Abstract
The purpose of this report is to describe our experience with the implementation of a practice quality improvement (PQI) project in thoracic imaging as part of the American Board of Radiology Maintenance of Certification process. The goal of this PQI project was to reduce the effective radiation dose of routine chest CT imaging in a busy clinical practice by employing the iDose4 (Philips Healthcare) iterative reconstruction technique. The dose reduction strategy was implemented in a stepwise process on a single 64-slice CT scanner with a volume of 1141 chest CT scans during the year. In the first annual quarter, a baseline effective dose was established using the standard filtered back projection (FBP) algorithm protocol and standard parameters such as kVp and mAs. The iDose4 technique was then applied in the second and third annual quarters while keeping all other parameters unchanged. In the fourth quarter, a reduction in kVp was also implemented. Throughout the process, the images were continually evaluated to assure that the image quality was comparable to the standard protocol from multiple other scanners. Utilizing a stepwise approach, the effective radiation dose was reduced by 23.62 and 43.63 % in quarters two and four, respectively, compared to our initial standard protocol with no perceived difference in diagnostic quality. This practice quality improvement project demonstrated a significant reduction in the effective radiation dose of thoracic CT scans in a busy clinical practice.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Hawkins CM, Alsip CN, Pryor RM, et al: Quality improvement and confirmation projects: facilitating rapid, measurable performance improvement. Radiographics 33(7):e225–35, 2013
Strife JL, Kun LE, Becker GJ, et al: The American board of radiology perspective on maintenance of certification: part IV—practice quality improvement for diagnostic radiology. Radiology 243(2):309–13, 2007
American Board of Radiology. MOC: Maintenance of certification. Available from: http://www.theabr.org/moc-landing. Accessed: May 8, 2014.
Griffith B, Brown ML, Jain R: Improving imaging utilization through practice quality improvement (maintenance of certification part IV): a review of requirements and approach to implementation. AJR Am J Roentgenol 202(4):797–802, 2014
Kouo T: Experience with a practice quality improvement system in a university radiology department. J Am Coll Radiol 9(11):814–9, 2012
Keegan J, Miglioretti DL, Gould R, et al: Radiation dose metrics in CT: assessing dose using the National Quality Forum CT patient safety measure. J Am Coll Radiol 11(3):309–15, 2014
Choudhery S, Richter M, Anene A, et al: Practice quality improvement during residency: where do we stand and where can we improve? Acad Radiol 21(7):851–58, 2014
Silva 3rd, E: MOC for dollars. J Am Col Radiol 8(11):746–8, 2011
Tamm EP, Szklaruk J, Puthooran L, et al: Quality initiatives: planning, setting up, and carrying out radiology process improvement projects. Radiographics 32(5):1529–42, 2012
Lee CS, Larson DB: Beginner’s guide to practice quality improvement using the model for improvement. J Am Coll Radiol 11(12ptA):1131–6, 2014
Hirsch JA, Becker GJ, Derdeyn CP, et al: Maintenance of certification: part 2-continuous certification. J Neurointerv Surg 6(2):156–60, 2014
Smith-Bindman R: Is computed tomography safe? N Engl J Med 363(1):1–4, 2010
Brenner DJ, Doll R, Goodhead DT, et al: Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. PNAS 100(24):13761–6, 2003
Takahashi EA, Yoon HC: Four-year cumulative radiation exposure in patients undergoing computed tomography angiography for suspected pulmonary embolism. Radiol Res Pract. 2013:482403, 2013
Beister M, Kolditz D, Kalender WA: Iterative reconstruction methods in X-ray CT. Phys Med 28(2):94–108, 2012
Gonzalez-Guindalini FD, Ferreira Botelho MP, Tore HG, et al: MDCT of chest, abdomen, and pelvis using attenuation-based automated tube voltage selection in combination with iterative reconstruction: an intrapatient study of radiation dose and image quality. AJR Am J Roentgenol 201(5):1075–82, 2013
Christe A, Heverhagen J, Ozdoba C, et al: CT dose and image quality in the last three scanner generations. World J Radiol 5(11):421–9, 2013
Lee SW, Kim Y, Shim SS, et al: Image quality assessment of ultra low-dose chest CT using sonogram-affirmed iterative reconstruction. Eur Radiol 24(4):817–26, 2014
Ning P, Zhu S, Shi D, et al: X-ray dose reduction in abdominal computed tomography using advanced iterative reconstruction algorithms. PLoS One 9(3):e92568, 2014
Matsuki M, Murakami T, Juri H, et al: Impact of adaptive iterative dose reduction (AIDR) 3D on low-dose abdominal CT: comparison with routine-dose CT using filtered back projection. Acta Radiol 54(8):869–75, 2013
Kim M, Lee JM, Yoon JH, et al: Adaptive iterative dose reduction algorithm in CT: effect on image quality compared to filtered back projection in body phantoms of different sizes. Korean J Radiol 15(2):195–204, 2014
Prakash P, Kalra MK, Digumarthy SR, et al: Radiation dose reduction with chest computed tomography using adaptive statistical iterative reconstruction technique: initial experience. J Comput Assist Tomogr 34(1):40–5, 2010
Noel PB, Renger B, Fiebich M, et al: Does iterative reconstruction lower CT radiation dose: evaluation of 15,000 examinations. PLoS One 8(11):e81141, 2013
Arapakis I, Efstathopoulos E, Tsitsia V, et al: Using “iDose4” iterative reconstruction algorithm in adults’ chest-abdomen-pelvis CT examinations: effect on image quality in relation to patient radiation exposure. Br J Radiol. 87:20130613, 2014
Lagmani A, Buhk JH, Henes FO, et al: Impact of a 4th generation iterative reconstruction technique on image quality in low-dose computed tomography of the chest in immunocompromised patients. Rofo 185(8):749–57, 2013
Li Q, Yu H, Zhang L, et al: Combining low tube voltage and iterative reconstruction for contrast-enhanced CT imaging of the chest—initial clinical experience. Clin Radiol 68(5):e249–53, 2013
Cook TS, Zimmerman S, Maidment AD, et al: Automated extraction of radiation dose information for CT examinations. J Am Coll Radiol 7(11):871–7, 2010
Yousem DM, Nidecker A: Maintenance of certification: update on attitudes of members of the American Society of Neuroradiology. AJNR Am J Neuroradiol 31(8):1369–72, 2010
Khawaja RD, Singh S, Gilman M, et al: Computed tomography (CT) of the chest at less than 1 mSv: an ongoing prospective clinical trial of chest CT at submillisievert radiation doses with iterative model image reconstruction and iDose4 technique. J Comput Assist Tomogr 38(4):613–9, 2014
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Takahashi, E.A., Kohli, M.D. & Teague, S.D. A Practice Quality Improvement Project: Reducing Dose of Routine Chest CT Imaging in a Busy Clinical Practice. J Digit Imaging 29, 622–626 (2016). https://doi.org/10.1007/s10278-016-9877-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10278-016-9877-x