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A Spoonful Of Data Helps The Dose Go Down

Health systems are using the vast amount of data from imaging scans to image smarter.

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For years, technologists at Kaiser Permanente’s hospital in Hawaii had been collecting and calculating data about radiation dose from exams and sharing it with radiologists for inclusion in reports.

Dose, as it’s commonly referred to, is the measure of exposure to ionizing radiation from medical imaging procedures.

But the clinical team wanted to go beyond just tracking the amount of dose, to begin benchmarking that data between facilities in the region and against other divisions in the Kaiser Permanente network. An ecosystem of data surrounds the medical devices involved during or after an imaging procedure and by automating the collection of this data, and using analytics to draw insights, they sought to allow their organizations to better manage clinical quality and safety.

“We want to eliminate the outliers and work toward modeling best practices. Outliers are easier to identify when you have a larger data pool to collect from,” said the director of diagnostic imaging for the Hawaii Division of Kaiser Permanente.

They began by deploying GE software called DoseWatch that retrieves, tracks, and reports the radiation dose administered to patients during medical exams and automatically organizes the data for hospital leaders so they can easily and effectively monitor dose provision in their institution. The system collects data in different ways – by imaging device, by the individual operator or by protocol – so it can compare and contrast the dose being administered in one exam to another from the past.

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“Such quality improvements initiatives require a holistic view of radiation exposure across multi-facility, multi-modality, and multi-vendor imaging environments,” said Michelle Reich, industry analyst with Frost & Sullivan and author of the firm’s new Best Practices Research Report for dose management solutions.

In a day-long Dose Management Design Workshop that included all key stakeholders in the division, the group collectively decided standard measurements across their network that would be captured using DoseWatch, and how to determine what is normal and appropriate.

After 30 days of data was collected, the GE team returned to review the data, point out insights, and train the staff to use the tool effectively. Critical next steps include setting dose targets for various exams – the amount of radiation that should be expected and act as a guiding point — and benchmarking with others in the Kaiser Permanente network.

“The guidance provided was a key part of figuring out our strategy, from facilitating discussion on how to best use the dose management program to achieve our desired end state,” said the director.

“We believe that if we can make meaningful change that truly reduces necessary dose, then we can sleep better at night, knowing we’ve done the right thing.”

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Most healthcare organizations have similar goals – to produce an accurate diagnosis in the safest manner for each patient, but every system is at a different stage of understanding and prioritizing their dose management strategy .

Salem Health in Oregon is striving to build a culture around managing dose for radiology and cardiology procedures. They are leveraging GE Healthcare’s dose management portfolio of solutions to build and implement a strategy focused first on dose monitoring and analytics, then plan to expand into a more comprehensive dose excellence program.

“At Salem Health, our top priority is the patient. State-of-the-art equipment and low dose practices are already in place, but we wanted to take our dose management even further,” said Anna Mench, Ph.D., Diagnostic Imaging Physicist with Salem Health.

The provider is working to reduce its CT doses by 10-20% across all scanners and in all protocols where feasible, for example. DoseWatch, the same software used at Kasier, pulls data on previous averages for the protocol land, after adjusting scanner acquisition techniques and consulting radiologists on preservation of image quality, verifies that the average has decreased by the desired amount.

“Our journey with DoseWatch is just beginning, but we have already implemented the software in many ways to best serve our patients,” said Anna.

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Affidea, the biggest independent provider of advanced diagnostic imaging services in Europe, believes a cornerstone to becoming the biggest global brand for diagnostic imaging and cancer care is introducing practices that are standardized, unified and optimized. This isn’t easy given the number of geographies it operates in and the amount of data it accrues.

“As far as we know, the Affidea dose excellence program is the largest dose optimization program of its kind,” said Rowland Illing, Chief Medical Officer with Affidea. The foundation of this program was its initial cooperation with GE Healthcare in 2012 on the DoseWatch analytics platform. Today, Affidea’s dose excellence program centralizes and analyses data from 65,000 CT scans each month.

“GE Healthcare had the foresight of making the platform vendor neutral, meaning that we are able to compare dose data between different models of CT and different manufacturers using different dose reduction algorithms,” said Rowland.

However, before this takes place they have to be certain that they are comparing ‘like with like’. There are no pan-European standards currently available, so Affidea had to develop their own standardized CT protocols. They have also created standard operating procedures and guidelines for the comprehensive implementation of the program.