HealthPartners Institute, Minneapolis, Minnesota.
University of California, San Francisco, San Francisco, California.
J Am Coll Radiol. 2020 Jul;17(7):951-959. doi: 10.1016/j.jacr.2020.01.044. Epub 2020 Mar 17.
The aim of this study was to identify organizational factors and quality improvement strategies associated with lower radiation doses from abdominal CT.
Cross-sectional survey was administered to radiology leaders, along with simultaneous measurement of CT radiation dose among 19 health care organizations with 100 imaging centers throughout the United States, Europe, and Japan, using a common dose management software system. After adjusting for patient age, gender, and size, quality improvement strategies were tested for association with mean abdominal CT radiation dose and the odds of a high-dose examination.
Completed surveys were received from 90 imaging centers (90%), and 182,415 abdominal CT scans were collected during the study period. Radiation doses varied considerably across organizations and centers. Univariate analyses identified eight strategies and systems that were significantly associated with lower average doses or lower frequency of high doses for abdominal CT examinations: tracking patient safety measures, assessing the impact of CT changes, identifying areas for improvement, setting specific goals, organizing improvement teams, tailoring decisions to sites, testing process changes before full implementation, and standardizing workflow. These processes were associated with an 18% to 37% reduction in high-dose examinations (P < .001-.03). In multivariate analysis, having a tracking system for patient safety measures, supportive radiology leaders, and obtaining clear images were associated with a 47% reduction in high-dose examinations.
This documentation of the relation between quality improvement strategies and radiation exposure from CT examinations has identified important information for others interested in reducing the radiation exposure of their patients.
本研究旨在确定与腹部 CT 辐射剂量降低相关的组织因素和质量改进策略。
对放射科领导进行横断面调查，同时在美国、欧洲和日本的 19 家医疗保健机构的 100 个成像中心使用通用剂量管理软件系统测量 CT 辐射剂量。在调整患者年龄、性别和体型后，测试质量改进策略与平均腹部 CT 辐射剂量和高剂量检查的几率之间的关联。
完成了 90 个成像中心（90%）的调查，并在研究期间收集了 182415 次腹部 CT 扫描。各组织和中心的辐射剂量差异很大。单变量分析确定了 8 种策略和系统，这些策略和系统与腹部 CT 检查的平均剂量降低或高剂量的发生频率降低显著相关：跟踪患者安全措施、评估 CT 变化的影响、确定改进领域、设定具体目标、组织改进团队、根据具体情况做出决策、在全面实施之前测试流程变更以及使工作流程标准化。这些过程与高剂量检查减少 18%至 37%（P<.001-.03）相关。在多变量分析中，对患者安全措施进行跟踪、有支持性的放射科领导以及获得清晰的图像与高剂量检查减少 47%相关。
本研究记录了质量改进策略与 CT 检查辐射暴露之间的关系，为其他有兴趣降低患者辐射暴露的人提供了重要信息。
