title: Contrast ureteropyelography in theatre: standardised flowchart reporting.
abstract: BACKGROUND
  Urologists perform retrograde contrast studies of the ureters and pelvicalyceal systems in the operating theatre, both for diagnostic purposes and to guide instrumentation. We describe the development of a set of guidelines that aim to standardise the diagnostic quality  of these studies and to reduce radiation dose to the patient and theatre staff. The guidelines incorporate a reporting template that allows a urologist's written report to be made available on the picture archiving and com- munication system (PACS) for subsequent multidisciplinary review.
  
  
  METHODS
  Three cycles of audit were conducted to assess the implementation of the guidelines. An independent reviewer rated image quality and screening times. During the audit cycle, the presentation of the guidelines was honed. The end prod- uct is a flowchart and reporting template for use  by urologists in the operating theatre.
  
  
  RESULTS
  Phase 1 of the audit included 63 studies, phase 2 included 42 studies and phase 3 included 46 studies. The results demonstrate significant improvements in the number of good quality studies and in the recording of control, contrast and post-procedure  images. The mean screening time decreased from 5.0 minutes in phase 1 to 3.2 minutes in phase 3. In phase 3, when in-theatre reporting of the studies by the urologist was added, the handwritten report was scanned in and made available on PACS in 43 of 46 cases (93%). CONCLUSIONS  Introduction  of guidelines improved retrograde contrast study quality and reduced screening times. A system has been developed to store appropriate pictures and a urologist's report of the study on PACS.
authors.affiliation: Salford Royal NHS Foundation Trust, UK. mayaharri@gmail.com
authors.forename: M A
authors.initials: MA
authors.lastname: Harris
authors.forename: T
authors.initials: T
authors.lastname: Marsh
authors.forename: A
authors.initials: A
authors.lastname: Llewellyn
authors.forename: A
authors.initials: A
authors.lastname: West
authors.forename: G
authors.initials: G
authors.lastname: Naisby
authors.forename: B D R
authors.initials: BD
authors.lastname: Gowda
mesh_terms: D003287:Contrast Media; D006801:Humans; D007902:Length of Stay; D008485:Medical Audit; D008505:Medical Staff, Hospital; D016273:Occupational Exposure / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011829:Radiation Dosage; D011872:Radiology Department, Hospital; D011873:Radiology Information Systems; D014567:Urography / Q000592:standards*
chemical_list: D003287:Contrast Media