A Dose of Prevention: The Role of the RIS in Preventing Overexposure

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Charles SociaIn many ways, the problem of radiation overexposure still resembles a crime scene. Investigators come in after the fact and attempt to determine what really happened. There is another way, however, according to Charles W. Socia, RT, CIIP, product manager for the information-systems division of FUJIFILM Medical Systems USA—one that focuses on prevention. The 23-year radiology veteran is working to overcome the retroactive-response mentality that still dominates the industry.

The idea is to improve care on the spot, while the patient is still on the table. “The majority of the solutions today are focused after the event to analyze overexposures,” Socia explains. “The focus of the Fujifilm solution is to notify users prior to the exposure and provide immediate notification in the event of an overexposure. We provide tools to notify referring physicians, radiologists, and technologists as to patients’ risk levels.”

On the heels of several high-profile cases of excessive radiation exposure, the state of California has attempted to improve the situation through a new dose-reporting law, the Medical Radiation Safety Act of 2010 (which went into effect on July 1, 2012). While acknowledging that the state’s efforts probably will not hurt, Socia is not convinced that the law will actually help.

“The California law is not going to solve the problem,” Socia says. “It may let more people know what overexposures are happening, but it won’t solve the real problem, which is that patients are being overexposed. Back in the old days, we heard a buzzer go off when we overexposed patients, and the result was a dark film. Those days are gone.”

In today’s digital environment, however, dose creep can occur in settings where technologists have no external information to let them know that patients are being overexposed, Socia says. Fujifilm now offers tools to prevent these incidents by providing crucial information that can help determine whether a specific technologist, piece of equipment, or protocol could cause a problem.

The Place of the RIS

Software engineers at Fujifilm examined ways to adapt the company’s Synapse® RIS and PACS to the task of prevention, and the result is that Synapse systems now are able not only to record modality exposure information, but also to provide real-time decision-support tools that allow for prompt intervention. Limited dose-management tools are also contained in the Communications Module of the Synapse PACS.

The key tools are an electronic alert and a cumulative-exposure notification that provides summary totals of individual exposure types (by modality) while technologists are preparing to do exams. Fujifilm’s total solution has the ability to check the protocol, history, and body weight of the patient to provide technologists with information on appropriate exposure levels—integrated within the normal workflow.

In the event of an overexposure, critical-alert notifications can be sent directly to referring physicians via fax, email, or text. Socia, who serves on American Board of Imaging Informatics, says, “We have automated the process of sending the information. We are working to provide that information to third-party systems.”

Seeking Standards: The Dose Index Registry

One of the ways that FUJIFILM Medical Systems USA is promoting better radiation-dose management is its publicizing of the Dose Index Registry (DIR) launched by the ACR®. Participation in the DIR enables facilities to benchmark their CT dose indices against regional and national standards. The registry is also a first step toward standardizing recommended exposure levels.

To participate, facilities enroll in the DIR and receive a unique facility identifier. The ACR software is then installed on a local computer, and CT dose-index information from each of the facility’s scanners is anonymized and sent to the ACR database. Participants receive periodic feedback reports comparing their results, by body part and exam type, with aggregate results.

Charles W. Socia, RT, CIIP, product manager for the information-systems division of Fujifilm, says, “The ACR is a leader in the industry in providing solutions, but the reality is that many customers are not aware that the DIR exists. We believe it is our responsibility, as the vendor in primary contact with customers, to provide the information, so that others can improve patient care.”

In enabling facilities to compare their dose indices with those of similar-sized