reduction opportunities on an ongoing basis; and we do so at only 10% to 15% of the cost of many third-party solutions.  Also our service does not require the facility to add staff or devote a partial (or full) FTE.

Additionally, because we work in a collaborative fashion with the facility’s staff, radiology department staff remain involved in the process, learn from their involvement, and are able to take (and own) these successes to the safety committee.  In short, ours is more of a service that works with you and your staff than a product – a service that works with you and your staff to reduce CT doses.

If you are considering purchasing a third-party solution, or if the solution you purchased is sitting unused in the corner because it is overly complex, you may want to consider having us help you.  We make you better.

Michael Bohl, Owner and CEO

 

 

 

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TJC Dose Monitoring Requirements: XR-29 Dose Notifications Don’t Meet Them

When the facility I was working with was exploring using their scanners’ XR-29 Notifications to meet PI 02.01.01.A6 Dose Incident Identification requirements we reviewed the technical elements underpinning XR-29’s Dose Check feature.  After reading them we grew very concerned that XR-29’s dose notifications would not meet TJC’s requirement.  The facility submitted a question to TJC asking about this specific issue.  We were correct to be concerned; TJC’s response indicated XR-29 Dose Notifications don’t meet the requirements.  Here is a copy of their response:

 tjcxr29response

TJC requires facilities establish the expected total dose ranges (CTDIvol, DLP, or SSDE) for each protocol and then test the actual total dose imparted after the exam has been completed to the protocol’s expected total.  The total is across all irradiation events;  this includes the sum of the pre-monitoring, bolus tracking, and then actual scan series dose values.  In the image below that equates to the Total DLP at the top of the image or the sum of the doses listed in the CTDIvol values column. 

Dose Page

There are several ways of complying with TJC’s dose incident identification requirements, some expensive, some free or nearly so. 

You may get lucky and have TJC auditors that don’t yet understand the technical aspects of dose monitoring.  However, this facility did not want to take that chance.  Dose Registry Support Services can provide facilities with a very low-cost, fully TJC compliant program using your DIR data and avoid the expense of purchasing and then operating a third-party software solution. 

 

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Dose Index Registry Exam Name Mapping Made Easy – On Sale

Reviewing existing exam name RPID mapping assignments is one of the most important Dose Index Registry® (DIR) maintenance tasks facilities should routinely perform. IncorrecBookcovertly mapped studies can result in misleading and/or incorrect Aggregate and Standardized Dose Reports. This guide is written to provide the reader with an easy method of validating your RPID mappings and identifying potentially incorrectly mapped studies for correction using the DIR’s bulk editing feature.  Includes step by step instructions.

The paperback is on sale at Amazon.com for $7.27.

Click here for more information.

www.doseregistry.com

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Announcing the Dose Index Registry® Support Services LinkedIn Group

I am renaming and repurposing my LinkedIn radiology management group to concentrate on supporting use of the ACR’s Dose Index Registry ® rather than a general radiology business forum. The new group is named “Dose Index Registry Support Services.” 

If you are a LinkedIn member and would like to join the new group enter Dose Registry Support Services in the search box.  You should see the group listed in the search query. 

Dose Registry Support Services is committed to providing the most cost efficient support available supporting facilities monitor and reduce their CT doses.  In many cases we can save facilities $60,000 to $100,000 or more each year, compared to some other third party-solutions.  

If you are struggling to implement an effective dose monitoring and dose reduction solution, please contact Dose Registry Support Services.   

Sincerely,
Michael Bohl
mbohl@doseregistry.com

Dose Registry Support Services
www.doseregistry.com

* Please note that the Dose Index Registry® Support Services LinkedIn group is not affiliated with or moderated by the American College of Radiology. Dose Index Registry® is a registered trademark of the American College of Radiology.

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CTDIvol vs DLP – a simple explanation

What do they represent? CTDIvol is based on measurements obtained when scanning either a 16cm or 32 cm phantom.   Essentially, it represents scanner output.  DLP is derived from CTDIvol, but incorporates a scan length component.  Both function as reasonable proxies for absorbed dose but do not represent the actual patient dose.  In other words, if your CTDIvol and/or DLP is twice as high as it could be, then the doses you are imparting will be about twice as high as they could be.

Can CTDIvol and DLP results tell me two different things?     Yes.  CTDIvol represents the output when scanning a phantom, while DLP takes into account the scan length.  We’ve seen instances where CTIDvol is considered well within a “normal” range but DLP was unexpectedly high.  We found the scan settings were appropriate for the study, but the exam length  was longer than what others were using.

For example, a Chest CT could be started too high into the neck and end too far into the abdomen.  If this is the case CTDIvol (basic scanner settings) could be just fine, but because scans extended more than necessary above and/or below the requested area, the DLP could easily be too high.

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The following information, obtained from RadDaily.com, is a more technical discussion of CTDIvol and DLP for those interested.

The following is taken from an article posted on RadDaily.com

CT Dose Index Volume (CTDIvol) The CTDIvol can be calculated as: CTDIvol = [(N x T)/I] x CTDIw where CTDIw = weighted or average CTDI given across the field of view N = number of simultaneous axial scans er x-ray source rotation T = thickness of one axial scan (mm) I = table increment per axial scan (mm)

In helical CT the ratio of the I to (N x T) is the pitch; therefore in helical mode:  CTDIvol = (1/pitch) x CTDIw

CTDIvol (or CTDI volume) represents the dose for a specific scan protocol which takes into account gaps and overlaps between the radiation dose profile from consecutive rotations of the x-ray source. Therefore CTDIw represents the average radiation dose over the x and y direction whereas CTDIvol represents the average radiation dose over the x, y and z directions.

Dose Length Product The dose length product (DLP) is the measure of ionizing radiation exposure during the entire acquisition of images.

Therefore, DLP (mGy-cm) = CTDIvol (mGy) x irradiated length (cm) (irradiated length is usually longer than imaged length in helical scanning)

CTDIw and CTDIvol are independent of scan length for determining the total energy absorbed whereas DLP is proportional to scan length.


Need help getting more from your participation in the ACR’s Dose Index Registry® ?  Let Dose Registry Support Services tailor a program designed specifically to help your department succeed.  Contact Dose Registry Support Services to see how we can help.

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DoseID helps facilities identify duplicate and superfluous scanner protocols

One of the more interesting and unique benefits Dose Registry Support Services’ DoseID Program has for facilities is its ability to shed light on duplicate and superfluous protocols in use at their facilities.  DuplicatedProtocols

The table to the right shows how one facility had 7 different protocols being used on a single scanner during a recent 3 month period.  As you can see, all protocols are purportedly for a CT Abdomen/Pelvis without contrast exam, yet they are used with significantly varying frequency.  One is used by staff 714 (79%) of the 903 without contrast studies performed, yet 2 were used just under 40 times and 3 were used five or fewer times.  One has to question why these protocols exist and on what basis is staff choosing the infrequently used protocols.

This creates several issues, from hanging protocols in PACS to patient safety issues.  For example, when it is time to alter the protocol will whomever is updating the scanner parameters really change all 7 protocols?  This is important as facilities review their Dose reports and begin to make protocols changes to lower patient doses.

This is a widely recognized issue within the industry.  In its 2016-2017 development cycle Integrating the Healthcare Enterprise (IHE) is developing a new profile titled Enterprise Scanner Protocol Management to address this very issue.  Click here for more information on IHE’s initiative.

The good news is that because of the information contained in our reports, we are able to help them identify and eliminate duplicate and superfluous scanner protocols.


Need help getting more from your participation in the ACR’s Dose Index Registry® ?  Let Dose Registry Support Services tailor a program designed specifically to help your department succeed.  Contact Dose Registry Support Services to see how we can help.

 

 

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Joint Commission Confirms Facilities Need an Expected Dose Range for All CT Protocols; Note to Self: XR-29 Does NOT Equal TJC Compliance

The following question was submitted to the Joint Commission:

Must we establish an expected dose range for every imaging protocol or can we pick and choose the protocols for which we establish expected dose ranges and monitor only those? I interpret [PI.02.01.01.A.6.] to require monitoring of every protocol we use, not just some portion of them.

The Joint Commission response:

All protocols need to have an expected dose index range included. For protocols that are of similar anatomical areas, I have suggested that a general range (like the AAPM alert levels or ACR Pass/Fail levels) be used. As data is collected, analyzed and benchmarked then the expected dose index range can be refined.

Associate Director Standards Interpretation Group, Standards Interpretation Division of Healthcare Improvement Group The Joint Commission

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Dose Registry Support Services Discussion: The reason we asked this question is to confirm my suspicion that XR-29, by itself, does not meet TJC’s dose incident identification requirement UNLESS facilities enter a dose range for every protocol they use, AND THEN have the ability to check the dose threshold UPON COMPLETION of the exam, which is much different than the XR-29 which often only test a subset of protocols and issues pre-scan alerts or notifications. Additionally, most XR-29 solutions do not establish a lower threshold in the system.  By definition, a “range” requires both an upper and lower threshold.  This was also confirmed with TJC during RSNA.  In summary, be very careful if you plan to depend solely on your scanner’s XR-29 capabilities to meet TJC’s Dose Incident Identification requirements.  It may not be set up to test doses on every protocol you use.

We have developed an effective, low cost solution for establishing both an upper and lower threshold dose range as well as identifying “dose Incidents” in which an exam exceeded the threshold.  The only requirement:  Participation in the ACR’s Dose Index Registry.  Contact us to learn more.