Smaller Hospitals Reach CT Dose Reduction Through Education, Collaboration

Smaller hospitals might worry they don’t have enough staff or time to effectively reduce CT dose exposure for patients, but one hospital’s success proves it can be done.

By changing protocols for CT angiographic imaging, Gundersen Lutheran Health System, a physician-led, La Crosse, Wis.-based health system serving 19 counties, endeavored to reduce dose exposure after purchasing a dual-source CT system in 2006. Rather than use a generic protocol for all patients receiving CT angiographic imaging, radiologists and technicians determined proper dosage based on patients’ body mass index. The result: a 29 percent drop in dose exposure.

This accomplishment prompted radiologists to apply reduction efforts to all protocols.

“Expanding the dose reduction plan fit with our overall strategy at Gundersen Lutheran to provide the highest quality services and protect patient safety,” said Mary Ellen Jafari, Gundersen’s radiation safety officer and medical radiation physicist. “The program fit nicely into the organization’s goals, and we had a lot of administrative support to make this happen.”

In addition to tailoring protocols to the patient, Jafari said the hospital’s program had other key points to ensure reduction, many of which focused on changes that were easily accessible. For example, Gundersen made advanced certification from the American Society of Radiologic Technologists a condition of employment for technicians. The hospital also created a “frequently asked questions” booklet for patients and physicians. The booklet is written in lay terms and includes answers to the questions Gundersen radiologists receive most often.

Other key steps included properly maintaining equipment and monitoring radiation dose.

The program has worked so well that Gundersen is in the process of expanding it throughout its affiliates.

“We are working to introduce the program to all our clinics because our radiologists for read for additional locations,” Jafari said. “We’re also hoping to bring other hospitals that have radiology contracts with us into the fold.”

There have been hurdles to fully implementing the program, however. Many different CT scanners exist, and each one is programmed with a different number of protocols.

“It’s really important to get the protocols and doses to match,” said Jafari, who developed and led the CT dose reduction program with Gundersen radiologist Lonnie Simmons, M.D. “Some scanners have different [x-Ray tube voltage], so matching the protocols and doses can be challenging.”

Educating referring physicians about the ALARA principle (“as low as reasonably achievable”) and how to use American College of Radiology criteria when ordering a CT scan can also be obstacles. You will likely need to meet with different departments to explain the resources you have available and how to access them, Jafari said.

But there are steps smaller hospitals can take to enhance their chances of successfully controlling CT dose exposure. Jafari recommended you focus reduction efforts on certain populations: pediatric, pregnant, and repeatedly scanned patients. Consultations with a qualified medical radiation physicist and a CT scan application specialist can help you stay up-to-date on the best ways to operate and maintain your equipment. Lastly, follow the guidance from the Image Wisely and Image Gently campaigns is always a good practice, she said.