Purpose

The suite of reports enable you to analyze fluoroscopy dose data using a variety of filters to obtain an overview of your systems’ performance and to delve into the details. Using the reports, you can identify outlier exams, highlight other patterns for further investigation and find missing data and gaps in data transmissions to the registry.

 

How to Access

From the DIR directory page in the NRDR portal, select Fluoro Standardized Dose Index Reports to access the report’s individual tabs: Exam Search, Scatterplot, Boxplot by Scanner, Boxplot by Procedure and Index Comparisons. The About this Report tab provides insight about the reports’ measures and filter use. Upon selecting a tab, hover over the information icon (blue circle in the upper left corner) to obtain details about maximizing the report’s analysis capabilities. 

 

Note: Please use the Feedback link in the top left corner of each tab to provide suggestions for improving the report or for new reports.    

 

Report Features

Get started by selecting a Corporate Account, a corresponding Facility, or Facilities, and timeframe of interest.

 

Exam Search Tab: This tool enables you to query procedures using a variety of criteria. The sample screenshot below shows results associated with abdominal procedures across all stations for a 30-day period.

Click on the image for better view.

The individual exam data appear in the left side of the table, with Total Fluoro Time (min.), Reference Air Kerma (mGy) and Kerma Air Product (Gy*cm^2) provided in the right side of the table. 


Also included in the right side of the table are two derived indices: Reference Air Kerma Rate (mGy/min) and Kerma Average Field Size (cm^2). Reference Air Kerma Rate is an estimate of the exam’s average air kerma rate value, calculated by dividing the Reference Air Kerma by the Total Fluoro Time. Kerma Average Field Size is similarly calculated by dividing the Kerma Area Product by the Reference Air Kerma. The rightmost column in the table, Pct Event With Filter, is the percentage of irradiation events in the exam’s RDSR that indicate copper filtration was used. 

 

The bar chart to the right of the table summarizes the distribution of exams by Study Type using either the mapped ACR Common procedure names or a facility’s internal clinical procedure names (Study Description or Procedure Description) populated in the DICOM header. Selecting a bar in the chart will filter the report by the procedure. 

 

Note: Procedure mapping to a common lexicon, or standard terminology, is an ongoing process that enables analysis and comparison of imaging procedures named differently across DIR participating facilities. ACR Common is the common lexicon for the DIR Fluoro. Learn more about procedure mapping here.  

 

Scatterplot: This feature helps you identify unusual patterns or outliers for DIR Fluoro dose indices. Use the report filters and parameters, e.g., fluoroscopy measure, patient age, body area, and study, to refine the data in the scatterplot. You also can hone in on performance by specific station and equipment manufacturer and model. 

 

The following screenshot illustrates several components of the scatterplot.

Click on the image for better view.


The report plots the value of each Reference Air Kerma measure for 105 abdominal procedures by date for a 30-day period. The Station Statistics table summarizes the number of observations and minimum, maximum, and median measure values with red highlighted text indicating the largest values within each column. 

 

Hovering over a measure dot in the scatterplot provides exam details, and clicking a measure dot will add a link to the Index Comparisons report to view boxplots of all indices for all exams for that procedure (see example in the Index Comparisons section below). 

 

Boxplot by Scanner: The filters allow you to assess dose index data between scanners for one or more facilities in a box-and-whisker format. 

 

In the example below, hovering the curser over the shaded “box” area for the GE system displays the Reference Air Kerma quartile data for abdominal procedures over a 30-day period with the black horizontal “whisker” lines denoting the cutoff for statistical outliers.

 

Hovering over a single measure dot shows procedure details.

Click on the image for a better view.

Note: Changing the Station Detail parameter from Device to Model may provide a more useful comparison by aggregating data to the model level, as different stations may require different dose levels to obtain the same quality diagnostic image.

 

Boxplot by Procedure: The filters allows you to analyze dose indices by procedure for one or more facilities in a box-and-whisker format. In the example below, hovering the curser over the shaded “box” area for the GE system displays the Reference Air Kerma quartile data for abdominal procedures over a 30-day period with the black horizontal “whisker” lines denoting the cutoff for statistical outliers. Hovering over a single measure dot shows procedure details.

Click on the image for a better view.

 

Index Comparisons: The screenshot below illustrates how charts of the dose indices can help to identify outliers across dose indices. Select one procedure at a time for the best report view.

Click on the image for a better view.

 

Selecting a procedure via the ACR/Req./Study filter or by linking from the Scatterplot report (see example in the scatterplot section above). Clicking a measure dot in a chart highlights the same exam across all five boxplots.