Image Gently, the international campaign to protect children from unnecessary radiation dose exposure, is practiced avidly in Finland. A network of PACS throughout the country helps make this possible, according to a recent article in the American Journal of Roentgenology.
Finland has implemented area-based district PACS, the largest of which is the Hospital District of Helsinki and Uusimaa (HUS). This district incorporates 33 hospitals and outpatient health centers, including the Hospital for Children and Adolescents in Helsinki. A single PACS (Impax Version 6.5, Agfa HealthCare) archive stores the images from almost 900,000 annual imaging procedures. The children's hospital contributes about 45,000 sets of exam images per year.
Children born in Finland are given permanent lifetime identification (ID) numbers within two to three days of being born. A pediatric patient's entire imaging history is associated with the ID, and for adults, as many records and images as possible that are digital. When a CT exam is performed, CT dose index (CTDI) and the dose-length product (DLP) data are stored. Dose reports can also be stored to a PACS. Radiology information systems (RIS) store dose data of digital radiographs and mammograms as the number of images and entrance surface doses (AJR, April 2013, Vol. 200:4, pp. 771-774).
When a physician needs to access radiology reports and related images of patients whose exams were performed in the same district, the process can be performed with the click of a button. If a patient is referred to a hospital in a different district, the person making the referral is responsible for electronically transferring all relevant radiology records to the receiving hospital.
But this doesn't always happen. And when it doesn't, the receiving hospital's radiology department staff is expected to telephone the originating hospital and request this. Images tend to arrive within minutes, and sometimes less than half an hour, Dr. Raija Seuri, a senior consultant pediatric radiologist at the Helsinki University Central Hospital, HUS Medical Imaging Center, told AuntMinnieEurope.com.
The value of access to a child's imaging history and exams is invaluable. A patient's history may reveal high levels of radiation dose exposure, thus influencing the choice of ordering a nonionizing radiation exam such as an MRI or ultrasound scan. Particularly for CT exams, additional new CT exams might not be needed when the required information is contained in the images and reports of prior CT exams. And of great importance, successful use of lower-dose protocols at sending institutions may convince radiologists to modify the exam protocols used at their own institutions.
Seuri and co-authors provided four examples of how access to prior CT exams could make treatment better and safer for patients who had been transferred to them. In Finland, only the children's hospital performs organ transplants, heart surgery, some orthopedic and liver problems, and some congenital malformations.
In one case, the order for a CT exam of a 6-month-old boy to check for metastases in the ribs from a neuroblastoma of the posterior mediastinum was avoided. Re-evaluation of the previous CT showed erosion of the ribs by the tumor, a finding that had not been noted in the radiology report. This finding alleviated concern generated by an exam performed two weeks earlier.
In another case, review of transferred CT exams not only provided information needed, the images that were of lower dose showed that lower-dose protocols produced diagnostic-quality images, and influenced the children's hospital to modify its own protocols.
And in a third case, a history of 232 radiology procedures, 16 of which were CT scans, provided the justification to order an MRI exam instead of a CT scan. Without this history, a CT scan would have been ordered because the patient required anesthesia for the MRI exam.
In Finland, a national archive of health information called KanTa is being deployed. It currently includes a pharmaceutical database, electronic prescriptions, and patient record archives. Diagnostic imaging is expected to be integrated around 2016, according to Dr. Jukka Lehtovirta from the Ministry of Health.
But for now, with the combination of unique patient IDs and the ability to transfer records among PACS, patients young and old in Finland know that they will not be exposed to any more radiation dose from imaging exams than is absolutely necessary.