Records of pediatric CT scans were gathered by specifying time span via the vendor-provided dose monitoring application DoseWatch™ (General Electric Inc., Milwaukee, USA), and routine scans of the four aforementioned body regions were selected with in-house queries. Archived DICOM images of these CT scans were gathered through the HERMES GOLD™ (Hermes Medical Solutions Inc., Stockholm, Sweden) system. All scans were performed on HD750 CT scanners (General Electric Inc., Milwaukee, USA). For organ dose and effective dose calculation, parameters were extracted from the DICOM headers of images; these included patient age (y), gender, body part examined, tube voltage (kVp), tube current (mA) of each image, revolution time (second), beam collimator width (mm), pitch, bowtie filter type, CTDIvol (mGy), DLP (mGy*cm), and SSDE (mGy).
Dosewatch
Manufactured by GE Healthcare
Sourced in United States, France
DoseWatch is a dose management software developed by GE Healthcare. It is designed to monitor and analyze radiation dose data from medical imaging equipment, with the goal of optimizing patient radiation exposure during medical procedures.
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Lab products found in correlation
8 protocols using dosewatch
1
Pediatric CT Dose Monitoring Workflow
2
Radiation Dose Monitoring in Interventional Suites
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This study was conducted with Institutional Review Board approval and complied with the Health Insurance Portability and Accountability Act of 1996. Radiation dose data were recorded and extracted using dose management software (DoseWatch; GE Healthcare, Buc, France) which was installed in all angiography suites. The DoseWatch software captured dosimetric data from 19 interventional suites including 4 hybrid operating rooms. Radiation dose data for 89,549 consecutive patient encounters from January 1, 2013 to August 1, 2019 at a single academic institution were reviewed.
3
CT Dose Monitoring and Optimization
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For CT dose management, patient data were collected using DoseWatch software by GE Healthcare (Milwaukee, Wis). In this investigation, no sensitive or private patient information was utilized. The software monitors, tracks, and analyses the dose data and consequently suggests strategies for dose reduction. Data from chest scans include patient information (age, gender, weight, height, Body Mass Index (BMI)), examination data (study description, protocol name, series name, series description, number of scans), acquisition data (scan region, distance source to detector, generator power (kW), reconstruction diameter, distance source to the patient, focal spot, slice thickness, spacing between slice, convolution length kernel, images per series, filter type, scan length), exposure parameters (KVP, tube current, pitch factor, exposure time per rotation, exposure time), radiation data (size-specific dose estimates for body examinations (SSDE) volumetric computed tomography dose index CTDIvol, dose length product DLP).
4
Percutaneous Screw Placement Procedure Evaluation
5
Optimized CT Imaging Protocols for Pediatric Patients
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The CT system was a 64-row MDCT (Discovery 750HD; GE Healthcare, Milwaukee, WI, USA). All CT imaging conditions were extracted using the dose optimization solution (DoseWatch; GE Healthcare, Milwaukee, WI, USA).
In addition, image noise was reduced by image reconstruction using Advanced Statistical Iterative Reconstruction (ASiR). The ASiR level setting was reconfigured at 80%.
The tube current was automatically controlled using CT-automatic exposure control, and the maximum tube current was set for FDM and HDM imaging conditions according to the patients’ age group (28 days, 28 days–3 years, 3–6 years, > 6 years.
The HDM reduces exposure by 50% of the maximum tube current for conventional head CT. The maximum tube currents of the FDM for 28 days, 28 days–3 years, 3–6 years, and > 6 years were 130, 210, 220, and 235 mA, respectively, whereas the maximum tube currents of the HDM were 65, 105, 110, and 115 mA, respectively.
The scanning parameters for imaging conditions other than the tube current were as follows: tube voltage, 120 kVp; gantry rotation, 0.4 s; helical pitch, 0.53; and beam width, 20 mm (or 40 mm). The reconstructed slice thickness was set at 5 mm and 2.5 mm for infants. Bone fusion was evaluated by three-dimensional reconstruction created by Centricity Advantage Workstation (GE Healthcare, Milwaukee, WI, USA).
In addition, image noise was reduced by image reconstruction using Advanced Statistical Iterative Reconstruction (ASiR). The ASiR level setting was reconfigured at 80%.
The tube current was automatically controlled using CT-automatic exposure control, and the maximum tube current was set for FDM and HDM imaging conditions according to the patients’ age group (28 days, 28 days–3 years, 3–6 years, > 6 years.
The HDM reduces exposure by 50% of the maximum tube current for conventional head CT. The maximum tube currents of the FDM for 28 days, 28 days–3 years, 3–6 years, and > 6 years were 130, 210, 220, and 235 mA, respectively, whereas the maximum tube currents of the HDM were 65, 105, 110, and 115 mA, respectively.
The scanning parameters for imaging conditions other than the tube current were as follows: tube voltage, 120 kVp; gantry rotation, 0.4 s; helical pitch, 0.53; and beam width, 20 mm (or 40 mm). The reconstructed slice thickness was set at 5 mm and 2.5 mm for infants. Bone fusion was evaluated by three-dimensional reconstruction created by Centricity Advantage Workstation (GE Healthcare, Milwaukee, WI, USA).
6
Estimating Radiation Dose in Catheterization Lab
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The catheterization laboratory is equipped with DICOM Radiation Dose Structured Reports, containing cumulative information about the patient's radiation exposure for the whole procedure, as well as information per irradiation event (ie, per fluoroscopy exposure and cinegraphy acquisition). At the end of each procedure, they are sent to a dose management system (DoseWatch, GE Healthcare, Milwaukee, WI).
For each procedure the average peak tube potential or kVp is calculated as the weighted sum of kVp values for all irradiation events, where the weighting factor per irradiation event is calculated as the corresponding DAP for said irradiation event divided by the cumulative DAP for that procedure. This is shown in formula(1) : where i is 1 irradiation event. Likewise, average additional filtration is calculated per procedure. With the latter parameters, aforementioned anode angle and inherent filtration as input, half value layer is then estimated using Spectrum Processor 3.0 for IPEM report 78.23
For each procedure the average peak tube potential or kVp is calculated as the weighted sum of kVp values for all irradiation events, where the weighting factor per irradiation event is calculated as the corresponding DAP for said irradiation event divided by the cumulative DAP for that procedure. This is shown in formula
7
Radiation Dose Monitoring with DoseWatch
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GE's (GE Healthcare Systems, Buc, France) dose management solution DoseWatch ® was implemented at our institution to improve radiation protection, while maintaining high diagnostic quality of images. DoseWatch ® is web-based software that allows for capturing, tracking, and reporting radiation dose information directly from any imaging device and was first connected to our computed tomography (CT) scanners. The software offers detailed analysis on the dose delivered to the patients and can be adapted to one's own preferences. Dose data analysis is possible for all scanners together as well as separately for each scanner, thereby allowing for comparison of dose data between different scanners. Moreover, the software inherits a notification system that transmits messages when dose levels exceed predefined thresholds ("alerts"). At the time as the installation of the software, national dose reference levels (DRLs) for 21 indication-based CT examinations, which were set as dose thresholds, were available in our country. For all other protocols we decided to derive DRLs by determining the 75 th percentile of the distribution of a defined dosimetric quantity [11] . The software received dose information as a separate file based on the dose protocol of the scanners, which included scout images for the assessment of patient diameter and positioning.
8
Effective Dose Calculation in CTA and DSA
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Dosimetry-related data for CTA and DSA studies were obtained through a dose-tracking system, DoseWatch (version 2.2.1, GE Healthcare). The effective dose was calculated by multiplying the dose length product (DLP) (mGy×cm) by the dose conversion factor (mSv/mGy×cm) for CTA and the dose area product (DAP) (Gy×cm 2 ) by the dose conversion factor (mSv/Gy×cm 2 ) for DSA. 27 The conversion factors used for head and head and neck CTA were 0.0021 and 0.00345 mSv/mGy×cm, respectively. 30 The dose conversion factor used for cerebral DSA was 0.056 mSv/Gy×cm 2 . 26
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