Minimum requirement: controlling radiation

Travellers visit the southern Spanish region of Murcia for its sandy beaches, delectable tapas bars and quaint hillside villages. It is a place to relax among friendly locals who relish the warm weather, long lunch breaks and a stroll by the riverside Paseo del Malecón. Yet, despite its beauty, Murcia too is affected by the usual difficulties that face modern societies.

The efficacy and funding of healthcare, and how the system deals with the occasional mistake, are abiding concerns within the region. Patient safety and dose management have been objects of focus for years, with scrutiny intensifying in the run-up to Euratom 2013/59’s implementation in February 2018.

The regional government of Murcia anticipated the EU directive by announcing that it had reduced patients’ average level of exposure to radiation by 35% across all ten of their public hospitals using GE Healthcare’s DoseWatch system. As a result, Murcia Health Services was compliant with the new regulations before they came into force.

A new beginning

Murcia is one of the first regions in Europe to comply with the stipulation that obliges hospitals to measure and control radiation from their imaging procedures.

Its health services care for nearly 1.5 million people, organising services into nine areas, each of which has a hospital of reference. Since DoseWatch was first used at University Hospital Virgen de la Arrixaca, an average of 970 exams have been carried out in the region every year.

DoseWatch automatically collects and analyses patient radiation and iodine exposure across a range of imaging environments, enabling healthcare professionals to evaluate their practices and make improvements to establish the optimum doses for the best outcomes.

The system also uses cumulative dose tracking across modalities and devices in order to enable the monitoring of radiation doses delivered to patients undergoing a variety of imaging procedures.

Like other systems, it also relies on analytics tools to find the right balance between image quality and dose, and enables compliance by offering better reporting capabilities for radiation safety.

The system has been used in more than 210,000 CT, 43,000 mammography and 23,000 interventional radiology exams. Radiologists and radio physicists in Murcia used the results of this monitoring to establish protocols governing the use of imagine equipment across all of the region’s hospitals.

Transparent aims

Explaining how the system came to be implemented in the first place, project leader Alfonso Martinez Cal, GE’s dose modality leader for Spain and Portugal, says that healthcare operators “wanted a tool to help the patient. We needed to connect the system to a central server that had specific software so we got immediate information on dose management.”

Accurate digital dose management records for patients are essential if hospitals are to minimise the amount of radiation to which they are exposed.

“We’re in a new age of approaching radiology set-up and organisation,” continues Martinez Cal. “All the different departments involved are working together towards improving patient care.”

Transparency is crucial to the project. The aim is to ensure patients are aware of the issues associated with imaging as well as the steps being taken towards minimising radiation exposure.

Positive reactions

New dose management systems like this will give physicians immediate access to patients’ dose histories, which will be vital when deciding which imaging techniques to use – those who have already been exposed to a lot radiation, for example, may be recommended for alternative examination methods.

Murcia’s regional health councillor, Manuel Villegas, explains that dose management had been an important step in improving patient care. “The importance of this initiative lies not only in avoiding unjustified overexposure,” he says, “but also in reducing the levels of radiation to the minimum level possible to maintain sufficient diagnostic image quality.”

Dr Bonifacio Tobara, head of radio physics and radiological protection of the hospital Clínico Universitario de la Arrixaca, says the new system has reduced patients’ average level of exposure to radiation by 35%, which he regards as very positive, given the increasing levels of radiation to which patients are being exposed due to the intensifying use of medical imaging. “It has also optimised dose levels on our 16 CTs in Murcia, enabling us to achieve high-quality images while avoiding overexposing patients,” he says.

The Murcia team hopes the new system will be particularly valuable in paediatrics and will help all adult patients to make more informed decisions about their care.

The next step, according to Martinez Cal, is optimisation. “The future of the project is focusing on data mining,” he says. “All the systems are connected, so addressing new areas, especially management and performance protocols, is our next big goal.”