The Centre of Excellence is currently developing a series of “Best Practice” documents for the analysis of computed tomography radiation dose. We have several publications under review that will be submitted to scientific journals–excerpts from these will be made available in the near future. Our first white paper (see below) is on the topic of regulations associated with medical radiation dose. In addition to our own publications, we make available here links to and excerpts of valuable sources of information on the management of medical radiation dose.


Expert Panel to Enhance the Safety and Quality of Energy-Applying Medical Devices in Ontario

An expert panel co-chaired by Dr. Tim Dowdell, the radiologist-in-chief at St. Michael’s Hospital and medical director of the hospital’s Centre of Excellence in Medical Imaging, has made recommendations on how to modernize Ontario’s radiation protection legislation.

Health Quality Ontario formed the Expert Panel to Enhance the Safety and Quality of Energy-Applying Medical Devices in 2015 to review the Healing Arts Radiation Protection, or HARP, Act.

Despite rapidly changing technology, the HARP Act has remained unchanged since it was passed more than 30 years ago to ensure the safety of patients receiving X-rays.

Dr. Bruce Gray, a radiologist and co-director of the Centre of Excellence in Medical Imaging at St. Michael’s, and Dawn-Marie King, the director of Medical Imaging and Laboratory Medicine at St. Michael’s, were also members of the expert panel.

The panel’s recommendations to the Ministry of Health and Long-Term Care extend beyond the HARP Act to accommodate all modern energy-applying medical devices, or EAMDs, such as MRIs, CT scanners, nuclear radiation devices and therapeutic and image-guided procedures.

The six recommendations are:

  • to expand the scope of legislation for radiation protection in Ontario
  • establish a new governance structure for quality oversight of EAMDs
  • use a phased approach to introduce modernized legislation and regulation
  • strike task forces on an ongoing basis to develop or update regulatory requirements where indicated by the Committee to Regulate Devices
  • continue to develop the digitally-enabled infrastructure required to drive system learning
  • develop and foster mechanisms to enhance public reporting and transparency in the system.

View the story at St. Michael’s Hospital’s Newsroom and the full report.

The Joint Commission in the US has recently imposed standards related to medical imaging that uses ionizing radiation and for MRI; these include:

  • Minimum competency for radiology technologists, including registration and certification by July 1, 2015
  • Annual performance evaluations of imaging equipment by a medical physicist
  • Documentation of CT radiation dose in the patient’s clinical record
  • Meeting the needs of the pediatric population through imaging protocols and considering patient size or body habitus when establishing imaging protocols
  • Management of safety risks in the MRI environmentCollection of data on incidents where pre-identified radiation dose limits have been exceeded

The Diagnostic Imaging Standards notification can be found on The Joint Commission website.

Identifying Institutional Diagnostic Reference Levels for CT with Radiation Dose Index Monitoring Software

We retrospectively evaluated radiation optimization efforts over 4 years for three computed tomography (CT) protocols and to determine institutional (local) diagnostic reference levels for prospective tracking by using automated radiation dose index monitoring software. Our results showed that automated methods of radiation dose data collection permit a detailed analysis of radiation dose according to protocol and equipment over time. Radiation dose optimization measures were effective, but their full value may be realized only with changes in internal processes and real-time, prospective data monitoring and analysis.

View the complete article at PubMed.

Automated Patient-Specific Dose Registries, or Radiation Dose Index Monitoring Software—Why they are a Very Good Idea!

We published a comment on the article, “Canadian Association of Radiologists Radiation Protection Working Group: Automated Patient-Specific Dose Registries—What Are They and What Are They Good for? [Can Assoc Radiol J. 2015]

View the complete article on PubMed.

Tracking and Resolving CT Dose Metric Outliers using Root Cause Analysis

We examined the frequency and type of outlier dose metrics for three common CT examination types on the basis of a root-cause analysis (RCA) approach, and found that systematic RCA of dose outliers identifies sources of variation and dose excess and pinpoints specific protocol and technical shortcomings for corrective action.

View the complete article on PubMed.