Dose Registries Gaining Ground

CHICAGO - National registries may be the new frontier in recording and reporting radiation dosage, as facilities sign on to compare and make improvements.

Kalpana Kanal, PhD, medical physicist at the University of Washington, explained at RSNA 2013 the significant role national dosage comparisons are playing in the radiology field. These data warehouses are helping imaging professionals track radiation dosage amounts. Without a national dosage average, comparing a facility's dosage to the 801 total facilities and 6.7 million exams using a national registry may help improve a patient's standard of care.

As medical professionals are concerned about how their respective dosage amount compares to the national average, registries can naturally allow for a detailed comparison. “It sets some benchmark on what would be the national level of common exam types,” Kanal said. “It's comparing your median values to that of other facilities.”

Kanal focused her attention on the American College of Radiology's National Radiology Data Registry (NRDR), which houses data from several other groups including the Colonography Registry (CT), the Dose Index Registry (DIR), and the General Radiology Improvement Database (GRID).

How do registries such as these work? A medical facility signs a participation agreement, registers on the national registry's website, downloads software to transmit their dosage data and configures scanners to transmit data, according to Kanal. Besides the initial setup, no personnel is required to be a part of the system.

The intention behind registries is a cyclic, data-driven improvement process. Each facility and physician submits their dosage data, and they receive periodic national benchmarking reports, allowing them to analyze their results and develop and implement a possible improvement plan. Kanal said tracking certain types of data can “empower facilities,” as the guiding principle behind these systems is allowing professionals to monitor and track their facility’s improvements.

But even with access to a litany of national averages, facilities are still encountering some challenges. Registries do not collect individual dosage amounts or a patient's identifiable information, making national comparability difficult among patients that vary in size. To alleviate some of the comparability problem, Kanal said physicians should make sure their dosage amounts are accurately recorded. She said mapping out the dosage amounts and frequency allotted for each patient will help facilities more accurately track data.

For registry participants, a semi-annual feedback report is uploaded every six months and is available to all its users. In the January through June 2013 report, for example, 431 facilities received feedback on their adult patients and 410 on their pediatric patients. The report breaks the data down in six vertical columns for easy reference.  Users can also view the nation's top 20 exams, allowing the viewer to see the median Computed Tomography Dose Index (CTDI) volume, and determine where the user should improve the dosage value. “The [registries are] very established,” Kanal said. “In general, they [are] doing very well.”