Patient dose management solution directly integrated in the RIS: "Gray Detector" software

Abstract

On X-ray modalities, the information concerning the dose delivered to the patient is usually available in image headers or in structured reports stored in the picture archiving and communication system (PACS). Sometimes this information is sent in the Modality Performed Procedure Step message. By saving the information inside the Radiological Information System, it can be linked to the patient and to his/her episode/request. A software, "Gray Detector," implementing different and complementary extraction methods was developed. Query/retrieve on images header, Modality Performed Procedure Step message analysis, or the combination of the two methods were used. In order to avoid erroneous dose-protocol association, every accession number is linked to its unique report code, allowing multiple-protocols exam recognition. The adoption of different methods to extract dosimetric information makes it possible to integrate any kind of modality in a vendor/version neutral way. Linking the dosimetric information received from a modality to the patient and to the unique report code solves, for example, common problems in computed tomography exams, where the dosimetric value related to multiple segments/studies on the modality can be associated by the technician who performs the exam only to one accession number corresponding to a single study/segment. Analyses of dosimetric indexes' dependence on modality type, patient age, technician, and radiologist were performed. Linking dosimetric information to radiological information system data allows a contextualization of the former and helps to optimize the image-quality/dose ratio, thereby making it possible to take a clinical decision that is "patient-centered."

Fig. 1

Screenshot from the Gray Detector dashboard page. a. Gray Detector software main dashboard page. The page shows modalities, manufacturer name, number of studies, date of last data received, and the state of connection (green means connection is ok). b Example showing the patient AGD for the 11 REDID mammography units. Each point represents a study. Different symbols refer to different mammography units. The filter applied is on modality type (MG), exam description (bilateral mammography), and data range (1 month). With this selection, 4,633 studies are shown (clicking on a single point, a series of data are shown: among these are AGD value, patient name, accession number, operator, etc.). c Example showing the patient AGD for the mammography unit as a function of operator. The point is the median, and the box includes values from the 25th to the 75th percentile. The filter applied is on mammography unit (SCMX2GE), exam description (bilateral mammography), and data range (4 months). Clicking on a single bar, a series of data are shown, including operator name, AGD median value, 25th and 75th AGD percentile, etc. d Example showing DLP values for a CT unit as a function of time. Each point represents a study. The filter applied is on modality type (CT), exam description (Head CT), and data range (8 months). After the protocol optimization (vertical line), an evident widespread reduction can be noticed

Fig. 2

Differences in DLP evaluation that can arise when no correction for wrong protocol-dose association is implemented. Report filtering for correct dose association to multiple accession numbers/exams (ID-Ref filtering) effect is shown in this figure for two of the most frequent CT exam protocols. Vertical lines represent the limit of the 90th and 99th percentile, the point is the 95th percentile, and the box includes values between 92.5 and 97.5 percentile. As the biggest difference is for high percentile values, only these values are shown here

Fig. 3

Percentile DLP values for abdomen CT examination, divided according to the diagnostic room where the exam was performed. Vertical lines represent the limit of the 10th and 90th percentile, the point is the median, and the box includes values between the 25th and 75th percentile. The horizontal line shows Italian DRL (920 mGy cm). The number under each candlestick indicates the size of the sample considered

Fig. 4

Percentile DLP values for head CT examination, divided according to the diagnostic room where the exam was performed. Vertical lines represent the limit of the 10th and 90th percentile, the point is the median, and the box includes values between the 25th and 75th percentile. The horizontal line shows Italian DRL (1,312 mGy cm). The number under each candlestick indicates the size of the sample considered

Fig. 5

Percentile DLP values for head CT examination performed in the same diagnostic room (RE1), divided according to age groups. Vertical lines represent the limit of the 10th and 90th percentile, the point is the median, and the box includes values between the 25th and 75th percentile. The horizontal line shows Italian DRL (1,312 mGy cm). The number under each candlestick indicates the size of the sample considered

Fig. 6

Percentile DLP values for head CT examination performed in the same diagnostic room (RE1), divided according to the technician who performed the exam. Vertical lines represent the limit of the 10th and 90th percentile, the point is the median, and the box includes values between the 25th and 75th percentile. The number under each candlestick indicates the size of the sample considered

Fig. 7

Percentile DLP values for head CT examinations performed in the same diagnostic room (RE1), divided according to the radiologist who oversaw the exam. Vertical lines represent the limit of the 10th and 90th percentile, the point is the median, and the box includes values between the 25th and 75th percentile. The number under each candlestick indicates the size of the sample considered

Fig. 8

Percentile DLP values for abdomen with contrast media CT examinations performed in the same diagnostic room (RE1), divided according to the radiologist who oversaw the exam. Vertical lines represent the limit of the 10th and 90th percentile, the point is the median, and the box includes values between the 25th and 75th percentile. The number under each candlestick indicates the size of the sample considered