Healthcare 2022, 10, 1970. https://doi.org/10.3390/healthcare10101970 www.mdpi.com/journal/healthcare Article Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience Entesar Zawam Dalah 1,2, *, Yousuf Mohammad Al Musfari 3 , Badriya Mohd Hassan Ali 4 , Anwaar Abdulrahim Al Hammadi 3 , Hashim Abdul Azeez Beevi 5 , Manal Ibrahim Jaber 3 , Alyazya Akeel Al-Ali 4 , Ayesha Khalid Alkharoossi 4 , Fairooz Hussain Al Hashemi 3 , Fatma Mahmood Alkhatib 3 and Sabaa Anam Aqil Khan 6 1 HQ Diagnostic Imaging Department, Dubai Academic Health Corporation, Dubai P.O. Box 4545, United Arab Emirates 2 College of Medicine, Mohammed Bin Rashid University, Dubai Academic Health Corporation, Dubai P.O. Box 505055, United Arab Emirates 3 Department of Radiology, Rashid Hospital, Dubai Academic Health Corporation, Dubai P.O. Box 4545, United Arab Emirates 4 Department of Radiology, Dubai Hospital, Dubai Academic Health Corporation, Dubai 7272, United Arab Emirates 5 Department of Radiology, Hatta Hospital, Dubai Academic Health Corporation, Dubai P.O. Box 7272, United Arab Emirates 6 Department of Radiology, Latifa Hospital, Dubai Academic Health Corporation, Dubai P.O. Box 9115, United Arab Emirates * Correspondence: edalah@dha.gov.ae Abstract: Computed tomography (CT) radiation dose management tools should be used whenever possible, particularly with the increasing demand for acquiring CT studies. Herein, we aim to assess the advantages and challenges faced with implementing two CT dose management tools. A second aim was to highlight CT examinations exceeding dose notification values (NVs) and define the com- mon set of causes. A total of 13,037 CT examinations collected over a six-month period, were eval- uated, using two independent CT dose management tools, a CT Dose Notification prospective-view tool (PVT) following CT Dose Check standards and a retrospective statistical-based view tool (RSVT). Dose NVs were set to twice the Local Diagnostic Reference Levels. There was a significant discrepancy between dose NV counts registered with prospective (4.15%) and retrospective (7.98%) tools using T-Test. A core difference is the dose configuration setup, with PVT and RSVT being dose per series and whole study, respectively. Both prospective and retrospective dose management tools were equally useful despite their technical difference. Configuring the CT prospective dose notification check tool using NVs that is based on DRLs has limitations, and one needs to establish dose NVs per series to overcome this technical hurdle. Technical challenges make the implementa- tion of CT Dose Check standards puzzling. Keywords: CT dose monitoring tools; CT Dose Check standard; radiation monitoring index; DOSE TQM; dose notification value; DRLs 1. Introduction Dose notifications and alert systems that trigger a dose notification pop-up or red flag when exceeding potentially high-radiation doses during radiological scans are very important, particularly for computed tomography (CT). Hence, radiation dose tracking and management tools should be implemented when available [1]. Such tools may exist in two forms: (a) a real time (prospective) monitor that is available on the CT system Citation: Dalah, E.Z.; Al Musfari, Y.M.; Ali, B.M.H.; Al Hammadi, A.A.; Beevi, H.A.A.; Jaber, M.I.; Al-Ali, A.A.; Alkharoossi, A.K.; Al Hashemi, F.H.; Alkhatib, F.M.; et al. Challenges Associated with Effective Implementation of CT Dose Check Standards and Radiation Monitoring Index in Computed Tomography: Healthcare Sector Experience. Healthcare 2022, 10, 1970. https:// doi.org/10.3390/healthcare10101970 Academic Editor: Alberto Modenese Received: 24 August 2022 Accepted: 3 October 2022 Published: 8 October 2022 Publisher’s Note: MDPI stays neu- tral with regard to jurisdictional claims in published maps and institu- tional affiliations. Copyright: © 2022 by the authors. Li- censee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and con- ditions of the Creative Commons At- tribution (CC BY) license (https://cre- ativecommons.org/licenses/by/4.0/).