Achieving personalized care delivery using standardized protocols: Sectra DoseTrack at UHCMC

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 - CT Scanner with patient

A year into implementing a better method to track and report patient radiation dose and the team at University Hospitals Case Medical Center (UHCMC) in Cleveland says they are on the right track. The center of UHCMC’s dose tracking and reporting is Sectra Dose Track™, the dose-monitoring and reporting platform from Sectra. As part of the initial pilot, UHCMC, a 1,032-bed tertiary care academic medical center specializing in adult/pediatric medical and surgical specialties that is affiliated with the Case Western Reserve University School of Medicine, began feeding information from six of its 24 CT scanners into the system and now, one year later, the entire suite of scanners feeds data into the system. Dave Jordan, senior medical physicist for the organization, says UHCMC began the pilot program in June, 2013. He is very pleased with the progress they’ve made getting all the equipment connected and online, and eager to offer the aggregated data to the UHCMC stakeholders for analysis.

“There is so much information available to us now, and I feel confident that with what I’m seeing, we will be able to do some very interesting analysis,” Jordan reports. A variety of different teams within the medical center have been formulating plans on how best to analyze the data. Some are interested in CT data for individual patients, while others are more broadly focused on the operational success of the department in terms of consistency and quality. The question is: Which group will be able to get the data it needs to do the analysis? The answer: All of them.

Evaluation and strategy

The UHMCM team is focused on two immediate questions on radiation dose tracking: How can we benchmark ourselves internally and externally? And how do we reduce our average or reduce our variability?  

Jordan looks forward to the more cooperative approach to dose management that the dose tracking system allows. “This will truly be a cross-functional effort,” he explains. “One group may want to analyze the data from the 30,000 foot level, and another could attack it by looking at dose protocols for one particular exam. My role is to make sure all the stakeholders are involved in the process and get what they need to look at the issues they want to address,” Jordan says.

“We’ll be able to pull out different datasets to initiate conversations with technologist supervisors and radiologists about what all of this means to them—and what kinds of questions it raises,” he notes. “Sectra DoseTrack will be a great guide for those discussions, ultimately bringing us to a point where we’re achieving, as we can achieve personalized care delivery in a standardized way.”

Jordan and his colleagues initially became interested in using the platform as a way to address dose monitoring and management more proactively, as well as to facilitate deeper collaboration among medical physicists, radiologists, and technologists.

“Our driver,” Jordan explains, “was in seeking a system with a lot of flexibility to slice and dice all this information. We haven’t been able to see this before. Scanners are already producing this information, but without a system in place to collect it, the data are just disappearing. Accessing and understanding the data will also help us figure out if we need to improve, or if we can have confidence in the way we’re doing things right now.”

One reason the Sectra system was chosen was the flexibility it offers. “The interface on this system gives you a lot of options,” he notes. “It doesn’t force you to look at certain default datasets or graphs. You pick the subset of patients, procedures, dates, or any other combination of parameters, and you get whatever it is you were looking for immediately.” That flexibility is valuable to the team at UHCMC precisely because they are seeking to take a proactive approach to dose management, rather than troubleshooting a particular issue. Jordan explains, “We wanted the capability to uncover things we didn’t know that we didn’t know.”

Data aggregation and implementation

By June 2014, UHCMC was feeding data from 24 CT systems and four PET/CT systems spread across its hospital campuses to Sectra DoseTrack. The University Hospitals serve the needs of patients through an integrated network of 12 hospitals, 26 outpatient centers and primary care physician offices in 15 counties. To date, UHCMC has collected data on more than 78,000 scans. “From the very beginning, with just a few months’ worth of data, we could go in and look at the performance of individual scanners,” Jordan says. “When we saw things that looked strange, we were able to drill down and look into what had happened.” In the end, all the CT systems turned out to be performing well. And Jordan’s instincts were right: “The system draws attention to what needs a closer look.”

With such a large fleet of scanners, Jordan knew that connecting all of them via dose tracking would probably not be completely plug and play. His team discovered that occasionally, even if a facility operates two CT scanners of the same make and model, and are running the same software, configuration differences can prevent a copy and paste approach to getting the scanner synched with dose tracking.

“It’s a step by step process to get each scanner on board and requires validation of the test data to be sure that good data are being collected. Sectra has been very helpful to us in working through some of the challenges we’ve encountered,” Jordan says.

But would they think of turning back now? No. “To return to a manual dose tracking spreadsheet is not something anyone wants to think about,” he says. “We’re really happy to have all of our systems online and will start analyzing the data very soon.”

Sectra DoseTrack will enable UHCMC to monitor and manage dose across large patient populations, its multitude of CT systems, and its many facilities—a boon to its team of medical physicists. “When you need to understand what’s going on with radiation dose with real patients, Sectra DoseTrack puts it right in front of you,” Jordan says. “When you decide, on Tuesday morning, that you want to see how the pediatric CT scanner is doing, in two clicks, you can have all the data from the past month. It’s a huge time savings.”

Jordan and his colleagues also will be able to save time calibrating CT protocols—a growing priority for the organization’s medical physicists as they become more collaborative with radiologists and technologists. “You’d never be able to look at every detail of every protocol on every scanner: There are way too many variations,” he says. “With Sectra’s system, we can see what we need without going to every individual scanner and scrolling through its details.”