Evaluation of high-dose alerts in computed tomography using an automated dose monitoring system: a retrospective institutional study.

Radiation dose monitoring software (DMS) tools are increasingly used to support automated monitoring of radiation dose in medical imaging. This study evaluated the frequency and causes of high-dose events detected by a DMS in computed tomography (CT). All CT examinations performed at one hospital across three CT scanners over a one-year period were retrospectively analysed to establish the frequency and causes of high-dose alerts. Descriptive statistics summarized alert frequency and distribution, and multivariable logistic regression identified factors independently associated with high-dose alerts. Of 11,865 CT examinations, 851 (7%) exceeded predefined dose thresholds. High-dose alerts occurred most frequently in spine (17%), musculoskeletal joint (14%), abdomen/pelvis (8%), vascular angiography (8%), chest/lung (5%), and head/face (4%) examinations. Reasons for high-dose alerts included high body mass index (29%), scan repetition (25%), additional scans (15%), patient malpositioning (12%), excess scan range (11%), and orthopaedic hardware (6%). Multivariable analysis showed that overweight status, scanner model, spine and joint examinations, and patients aged 45-74 years were independently associated with high-dose alert occurrence (P < .05). DMS is an effective tool that enables imaging facilities to automatically identify high-dose events, facilitating investigation of their causes, protocol review, and identification of opportunities for dose optimisation.