For every image obtained in medicine there is an abundance of metadata captured. In the case of computed tomography (CT), this data is typically found in the DICOM, which stands for Digital Imaging and Communications in Medicine. The DICOM standard is the documentation for how this metadata is captured and transmitted. Until very recently little has been done to capture and make use of this information. One of the most vibrant areas of software development in Radiology Informatics is focused on capture this information and making it accessible to the user in easy to understand analytic “dashboards.” The real benefit is to patients, as it allows institutions to track imaging in a whole different way and make this information usable in the context of Quality Improvement and Quality Control. The advantage for patients that we seek to explore is one where the metadata is aggregated across institutions to ensure that medical imaging quality information can be shared and best practices can be rapidly disseminated.

In the case of radiation dose for CT, our focus is on benchmarking radiation dose for routine protocols and ensuring that the doses are As Low As Reasonably Achievable (“ALARA”). By optimizing radiation dose across our patient populations, we plan to demonstrate a reduction in exposure to medical radiation within the province of Ontario.

In future phases of our research, we plan to explore how these patient registries can be expanded to include studies of “appropriateness.”  Appropriateness refers to the right study at the right time for that patient. The only way to provide evidence of appropriateness is to conduct Comparative Effectiveness Research (CER) using expensive clinical trials, or to develop a patient registry where patient outcomes can be aggregated based on clinical indications and the “appropriate” type and number of examinations (and radiation dose) can be determined. These “retrospective cohort” studies require accumulation of a large number of cases, which is made possible in a regional registry.