Optimizing Protocols for Patient Size

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By Olav Christianson, MS, DABR 

Think about the last time you saw something advertised as “one size fits all.” That approach has failed in clothing, education, investing, and marketing. Instead, today’s world is one of customization. Even when ordering a cup of Starbucks coffee, customers can select short, tall, grande, venti, or trenta–a dose of caffeine tailored to their exact needs. Gone are the days of “one size fits all” and the problems that come with it.

In this wholly customizable world, shouldn’t our healthcare be at least as tailored as our morning cups of coffee?

Regulators and other organizations within the healthcare community are starting to think so, especially within the realm of medical imaging. In 2015, the Centers for Medicare & Medicaid Services built patient size into the dose requirements for computed tomography (CT) lung screening. In 2018, the Leapfrog organization (which conducts annual safety, quality, and efficiency surveys of hospitals) developed age-specific benchmarks for pediatric CT dose. Each of these changes encouraged development of new standards for medical imaging, in which patients receive specified dose levels customized to their size.

However, these new standards raise novel and important questions for the medical community. How can hospitals design their protocols to meet new, size-based standards? How do hospitals prove compliance with these standards? Perhaps most importantly, what constitutes an appropriate increase (or decrease) in dose for a patient of a given size?

With Tamara Ingle, CT Quality Assurance Lead Technologist at UnityPoint Health, my colleagues and I in the LANDAUER Clinical Dose Optimization ServiceTM worked to answer these questions by developing strategies to optimize CT protocols for patients of different sizes. Through this effort, we have identified solutions that take advantage of existing features of CT scanners (eg, dose modulation) to ensure compliance with the lung screening program dose requirements. Further, we have expanded these solutions to encompass not just adult, but also pediatric protocols, which means that it is now possible to specify dose levels for patients of every size.

While the technical progress has been crucial, we have also discovered other key issues along the way–for example, the need to expand quality assurance roles within the hospital to aid with standardization and training.

You have the opportunity to learn more about optimizing protocols for patient size by attending our breakout session, “Will it Play in Peoria? Optimizing Protocols for Patient Size at UnityPoint,” at the AHRA Annual Meeting in Orlando on Wednesday, July 25 from 1:45-2:45 PM.


Olav Christianson, MS, DABR, is the medical physics senior physicist, clinical dose optimization service™ at LANDAUER. He can be reached at ochristianson@landauermp.com.

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