Computed tomography (CT) is considered as one of the greatest advancements in medicine. Although, it provides very valuable diagnostic information that considerably affect clinical management of many diseases, the relatively high level of ionizing radiation inherent to the technique, may cause adverse biological effects on human cells. In modern practice, the magnitude of patient exposure is much below the levels for acute deterministic effects -such as acute radiation sickness, to be observed. Late stochastic effects, on the other hand, are inevitable, as they have no dose treshold in individuals. Such effects are seen as malignancies, teratogenic disorders and mutations, and their incidences are known to be related to collective dose levels (1). These effects are especially important in children where life expectancy is longer and the radiosensitivity is higher.
The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) indicates that medical diagnostic and interventional radiology is the largest man-made source of radiation exposure. Between 1980 and 2006 the annual per-capita effective dose from radiologic and nuclear medicine procedures was increased by 600% (2). CT has the major share in that context, and, is now responsible of almost 24% of collective effective dose. This makes this modality an important causative forstochastic effects.
Typical dose levels during CT examinations may reach, for example, to »10 mSv in abdominal scans, This dose level is almost fifty times more than the average exposure caused by Chernobly accident, and is expected to result in an increased cancer risk of 1/2000 (3). There are also some reports on patients that were accidentally exposed to very high radiation, at the magnitude of 2.800-11.000 mSv (e.g. Arcata Medical Imaging Accident, USA, 2008). However -from the point of patient and population point of view, the most important aspect in radiation protection is not the detection of such exceptional accidents (so called strong signals) but the detection of frequent small anomalies (so called weak signals) in daily practice that may only be detected by the use of advanced analytics (Figure 1). In US, for example, more than 200 patients that were exposed to inappropriately high doses, were able to be detected long afer the incidents. Many of these patients had shown signs of overexposure (e.g. epilation) but went unnoticed by relevant authorities for the next several months. Such unfortunate events are not exclusive to any hospital or to any country. In hospitals where hundreds to thousands CT scans are performed daily, low levels of overexposure may only be deceted with the use automated of dose tracking systems that receive on-line demographical and dose data of large number of patients from several CT scanners and perform real-time analytics on them.
Although above-mentioned IT solutions are now indispensable in high-quality and value-based healthcare systems, they are only meaningful in the context of comprehensive quality improvement systems on dose management. Such systems encompasses whole imaging cycle (Figure 2) and incorporate leadership, technology and practices to lower patient doses according to ALARA principle.
In this presentation an overview of several aspects of a comprehensive dose management system in a EuroSafe Imaging Star (*****) pediatric dose excellence center (Figure 3), was presented to show current concepts and applications of modern dose management in pediatric patients.