Proactively monitoring the compliance with Diagnostic Reference Levels

Regulatory requirements & deadlines

Compliance monitoring for radiology is often mandatory. Although regulations are country specific, the size and detail level of the data sets required by regulatory organisations are increasing. So does the effort to trace, collect and format all the monitoring data.

In most cases such a regulatory submission project keeps one or more persons busy for weeks every year. Usually, their prime focus is meeting the submission deadline. As a result, there is no time left to analyse the data, discover trends, and further improve internal quality processes.

Continuous compliance monitoring

A more proactive approach is to continuously capture all radiation dose data to evaluate compliance. An increasing number of hospitals across Europe realise this objective with DOSE by Qaelum. They use the software to optimise and export compliance reports, formatted exactly as stipulated by local regulatory organisations. As a result, continuous compliance monitoring saves manpower and offers the opportunity to turn the data into valuable insights.

Compliance monitoring for radiology is often mandatory. Although regulations are country specific, the size and detail level of the data sets required by regulatory organisations are increasing. So does the effort to trace, collect and format all the monitoring data.

In most cases such a regulatory submission project keeps one or more persons busy for weeks every year. Usually, their prime focus is meeting the submission deadline. As a result, there is no time left to analyse the data, discover trends, and further improve internal quality processes.

Monitoring dashboard

Compliance monitoring widgets in DOSE are developed to formally follow up and evaluate radiation dose exposure for a range of selected examinations across all modalities. The software tracks and records all individual doses given to any patient, applying correct segmentation as configured in collaboration with Qaelum. The widgets can be combined in an information dashboard so that authorised users can monitor dose quantities day-to-day and perform general and detailed assessments.

What users specifically value is the ‘traffic lights’ based monitoring. The studies or series presenting doses higher than the achievable and acceptable regulatory levels, are flagged orange or red, respectively. Lower values are marked with a green flag. These regulatory dose levels are called diagnostic reference levels (DRLs). During installation, the DRLs for the local requirements are preloaded. The used studies can be segmented in age, age group, length, height, weight, number of series, etc.

Figure 1. Advanced compliance monitoring screen lists dose metrics for different study groups – a) on study level and b) on series level. The DRL traffic lights show how the hospital scores in terms of regulatory dose levels. The left colour indicator shows the outcome for all linked studies within date range; the right colour indicator shows the outcome of the dataset that will be exported. The miniature ‘spark line’ graphs next to the traffic lights show the dose history.

Compliance related configuration and reporting

Important with respect to DRL compliance is that when exporting from DOSE all information becomes available immediately and in the correct template. The software currently covers the DRLs for the majority of the European and Middle East countries. Configurations for additional countries or hospital specific reference values can be easily added.

When setting up DOSE for a new installation, the software is configured by linking the study descriptions with the targeted examination categories (as defined by the national government or local authorities). Then, the creation of a legal report is just one click away for any authorized user. If there is no standard template available, Qaelum can assist in creating such a template.

Acquiring insights, discovering trends, increasing quality

Next to legal compliance monitoring, DOSE can be used to compare individual studies against the statistics of a local population in order to optimise the protocols of the department. With all data managed centrally, hospitals are able to drill down in DOSE and acquire valuable insights. They can look at any individual study, and compare it with all studies from the same modality having the same body part examined, for example. The screen – Figure 2 a) en b) – informs radiologists, surgeons, medical specialists, etc. where the individual study is situated in the dose distribution histogram. Alternatively, non-dose related parameters are available for comparison to improve the understanding of the potential problem.

Figure 2. An individual study is compared with all patient studies from the same modality (CT) having the same study description. The orange triangle marks the bar in the dose distribution histogram the study belongs to. Figure a) shows a study with a dose much higher than the acceptable reference level, but falls nicely within the Inter Quartile Range (IQR) of the local distribution. Figure b) shows a study which has a very low dose compared with the local distribution but adheres to the acceptable reference level.

Due to all the possibilities of the DOSE solution, monitoring your compliance can be seen as a cumbersome and time-consuming task. However, the possibilities in DOSE to fine tune the notification settings make sure that only the relevant uses will only receive alerts of the major issues. Also, scheduled reports can be configured. These reports can be delivered periodically as a static document or as a link to an on-the-fly created dynamic website.

Often one is also confronted with datasets containing non-relevant studies. DOSE allows to hide these studies and as such avoid pollution of the exported data. Examples of this can be seen in Figure 3.

Figure 3. Before creating compliance reports, datasets can contain non relevant datasets. Figure a) shows a group of screening mammography studies, including a study of a foetus. Figure b) shows two studies with the description of CT Sinus, but which actually are CT Chest examinations. Built-in tools of DOSE can be used to ignore these two studies in reporting or other types of statistics.

Conclusion

Hospitals use DOSE software to keep track of radiation dose on a daily basis. It provides the tools to maintain a helicopter view on the current situation, and if needed they can drill down on individual studies. The flags and trends show them how well the hospital or specific departments score with respect to regulatory compliance. This kind of information is extremely valuable to hospitals. It enables them to work towards lowering overall radiation doses and other quality objectives without compromising on patient safety.