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CT Protocol Analysis Paper

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Either for possible dose reduction or changes in clinical practice, evaluation of CT protocols is an important part of imaging management. Many institutions have undertaken dose reduction programs [1-9] which are now mandated by the latest Joint Commission [10], American College of Radiology [11, 12], Image Wisely [13], Image Gently [14], and the American Association of Physicists in Medicine guidelines [15, 16]. These programs evaluate whether the written protocols reflect the latest in our scientific understanding of what scanner parameters produce the lowest possible dose while still providing diagnostic images. These studies focus on the protocol design. The actual implementation of the protocols, however, has an important impact on whether …show more content…

This concept takes advantage of the inherent similiarity among CT protocols covering similar indications and body regions and imparts a high level lof uniformity to our protocol parameter settings [22, 23]. Where appropriate, we designed our protocols with size-specific variations so that the acquisition parameters are appropriate across the spectrum of body habitus. At our institution, technologists are expected to choose the appropriate protocol based on patient size and implement it without modification. We have roughly 300 protocols in use covering all body size and indication specific protocol modifications to mitigate the need for scan time protocol adjustments. In this paper we analyze the instances in which protocols were modified at scan time to understand technologist compliance with our …show more content…

This multiplicity of scans will occur not only at sites using relatively small numbers of protocols such at the Cleveland Clinic, who report to employ 30 protocols across their fleet of ~70 CT scanners [5] but also at sites like ours which employs ~300 protocols over ~15 scanners. Sites using a small number of protocols will scan using the same protocols for multiple indications and sites like ours using a master protocol concept will end up scanning multiple indications using similar acquisition parameters. We hypothesize that an analysis of all the scan time acquisition parameters used at our institution would reveal repeated use of common protocols. These would represent frequent exams such as routine heads, routine chests, and routine abdomen exams. In this work, we analyze sets of scan parameters that were only used once over the course of about a year for a single scanner in our fleet. The hypothesis motivating the present work is that “one-offs” contain the majority of un-desired scan time changes. Root cause analysis of these events, in theory would improve our clinical practice of

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