Implementation of the ACR Dose Index Registry

Abstract

workflow for image data routing. The ACR recommends that Triad, which we installed in the virtual machine environment maintained by our hospital’s IT department, be a destination on all CT workstations and directly receives the radiation dose structured reports, dose sheets, and localizers, but a second acceptable option was that these data could be mirrored to the Triad host from the PACS. Sending directly from each workstation had the advantage that all dose data would be indexed, specifically series that were not sent to the PACS, but this was a minor advantage because those data would be in radiation dose structured reports and dose reports. Disadvantages regarding network operations included increasing bandwidth overhead at each workstation; if the Triad host was unreachable, errors would compound from workstation network queues; and the Triad destination would have to be maintained after workstation installations and upgrades. Additionally, to send image data, either technologists would have to manually send a subset of specific series or autosend rules would have to be managed for all protocols across workstations. None of those disadvantages were considered insurmountable, but because dose monitoring has not yet reached the status of “mission critical,” they would hinder use. Mirroring dose data from the PACS to the Triad host, which is the workflow we adopted, offered several advantages. The PACS is mission critical, has reliable connectivity, and will always be a destination on workstations, so network operations and workstation management by a dosemonitoring specialist would be mitigated. A potential disadvantage, which we discovered after initial use, was that all outside films imported into the PACS would also be relayed to the DIR through Triad. Currently in our facility’s DIR, there are 310 station names to sort through to find the 20 to 25 units that have belonged to our facility. Thus, in this workflow scheme, an additional DICOM router with filtering rules to avoid sending outside films to our institution’s registry is needed between the PACS mirror and Triad.