The benefits of New generation CT scanners equipped with iterative reconstruction algorithms has been well reported, especially with newer generation algoriths (MBIR) demonstrating further dose reduction benefits(14). 

Despite the integration of 3rd generation CT technology and advanced IR algorithms in our practice, radiation dose in Group A were higher than institutional and National averages for KS-CT exams

Although technological advances are imperative for dose reduction, however, consideration of other contributing factors are essential to achieve intended dose reduction benefits.

After installation/ upgradation of new technology, protocols should be optimized to achieve maximal dose reduction benefits at diagnostically acceptable image quality. Protocoling Radiologist and CT technologists should be updated/educated regarding new/revised CT protocols and encouraged to adhere to optimized protocols. CT protocol names should preferable reflect protocol changes, especially when multiple protocols are available for given indication on same/different scanners. 

It must be mentioned that the standardization of protocol optimization within institutions may be challenging due to busy practice with multiple CT vendors/ diverse CT Technology, multiple protocols for the same indication, variability among technologist in regards to experience, training and protocol adherence and finally clinical indication and acuity. 

After protocol optimization and integration with clinical practice, the next step is to assess performance of modified protocols with regards to radiation dose reduction and image quality across institution. Image quality assurance/control are performed routinely by radiologists as they are dictating the studies and any quality issues are reported to the technologist and CT management. However, assessing dose reduction benefits of modified protocols for each patient/exam is challenging especially in busy practice. Commercially available dose monitoring softwares have been introduced and widely available to continually monitor radiation doses for given protocol on specific scanner. 

Dose monitoring is particularly important when a new CT technology/scanner is introduced into the practice and new/modified scan protocols introduced. Any radiation dose variability for specific protocol/ exam compared to National or Institutional benchmarks should be further investigated. Most often dose variability is secondary to patient demographics especially patient size/ habitus. Other causes of dose variability would include wrong protocol used for scanning either due to incorrect protocol selection by radiologist or non-adherence to optimized protocol by technologist, adaption of protocols from old generation scanners without adequate optimization congruent with the new generation CT technology/IR algorithm to achieve diagnostically acceptable dose reduction benefits.

Comprehensive approach to dose reduction including protocol optimization congruent to the CT scan technology/IR algorithm, periodic institution-wide dose monitoring and technologist education enabled 45% dose reduction in KS-CT exams on our newly installed CT scanners in ED.