The UK Radiological Congress (UKRC) and Radiation Oncology Congress (UKRO) convened in Manchester from Monday 12th to Wednesday 14th June 2017, featuring a busy exhibition hall and an extensive scientific educational programme. Tuesday 13th June was dedicated to ‘Dose Awareness Day’ and aptly radiation dose management was a fundamental topic of conversation throughout the congress.
Technical product features, procedural techniques, and image processing solutions were all highlighted as areas where developments have been focused on dose control. However, the most prominent theme at UKRC in relation to radiation dose awareness was dose management software, with a number of vendors highlighting these systems in the exhibition hall.
Dose management software solutions can be used for a variety of tasks depending on the requirements of the user, including: dose tracking for individual patients, recording of dose for specific modalities and procedures, analysis of correlations between dose levels and image quality, and dose reporting for audits. Such software solutions typically are scalable and can be used across facilities within hospital groups. The topic of dose management is particularly relevant because of the need to comply with the Joint Commission’s dose requirements in the United States to ensure reimbursement is received, and to comply with the European Commission Directive dose guidelines across Europe.
To ensure the accuracy of the dose data in the dose management systems, a number of factors must be taken into consideration. They include taking the data directly from the imaging modality (rather than from the PACS system) so that the additional dose required for any necessary re-takes is accounted for; and taking into consideration patient-specific information (such as the size of the patient) to measure unique radiation absorption levels for individual patients accurately.
It is easy to assume that focus on dose awareness and dose management is centred on reducing the dose; however, this is not necessarily the case. It has been reported that there have been instances of mammography imaging facilities increasing the dose rate used per exam, rather than reducing it. The radiation used needs to be balanced with the quality of the image produced; if using a lower dose is going to result in a re-take being needed or lesions being missed, it is not the most effective dose management. The level of dose used must be optimised to create the best image possible, without using an excessive radiation dose unnecessarily.
Dose awareness and dose management must consider the total radiation dose that patients may receive during their life-time, rather than simply the dose levels for individual procedures. Reducing dose levels to the point where image quality is sacrificed, leading to misdiagnosis or need for re-takes, is not an effective use of radiation and will ultimately lead to higher overall radiation exposure for patients. The amount of dose used must be balanced with image quality and, ultimately, the best outcome for the patient.