recorded in the patient letter as a dose
range based on the examination. The
actual dose for the patient was recorded
electronically when the patient received
the dose. This information would be the
simplest to provide in the technologist’s
notes in PACS because no calculation or
conversion would be necessary.
Due to the complexity of this problem,
the best way to perform and record the
dose calculations is still being explored.
Possible software solutions for long term
storage and retrieval of the data are being
researched, as well as tools to assist the
radiologists in dictating this information,
such as auto-populating templates.
Notification for Excessive
According to SIR, “If the cumulative air
kerma at the reference point exceeds 3
gray, provisions should be made for follow-up of those areas for determination
of radiation effects… In such circumstances there should be documentation
in the medical record that the patient was
advised of the potential for radiation injury to the skin and was given instructions for proper follow-up.” 1 Until the
TRACE program began, Overlake did
not have the ability to record this information. In recording it, we recognized
that some exams, by the nature of their
length and complexity, would fall into
the range in excess of 3 gray.
Vetting this particular change with
the Quality Improvement Committee will
be the first step in introducing it to the
medical staff. Further education of the
medical staff will be necessary to field
the potential patient questions associated with this type of notification. Risk
management would need to assess the
letters and consult with other resources
to determine potential issues.
The next step in the TRACE program
will be to purchase a dose area product
(DAP) monitor (about $16,000) for the
fluoroscopic room in the main depart-
ment. Currently, this machine only
records fluoroscopy time. Pending ad-
ministrative approval, the software will
be purchased for the 64-slice CT scanner
to reduce radiation dose. The request for
excessive dose notification letters will be
submitted to the Quality Improvement
Committee and the change will be vetted
through the risk management depart-
ment. In addition, we will continue to
look at software applications and EMR
technologies that offer access to dose in-
dex registries and permanent storage of
cumulative radiation dose information,
as well as software that provides the abil-
ity to set up notifications to alert order-
ing physicians to potential radiation dose
issues due to multiple radiation produc-
ing imaging procedures. EMR applica-
tions will also be analyzed for physician
order entry that check appropriateness
criteria for CT and other radiation pro-
1Guidelines for Patient Radiation Dose Management. Society of Interventional Radiology (SIR) Safety and Health Committee.
Journal of Vascular Interventional Radiology. July 2009.
2RadiologyInfo.org. Patient Safety Radiology
and CT, Naturally-Occurring “
Background” Radiation Exposure. Radiological
Society of North America, Inc. (RSNA).
index.cfm?pg=sfty_xray. Updated November 15, 2010. Accessed May 19, 2011.
Brenda Rinehart has been the director of medical
imaging for Overlake Hospital in Bellevue, WA for the
past seven years and teaches marketing and finance as
an adjunct professor at Bellevue College. She also
operates her own consulting business and has
co-authored a book, Moving From Judgment, to be
released in August 2011. Brenda earned her CRA in
2003 and has participated in speaking events, poster
presentations, and volunteer work, actively supporting
the AHRA for the past several years. She may be
contacted at Brenda.Rinehart@overlakehospital.org.