Abstract ID: 370 Dose tracking in radiology: From implementation to operational tools

Purpose To highlight implementation challenges and tricks in the use of a dose tracking software. Methods We have been using a software radiation dose index monitoring system (Physico® by Emme-Esse, developed in collaboration with our Medical Physics department) for some years, and we used it to evaluate dose indexes for single patients, for statistical purposes, to evaluate local diagnostic reference levels, to optimise radiological procedures, to get alerts to identify troublesome situations. This was possible only with continuous tests of accuracy of generated values, and their transmission, registration and possible use to calculate other quantities. Results Nowadays we have more than 106 studies present on the system. In the followings we list examples of troublesome situations found and, where possible, fixed. Radiological devices of the same model provided the KAP (kerma area product) with different units of measurements. Several XA devices for angiography do not complete the table height DICOM tag, leaving it filled with a standard value. There are differences among vendors about the calibration of KAP values: some calibrate it in air, some consider the patient bed attenuation. The many protocols present on some radiological devices make it difficult to perform meaningful statistics on their dose levels. Diagnostic reference levels are difficult to evaluate on devices that provide DICOM dose structured report (SR), where often only the body part is present (like “chest”), but not the exam type (like “general chest”), nor the laterality (like “PA” or “LL”). A CT completes the body part DICOM tag with the first body part used on the device console. This is not correct when studies involving several body parts are performed, leading to inconsistent data in dose evaluations. Above all, how and when the dose data of a patient are evaluated is to be considered. In fact, in case of registration errors on the radiological device or of examinations closed and later opened again, the topic of dose data realigning is to be considered. Conclusions Radiation dose index monitoring software are nowadays a must, but medical physicists must manage them continuously to obtain the useful information they can provide.