Implementation of a computed tomography dose management program across a multinational healthcare organization

Radiation dose management system in computed tomography procedures: a systematic review

A systematic literature review was carried out to explore articles that reported the use of radiation dose management systems (RDMSs) in computed tomography (CT). The preferred reporting items for systematic review and meta-analysis flow chart were used to screen articles in PubMed, EBSCOhost, Web of Science, SCOPUS and Cochrane Library. A total of 1041 articles were retrieved and screened. After evaluation against criteria, 38 articles were selected and synthesised narratively. The results revealed that several RDMSs have been used in CT. The review also indicated that the use of RDMSs has promoted the implementation of diagnostic reference levels for dose optimisation. A RDMS, such as DoseWatch, is associated with compatibility challenges and failure in data transmission, while manual RDMSs are cumbersome and prone to data entry errors. Thus, a robust automated RDMS that is compatible with the different CT systems would provide efficient CT dose management.

Impact of abdominal imaging on the diagnosis of acute pancreatitis in patients with painless lipase elevation

Abdominal pain is considered a cardinal feature of acute pancreatitis (AP), and abdominal imaging is only required to diagnose AP when the pain is atypical, or serum enzyme elevation does not match the clinical picture. While painless lipase elevation is being increasingly associated with worse outcomes in various diseases, the diagnostic approach to such elevation is so-far unclear. We thus aimed to learn the impact of pain on the diagnosis of AP.

METHODS

All patients presenting to the Mayo Clinic Arizona Hospital emergency department with a serum lipase ≥3x upper limit of normal between April 2016 and January 2020 were prospectively followed. Their charts were reviewed for the nature of pain, serum lipase levels on presentation, abdominal imaging, and whether a diagnosis of AP was made. Chronic pancreatitis was excluded.

RESULTS

Among 320 patients, 85 (26.5%) had painless lipase elevation. These patients had abdominal imaging less often (56/85, 66%) than in those with abdominal pain (201/235, 83%; p = 0.001). The diagnosis of AP increased overall from 31/63 (49%) without imaging to 198/257 (77%) with imaging (P < 0.001). Imaging increased the diagnosis of AP in patients with painless lipase elevation from 2/29 (7%) without imaging to 16/56 (29%; p = 0.025) among those who were imaged.

CONCLUSIONS

Painless lipase elevation >3-fold the upper limit of normal is common in emergency department patients. 1/3 to 1/4 of these may have AP. Abdominal imaging increases the diagnosis of AP in patients with painless lipase elevation. Therefore, abdominal imaging in such patients may help detect AP that otherwise eludes diagnosis.