CT radiation dose optimization and tracking program at a large quaternary-care health care system

Purpose The authors report the implementation and outcomes of a CT radiation dose optimization and tracking program at a large quaternary-care health care system. Methods A committee reviewed, optimized, and released standardized imaging protocols for the most common CT examinations across the health system. Volume CT dose index and dose-length product (DLP) diagnostic reference levels (DRLs) were established, with the goal of decreasing the percentage of outliers (CT scans with DLPs greater than the established DRLs) to <5% of tracked CT examinations. Baseline radiation dose data were manually extracted for 5% of total examinations. A semiautomated process to analyze all DLP data was then implemented to monitor outliers. Results The baseline percentage of outliers was slightly higher than 10% for pediatric scans but nearly 26.5% for adult scans. Over the first year, after standardized protocols were distributed, the percentage of outliers decreased for pediatric brain (from 22% to 6%), adult brain (from 23% to 3%), and adult chest (from 22% to 11%) examinations. Over the next 2 years, after the dose-tracking program was implemented, the percentage of outliers decreased for adult (brain, from 3% to 1%; chest, from 11% to 1%; abdomen, from 24% to 1%) and pediatric (brain, from 6% to 2%; chest, from 11% to 0%; abdomen, from 7% to 1%) examinations. Conclusions The reported CT protocol optimization and dose-tracking program enabled a sustainable reduction in the proportion of CT examinations being performed above established DRLs from as high as 26% to <1% over a period of 2 years.