QF14 Storyboard Winner - Patient Dose Reduction in CT Examinations


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This was a winning storyboard from Quality Forum 2014. It was presented by:

Mitch Griffith
Interim Manager-Home and Community Care
Northern Health

Published in: Health & Medicine
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QF14 Storyboard Winner - Patient Dose Reduction in CT Examinations

  1. 1. Improving Patient Care CT Dose Reduction through a Collaborative Approach Mitch Griffith -Radiation Safety- Northern Health Authority Ken Winnig -Regional Director Diagnostic Services- Northern Health Authority The Need for Change The use of Computerized Tomography (CT) in medical imaging has risen dramatically over the past 3 decades with a 20 fold increase in the number of scans done annually. In Canada there was a 31.8% increase in the number of CT scans done between 2003 and 2006, this coupled with the relatively high level of radiation involved, CT is now the single greatest source of radiation exposure from medical imaging procedures. Quantifying a link between exposure to “low” levels of radiation and cancer has been a controversial subject however there are some general principles that are emerging; the age at exposure to and the amount of radiation exposure increases the probability of cancer induction. For an individual patient undergoing a CT scan, the probability of developing a cancer as a result of radiation exposure is exceedingly low, when consideration is given to the large number of scans done nationally, the probability of cancer induction becomes significant. Across Northern Health 28,000 CT procedures are performed annually therefore it was concluded that any reduction in patient radiation dose could have a statistically significant impact on the population as a whole. Where to start It was determined that Lumbar spine scans would be the procedure by which the dose optimization (reduction) strategy would be developed and implemented. Lumbar spine scans are a relatively common exam type with a high degree of variability in patient dose across the health authority; therefore significant gains might be realized through a review of clinical and technical practices. What we did Bringing together a project of this scope required the collaborative efforts of groups across the spectrum of the healthcare team and with the endorsement of the Regional Director of Diagnostic Imaging and Diagnostic Imaging Quality Assurance Committee (DIQAC) the work began. Dose  reduc*on  strategies-­‐     protocol  sharing  and  clinical   scanning  parameters  -­‐  2nd   Audit   Ongoing  protocol   revisions  -­‐  3rd   Audit   Equipment  and   so<ware  upgrades   at  2  sites-­‐  4th   Audit   Dose  Reduc*on   Strategies  Created   Protocol   sharing-­‐     Department   Managers   Protocol   revisions-­‐   Radiologists   Clinical   scanning   parameters   defined-­‐   DIQAC   Baseline  Results   Derived   Data   analysis  and   sharing  with   sites-­‐  RSO/ DIQAC   QA  results   confirmed-­‐   Biomed   Manual   audit  of   doses  using   PACS-­‐  RSO   Project  Plan   Inita.on   Local  support   for  Project-­‐   Hospital   Administra/on   Project   Support-­‐   Regional   Manager   Project   Defined-­‐   Radia/on   Safety   Officer   How we did In the months following the audit it was evident that radiation dose awareness was increasing across the region as some sites began to take an active role in dose optimization steps, regardless of whether their average doses were above or below the established DRL’s. Since dose optimization steps were underway in multiple paths simultaneously we were unable to determine which pathway contributed the most to the overall reductions realized. As of December 2013 the results were as follows Audit Period Avg DLP Regional DRL % reduction Overall % reduction 2011 1381 1836 N/A N/A 2012 1199 1565 15 15 2013 (1st half) 1075 1374 12.2 25.2 2013 (2nd half) 922 1181 14.1 35.7 A 35.7% reduction in the regional DRL was a remarkable achievement, considering the scope of the project on so many fronts; numerous radiologists, multiple sites spread across the health authority and the wide range of groups involved in implementing the change. The quality improvement for the patients of Northern Health is an example of the positive outcomes that can be realized through a collaborative approach. Where are we going from here? Radiation safety operates on the ALARA principle, (As Low As Reasonably Achievable) so future reductions may be achievable within this exam type however the diagnostic quality needs to be maintained. Dose optimization has been carried over to other exam categories however the process is ongoing, accurate data collection is critical and translating the success of the Lumbar spine optimization is proving to be challenging, however the work continues. Contact Mr. Mitch Griffith, Radiation Safety Officer Terrace, BC 250-615-2107 Mitch.griffith@northernhealth.ca FIGURE 2 Initial audit 2010-2011. Note the variability in patient radiation dose. FIGURE 3 2012 Audit of patient dose was done following the development of the automated RIS report. Internal reviews of imaging protocols begun with DIQAC approved clinical changes adopted. FIGURE 4 2013 January to June. Further protocol sharing and ongoing site participation in adopting changes. FIGURE 5 2013 July-December. Technological changes (dose reduction software) implemented at 2 sites. Figure 1 - DRL Measure the outcomes. Dose reduction would be managed using the Diagnostic Reference Level (DRL) concept. Patient data was analyzed at a regional level and the DRL calculated as the 75th percentile of the distribution of doses. Dose reduction strategies would be implemented and follow up audits performed, success would be measured at the site level (lower average dose/exam) and regionally through a reduction of the DRL and a left shift of the dose distribution as demonstrated in Figure 1. Mission Statement Our Purpose Through the efforts of our dedicated staff and physicians, in partnership with communities and organizations, we provide exceptional health services for Northerners. the northern way of caring