Quality Improvement Report: Improving Retrieval Time for CT Supplies by Using 5S.

The CT supply room is a critical resource in the imaging workflow. However, the supply room for the two CT scanners at our cancer center, one of which is used for our busy interventional service, was disorganized, and the time spent searching for the appropriate equipment could potentially lead to delays in service and contribute to patient safety risks. The purpose of this project was to reduce the time to find supplies and to increase the satisfaction of CT technologists and medical providers by reorganizing and clearly labeling supplies using "lean" principles.

Large variation in radiation dose for routine abdomen CT: reasons for excess and easy tips for reduction.

Objective: To characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT.

Methods: We retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation.

REFLACX, a dataset of reports and eye-tracking data for localization of abnormalities in chest x-rays.

Deep learning has shown recent success in classifying anomalies in chest x-rays, but datasets are still small compared to natural image datasets. Supervision of abnormality localization has been shown to improve trained models, partially compensating for dataset sizes. However, explicitly labeling these anomalies requires an expert and is very time-consuming.

Revisiting racial disparities in ED CT utilization during the Affordable Care Act era: 2009-2018 data from the NHAMCS.

Objective: To examine the trends in CT utilization in the emergency department (ED) for different racial and ethnic groups, factors that may affect utilization, and the effects of increased insurance coverage since passage of the Affordable Care Act in 2010.

Materials And Methods: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for the years 2009-2018 were used for the analysis. The NHAMCS is a cross-sectional survey which has random and systematical samples of more than 200,000 visits to over 250 hospital EDs in the USA.

Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry.

Ob Jectives: The European Society of Radiology identified 10 common indications for computed tomography (CT) as part of the European Study on Clinical Diagnostic Reference Levels (DRLs, EUCLID), to help standardize radiation doses. The objective of this study is to generate DRLs and median doses for these indications using data from the UCSF CT International Dose Registry.

Methods: Standardized data on 3.

Decreasing CT Acquisition Time in the Emergency Department through Lean Management Principles.

Background Emergency departments (EDs) rely on advanced imaging such as CT for diagnosis. Owing to increased ED volumes at the authors' institution, CT image acquisition became a significant bottleneck in ED patient throughput. Methods A multidisciplinary team was formed to solve this complex patient flow issue.

Implementing a Novel Through-Glass Chest Radiography Technique for COVID-19 Patients: Image Quality, Radiation Dose Optimization, and Practical Considerations.

Rationale And Objectives: The novel coronavirus (COVID-19) pandemic has presented many logistical challenges, including unprecedented shortages of personal protective equipment (PPE). A technique of obtaining portable chest radiographs (pCXR) through glass doors or windows to minimize technologist-patient contact and conserve PPE has gained popularity, but remains incompletely evaluated in the literature. Our goal was to quickly implement this technique and evaluate image quality and radiation dose.

Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial.

Importance: Computed tomography (CT) radiation doses vary across institutions and are often higher than needed.

Objective: To assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT.

Design, Setting, And Participants: This randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017.

Achieving CT Regulatory Compliance: A Comprehensive and Continuous Quality Improvement Approach.

Computed tomography (CT) represents one of the largest sources of radiation exposure to the public in the United States. Regulatory requirements now mandate dose tracking for all exams and investigation of dose events that exceed set dose thresholds. Radiology practices are tasked with ensuring quality control and optimizing patient CT exam doses while maintaining diagnostic efficacy.

Second-Opinion Reads in Interstitial Lung Disease Imaging: Added Value of Subspecialty Interpretation.

Purpose: The purpose of this study was to determine how often a second-opinion interpretation of interstitial lung disease (ILD) by an academic cardiothoracic radiologist is discordant with the initial interpretation by a nonacademic radiologists and how often the clinical diagnosis determined by multidisciplinary consensus agrees with the initial and second-opinion interpretations.

Methods: This retrospective study included 364 consecutive second-opinion CT examination reports of imaging from nonacademic radiology practices from July 2014 to May 2016. The second-opinion interpretations, provided by seven fellowship-trained cardiothoracic radiologists, were compared with the initial interpretations and the clinical diagnoses determined by multidisciplinary consensus.

Structured Reporting in Radiology.

Radiology reports are vital for patient care as referring physicians depend upon them for deciding appropriate patient management. Traditional narrative reports are associated with excessive variability in the language, length, and style, which can minimize report clarity and make it difficult for referring clinicians to identify key information needed for patient care. Structured reporting has been advocated as a potential solution for improving the quality of radiology reports.

Radiology Trainee vs Faculty Radiologist Fluoroscopy Time for Imaging-Guided Procedures: A Retrospective Study of 17,966 Reports Over a 5.5-Year Period.

To evaluate differences in fluoroscopy time (FT) for common vascular access and gastrointestinal procedures performed by radiology trainees vs faculty radiologists. Report information was extracted for all 17,966 index fluoroscopy services performed by trainees or faculty, or both from 2 university hospitals over 66 months. Various vascular access procedures (eg, peripherally inserted central catheters [PICCs] and ports) and gastrointestinal fluoroscopy procedures (eg, upper gastrointestinal and contrast enema studies) were specifically targeted.

Radiology Research in Quality and Safety: Current Trends and Future Needs.

Promoting quality and safety research is now essential for radiology as reimbursement is increasingly tied to measures of quality, patient safety, efficiency, and appropriateness of imaging. This article provides an overview of key features necessary to promote successful quality improvement efforts in radiology. Emphasis is given to current trends and future opportunities for directing research.

The Science of Quality Improvement.

Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs.

Imaging of Diseases of the Large Airways.

Imaging of the large airways is key to the diagnosis and management of a wide variety of congenital, infectious, malignant, and inflammatory diseases. Involvement can be focal, regional, or diffuse, and abnormalities can take the form of masses, thickening, narrowing, enlargement, or a combination of patterns. Recognition of the typical morphologies, locations, and distributions of large airways disease is central to an accurate imaging differential diagnosis.

Increased Computed Tomography Dose Due to Miscentering With Use of Automated Tube Voltage Selection: Phantom and Patient Study.

The purpose of the article is to determine if miscentering affected dose with use of automated tube voltage selection software. An anthropomorphic phantom was imaged at different table heights (centered in the computed tomography [CT] gantry, and -6, -3, +3, and +5.7cm relative to the centered position).

The Value of Imaging Part II: Value beyond Image Interpretation.

Although image interpretation is an essential part of radiologists' value, there are other ways in which we contribute to patient care. Part II of the value of imaging series reviews current initiatives that demonstrate value beyond the image interpretation. Standardizing processes, reducing the radiation dose of our examinations, clarifying written reports, improving communications with patients and providers, and promoting appropriate imaging through decision support are all ways we can provide safer, more consistent, and higher quality care.

Value of Imaging Part I: Perspectives for the Academic Radiologist.

With payers and policymakers increasingly scrutinizing the value of medical imaging, opportunities abound for radiologists and radiology health services researchers to meaningfully and rigorously demonstrate value. Part one of this two-part series on the value of imaging explores the concept of value in health care from the perspective of multiple stakeholders and discusses the opportunities and challenges for radiologists and health service researchers to demonstrate value. The current absence of meaningful national value metrics also presents an opportunity for radiologists to take the lead on the discussions of these metrics that may serve as the basis for future value-based payments.

A Comprehensive CT Dose Reduction Program Using the ACR Dose Index Registry.

Purpose: The purpose of this article is to demonstrate the role of the ACR Dose Index Registry(®) (DIR) in a dose reduction program at a large academic health care system.

Methods: Using the ACR DIR, radiation doses were collected for four common CT examination types (head without contrast, chest with contrast, chest without contrast, and abdomen and pelvis with contrast). Baseline analysis of 7,255 CT examinations from seven scanners across the institution was performed for the period from December 1, 2011, to March 15, 2012.

Dose tracking and dose auditing in a comprehensive computed tomography dose-reduction program.

Implementation of a comprehensive computed tomography (CT) radiation dose-reduction program is a complex undertaking, requiring an assessment of baseline doses, an understanding of dose-saving techniques, and an ongoing appraisal of results. We describe the role of dose tracking in planning and executing a dose-reduction program and discuss the use of the American College of Radiology CT Dose Index Registry at our institution. We review the basics of dose-related CT scan parameters, the components of the dose report, and the dose-reduction techniques, showing how an understanding of each technique is important in effective auditing of "outlier" doses identified by dose tracking.

Variability of MDCT dose due to technologist performance: impact of posteroanterior versus anteroposterior localizer image and table height with use of automated tube current modulation.

Objective: The purpose of this study was to determine MDCT dose variability due to technologist variability in performing CT studies.

Materials And Methods: Fifty consecutive adult patients who underwent two portal venous phase CT examinations of the abdomen and pelvis on the same 64-MDCT scanner between January and December 2011 were retrospectively identified. Tube voltage (kVp), tube current (mA), use of automated tube current modulation (ATCM), dose-length product (DLP), volume CT dose index (CTDIvol), table height, whether the localizer image was obtained using the posteroanterior or the anteroposterior technique, arm position, and number of overscanned slices were recorded.