title: Weekly dose reports: the effects of a continuous quality improvement initiative on coronary computed tomography angiography radiation doses at a tertiary medical center.
abstract: OBJECTIVE
  Numerous protocols have been developed to reduce cardiac computed tomography angiography (cCTA) radiation dose while maintaining image quality. However, cCTA practice is highly dependent on physician and technologist experience and education. In this study, we sought to evaluate the incremental value of real-time feedback via weekly dose reports on a busy cCTA service.
  
  
  METHODS
  This time series analysis consisted of 450 consecutive patients whom underwent physician-supervised cCTA for clinically indicated native coronary evaluation between April 2011 and January 2013, with 150 patients before the initiation of weekly dose report (preintervention period: April-September 2011) and 150 patients after the initiation (postintervention period: September 2011-February 2012). To assess whether overall dose reductions were maintained over time, results were compared to a late control group consisting of 150 consecutive cCTA exams, which were performed after the study (September 2012-January 2013). Patient characteristics and effective radiation were recorded and compared.
  
  
  RESULTS
  Total radiation dose was significantly lower in the postintervention period (3.4 mSv [1.7-5.7] and in the late control group (3.3 mSv [2.0-5.3] versus the preintervention period (4.1 mSv [2.1-6.6] (P = .005). The proportion of high-dose outliers was also decreased in the postintervention period and late control period (exams <10 mSv were 88.0% preintervention vs. 97.3% postintervention vs. 95.3% late control; exams <15 mSv were 98.0% preintervention vs. 100.0% postintervention vs. 98.7% late control; exams <20.0 mSv were 98.7% preintervention vs. 100.0% postintervention vs. 100.0% late control).
  
  
  CONCLUSIONS
  Weekly dose report feedback of site radiation doses to patients undergoing physician-supervised cCTA resulted in significant overall dose reduction and reduction of high-dose outliers. Overall dose reductions were maintained beyond the initial study period.
authors.affiliation: Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge St., Suite 400, Boston, MA 02114, USA.
authors.forename: Leif-Christopher
authors.initials: LC
authors.lastname: Engel
authors.forename: Ashley Mingshin
authors.initials: AM
authors.lastname: Lee
authors.forename: Harald
authors.initials: H
authors.lastname: Seifarth
authors.forename: Manavjot S
authors.initials: MS
authors.lastname: Sidhu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
mesh_terms: D017023:Coronary Angiography / Q000592:standards / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D058996:Quality Improvement / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D011835:Radiation Protection; D011874:Radiometry / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers / Q000592:standards / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*
keywords: Coronary CT angiography; process improvement; quality improvement; radiation dose