title: CT Radiation Dose Optimization and Tracking Program at a Large Quaternary-Care Health Care System.
abstract: OBJECTIVE
  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.
authors.affiliation: Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ajit H
authors.initials: AH
authors.lastname: Goenka
authors.affiliation: Section of Medical Physics, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Frank
authors.initials: F
authors.lastname: Dong
authors.affiliation: Section of Medical Physics, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wildman
authors.affiliation: Section of Medical Physics, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Katie
authors.initials: K
authors.lastname: Hulme
authors.affiliation: Section of Medical Physics, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Paul
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: hertsb@ccf.org.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Herts
mesh_terms: D006801:Humans; D009820:Ohio; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000592:standards*; D012016:Reference Values; D014057:Tomography, X-Ray Computed / Q000592:standards*
keywords: CT; dose reduction; dose-length product; optimization; radiation dose; volume CT dose index