Optimizing radiation doses for computed tomography across institutions

Dose auditing and best practices

Joshua Demb, Philip Chu, Thomas Nelson, David Hall, J Anthony Seibert, Ramit Lamba, John M Boone, Mayil Krishnam, Christopher Cagnon, Maryam Bostani, Robert Gould, Diana L Miglioretti, Rebecca Smith-Bindman

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE: Radiation doses for computed tomography (CT) vary substantially across institutions. OBJECTIVE: To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers. DESIGN, SETTING, AND PARTICIPANTS: In this before/after interventional study, we prospectively collected radiation dose metrics on all diagnostic CT examinations performed between October 1, 2013, and December 31, 2014, at 5 medical centers. Using data from January to March (baseline), we created audit reports detailing the distribution of radiation dose metrics for chest, abdomen, and head CT scans. In April, we shared reports with the medical centers and invited radiology professionals from the centers to a 1.5-day in-person meeting to review reports and share best practices. MAINOUTCOMES ANDMEASURES: We calculated changesinmean effective dose 12 weeks before and after the audits and meeting, excluding a 12-week implementation period when medical centers could make changes. We compared proportions of examinations exceeding previously published benchmarks at baseline and following the audit and meeting, and calculated changes in proportion of examinations exceeding benchmarks. RESULTS: Of 158 274 diagnostic CT scans performedin the study period, 29594CT scans were performed in the3 months before and 32839 CT scans were performed 12 to 24 weeks after the audit and meeting. Reductions in mean effective dose were considerable for chest and abdomen. Mean effective dose for chest CT decreased from 13.2 to 10.7 mSv (18.9% reduction; 95% CI, 18.0%-19.8%). Reductions at individual medical centers ranged from 3.8% to 23.5%. The mean effective dose for abdominal CTdecreased from 20.0 to 15.0 mSv (25.0% reduction; 95% CI, 24.3%-25.8%). Reductions at individual medical centers ranged from 10.8%to 34.7%. The number of CT scans that had an effective dose measurement that exceeded benchmarks was reduced considerably by 48% and 54% for chest and abdomen, respectively. After the audit and meeting, head CT doses varied less, although some institutions increased and some decreased mean head CT doses and the proportion above benchmarks. CONCLUSIONS AND RELEVANCE: Reviewing institutional doses and sharing dose-optimization best practices resulted in lower radiation doses for chest and abdominal CT and more consistent doses for head CT.

Original languageEnglish (US)
Pages (from-to)810-817
Number of pages8
JournalJAMA Internal Medicine
Volume177
Issue number6
DOIs
StatePublished - Jun 1 2017

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Practice Guidelines
Tomography
Radiation
Benchmarking
Thorax
Head
Abdomen
Radiology

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Optimizing radiation doses for computed tomography across institutions : Dose auditing and best practices. / Demb, Joshua; Chu, Philip; Nelson, Thomas; Hall, David; Seibert, J Anthony; Lamba, Ramit; Boone, John M; Krishnam, Mayil; Cagnon, Christopher; Bostani, Maryam; Gould, Robert; Miglioretti, Diana L; Smith-Bindman, Rebecca.

In: JAMA Internal Medicine, Vol. 177, No. 6, 01.06.2017, p. 810-817.

Research output: Contribution to journalArticle

Demb, Joshua ; Chu, Philip ; Nelson, Thomas ; Hall, David ; Seibert, J Anthony ; Lamba, Ramit ; Boone, John M ; Krishnam, Mayil ; Cagnon, Christopher ; Bostani, Maryam ; Gould, Robert ; Miglioretti, Diana L ; Smith-Bindman, Rebecca. / Optimizing radiation doses for computed tomography across institutions : Dose auditing and best practices. In: JAMA Internal Medicine. 2017 ; Vol. 177, No. 6. pp. 810-817.
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AU - Seibert, J Anthony

AU - Lamba, Ramit

AU - Boone, John M

AU - Krishnam, Mayil

AU - Cagnon, Christopher

AU - Bostani, Maryam

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N2 - IMPORTANCE: Radiation doses for computed tomography (CT) vary substantially across institutions. OBJECTIVE: To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers. DESIGN, SETTING, AND PARTICIPANTS: In this before/after interventional study, we prospectively collected radiation dose metrics on all diagnostic CT examinations performed between October 1, 2013, and December 31, 2014, at 5 medical centers. Using data from January to March (baseline), we created audit reports detailing the distribution of radiation dose metrics for chest, abdomen, and head CT scans. In April, we shared reports with the medical centers and invited radiology professionals from the centers to a 1.5-day in-person meeting to review reports and share best practices. MAINOUTCOMES ANDMEASURES: We calculated changesinmean effective dose 12 weeks before and after the audits and meeting, excluding a 12-week implementation period when medical centers could make changes. We compared proportions of examinations exceeding previously published benchmarks at baseline and following the audit and meeting, and calculated changes in proportion of examinations exceeding benchmarks. RESULTS: Of 158 274 diagnostic CT scans performedin the study period, 29594CT scans were performed in the3 months before and 32839 CT scans were performed 12 to 24 weeks after the audit and meeting. Reductions in mean effective dose were considerable for chest and abdomen. Mean effective dose for chest CT decreased from 13.2 to 10.7 mSv (18.9% reduction; 95% CI, 18.0%-19.8%). Reductions at individual medical centers ranged from 3.8% to 23.5%. The mean effective dose for abdominal CTdecreased from 20.0 to 15.0 mSv (25.0% reduction; 95% CI, 24.3%-25.8%). Reductions at individual medical centers ranged from 10.8%to 34.7%. The number of CT scans that had an effective dose measurement that exceeded benchmarks was reduced considerably by 48% and 54% for chest and abdomen, respectively. After the audit and meeting, head CT doses varied less, although some institutions increased and some decreased mean head CT doses and the proportion above benchmarks. CONCLUSIONS AND RELEVANCE: Reviewing institutional doses and sharing dose-optimization best practices resulted in lower radiation doses for chest and abdominal CT and more consistent doses for head CT.

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