Abstract
IntroductionThis study investigates instances of elevated radiation dose on a radiation tracking system to determine their aetiologies. It aimed to investigate the impact of radiographer feedback on these alerts. MethodsOver two six-month periods 11,298 CT examinations were assessed using DoseWatch. Red alerts (dose length products twice the median) were identified and two independent reviewers established whether alerts were true (unjustifiable) or false (justifiable). During the second time period radiographers used a feedback tool to state the cause of the alert. A Chi–Square test was used to assess whether red alert incidence decreased following the implementation of radiographer feedback. ResultsThere were 206 and 357 alerts during the first and second time periods, respectively. These occurred commonly with CT pulmonary angiography, brain, and body examinations. Procedural documentation errors and patient size accounted for 57% and 43% of false alerts, respectively. Radiographer feedback was provided for 17% of studies; this was not associated with a significant change in the number of alerts, but the number of true alerts declined (from 7 to 3) (χ2 = 4.14; p = 0.04). ConclusionProcedural documentation errors as well as patient-related factors are associated with false alerts in DoseWatch. Implementation of a radiographer feedback tool reduced true alerts. Implications for practiceThe implementation of a radiographer feedback tool reduced the rate of true dose alerts. Low uptake with dose alert systems is an issue; the workflow needs to be considered to address this.
Highlights
This study investigates instances of elevated radiation dose on a radiation tracking system to determine their aetiologies
The number of red alerts triggered by computed tomography (CT) pulmonary angiography (p < 0.001) and CT brain (p < 0.001) decreased significantly
There were no statistically significant differences in the number of red alerts triggered by CT abdominopelvic (p 1⁄4 0.76), and CT thorax (p 1⁄4 0.12) examinations; the red alerts for CT thorax abdomen and pelvis increased significantly (p 1⁄4 0.004) between the time intervals
Summary
This study investigates instances of elevated radiation dose on a radiation tracking system to determine their aetiologies It aimed to investigate the impact of radiographer feedback on these alerts. The use of computed tomography (CT) in medicine has increased significantly over the years and recent statistics show a 10e57% annual increase in the number of CT examinations.[1,2] This increased use is associated with higher exposure to ionizing radiation, and CT is the highest contributor to radiation dose from medical use.[3,4] In the United States, 49% of medical exposure to radiation is from CT procedures.[4] Effective dose, a determinant of Abbreviations: AEC, Automatic exposure control; CT, Computed tomography; DLP, Dose length product; DRL, Diagnostic reference level; PACS, Picture Archive and Communication System. Crowley et al / Radiography 27 (2021) 67e74 the potential effect of radiation for most routine CT procedures varies from 1 to 15 mSv and can be higher in circumstances where a repeat examination is required.5e7 Increased awareness of the risks of ionizing radiation exposure has precipitated the establishment of justification and dose optimisation strategies by national and international regulatory bodies.[8,9] Whilst justification using evidence-based referral guidelines has reduced human exposure to radiation by reducing the number of imaging investigations performed, doses to patients undergoing CT investigations remain considerable and can dramatically vary across sites and patients.5e7 This variation underscores the need to monitor and optimise patient dose data and scanning practices
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