Abstract
Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve.
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References
Flohr TG, Schaller S, Stierstorfer K et al (2005) Multi-detector row CT systems and image-reconstruction techniques. Radiology 235:756–773
Berrington de González A, Mahesh M, Kim K-P et al (2009) Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169:2071–2077
Frush DP, Morin R, Rehani MM (2013) Monitoring of medical radiation exposure for individuals. In: Lau L, Kwan-Hoong N (eds) Radiology safety and quality. Springer, New York, pp 69–84
Kalra MK, Maher MM, Toth TL et al (2004) Strategies for CT radiation dose optimization. Radiology 230:619–628
Cody DD, Fisher TS, Gress DA et al (2013) AAPM medical physics practice guideline 1.a: CT protocol management and review practice guideline. J Appl Clin Med Phys 14:3–12
Larson DB, Johnson LW, Schnell BM et al (2011) Rising use of CT in child visits to the emergency department in the United States, 1995–2008. Radiology 259:793–801
(1991) Standards for protection against radiation — Nuclear Regulatory Commission. Final rule. Fed Regist 56:23360–23474
National Council on Radiation Protection and Measurements (2012) Reference levels and achievable doses in medical and dental imaging: recommendations for the United States. NCRPM report 172. National Council on Radiation Protection and Measurements, Bethesda, MD
Larson DB, Wang LL, Podberesky DJ et al (2013) System for verifiable CT radiation dose optimization based on image quality. Part I: optimization model. Radiology 269:167–176
Larson DB, Malarik RJ, Hall SM et al (2013) System for verifiable CT radiation dose optimization based on image quality. Part II: process control system. Radiology 269:177–185
Fleischmann D (2009) Contrast medium administration in computed tomographic angiography. In: Rubin GD, Rofsky NM (eds) CT and MR angiography. Lippincott Williams & Wilkins, Philadelphia, pp 129–154
Fleischmann D, Kamaya A (2009) Optimal vascular and parenchymal contrast enhancement: the current state of the art. Radiol Clin North Am 47:13–26
Goldman LW (2007) Principles of CT: radiation dose and image quality. J Nucl Med Technol 35:213–225
Renne J, Falck CV, Ringe KI et al. (2013) CT angiography for pulmonary embolism detection: the effect of breathing on pulmonary artery enhancement using a 64-row detector system. Acta Radiol [Epub ahead of print]
Talati RK, Dunkin J, Parikh S et al (2013) Current methods of monitoring radiation exposure from CT. J Am Coll Radiol 10:702–707
Wang J, Duan X, Christner JA et al (2012) Attenuation-based estimation of patient size for the purpose of size specific dose estimation in CT. Part I. Development and validation of methods using the CT image. Med Phys 39:6764–6771
Wang J, Christner JA, Duan X et al (2012) Attenuation-based estimation of patient size for the purpose of size specific dose estimation in CT. Part II. Implementation on abdomen and thorax phantoms using cross sectional CT images and scanned projection radiograph images. Med Phys 39:6772–6778
Kleinman PL, Strauss KJ, Zurakowski D et al (2010) Patient size measured on CT images as a function of age at a tertiary care children’s hospital. AJR Am J Roentgenol 194:1611–1619
Li X, Samei E, Williams CH et al (2012) Effects of protocol and obesity on dose conversion factors in adult body CT. Med Phys 39:6550–6571
Menke J (2005) Comparison of different body size parameters for individual dose adaptation in body CT of adults. Radiology 236:565–571
Conflicts of interest
Dr. Larson discloses a commercial interest in Radimetrics and has no investigational or off-label uses to disclose. Drs. Molvin, Wang, Chan, Newman and Fleischmann have no financial interests, investigational or off-label uses to disclose.
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Larson, D.B., Molvin, L.Z., Wang, J. et al. Pediatric CT quality management and improvement program. Pediatr Radiol 44 (Suppl 3), 519–524 (2014). https://doi.org/10.1007/s00247-014-3039-4
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DOI: https://doi.org/10.1007/s00247-014-3039-4