Specialist commentator comments

Comments on this technology were invited from clinical and scientific experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 5 specialist commentators were familiar with these technologies. One specialist used at least 1 of the technologies infrequently (approximately 5 times per year); another used them regularly (on a weekly or monthly basis).

Level of innovation

Two specialists stated that the radiation dose monitoring software technologies are a minor variation of current technology, automating an existing process by using modern IT standards to interconnect imaging devices with data collection devices. Four commentators thought that the technologies could potentially improve data collection and image quality, and minimise radiation doses. One of the specialists stated that the technologies are a significant development in allowing real-time evaluation of all systems in an organisation, helping to identify imaging systems in which problems may be developing.

All but 1 specialist commentator thought that some level of training would be needed to use the software.

Potential patient impact

Three specialists anticipated that the technologies would have little or no direct effect on patients. However, 3 other specialists felt that the software could reduce overall population radiation exposure by allowing for regular reliable audits, which would improve patient safety and reduce risk. Two specialists stated that the technologies would particularly benefit young people, and 1 felt that they could help to identify people with chronic conditions who have repeated examinations and therefore radiation exposure.

Three commentators thought that using the technologies could improve diagnostic accuracy and confidence, which would benefit patients. One stated that they may enable higher radiation doses to be used where appropriate to increase image quality. Another specialist stated that an alert system to identify relevant previous imaging might reduce a very small number of unnecessary examinations.

Potential system impact

The commentators agreed that the technologies would help to optimise images, which would be beneficial for the healthcare system. Three specialists felt that the automation would ease the burden of the current manual process of recording dose monitoring data. One specialist stated that the technologies would help identify variation in techniques within or between institutions, highlighting the need for optimisation of radiation dose and image quality. Two commentators stated that using this software would lead to multidisciplinary teams optimising their work, possibly reducing the amount of time spent by the team on analysing patient dose data. However, another commentator expressed doubt that the additional information would reduce time spent by medical physicists on collection, analysis and reporting, stating that more time will be needed for analysis and interpretation. One of the commentators added that additional staff resources would be necessary for maximum benefit from the systems.

All the specialist commentators acknowledged that the database system would need to connect to existing IT infrastructure: some systems would be able to work with existing IT infrastructure with minimal changes and updates, whereas others may need a larger investment (for example, an increase in server capacity).

Four specialists thought that the potential for NHS cost savings was unclear, and 1 stated that a detailed cost analysis would be necessary to assess the cost implications. Another commentator stated that the cost savings would be minimal, because the technologies provide quality improvements rather than to significant cost savings. One specialist stated that although dose monitoring systems may make data recording faster, the process is likely to include more examinations than would have been included with manual data entry. Another explained that some people may choose to pursue legal action over excess radiation exposures, so the technologies could reduce legal costs for the NHS.

General comments

One specialist noted that the Public Health England report called for patient-size measurements to be taken from the images, because this information is rarely available and is a significant factor in terms of variation in radiation dose; the commentator did not feel that dose monitoring technologies would eliminate this manual step. Two specialists noted that dose monitoring systems are most useful if they are connected to multiple modalities, information systems and shared across organisations.

One commentator stated that regional or national dose collection would be needed for setting and optimising interventional diagnostic reference levels (DRLs); the potential for collection of large-scale data offered by these technologies could transform the insight available. Another commentator expected the evidence to be generalisable across all technologies because the handling of data will have more of an effect than the technology itself.

One specialist pointed out that according to another Public Health England report, Medical and dental X-rays: frequency and collective doses in the UK (2010), 26% of medical imaging examinations with ionising radiation are for dental purposes and, despite their small dose contribution, the software will not be able to analyse most of these.