Automated Extraction of Radiation Dose Information for CT Examinations Tessa S. Cook, MD, PhD, Stefan Zimmerman, MD, Andrew D. A. Maidment, PhD, Woojin Kim, MD, William W. Boonn, MD Exposure to radiation as a result of medical imaging is currently in the spotlight, receiving attention from Congress as well as the lay press. Although scanner manufacturers are moving toward including effective dose information in the Digital Imaging and Communications in Medicine headers of imaging studies, there is a vast repository of retrospective CT data at every imaging center that stores dose information in an image-based dose sheet. As such, it is difficult for imaging centers to participate in the ACR’s Dose Index Registry. The authors have designed an automated extraction system to query their PACS archive and parse CT examinations to extract the dose information stored in each dose sheet. First, an open-source optical character recognition program processes each dose sheet and converts the information to American Standard Code for Information Interchange (ASCII) text. Each text file is parsed, and radiation dose information is extracted and stored in a database which can be queried using an existing pathology and radiology enterprise search tool. Using this automated extraction pipeline, it is possible to perform dose analysis on the 800,000 CT examinations in the PACS archive and generate dose reports for all of these patients. It is also possible to more effectively educate technologists, radiologists, and referring physicians about exposure to radiation from CT by generating report cards for interpreted and performed studies. The automated extraction pipeline enables compliance with the ACR’s reporting guidelines and greater awareness of radiation dose to patients, thus resulting in improved patient care and management. Key Words: Radiation dose reporting, quality assurance, patient safety, CT J Am Coll Radiol 2010;7:871-877. Copyright © 2010 American College of Radiology INTRODUCTION Computed tomographic utilization has increased signif- icantly in the past decade [1,2]. In the past two decades, the proportion of background radiation in the United States attributed to medical imaging has increased from approximately 15% in 1987 to nearly 50% today [3,4]. Furthermore, exposure to radiation as a result of med- ical imaging is currently in the spotlight, receiving attention from professional organizations such as the ACR and the American Association of Physicists in Medicine and, more notably, from the US House of Representatives Subcommittee on Health [5], as well as the lay press [6,7]. Although a number of scientific articles have debated the potential for deleterious effects as a result of this imaging boom [8-11], the answers to these questions are not easily obtained. What is clear, though, is that increas- ing awareness of health care professionals regarding im- aging-related radiation dose is integral to improving pa- tient care. The ACR’s white paper on radiation dose [12] states that: there should be special attention paid to . . . education for all stake- holders in the principles of radiation safety, the appropriate utilization of imaging . . . the standardization of radiation dose data to be ar- chived during imaging for its ultimate use in benchmarking, good practice, and finally, the identification and perhaps alternative imag- ing of patients who may have already reached threshold levels of estimated exposure. Recent studies have demonstrated that there is wide vari- ability in estimated effective radiation dose among CT scans, even when performed at the same institution using the same protocols [13,14]. Reported doses were also considerably higher than those previously quoted in the Department of Radiology, Hospital of the University of Pennsylvania, Phila- delphia, Pennsylvania. Corresponding author and reprints: Tessa S. Cook, Hospital of the Univer- sity of Pennsylvania, Department of Radiology, 3400 Spruce Street, Philadel- phia, PA 19104; e-mail: tessa@alumni.upenn.edu. © 2010 American College of Radiology 0091-2182/10/$36.00 ● DOI 10.1016/j.jacr.2010.06.026 871