Weekly Dose Reports: The Effects of a Continuous Quality Improvement Initiative on Coronary Computed Tomography Angiography Radiation Doses at a Tertiary Medical Center

doi:10.1016/j.acra.2013.04.012

Academic Radiology

Volume 20, Issue 8, August 2013, Pages 1015-1023

https://doi.org/10.1016/j.acra.2013.04.012 Get rights and content

Rationale and Objectives

Numerous protocols have been developed to reduce cardiac computed tomography angiography (cCTA) radiation dose while maintaining image quality. However, cCTA practice is highly dependent on physician and technologist experience and education. In this study, we sought to evaluate the incremental value of real-time feedback via weekly dose reports on a busy cCTA service.

Materials and Methods

This time series analysis consisted of 450 consecutive patients whom underwent physician-supervised cCTA for clinically indicated native coronary evaluation between April 2011 and January 2013, with 150 patients before the initiation of weekly dose report (preintervention period: April–September 2011) and 150 patients after the initiation (postintervention period: September 2011–February 2012). To assess whether overall dose reductions were maintained over time, results were compared to a late control group consisting of 150 consecutive cCTA exams, which were performed after the study (September 2012–January 2013). Patient characteristics and effective radiation were recorded and compared.

Results

Total radiation dose was significantly lower in the postintervention period (3.4 mSv [1.7–5.7] and in the late control group (3.3 mSv [2.0–5.3] versus the preintervention period (4.1 mSv [2.1–6.6] (P = .005). The proportion of high-dose outliers was also decreased in the postintervention period and late control period (exams <10 mSv were 88.0% preintervention vs. 97.3% postintervention vs. 95.3% late control; exams <15 mSv were 98.0% preintervention vs. 100.0% postintervention vs. 98.7% late control; exams <20.0 mSv were 98.7% preintervention vs. 100.0% postintervention vs. 100.0% late control).

Conclusion

Weekly dose report feedback of site radiation doses to patients undergoing physician-supervised cCTA resulted in significant overall dose reduction and reduction of high-dose outliers. Overall dose reductions were maintained beyond the initial study period.

Section snippets

Financial Disclosure

The study was approved by the human research committee of the institutional review board and compliance with the Health Insurance Portability and Accountability Act guidelines was maintained. The requirement for informed consent was waived for this quality assurance study. All authors have no relevant financial disclosures and had unrestricted control of the data at all stages of the study. No outside funding was used.

Study Cohort

This study includes a total of 450 consecutive patients that underwent

Results

No differences in baseline patient characteristics were seen between control and intervention period (postintervention) (Table 1). Total radiation dose in mSv was lower in the postintervention period (3.4 mSv [1.7–5.7]) and late control period (3.3 mSv [2.0–5.3]) compared to the preintervention period (4.1 mSv [2.1–6.6]), a statistically significant difference (P = .005).

In the postintervention period, 97.3% of all cCTAs resulted in a radiation dose <10.0 mSv versus 88.0% in the preintervention

Discussion

Relatively high radiation doses are often cited as a counterargument to the use of cCTA (24). However, at our institution we have demonstrated that cCTA carefully performed using relatively simple and widely available default protocol recommendations (20), we can achieve routine cCTA doses with a median dose, lower than that of an invasive diagnostic angiography or the most commonly used noninvasive modality, nuclear myocardial perfusion imaging (25). These results are concordant with the work

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Original InvestigationWeekly Dose Reports: The Effects of a Continuous Quality Improvement Initiative on Coronary Computed Tomography Angiography Radiation Doses at a Tertiary Medical Center

Rationale and Objectives

Materials and Methods

Results

Conclusion

Section snippets

Financial Disclosure

Study Cohort

Results

Discussion

J Am Coll Cardiol

JACC Cardiovasc Imaging

JACC Cardiovasc Imaging

J Cardiovasc Comput Tomogr

Can J Cardiol

Eur J Radiol

Am J Cardiol

Am J Cardiol

J Cardiovasc Comput Tomogr

Am J Med

J Cardiovasc Comput Tomogr

Eur J Radiol

J Cardiovasc Comp Tomogr

J Cardiovasc Comp Tomogr

Soc Sci Med

Coronary multidetector computed tomography in the assessment of patients with acute chest pain

Circulation

Original Investigation
Weekly Dose Reports: The Effects of a Continuous Quality Improvement Initiative on Coronary Computed Tomography Angiography Radiation Doses at a Tertiary Medical Center