But tracking that dose information is
another story. Experts disagree on what in-
formation is relevant to the long-term care
of the patient and thus what should be in-
cluded in the medical record. “We need to
be cautious about tracking something we
don’t understand,” says James Brink, M.D.,
chair of diagnostic radiology at Yale. “I get
nervous when I see EHR vendors advertis-
ing dose tracking. Some distill it down to a
single number and that’s dangerous.”
Brink says dose is a tricky number to
track. ;e radiation produced by a CT scan-
ner is not the same as radiation absorbed
by the body, which can vary depending on
whether the site of the scan is bone or soft
tissue. ;e absorbed, or “e;ective” dose, is
measured in millisieverts, which were never
intended to be used as an individual dose-
tracking measurement. “It’s more appropri-
ate to use as a measure for the dose to a spe-
ci;c organ, but it’s a rigorous challenge to
estimate the dose to a group of organs,” Brink
says. For example, a neck CT would speci;-
cally expose the thyroid gland, but might not
a;ect other organs in the body at all.
;e Image Wisely campaign, which
Brink co-chairs, advocates tracking procedures only, and its Web site o;ers a model
medical imaging history card that simply
shows the date, the procedure, and the facility where it was performed.
ECRI’s Inamdar also favors measuring what can be measured—the radiation
coming out of the scanner, and the number
of CT exams that a patient has had.
ECRI and the Health Care Improvement
Foundation are working with 30 Philadel-phia-area hospitals on a CT safety collaborative. Patients who have had ;ve or more
CTs in the last two years are ;agged in the
radiology information system, the PACS, or
the order entry system, depending on the
hospital’s I. T. con;guration, when a physician tries to order another CT, so that alternatives can be considered.
However, Rasu Shrestha, M.D., vice
president of medical information tech-
nology at University of Pittsburgh Medi-
cal Center, thinks “the number” is both
desirable and achievable. (He will teach a
course on informatics for dose tracking at
this month’s RSNA meeting in Chicago.)
Leading low dose
Advocate Health Care, the largest system
in the Chicago area, is trying to lead the
way in low-dose CT imaging. John Anas-
tos, M.D., chief of radiology at Advocate
Lutheran General Hospital, Park Ridge, Ill.
and chair of the radiology council for the
10-hospital system, says about 90 percent
of the 250,000 annual CT scans done at
Advocate facilities are already being done
with low dosage, and he expects to push
that number higher as a result of installing
dose tracking software and having data to
