Data analysis for compliance ... Outlier analysis for safety and quality ... physicists are under pressure to meet a rig
Automated Dose Reporting and Monitoring: The Medical Physicist’s Tool for Compliance with The Joint Commission Perspectives and lessons learned from Bayer’s Radimetrics User Group Meeting
Mark Supanich leads interactive user group discussion focused on the value of analytics.
The Joint Commission’s new and revised standards for diagnostic imaging leave a number of directives open for interpretation. The Joint Commission no longer explicitly states, for instance, that the radiation dose index be included in the patient record or radiology report; just that it be documented in a retrievable format. In another example, organizations are required to make sure that image protocols conform to “current standards of practice” — with no further clarification on whether these standards might be external or internal. One requirement, however, is clear: no matter how compliance with The Joint Commission is met, the organization’s medical physicists are accountable for meeting it 1. At Bayer’s recent Radimetrics User Group Meeting, medical physicists and other radiology professionals converged to discuss how they use the Radimetrics solution for automated dose reporting and monitoring to support compliance with The Joint Commission, and other safety and quality initiatives. Insights gleaned from the meeting may offer useful context for understanding how automated dose monitoring and reporting can help other medical physicists comply with The Joint Commission standards as part of their respective health organizations’ broader goal to administer effective diagnostic exams at the lowest possible dose.
http://www.jointcommission.org/assets/1/18/AHC_DiagImagingRpt_MK_20150806.pdf.
Automated patient radiation dose reporting In theory, healthcare organizations can manually perform certain standards required by The Joint Commission, such as manually logging CTDIvol, DLP and SSDE values from every study produced during a diagnostic CT scan. But in reality, this can quickly become an overwhelming responsibility. In his presentation “Perspectives of a Radimetrics User,” Dr. Tony Seibert, medical physicist at UC Davis Health System, illustrated how dose reporting and monitoring processes are instead automated within Radimetrics platform — which UC Davis has deployed at five medical centers. Dr. Seibert noted that while data can be sent to Radimetrics platform as a “pass through” from an organization’s PACS or directly from each CT scanner, UC Davis has opted for the latter. The platform then routes the captured data to: QThe radiology report via speech recognition software QThe ACR Dose Index Registry QThe UC DOSE central repository at UC San Francisco QThe local UC Davis dose registry This vastly speeds documentation while fulfilling The Joint Commission requirement Dr. Tony Seibert
that data such as a patient’s CT radiation dose index be recorded in a retrievable format.
Data analysis for compliance The Joint Commission requires that organizations review incidents where the radiation dose index exceeds expected dose index ranges identified in imaging protocols. Of course, to carry this process out, organizations need expected dose ranges in hand. Dr. Seibert explained how Radimetrics platform can help identify and devise CTDIvol DRL values for this purpose. Using the sample protocol “CT abdomen multiphase with or without contrast,” Dr. Seibert showed users a histogram representing studies performed under this protocol for a given date range. He then demonstrated how minimum, average, and maximum CTDIvol dose reference levels could be set based on the 5th, 50th and 98th percentiles.
Histograms can be used to identify values for DRL thresholds.
In his presentation, Mark Supanich demonstrated additional capabilities within Radimetrics that assist him with periodic review of exams exceeding DRLs. As Supanich observed, the Radimetrics solution reports and dashboards make it a simple process to filter and display exam outliers by different criteria — such as by anatomy, gender, age, patient size and more.
Mark Supanich
Outlier analysis for safety and quality The Joint Commission requests that users document dose and investigate outliers. Just as Radimetrics platform considerably speeds documentation, it also enables root cause analysis that would otherwise be difficult if not impossible to conduct manually. Supanich shared an example that reflects this
capability within the platform. In response to complaints that certain pulmonary embolism (PE) studies were showing up as grainy on a specific scanner, Supanich built a histogram dashboard within Radimetrics platform comprised of PE studies from a broad date range, with SSDE plotted. The histogram depicted disparate spikes in distribution, including one low distribution area where studies were around five milligray. By clicking on that area, Supanich was able to get more granular detail on the exams. A common element was soon apparent: all used two localizer radiographs; one lateral and one AP, on a scanner that allows for tube potential selection. From there, Supanich’s team identified and contacted the scanner’s manufacturer, who explained that processing lateral topograms — a standard component of this type of exam — created problems
Radimetrics reports and dashboards provide visual tools for outlier analysis.
for the equipment. Supanich and his team subsequently devised a newprotocol that worked around this difficulty. Showing meeting attendees a second histogram, this one post-intervention, Supanich pointed out how the new distribution of studies contained no abnormal peaks of SSDE — and that he no longer received complaints about image quality for this particular exam. As this anecdote indicates, outlier analysis tools within the Radimetrics solution give physicists newfound capabilities to identify and study outliers by modality, manufacturer and other quality and safety factors.
Conclusion Medical physicists are under pressure to meet a rigorous yet unevenly defined set of standards. Nevertheless, while there is less specificity in the actual requirements, the consequences of not meeting them can be significant for the organization, and most importantly, for patients. There are more standards required by The Joint Commission than are detailed in this article, and Radimetrics can support medical physicists’ efforts to meet compliance with many of them. For more information about Radimetrics features that enable visibility into large volumes of diagnostic exam and equipment data at an unprecedented speed, visit www.Radimetrics.com.
Radiology Bayer HealthCare Medical Care Bayer HealthCare LLC 100 Bayer Boulevard P.O. Box 915 Whippany, NJ 07981 www.radiologysolutions.bayer.com
Bayer Medical Care Inc. 1 Bayer Drive Indianola, PA 15051 USA Customer Ser vice/Orders 1-800-633-7231 Customer Service Fax 1-412-767-4120
Bayer reserves the right to modify the specifications and features described herein, or discontinue manufacture of the product described at any time without prior notice or obligation. Please contact your authorized Bayer HealthCare representative for the most current information. Bayer, the Bayer Cross, Certegra®, and Radimetrics™ are trademarks of the Bayer group of companies. © 2014-2015 Bayer PP-REP-US-0191
November 2015
