In 2008-2009, hundreds of patients in the U.S. were overexposed to ionizing radiation from CT brain perfusion scans. Learning of this, Advocate Health Care, Illinois’ largest health care system, took immediate proactive measures by evaluating and deploying advanced technologies for managing radiation dose throughout the enterprise to enhance patient safety and quality. As a premier Level I trauma center in the western suburbs of Chicago, Advocate Lutheran General Hospital (ALGH), a member of Advocate Health Care, felt it was their responsibility to implement state-of-the-art diagnostic imaging innovations. Incorporating electronic analytics tools is the mainstay of advanced cross-sectional imaging.
In 2011, ALGH implemented computer-assisted CT delivery software for IV contrast. They deployed the Certegra Informatics Platform®
(Bayer Healthcare) to calculate the appropriate dose by computing custom injection protocols based on patient weight. This automated algorithm minimizes dose and contrast use while maximizing attenuation of the target vessels. In 2012, GE Healthcare and Advocate Health Care collaborated to launch a system-wide radiation dose reduction initiative utilizing GE DoseWatch™, a management tool to measure, track, and optimize patient radiation dose over time.
These tools facilitate both quantitative and qualitative analyses of how patients are imaged. They form the bedrock for ongoing quality improvement and enhanced patient safety and are completely integrated into the hospital’s workflow. At ALGH, the tools have proven invaluable in objectively evaluating performance metrics through regular internal auditing. In the case of radiation dose, external auditing is facilitated by submitting data to the ACR’s Dose Index Registry (DIR) for evaluation against national benchmarks.
According to Lisa Laurent, MD, MBA, CT medical director at ALGH and chair of the CT medical directors at Advocate Health Care, “One of the most helpful, relevant, and pragmatic applications for the Certegra informatics platform was point-of-care documentation. This provided us with accurate, reliable, and objective information rather than surrogate or anecdotal data. By being able to identify and analyze what was done at any point along the timeline of performing a CT, we were able to troubleshoot quality, safety, efficiency, and process improvement opportunities across all shifts.”
This methodology was the framework for training technologists, monitoring compliance, and facilitating continued performance improvement in using the new P3T technology. “Rather than relying on conjecture, we had factual information,” Laurent emphasizes. “We provided that data to the staff in a non-punitive, supportive environment that promoted increased awareness and engagement.”
The breadth of data mining capabilities also included analyzing repeat exam rate and the effect of flow rates and pressures on target vessel enhancement. The latter is particularly helpful when educating medical, nursing, and house staff about the necessity of using the lowest gauge needle possible to deliver IV contrast at the highest flow rate possible to maximize target vessel enhancement (thereby producing the highest quality image possible).
Certegra also links radiologists to the hospital’s PACS. “The informatics platform shows us what happens, when, and by whom — from the time a patient enters the CT suite to the moment the patient is discharged from the department,” Laurent states. “I can tell you exactly how much IV contrast was given and why as well as the effect that it had. Then I can compare that to the image quality. So it really is a revolutionary way to help our patients."
Just as integral to quality patient care at ALGH, the DoseWatch analytics tool is an invaluable resource to monitor, track, and optimize dose. DoseWatch automatically sends alerts when dose parameters exceed established thresholds; limits can be set manually or automatically according to a practice’s procedure guidelines and Diagnostic Reference Levels. It provides a mechanism by which technologists and radiologists alike can re-think the significance of ionizing radiation in daily practice.
During two weeks of focused dose assessment and protocol optimization activities, the team was able to personally witness the effects of modifying variables that directly affect CTDIvol. “Radiologist, technologist, and applications specialist — standing side-by-side at the scanner tweaking protocols to see how changes could impact dose — that was a powerful learning experience,” says Laurent. “It is more impactful than any classroom didactic lecture, because it makes the physics of radiation dose analysis real and relevant. And it helps all of us approach radiation dose reduction strategy in a more meaningful way.”
As part of the intensive two-week session, randomly selected technologists took a 59-question radiation dose self-assessment test
. They graded themselves on topics spanning radiation physics, dose management, and patient safety. The team matched their scores against the assessment of the applications specialist to identify strengths and opportunities for improvement. “We presented results anonymously and in a supportive fashion, so the technologists felt very comfortable,” explains Laurent. “It was purely educational and part of the process to learn and reinforce concepts. We realize that the test should not be viewed as a one-time exercise, but as a foundation for ongoing awareness, healthy dialog, and productive feedback.”