Titus Regional Medical Center's Journey on implementing CT dose tracking and the effects of newer technology

Dose tracking has been a concern in the Imaging world since accidental overexposure to radiation during CT examinations of the head were reported in 2009. As a result of these overexposures and other safety factors, the Joint Commission began requiring routine analysis of CT patient exposures in 2015.

Titus Regional Medical Center partnered with Imalogix, LLC in 2015 to start tracking CT radiation dose. We worked diligently with our CT scanner manufacturers, Imalogix, Radiologist, and Medical Physicist to establish threshold doses for each exam type. In mid-2015 we began the process of transferring studies to Imalogix, LLC to track and analyze the radiation doses on all CT exams. In the event an exam exceeds the set threshold we are sent correspondence so the study can be reviewed for any process or protocol improvements.

As we started this journey, we were utilizing two CT scanners that were 14 and 7 years old. An interesting find in this process was “you don’t know what you don’t know” until you start analyzing the data. We started a PDSA project on CT dose tracking in 2016 (Exhibit A). In 2016, our first complete year of tracking, our percentage of exams that exceeded the set thresholds was 11.6%. After analyzing this data and making slight protocol adjustments in 2017 our percentage of exams exceeding the threshold showed a slight decline to 10.9%.

In 2018 we replaced the oldest scanner with a Siemens Perspective 64 system. The manufacturer configured this system with DoseMAP, Iterative Reconstruction (Safire), CARE Dose4D and CARE Dose Configurator. These features are intended to lower the overall CT patient dose. After this system was brought on-line, we realized a decrease in exams exceeding the dose thresholds, taking us from 10.9% to 8.26% of exams exceeding the thresholds. 

In 2019 and 2020, we saw an increase in volumes in the emergency department and inpatient exams due to COVID 19. All the inpatient and emergency department exams were utilizing the now 11–12-year-old technology thus an increase in exams exceeding the set thresholds to 9.92% and 11.26% respectively were identified.

In May of 2021 we replaced the 13 year old emergency department and inpatient scanner with a new SOMATOM Siemens go.Top scanner. Siemens configured this scanner with Adaptive Dose Shield, CAREDose 4D, X-CARE, Tin Filter Technology, CARE kV, 10 kV steps and SAFIRE. As noted previously these features are intended to lower the overall CT dose to the patients. With the implementation of the go.Top scanner along with the existing Perspective 64 scanner we observed a dramatic decrease in the number of CT exams exceeding the dose thresholds. In calendar year 2021 the percentage of exams exceeding the dose threshold was 4.30%.

Data analyzed for the year 2022 yielded the most significant improvement rate to date for our team. Utilizing both scanners equipped with the dose reduction technology we drove the overall rate down to 1.2% which we are proud to have maintained throughout 2023. Our approximate 10% reduction in exams exceeding the CT dose threshold at Titus Regional Medical Center since project inception points to supports the hypothesis that use of evidence-based dose reduction technology will positively effect on overall patient dose. This reduction not only justifies the use of new technology to improve patient safety, but also favorably impacts the health of the communities we serve.