Having such information available is especially helpful for children with certain chronic health problems, as they may need to have many tests involving radiation during their lifetime.
In developing the system, we created a database into which we could record the examinations provided in four key areas: CT scans, cardiac nuclear medicine, the cardiac catheterization laboratory and the radiology special procedures lab. This would cover the majority of higher-dose exposures.
We initiated a two-year development project with three teams of researchers. The first team would write the software to record the exams into the database and connect that database to IT reports available through our electronic health records. The second team would develop educational materials for the reader: radiation professionals, referring physicians and patients. The third team would develop and pilot-care process models for two specific focus areas where we believed there was opportunity to reduce exams being performed.
These two focus areas are the use of CT for evaluation of pulmonary embolism and the use of cardiac nuclear medicine procedures. The care process models drew upon a thorough literature review and involved a multidisciplinary team to determine how these tests should most appropriately be used in caring for patients.
The three teams went about their work, completing the project last August. The new system became operational in December, with all educational materials available, and is being rolled out across all Intermountain hospitals and clinics in 2013. The lessons learned include the following:
First, the complexity of measuring doses is profound. For every modality, there is a different way of measuring and recording the dose. Not only do the different imaging modalities record dose differently, standard dose reporting procedures have only recently begun to emerge, and within a modality there is variability in how dose is reported. We developed standard procedures to handle these variables and convert all doses to a standard metric. The metric we chose is effective dose as measured in millisieverts.
All of these “measurements” are really estimates. My hope is that, over time, the technology and science will advance and that it will become a national priority to improve the accuracy of these estimates.
Second, getting consensus on the educational materials is complicated, as there is room for debate on the science, especially as it relates to the seriousness of dosage risks. Creating ultimate buy-in is a function of representation of key departments, thorough airing of concerns, personal rapport among representatives and keeping the focus on the shared goal of ensuring that patients are exposed to no more radiation than necessary.