The key to meeting the latest Joint Commission standards for diagnostic imaging, and preparing for future initiatives, is developing an effective dose monitoring program, according to Olav Christianson, clinical dose optimization service team leader at Landauer Medical Physics.

Christianson gave a detailed webinar presentation this week, organized by AHRA, about what radiologists and technologists can do to help their facilities stay up to date with the latest standards.

The Joint Commission’s revised requirements for diagnostic imaging services went into effect on July 1, but Christianson said there are a lot of facilities struggling to comply. Standards causing the most headaches are those that involve recording every patient’s CT radiation dose and making it available in a retrievable format, adopting protocols based on current standards of care, and then periodically reviewing those protocols.

“These new requirements are not easy to meet,” Christianson said.

While thinking about these standards, Christianson said he was inspired by a 2011 film starring Brad Pitt, Moneyball. The film, which was based on a bestselling book by author Michael Lewis, tells the true story of a small-market baseball team that competes with big-market teams by studying what had historically made some teams of the past more successful than others.

If that process worked for a baseball team, he thought, maybe it could work outside of baseball as well.

“I’ve taken that same approach to looking at dose monitoring programs,” Christianson said. “I’m now working with nearly 100 hospitals across the country, and I’ve seen programs that are successful and some that are not as successful. So I took a look back at what the different programs have done, and what’s made them successful.”

Christianson broke this down into four “keys for success” for developing an effective dose monitoring program:

1. Motivated clinical leader

This, according to Christianson, is the most important key to success. There must be someone at the facility who is willing to take ownership of the project and coordinate the entire team’s efforts.

“Without that person, you cannot be successful,” Christianson said.

2. Experienced medical physics support

Having a motivated clinical leader is the most important key, but Christianson said an experienced medical physicist is No. 2 on the list. Their knowledge and education can make a huge impact and help everyone make sure their information is up to date and accurate.

“Medical physicists are experts when it comes to image quality, radiation dose, analyzing data, and the operation of CT scanners,” Christianson, a medical physicist himself, said.

3. Allot time for staff to work on the project

Documenting each dose and looking over each protocol will take a lot of time. Medical physicists and technologists will need specific time set aside to help them focus on getting these things done.

4. Right tools for the job

Make sure you have the proper technology to meet all these requirements. With the right software, Christianson said, you can set dose alerts and help technologists learn from their mistakes by reviewing what they’ve done in the past.

Dose review committee: the fifth key?

Christianson also said an effective dose monitoring program needs a high-quality patient dose review committee. The committee should be made up of at least a medical physicist, a radiologist and a lead technologist, but administrators can also be present for these discussions.

Christianson recommends quarterly meetings, but said every protocol won’t be discussed at every meeting. However, the committee should confirm it is reviewing protocols every one or two years.

Christianson also said he has seen some dose monitoring programs that include far too many action levels, which just makes things more confusing for the staff and leads to too much time being spent on avoidable training.

“My advice is to keep it simple,” he said. “Use one action level. If you’re going to generate an alert, that needs to be something where everyone knows what it means and knows what their role is.”