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DIR Corporate-level Aggregate Report Update

The DIR is working to restore Corporate-level reports.

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Previously, the NRDR announced several changes to its portal effective August 18, 2018.  The changes included:

  • Changes to the organizational structure;
    • e.g., Master/Child accounts;
  • Adding a new user type – Service User;
  • Introduced a new pricing option for limited;
    • i.e., single registry enrollment vs. multiple registry enrollment;
  • Simplified the new facility application workflow; and,
  • Several other important changes.

Click on the link above to read the announcement and details.

I want to draw your attention to a couple of specific changes the NRDR made to the Dose Index Registry specifically.

  • The DIR report menu has new submenus for Interactive Reports which provide some new and interesting functionalities, including Tableau reports; and,
  • With the exception of CTDIvol Boxplot reports, all Operational Reports remain.

There is one set of reports that was inadvertently removed from the portal – the Corporate Level Aggregate Reports.  While each child site’s report contains the DIR results for that child site, the Corporate level report contained the results from all child sites for easy side by side comparison.

However, I have been informed by the DIR that it is working to restore Corporate level reports.  I will provide an update when this comes available.

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As always, if you are challenged to use or understand the DIR we are here to help.   The DIR is a powerful (and nearly free) tool for identifying dose reduction opportunities and meeting The Joint Commission’s Dose Incident Identification requirements.  If you are looking to implement a low-cost, highly effective program, that is staff-friendly, take a look at how Dose Registry Support Services can help you achieve your goal.  We offer a service, not a product.  This means that we work with you and your physicists directly – we don’t sell you a platform then walk away.  No contracts.  No upfront costs. No long-term commitments. Tailored to meet your needs.  

 

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Important Announcement: The DIR Restructured – Existing Users Should Confirm DIR Account Status and Data Access

The NRDR restructured all existing DIR accounts effective August 18, 2018.  This changed the way sites are structured, reassigned some users, added a new user type, and limited the data to which some of the users have access.  It also eliminated a few reports.

If you are a DIR user at any level it is important you log in and check your account status to make sure it works for you and that you can access the reports and perform the tasks you were able to do prior to the change. 

Here is a summary of the changes taken in large part, and sometimes copied directly, from the NRDR Announcement.   As always, Dose Registry Support Services is ready to help facilities navigate the DIR/NRDR.   Michael Bohl

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Master Accounts have been replaced by Corporate Accounts.  Corporate accounts will not accept data whereas previously they would.  Corporate Accounts are managed by a single Corporate Account Administrator who is responsible for all communications with the NRDR team.

Critical to Understand:  Corporate Account Administrators have no default access to data management for their facilities, e.g. submitting data via web forms, data upload files or web services, viewing data through the portal, searching cases/exams for all subordinated facilities, accessing patient data, etc.

In order to have access to facility data, Corporate Account Administrators must also have a specific user profile associated with the facility ID such as Facility Administrator, Registry Administrator or Facility User.  If you used your Master Account administrator log in credentials to submit data or review reports you may not be able to do so under those credentials today – you would have to create a second account type to do so.  You won’t know until you log in and test the system.

For existing “Master” facilities, the master facility ID will become the corporate account ID, and the master Facility Administrator will become the Corporate Account administrator.

For standalone facilities, the existing Facility Administrator will become the Corporate Account Administrator, and a new Corporate Account ID will be created and sent to them.

The Facility Administrator, Registry Administrator, and Facility User roles remain unchanged. You can find more information in link to NRDR Accounts and Profiles link accessible through the Announcement document link above.

There is a new user type named Service User.  The new Service User profile allows support staff, such as IT personnel, to have NRDR credentials without access to data or reports. Service User profiles are corporate-level roles and are associated with all facilities within a corporate account, so there is no need to update a Service User’s profile when facilities are added to a corporate account.

The NRDR announcement also discusses the new TRIAD Site Server v.4.5.  You may want to plan to upgrade as it contains several convenient features like mapping a new scanner directly from the unmapped Data tab and the ability to view the number of scans submitted by scanner.

There are other changes as well.  Please click on the Announcement link at the beginning of this post to read more.

 

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Tailored DIR Analysis; Is your current solution providing less for more?

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 CT Head_wo contrast and CT Head_wo_kyphotic.  The CT Head wo contrast 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 appropriate when warranted, a larger field of view can significantly decrease mage resolution and should be selected 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 49.5% 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 these charts suggest may be happening?   Hint, if you are not doing your quality checks, you should.

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Dose Registry Support Services provides personalized, tailored dose support services to facilities and radiologists.  This story represents but one creative, proprietary analysis Dose Registry Support Services brings to its clients – an approach not generally provided by other solutions.  Is your solution providing these kinds of insights to you?  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 www.doseregistry.com.

Gap Analysis

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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.

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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 www.doseregistry.com.

Gap Analysis

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Watch Now: Using the DIR to Implement an Effective and TJC Compliant Dose Monitoring Program Webinar

Using the DIR to Implement an Effective and TJC Compliant Dose Monitoring Program” is now available for viewing.  Recorded by Michael Bohl, MHA, BSRS, CEO of Dose Registry Support Services, this webinar reviews how several radiology departments are using the ACR’s Dose Index Registry to implement effective, comprehensive and cost-efficient dose monitoring programs, and meet The Joint Commission’s requirement to establish dose ranges for every study and then identify studies that exceed their expected range. 

 Upon completion, viewers are eligible to receive 1.0 CE credit from the ASRT.

 Dose Registry Support Services provides cost-effective support to facilities using the Dose Index Registry.  In many cases, facilities find they are saving $50,000 to $100,000 annually, or more, using this approach. 

 If your facility is looking for ways to reduce costs, take a look at what Dose Registry Support Services can do for you.    

Click here to view the webinar.

Click here to request a copy of the slides.

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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.