Department of Radiology, Mayo Clinic, Rochester, MN, USA.
J Appl Clin Med Phys. 2021 Feb;22(2):194-202. doi: 10.1002/acm2.13098. Epub 2020 Dec 18.
It is important to employ radiation dose reduction techniques in pediatric computed tomography (CT) to reduce potential risks of radiation-induced malignancy. Automatic tube potential (kV) selection tools have been developed and become available on many CT scanners, which select the optimum kV based on the patient size and clinical task to improve the radiation dose efficiency. However, its use in pediatric CT has been mostly empirical, following manufacturer's default recommendation without solid demonstration for quality improvement. This study aimed to implement an automatic tube potential tool (CAREkV, Siemens Healthcare) into routine pediatric CT practice, using the "Plan-Do-Study-Act" quality improvement process, in place of an existing kV/mAs technique chart. The design of this quality improvement project involved Plan-Do-Study-Act stages. Plan and Do stages identified the criteria for optimal automatic kV selection; a range of phantoms representing typical pediatric groups were scanned on a dual-source 128-slice scanner using a fast-pitch scanning mode. The identified CAREkV settings were implemented into the CT protocol and evaluated after a 6-month period. In the Study stage, an objective evaluation of the image metrics and radiation dose for two similar patient cohorts using CAREkV and the technique-chart, respectively, were compared. The kV selected, image quality and radiation dose determined by CAREkV were comparable to those obtained while using the technique-chart. The CAREkV was successfully implemented into our pediatric abdominopelvic CT practice. By utilizing the "PDSA" process optimal image quality and radiation dose reduction were achieved with an automatic kV selection tool to improve CT workflow.
在儿科计算机断层扫描（CT）中采用降低辐射剂量的技术以降低辐射诱发恶性肿瘤的潜在风险非常重要。已经开发出并在许多 CT 扫描仪上提供了自动管电压（kV）选择工具，该工具根据患者的体型和临床任务选择最佳的 kV，以提高辐射剂量效率。然而，其在儿科 CT 中的应用主要是经验性的，遵循制造商的默认建议，而没有确凿的证据表明可以提高质量。本研究旨在通过使用“计划-执行-研究-行动”（Plan-Do-Study-Act）质量改进流程，实施自动管电压工具（CAREkV，西门子医疗），替代现有的 kV/mAs 技术图表，将其纳入常规儿科 CT 实践中。该质量改进项目的设计涉及计划-执行-研究-行动阶段。在计划和执行阶段确定了最佳自动 kV 选择标准；使用快速 pitching 扫描模式，在双源 128 层扫描仪上对代表典型儿科人群的一系列体模进行了扫描。将确定的 CAREkV 设置实施到 CT 协议中，并在 6 个月后进行评估。在研究阶段，使用 CAREkV 和技术图表分别对两组类似患者的图像指标和辐射剂量进行了客观评估。CAREkV 选择的 kV、图像质量和辐射剂量与使用技术图表获得的结果相当。CAREkV 已成功纳入我们的儿科腹部和盆腔 CT 实践。通过利用“PDSA”流程，使用自动 kV 选择工具实现了最佳的图像质量和辐射剂量降低，从而改善了 CT 工作流程。
