Abstract
Purpose
To test the hypothesis that quality clinical audits improve compliance with the procedures in computed tomography (CT) scanning.
Materials and methods
This retrospective study was conducted in two hospitals, based on 6950 examinations and four procedures, focusing on the acquisition length in lumbar spine CT, the default tube current applied in abdominal un-enhanced CT, the tube potential selection for portal phase abdominal CT and the use of a specific “paediatric brain CT” procedure. The first clinical audit reported compliance with these procedures. After presenting the results to the stakeholders, a second audit was conducted to measure the impact of this information on compliance and was repeated the next year. Comparisons of proportions were performed using the Chi-square Pearson test.
Results
Depending on the procedure, the compliance rate ranged from 27 to 88 % during the first audit. After presentation of the audit results to the stakeholders, the compliance rate ranged from 68 to 93 % and was significantly improved for all procedures (P ranging from <0.001 to 0.031) in both hospitals and remained unchanged during the third audit (P ranging from 0.114 to 0.999).
Conclusion
Quality improvement through repeated compliance audits with CT procedures durably improves this compliance.
Key Points
• Compliance with CT procedures is operator-dependent and not perfect.
• Compliance differs between procedures and hospitals, even within a unified department.
• Compliance is improved through audits followed by communication to the stakeholders.
• This improvement is sustainable over a one-year period.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hricak H, Brenner DJ, Adelstein SJ et al (2011) Managing radiation Use in medical imaging: a multifaceted challenge. Radiology 258:889–905
McCollough CH, Chen GH, Kalender W et al (2012) Achieving routine submillisievert CT scanning: report from the summit on management of radiation dose in CT. Radiology 264:567–580
Eze CU, Abonyi LC, Njoku J, Irurhe NK, Olowu O (2013) Assessment of radiation protection practices among radiographers in Lagos, Nigeria. Niger Med J 54:386–391
D’Hondt A, Cornil A, Bohy P, De Maertelaer V, Gevenois PA, Tack D (2014) Tuning of automatic exposure control strength in lumbar spine CT. Br J Radiol 87:20130707
International Atomic Energy Agency (IAEA) (2010) Comprehensive clinical audits of diagnostic radiology practices: a tool for quality improvement quality assurance audit for diagnostic radiology improvement and learning (QUAADRIL). http://www-pub.iaea.org/mtcd/publications/PubDetails.asp?pubId=8187
Maldjian PD, Goldman AR (2013) Reducing radiation dose in body CT: a primer on dose metrics and Key CT technical parameters. AJR Am J Roentgenol 200:741–747
Lee KH, Lee JM, Park JH et al (2012) Attenuation-based automatic tube voltage selection and tube current modulation for dose reduction at contrast-enhanced liver CT. Radiology 265:437–447
Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimated risks of radiation. AJR Am J Roentgenol 176:289–296
ESR Eurosafe Committee (2012) Bonn call for action: 10 actions to improve radiation protection in medicine in the next decade. Access on line at https://rpop.iaea.org/RPOP/RPoP/Content/Documents/Whitepapers/Bonn-Call-for-Action.pdf on July 25, 2015
Smith AB, Dillon WP, Lau BC, Gould R, Verdun FR, Lopez EB, Wintermark M (2008) Radiation dose reduction strategy for CT protocols: successful implementation in neuroradiology section. Radiology 247:499–506
Tamm EP, Rong XJ, Cody DD, Ernst RD, Fitzgerald NE, Kundra V (2011) Quality initiatives: CT radiation dose reduction: how to implement change without sacrificing diagnostic quality. Radiographics 31:1823–1832
Miglioretti DL, Zhang Y, Johnson E, Lee C, Morin RL, Vanneman N, Smith-Bindman (2014) Personalized technologist dose audit feedback for reducing patient radiation exposure from CT. J Am Coll Radiol 11:300–308
Logan CA, Cressey BD, Wu RY et al (2012) Monitoring universal protocol compliance through real-time clandestine observation by medical students results in performance improvement. J Surg Educ 69:41–46
Gierada DS, Garg K, Nath H, Strollo DC, Fagerstrom RM, Ford MB (2009) CT quality assurance in the lung screening study component of the National Lung Screening Trial: implications for multicenter imaging trials. AJR Am J Roentgenol 193:419–424
Engel LC, Lee AM, Seifarth H, Sidhu MS, Brady TJ, Hoffmann U, Ghoshhajra BB (2013) Weekly dose reports: the effects of a continuous quality improvement initiative on coronary computed tomography angiography radiation doses at a tertiary medical center. Acad Radiol 20:1015–1023
Mayo-Smith WW, Hara AK, Mahesh M, Sahani DV, Pavliceck W (2014) How I Do It: managing radiation dose in CT. Radiology 273:657–672
Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom (2014) Available at http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=OJ:L:2014:013:TOC Published on 17.1.2014
Brassart N, Winant C, Tack D, Gevenois PA, De Maertelaer V, Keyzer C (2013) Optimised z-axis coverage at multidetector-row CT in adults suspected of acute appendicitis. Br J Radiol 86:20130115
Acknowledgments
The scientific guarantor of this publication is Denis Tack. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational - quality assurance study, performed at one institution
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oliveri, A., Howarth, N., Gevenois, P.A. et al. Short- and long-term effects of clinical audits on compliance with procedures in CT scanning. Eur Radiol 26, 2663–2668 (2016). https://doi.org/10.1007/s00330-015-4100-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-015-4100-x