CT Protocol Review and Optimization

Kofler, James M.; Cody, Dianna D.; Morin, Richard L.

doi:10.1016/j.jacr.2013.10.013

Cited by 35 publications

(31 citation statements)

References 11 publications

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“…The request form provides three levels of priority for protocol change: (1) if a patient is on the table and clinical needs require a change for patient safety, the radiologists and technologists are free to do so, but this cannot result in a change to the stored protocol on the machine; (2) if evidence mandates an urgent change to protocol across the enterprise, the form is submitted as level 2 and the governance committee will respond within 2 weeks; (3) if Fig. 1 A portion of an example Excel template used for standardization of CT protocols the request is non-urgent, the requesting party must submit evidence with the request and the committee will respond within 3 months [3].…”

Section: Methodsmentioning

confidence: 99%

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CT and MR Protocol Standardization Across a Large Health System: Providing a Consistent Radiologist, Patient, and Referring Provider Experience

Sachs

Hunt

Mansoubi³

et al. 2016

J Digit Imaging

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Building and maintaining a comprehensive yet simple set of standardized protocols for a cross-sectional image can be a daunting task. A single department may have difficulty preventing "protocol creep," which almost inevitably occurs when an organized "playbook" of protocols does not exist and individual radiologists and technologists alter protocols at will and on a case-by-case basis. When multiple departments or groups function in a large health system, the lack of uniformity of protocols can increase exponentially. In 2012, the University of Colorado Hospital formed a large health system (UCHealth) and became a 5-hospital provider network. CT and MR imaging studies are conducted at multiple locations by different radiology groups. To facilitate consistency in ordering, acquisition, and appearance of a given study, regardless of location, we minimized the number of protocols across all scanners and sites of practice with a clinical indication-driven protocol selection and standardization process. Here we review the steps utilized to perform this process improvement task and insure its stability over time. Actions included creation of a standardized protocol template, which allowed for changes in electronic storage and management of protocols, designing a change request form, and formation of a governance structure. We utilized rapid improvement events (1 day for CT, 2 days for MR) and reduced 248 CT protocols into 97 standardized protocols and 168 MR protocols to 66. Additional steps are underway to further standardize output and reporting of imaging interpretation. This will result in an improved, consistent radiologist, patient, and provider experience across the system.

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Section: Methodsmentioning

confidence: 99%

“…The principle motivation is to achieve diagnostic quality images with the lowest radiation dose possible (ALARA) [3][4][5]. Most work in protocol management has defined tools to take the protocol output from the scanners and collect it in a standardized format on an electronic tool for the purposes of comparison and auditing [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

CT and MR Protocol Standardization Across a Large Health System: Providing a Consistent Radiologist, Patient, and Referring Provider Experience

Sachs

Hunt

Mansoubi³

et al. 2016

J Digit Imaging

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show abstract

“…We maintain uniform numbering for all protocols across all of our scanners. Uniformity in naming and numbering (12) of protocols across all of their scanners is important as this reduces the chance of error as CT technologists move from scanner to scanner.…”

Section: Methodsmentioning

confidence: 99%

“…In reality, these protocols must be properly applied, managed, and reviewed in the clinical environment. The literature is sparse (see the work of Kofer (12) for one example of an exception to this statement) when it comes to proper management techniques for CT protocols and proper methods to review protocols for compliance with ACR mandates (13) . Recently, the practice guideline produced by the AAPM titled “CT Protocol Management and Review Practice Guideline” (14) serves as a minimum standard which clinical physicists can use to gauge how their CT protocol management, review, and optimization program should be run.…”

Section: Introductionmentioning

confidence: 99%

Compliance with AAPM Practice Guideline 1.a: CT Protocol Management and Review — from the perspective of a university hospital

Szczykutowicz

Bour

Pozniak

et al. 2015

J Applied Clin Med Phys

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The purpose of this paper is to describe our experience with the AAPM Medical Physics Practice Guideline 1.a: “CT Protocol Management and Review Practice Guideline”. Specifically, we will share how our institution's quality management system addresses the suggestions within the AAPM practice report. We feel this paper is needed as it was beyond the scope of the AAPM practice guideline to provide specific details on fulfilling individual guidelines. Our hope is that other institutions will be able to emulate some of our practices and that this article would encourage other types of centers (e.g., community hospitals) to share their methodology for approaching CT protocol optimization and quality control. Our institution had a functioning CT protocol optimization process, albeit informal, since we began using CT. Recently, we made our protocol development and validation process compliant with a number of the ISO 9001:2008 clauses and this required us to formalize the roles of the members of our CT protocol optimization team. We rely heavily on PACS‐based IT solutions for acquiring radiologist feedback on the performance of our CT protocols and the performance of our CT scanners in terms of dose (scanner output) and the function of the automatic tube current modulation. Specific details on our quality management system covering both quality control and ongoing optimization have been provided. The roles of each CT protocol team member have been defined, and the critical role that IT solutions provides for the management of files and the monitoring of CT protocols has been reviewed. In addition, the invaluable role management provides by being a champion for the project has been explained; lack of a project champion will mitigate the efforts of a CT protocol optimization team. Meeting the guidelines set forth in the AAPM practice guideline was not inherently difficult, but did, in our case, require the cooperation of radiologists, technologists, physicists, IT, administrative staff, and hospital management. Some of the IT solutions presented in this paper are novel and currently unique to our institution.PACS number: 87.57.Q

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“…Regardless of the method chosen, the generated master protocols require thorough review to ensure that each parameter is set appropriately. Given the importance of protocol management, protocol management solutions have been actively explored by the CT community 2 , 6 , 8 , 9 . In addition, commercial vendors are also exploring software solutions for protocol management (e.g., Toshiba released a protocol management system in 2015).…”

Section: Protocol Monitoring Workflowmentioning

confidence: 99%

Implementation and evaluation of a protocol management system for automated review of CT protocols

Grimes

Leng

Zhang

et al. 2016

J Applied Clin Med Phys

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Protocol review is important to decrease the risk of patient injury and increase the consistency of CT image quality. A large volume of CT protocols makes manual review labor‐intensive, error‐prone, and costly. To address these challenges, we have developed a software system for automatically managing and monitoring CT protocols on a frequent basis. This article describes our experiences in the implementation and evaluation of this protocol monitoring system. In particular, we discuss various strategies for addressing each of the steps in our protocol‐monitoring workflow, which are: maintaining an accurate set of master protocols, retrieving protocols from the scanners, comparing scanner protocols to master protocols, reviewing flagged differences between the scanner and master protocols, and updating the scanner and/or master protocols. In our initial evaluation focusing only on abdomen and pelvis protocols, we detected 309 modified protocols in a 24‐week trial period. About one‐quarter of these modified protocols were determined to contain inappropriate (i.e., erroneous) protocol parameter modifications that needed to be corrected on the scanner. The most frequently affected parameter was the series description, which was inappropriately modified 47 times. Two inappropriate modifications were made to the tube current, which is particularly important to flag as this parameter impacts both radiation dose and image quality. The CT protocol changes detected in this work provide strong motivation for the use of an automated CT protocol quality control system to ensure protocol accuracy and consistency.PACS number(s): 87.57.Q‐

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CT Protocol Review and Optimization

Cited by 35 publications

References 11 publications

CT and MR Protocol Standardization Across a Large Health System: Providing a Consistent Radiologist, Patient, and Referring Provider Experience

CT and MR Protocol Standardization Across a Large Health System: Providing a Consistent Radiologist, Patient, and Referring Provider Experience

Compliance with AAPM Practice Guideline 1.a: CT Protocol Management and Review — from the perspective of a university hospital

Implementation and evaluation of a protocol management system for automated review of CT protocols

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