https://orcid.org/0000-0002-6590-5850
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Abstract
Purpose
This study primarily aimed to evaluate the effectiveness of computational data management and analytical software for establishing departmental diagnostic reference levels (DRLs) for computed tomography (CT) scanning in clinical settings, and monitor achievable doses (ADs) for CT imaging, particularly during the coronavirus disease 2019 (COVID-19) era. Secondarily, it aimed to correlate these standards with national and international benchmarks.
Patients and Methods
This ambidirectional cohort study enrolled 4668 patients (6419 CT-based examinations) who visited King Fahd Hospital of the University from May 25, 2021, to November 4, 2021. Participants’ demographic data were acquired from their electronic medical charts, in addition to all corresponding CT-dose determinant parameters. The study was divided into two phases (pre- and post-data management) based on the implementation of digital data management software.
Results
In both phases of the study, the size-specific dose estimate (SSDE) was the most significant confounder of dose determination compared to the dose-length product (DLP) and computed tomography dose index (CTDI) (P = 0.003). The head was the most frequently imaged body region (pre-implementation, 1051 examinations [35.1%]; post-implementation, 1071 examinations [31.3%]; P = 0.001), followed by the abdominal region (pre-implementation, 616 examinations [20.6%]; post-implementation, 256 examinations [7.48%]; P = 0.001). Based on the SSDE, DLP, and volume CTDI, the average per-section radiation exposure among organ-based scanning type was highest for the lumbar spine during the pre- and post-implementation periods.
Conclusion
Data management software enabled the establishment of DRLs and reduction of ADs in CT examinations, which consequently improved key performance indicators, despite the ergonomic complexities of COVID-19. Institutions are encouraged to apply DRLs and ADs via automatic systems that monitor patient dose indices to evaluate aggregate results.
Abbreviations
COVID-19, coronavirus disease 2019; AD, achievable dose; AAPM, American Association of Physicists in Medicine; CT, computed tomography; CAP, chest abdominopelvic; CTPA, CT pulmonary angiography; DRLs, diagnostic reference levels; DICOM, Digital Imaging and Communications in Medicine; PACS, Picture Archiving and Communication System; KPI, key performance indicator; KFHU, King Fahd Hospital of the University; DLP, dose-length product; CTDI, CT dose index; CTDIvol, volume CT dose index; SSDE, size-specific dose estimate; SFDA, Saudi Food and Drug Authority; WED, water-equivalent dose; mGy, milligray.
Data Sharing Statement
All data generated and/or analyzed are included within the manuscript itself.
Ethics Approval and Informed Consent
This study was performed in accordance with the Declaration of Helsinki of 1975 (revised in 1983). The Institutional Review Board of Imam Abdulrahman Bin Faisal University granted approval for this study to be conducted at KFHU (IRB-2022-01-206) after considering the descriptive and retrospective nature of the study. The collected data were anonymized, analyzed, and reported solely in aggregate form. No identifiable participant information (such as patients’ images, faces, or names) was disclosed in the study.
Consent for Publication
Consent for publication of the manuscript and related patient information has been obtained by the Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University.
Acknowledgments
The authors gratefully acknowledge Mr. Khoury, Walid (Siemens-Healthineers) for his assistance in implementing the teamplay™ software.
Disclosure
The authors declare that they have no conflicts of interest.