The health care industry has increasingly sharpened its focus on radiation monitoring, and that can only mean good things for patients receiving dose. That priority, coupled with the issue of implementing data into cross-platform EHRS and PACS, make this an especially interesting time to be in health care.

DOTMed News had an opportunity to explore these issues with Yossi Srour, the president of UltraSPECT and a pioneer in the low-dose movement.

DOTmed News: Your company offers solutions for imaging with less radiation. Where did your interest in dose reduction originate?

Yossi Srour: My interest in dose reduction started in early 2008 when we first approached the FDA with our low-dose imaging product. For the 510(k) approval by the FDA, we presented equivalency of general full-dose images with half-dose UltraSPECT images. In April 2008, UltraSPECT was the only FDA-510(k) cleared product for low-dose imaging. The regulatory approach was to show equivalency between half-dose imaging using our proprietary Wide-Beam Reconstruction (WBR™) technology and full-time imaging using Filtered back projection (FBP) / Ordered Subset Expectation Maximum (OSEM). In this approach, UltraSPECT customers can reduce the radiopharmaceutical injected dose without compromising image quality. This is safer imaging, lowering the radiation exposure to patients, technologist and physicians. The other benefit is securing the radiopharmaceutical supply continuity by relying on a lower dose.

Many benefits, though the market response to our approved low-dose product in mid-2008 was "it is too early to the US market; maybe it is appropriate for the European market," It was in the following year, in mid-2009, when the U.S. market awareness of radiation risks was increased dramatically, though the circumstances were unfortunate. This was when two children in California received significantly more CT dose than they should have.

Following this event we have seen the much needed low-dose movement progress, though still a bit slowly, or at least more slowly than I would like to see. I was very interested in the American Society of Nuclear Cardiology (ASNC) outline methods for Minimizing Radiation Exposure in Patients which was published for the public review in June 2010. Also, the Image Wisely and Image Gently initiatives were gaining visibility as they pushed the demand for low-dose imaging, though mainly in CT. It took years, till January 1st 2014, to make ASNC low dose guidelines official. And now, although the ASNC guidelines have been effective for a year, the adaptation by NM labs is going very slow and the statistic shows only single digit percentage of adoption.

Progress is being made, but more can be done to protect our patients and the medical community. I believe the only way to make low dose take hold is to mandate it by including low-dose imaging as part of the accreditation review either by IAC or ACR.

DOTmed News: You attended the 100th meeting of the RSNA last November. What did you see as the big take away from that meeting?

YS: The main two topics from RSNA 2014 were enterprise imaging and dose reduction.

Enterprise imaging was heavily discussed throughout the show. We are experiencing a time where many hospitals are acquiring imaging centers. With each acquisition comes a facility that has its own particular technologies and systems, providing hospitals with a challenge in getting these new additions, along with its existing network, onto the same page in terms of functioning collaboratively. Integration is critical - and PACS systems, viewing stations, CAD systems and support systems must all be able to gather information from all modalities of all departments to operate efficiently. A single, completely unified imaging platform enables the archiving, reporting, advanced image processing and integration of all clinical information. Understandably, for high performance results - the imaging workflow must be standardized across the entirety of the hospital's network.

Dose reduction was the second topic that saw greater awareness than ever before during RSNA. Discussions highlighted the need to lower radiation dose for safer imaging and showcased the ways technology was enabling the reduction of dose by 60 to 80 percent - and even 85 percent in CT systems.

My personal take away is that we have to continue the push towards low-dose imaging in all modalities and to look for advanced 'outcomes-based' payment system and physician support tools. The goal is to improve quality of care - for both the physician / clinical staff and the patient -- as well as the overall cost effectiveness to the payer.

DOTmed News: What makes UltraSPECT unique among other dose reduction tools?

YS: Among all the benefits of UltraSPECT products there are three which make them truly unique:

1. Quarter count density - UltraSPECT offers the only software solution coping with quarter count density i.e. half-dose and half-time scan, or quarter-time scan or quarter-dose (ultra-low-dose). Patients will not only benefit from less dose, but can also have the ease of mind of a shorter exam time. This is especially beneficial for facilities who are imaging older or extrelemly sick patients who cannot tolerate a long scan.

2. Cost-effective - UltraSPECT products have consistently proven to be the most cost-effective alternative for lowering dose in NM. Not only is the investment price considerably less than the investment in a new camera, but facilities can ‎leverage their existing investment in their NM equipment, and also increase equipment performance both in terms of patient care and patient throughput, all with no trade-off in image quality.

3. Vendor neutral low dose imaging solution - Offers standardized/unified protocol for all equipment across all hospitals and imaging centers, regardless of the age or manufacturer of the NM cameras and the NM workstations.

DOTmed News: What stands between breakthroughs in PACS- and EHR-integrated low-dose imaging solutions, and their implementation on a national scale?

YS: Let's start with the fact that PACS and EHR has to include elements of dose monitoring and reporting systems. The best way to monitor and control the dose level in each scan is to include automatic reporting systems and records keeping. Once the accreditation process will include review of the records of the dose levels, the implementation on national scale will increase dramatically. Once again, the ASNC low dose imaging guidelines have to be mandated and have to be included in the accreditation by IAC or ACR if they are going to result in large scale change.