Purpose or Case Report: The American College of Radiology (ACR) Dose Index Registry (DIR) compares site or practice exposure indices among regional and national values. While the CT DIR was established in 2011, Digital Radiography (DR) is only in the pilot phase. This single-site, single-vendor experience will inform the pediatric radiology community of the establishment of the ACR DIR DR module.
Methods & Materials: Radiation dose structured report data from images obtained on Siemens Ysio DR systems with Fluorospot Compact FD software from a single pediatric hospital system were anonymized using the ACR TRIAD software. This Siemens software used the International Electrotechnical Commission (IEC) 62494-1 exposure index standard. The data was transmitted to the ACR DIR. Each individual radiation event was recorded. The data was retrieved from the ACR records by the sending institution using an Excel spreadsheet. The 5 most common exams, excluding stitched exams, were reviewed. The mean and standard deviation of the Exposure Index (EI), Target Exposure Index (EIT), and Deviation Index (DI) were analyzed.
Results: There were 7 rooms (2 in-department, 2 orthopedic, 2 outpatient, and 1 emergency) that supplied data from 6/25/18 until 9/23/19. 143921 exposure events were recorded. 1207 events had no values listed (0.83%). The 5 most common exams (number of events) were: 2-view CXR (22134), foot (9429), knee (9158), wrist (8060), and 2-view abdomen (7086). The preferred EIT for CXR, abdomen, and knee was 250 and EIT for wrist and foot was 350. The EI (std) was for CXR 341 (165), foot 419 (213), knee 545 (387), wrist 440 (190), and abdomen 411 (199). The DI (std) was for CXR 0.9 (2.0), foot 0.2 (2.3), knee 2.6 (2.7), wrist 0.6 (1.8), and abdomen 1.7 (2.0). Most common and impactful difficulties encountered were incorrectly programmed EIT and proper naming protocols.
Conclusions: Dose Index Registries are important to assure quality and safety of patient care. The ACR CT DIR has established diagnostic reference levels for the 10 most common adult CT exams. Radiographs comprise 85% of all pediatric examinations, but there is no national benchmarking of dose indices. This single-site experience indicates that the exposure data can be easily acquired and analyzed using ACR TRIAD. There was a tendency to overexposure with the mean knee and abdomen exams approaching overexposure by a factor of 2 and the foot exam close to optimal. Additional sites need to be recruited to help benchmark exposure indices for common pediatric examinations.