Using Multidisciplinary Teams to Achieve Dose Reduction
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The radiologists who conduct CT and interventional radiology with fluoroscopic guidance examinations are in a position where dose reduction is of the utmost importance. Presently, less than 40% of medical imaging examinations are CT and CAT scans, but they account for about 95% of radiation dose among these exams.
A multi-disciplinary dose team is a necessity if successful dose reduction is to be achieved. I have learned this through personal experience, starting back in 2010 when my hospital put a dose reduction plan into practice using a dose tacking system and then had to redesign the plan after it did not work as well as we would have liked it to in the beginning.
From October 2010 – October 2012, we had what we called a retrospective approach to dose reduction. The advantage that this provided was that it allowed us to get a glimpse of any malpractice taking place and ways in which to make corrections. The drawbacks of this approach outweighed the advantages, which forced us to examine the protocol all together. These disadvantages included a lack of collective implication, data only being shared between the Radiologist Safety officer and the department’s chairman with no implications on the technologists or other radiologists, and no sustained communication among the small team.
Since 2010, we had metrics at the end of each month and conductive results that showed the way we used our two CT scan units, such as which examinations used the highest dose in the month. To better explain, we used the tracking system from 2010-2012 only with a retrospective approach, meaning at the end of the month, the radiation safety officer and myself would analyze results to increase our knowledge about the usage of our CT system and how it relates to dose.
We changed this approach at the end of 2012. Our first step was to install dedicated screens that inform the technologists about the dose being delivered to the patient in real time. Our next step was to officially create a multi-disciplinary dose team, which included the following members:
- Radiation Safety Officer (technologist, involved since 2010)
- Chief CT technologist (was missing from 2010-2012 because our data results were not involved in the daily practice)
- Radiologist (dedicated to newer physics and competencies)
- A middle-manager technologist (helps with logistics, communications, meetings, etc.)
The advantages of creating this multi-disciplinary team have been numerous. The quality of the communication throughout the department has improved immensely. We are better organized and have implemented new processes and protocols that have improved efficiency. For example, with the diagnosis of a pulmonary embolism, it has been much easier to communicate from the chief technologist through the radiologist, receive feedback about the protocol, and implement a new protocol (if necessary) for the next exam.
While the advantages have been numerous, there remain some challenges when it comes to dose reduction. Ultimately, the best way to reduce dose is to decrease the volume of imaging examinations a person has in their lifetime. In the meantime, there are other valuable tactics. Any examination using radiation should be justified and using dedicated instructions, new technologies, and following the good practices guidelines can lead to only administering these justified examinations.
Using the multi-disciplinary team, it has become easier to sustain quality time, and better communicate metrics of the dose tracking solution in CT units. There is a great deal of research dedicated to reducing dose, which will improve new technologies using advanced iterative reconstruction, allowing exams to possibly take 10 or 20 seconds in data reconstruction compared to a normal CT. In the next five to 10 years, that time may decrease even more, become available in daily practices, and ultimately allow for a much lower dose for the patient.
What about involving a medical physicist in the team?
We sent your question to Dr. Zins and this was his response:
“Many thanks for your relevant proposal. For sure, including a medical physicist in our dose team would be great. Unfortunately, we do not have such competency available on site. Nevertheless, we have contracted and we collaborate closely with a medical physicist from another hospital, which is a great help for us.”
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