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The experience of the University Hospital of Pisa

Radiological dose management: the experience of the University Hospital of Pisa

The University Hospital of Pisa is composed of two hospitals, the historical and central Spedali Riuniti of Santa Chiara and the modern and peripheral hospital of Cisanello.

The Radiological organization consists of six departments of radiology (three generic, one for emergency/urgency, and two specialized respectively in neurological and breast diseases) and it is equipped with Synapse PACS provided by Fujifilm.

The computerized monitoring of the dose


Monitoring of radiation dose is an increasingly important activity, with the aim of improving the quality of service provided to patients. This activity, in fact, if carried out in a consistent manner can allow to check the performance, to optimize the protocols and to prevent incorrect procedures.

The systematic verification and reporting of the dose is becoming a mandatory task due to the regulatory changes (in particular the implementation of the Euratom Directive 2013/59).

The Directive was published in January 2014, forcing for basic safety standards for the protection against the dangers arising from exposure to ionizing radiation.

The Total Quality Monitoring (“tqm|DOSE”) software solution by QAELUM NV

Until a short time ago, the dosimetric data were analyzed only after a cumbersome process of manual recovery, with significant expenditure of resources and the accuracy risk of manually copying data.

In addition, the manual data collection, because of its burden, does not lend itself to systematic checks on large samples.

The Total Quality Monitoring software (tqm|DOSE) by QAELUM NV, installed at the University Hospital of Pisa in June 2013, allows players to automatically acquire and analyze the dosimetric data and the technical parameters.

The feasible statistics and analysis

TQM is able to show the history of radiological and dosimetric data of patients. This tool allows to assist the radiologist in assessing the need for a radiological investigation, especially in cases of follow-up or monitoring of outcomes that often require many repeated examinations (sometimes incorrectly ) in a short distance from each other.

From the perspective of optimization tasks, tqm|DOSE allows for the visualization of technical parameters and dosimetric data relating to the performed studies, which, in the case of repeated examinations during follow –up, provide insights for optimization.

At the end of each radiological procedure, the system provides statistics on the dose delivered during the exam: these statistics can be benchmarked with the doses delivered in the course of other procedures with the same Study Description, or with the same area of the body.

This information, in relation with the clinical request and the diagnostic quality of the images, allows rapid detection of incorrect behavior and best practices: the former can be corrected through optimization tasks and audit; the latter can be used in the training of staff and for the improvement of the protocols.

In addition, TQM helps to assess  dose averages  by type of examination, by equipment type, by operator, per time slot or day of the week, etc. .This leads to vauable insights for performance and safety optimization and problem identification,  such as increased average of the dosimetry during the night (when the staff is recalled in service) or due to aged equipment.