CT Dose Optimization in Pediatric Radiology: A Multiyear Effort to Preserve the Benefits of Imaging While Reducing the Risks.
The marked increase in radiation exposure from medical imaging, especially in children, has caused considerable alarm and spurred efforts to preserve the benefits but reduce the risks of imaging. Applying the principles of the Image Gently campaign, data-driven process and quality improvement techniques such as process mapping and flowcharting, cause-and-effect diagrams, Pareto analysis, statistical process control (control charts), failure mode and effects analysis, "lean" or Six Sigma methodology, and closed feedback loops led to a multiyear program that has reduced overall computed tomographic (CT) examination volume by more than fourfold and concurrently decreased radiation exposure per CT study without compromising diagnostic utility. This systematic approach involving education, streamlining access to magnetic resonance imaging and ultrasonography, auditing with comparison with benchmarks, applying modern CT technology, and revising CT protocols has led to a more than twofold reduction in CT radiation exposure between 2005 and 2012 for patients at the authors' institution while maintaining diagnostic utility.
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Taylor J
TJ
Greenwood
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Rodrigo I
RI
Lopez-Costa
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Patrick D
PD
Rhoades
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Juan C
JC
Ramírez-Giraldo
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Matthew
M
Starr
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Mandie
M
Street
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
James
J
Duncan
From the Mallinckrodt Institute of Radiology, St Louis Children's Hospital, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.
Robert C
RC
McKinstry
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D057286:Electronic Health Records; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods; D008498:Medical Record Linkage; D008923:Missouri; D010372:Pediatrics; D011829:Radiation Dosage; D000069079:Radiation Exposure; D011835:Radiation Protection / Q000379:methods*; D011872:Radiology Department, Hospital; D012017:Referral and Consultation; D012308:Risk Management; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D019564:Unnecessary Procedures