Derivation and approval of all components of the protocols … Pre-load specific CT protocols on individual CT scanners to avoid potential technologist error in entering parameters. If recommending follow-up imaging, attempt to use recommended guidelines for both primary and incidental findings. Be the patient’s advocate. Smith-Bindman R, Wang Y, Yellen-Nelson TR, et al. For example, a renal calculus protocol should use a lower dose than a screening abdomen/pelvis protocol because the inherent high contrast of a renal calculus enables the use of lower dose techniques to make the diagnosis. not image outpatients presenting with acute back/leg pain without red flags. Multiphase exams are very useful for specific indications, but should not be routinely used to answer general questions. Likewise, if a renal mass is the clinical question, a pelvis should not be routinely performed. ≥1 cm for other nodes. Resources for Patients and Referring Practitioners, https://www.radiology.wisc.edu/sections/msk/protocols.php, How I do it: Managing radiation dose in CT, CT radiation: Key concepts for gentle and wise use, Achieving routine submillisievert CT scanning: Report from the summit on management of radiation dose in CT, Adaptive statistical iterative reconstruction technique for radiation dose reduction in chest CT: A pilot study, Quality initiatives: CT radiation dose reduction: how to implement change without sacrificing diagnostic quality, Radiation Dose Management: A Comprehensive Optimization Process for Improving Patient Safety, Acute appendicitis in young adults: Low- versus Standard-Radiation-dose contrast-enhanced abdominal CT for diagnosis. ≥1.5 cm in short axis for jugulodigastric nodes 2. Follow pediatric CT protocols for intravenous contrast in children (< 18 years old). Size criteria for enlarged lymph nodes: 1. Imaging wisely: patient safety in CT Imaging wisely: patient safety in CT Lu, Zheng; Thomas, Stephen 2016-03-12 00:00:00 tribute to approximately 49% of collective effective The past decade has seen a significant growth in diag- radiation dose from medical exposure in the U.S. [4]. AAPM Releases Adult CT Colonography Protocols The American Association of Physicists in Medicine (AAPM), through its Alliance for Quality Computed Tomography, has posted adult CT colonography protocols that include manufacturer and model-specific protocols for all of the applicable manufacturers of CT equipment currently sold in the US. J Am Coll Radiol. Amyloid Imaging. Likewise, if a renal mass is the clinical question, a pelvis should not be routinely performed. medically necessary imaging studies and to eliminate unnecessary procedures, Copyright © 2010-21 American College of Radiology Imaging institutions and patients should consider keeping a record of the number of imaging exams involving radiation, including the year performed. • Popular radiation safety cases for technologist, physician, and medical physicist credit. William W. Mayo-Smith, MD, Brigham and Women's Hospital, Boston, MA Because you cannot see radiation, higher doses can be administered inadvertently by manually entering parameters for each exam. September 2019 — Pamela Johnson, MD, discussed harmonizing abdominal CT protocol utilization without compromising quality of care during an Image Wisely ® Facebook Live event. Image Gently ® has created many educational materials and offer them here on the website. J Am Coll Radiol. To routinely review imaging protocols to ensure that the least radiation necessary to acquire a diagnostic-quality image is used for each ... After you submit your pledge, look for the Image Wisely confirmation email containing a link to your pledge certificate. Make sure an alternative imaging exam such as ultrasound or magnetic resonance imaging (MRI) is not available which could provide the same information without radiation exposure, particularly in pediatric and pregnant patients. A radiologist, medical physicist, and lead technologist should regularly review departmental CT protocols to make sure they are optimized. New Image Gently “Universal” CT Protocols are now available for Head, Thorax and Abdomen. Watch on-demand . For example, if a chest CT is ordered, a full abdomen should not be performed. Children are more sensitive to radiation. DISCLOSURES • Research Grant: Siemens AG • All patient images acquired and used under IRB approval. Updated protocols are now available to address technology improvements to CT scanners since that time. Within the radiology department, all CT protocols were reviewed and optimized for dose reduction. “Image Wisely” is a social marketing campaign that promotes radiation awareness and education in adult imaging. Choose a specific exam protocol which addresses the clinical question while minimizing dose (see below). Radiation dose optimization for adult and pediatric protocols, as addressed in Image Gently and Image Wisely campaigns Safe procedures for operation of CT equipment Expected or typical dose levels for common CT exams Dose notification and alert levels Adult CT scan protocols I have read the documents and understand their content. Decision support to determine appropriateness of the exam before ordering are assuring appropriate CT exams are being performed. FAQs. PubMed PMID: 25892227. Terms and Conditions | Privacy. Consider reporting the dose of the exam in the dictation, then downloading it to an electronic medical record for monitoring in a local, regional, or national database. ii. (Low Dose) CT Protocols Christopher Cagnon, PhD Assoc. Available at: Yu L., Lui X., Leng S., et al., “Radiation Dose Reduction in Computed Tomography: Techniques and Future Perspective,”, McCollough C.H., Primak A.N., Braun N., et al., “Strategies for Reducing Radiation Dose in CT,”. MRI Referring Providers; MRI - Parent Information; Nuclear Medicine; Ultrasound. Terms and Conditions | Privacy, Resources for Patients and Referring Practitioners, https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/CT-Protocols-and-Radiation-Dose. Use of the split bolus in this example results in physiologic information about both the ureters and the renal parenchyma with only one radiation exposure. medically necessary imaging studies and to eliminate unnecessary procedures, Copyright © 2010-21 American College of Radiology Also discussed are the contributions of radiation awareness cam-paigns such as the Image Gently and Image Wisely campaigns and The first steps are to be sure the examination is JUSTIFIED: If the exam is clinically indicated, be sure it is OPTIMIZED to tailor the CT dose: At the dictation level, consider the following: At the protocol development and quality improvement levels, consider the following: In addition, there are a number of websites which list specific protocols for various types of CT scanners and manufacturers. Image Wisely (adult imaging) The purpose of these CT protocol pages is to provide a reference for radiology residents, fellows and technologists when prescribing a CT examination. Epub 2015 Apr 16. Review. Multiphase exams expose a body part more than once during the CT exam and thus increase dose per exam. ACR Practice Parameters and Technical Standards, American College of Radiology, 2013. CT radiation dose: What can you do right now in your practice? Asymmetric positioning can result in decreased image quality and an increase in patient dose. These advances have resulted in our ability to image faster, capture rapidly moving structures such as the heart, and improve both temporal and spatial resolution. Furthermore, many radiologists do not have a working understanding of the physics of dose reduction (eg, volumetric CT dose index), thereby impeding a uniform approach to ALARA. Read about CT Protocol Design and Optimization. The ACR Dose Index Registry has been developed to determine national Diagnostic Reference Levels. Through the looking glass revisited: The need for more meaning and less drama in the reporting of dose and dose reduction in CT, A comprehensive approach to CT radiation dose reduction: One institution's experience, Radiation doses in consecutive CT examinations from five University of California medical centers, Identifying institutional diagnostic reference levels for CT with radiation dose index monitoring software, U.S. national diagnostic reference levels: Closing the gap, Predictors of CT radiation dose and their effect on patient care: A comprehensive analysis using automated data, CT radiation dose optimization and tracking program at a large quaternary-care health care system, Toward large-scale process control to enable consistent CT radiation dose optimization, Methods for clinical evaluation of noise reduction techniques in abdominopelvic CT, Eight decades of ICRP recommendations in medicine: A perspective, Follow-up of incidental pulmonary nodules and the radiology report, Managing incidental findings on abdominal and pelvic CT and MRI, part 1: White paper of the ACR Incidental Findings Committee II on adnexal findings, ACR-AAPM-SPR Practice Parameter for Diagnostic Reference Levels and Achievable Doses in Medical X-ray Imaging. James M. Kofler, Jr. PhD, Mayo Clinic, Rochester, MN All aspects of the exam should be included in the protocol, including patient positioning, nursing instructions, scan parameters, reconstruction/reformatting instructions, and any other information necessary for the imaging team to complete the CT study successfully. Attempt to minimize phase creep. And be sure to take the pledge to Image Wisely! The first bolus results in opacification of the ureters; the second results in nephrographic enhancement. Currently many new strategies and technologies are being developed to address concerns over CT radiation exposure. McCollough CH, Chen GH, Kalender W, et al. CT HEAD PROTOCOLS. Minimize “image creep” so only the area requested is imaged. Technical developments in the past have focused on helical technology, increased speed of gantry rotation, increasing number of detector rows, and increasing tube outputs to maintain adequate signal-to-noise ratios. In younger patients, consider follow-up with modalities that use lower or no radiation dose (ultrasound or MRI). PubMed PMID: 25892227. i. An example is a three-phase liver where a non-contrast, arterial phase then portal venous phase series is performed through the same body part during one exam. Computed tomography (CT) scanners have become markedly more complex over the past three decades, with a myriad of new options for performing CT examinations. Asymmetric positioning can result in decreased image quality and an increase in patient dose. Ultrasound Protocols ; International Activities/ Resources. Derivation and approval of all components of the protocols should be completed by a team consisting at least of a radiologist, a medical physicist, and a technologist. The Mission of Image Gently is Radiation Safety in Pediatric Imaging to improve safe and effective imaging care of children worldwide like: pediatric X ray imaging, x ray pediatrics, CT scan x ray, radiation from dental x rays. Image Wisely is a joint initiative of the American College of Radiology, Radiological Society of North America, American Society of Radiological Technologists and American Association of Physicists in Medicine. Compare CT exposures to currently developing Diagnostic Reference Levels (DRLs) to compare your protocols to regional and national values. Protocols, or scan instructions, are the core of every CT examination. Check your spam folder if you don't receive the email. Image Wisely and Choosing Wisely: Importance of Adult Body CT Protocol Design for Patient Safety, Exam Quality, and Diagnostic Efficacy. The mean number of CT and MRI protocols per imaging workgroup decreased by 31.1% after optimization efforts (from 37.0 to 25.5) and the median number decreased 29.0% (from 31 to 22). Methods . Epub 2015 Apr 16. Review. Professor Health Sciences Dept. » http://www.ctisus.com/protocols  The protocol team should assure that protocols are appropriate for the clinical indication and that the scan parameters, including radiation dose, are tailored to the specific imaging task. OUTLINE • Dose and image quality requirements • Protocol examples from vendors • Axial vs. Helical and other scanning considerations • Is 120 kVp the optimal tube potential? Many radiologists, however, disagree on what constitutes a diagnostic image, with some preferring greater image clarity (and higher dose) than others. Representatives from other areas, such as nursing, should also be consulted as necessary. The following references discuss dose-reducing techniques, including the principles and considerations for optimizing dose using automatic exposure technologies in CT: The following references discuss the potential advantages and disadvantages of using in-plane patient shielding in CT, which has been suggested as a means to reduce radiation dose: Image Wisely encourages practitioners to optimize the amount of radiation used in Download PDF. Use automatic exposure control techniques of tube current modulation (available from all manufacturers) to reduce dose. Therefore, we could not assess the justification of follow-up CT exams in patients with COVID-19 pneumonia. Other strategies to reduce dose occur at the ordering stage when referring doctors and patients are made aware of duplicate exams and referring doctors are educated about alternative exams with lower dose or no radiation. Johnson PT, Mahesh M, Fishman EK. 3. Work with your physicist, radiologist and department manager to review your adult CT protocols; then use the simple CT protocols on this Web site to “down-size” the protocols for kids. Additional protocols that encouraged dose reduction techniques, such … For example, if a chest CT is ordered, a full abdomen should not be performed. Some examples include: » https://www.radiology.wisc.edu/sections/msk/protocols.php  » http://www.aapm.org/pubs/CTProtocols/, Image Wisely encourages practitioners to optimize the amount of radiation used in A third area with potential to reduce radiation dose involves specific CT protocol development to maximize diagnostic yield while tailoring dose to the appropriate indication and patient size. 2015 Nov;12(11):1185-90. doi: 10.1016/j.jacr.2015.02.021. Protocols, or scan instructions, are the core of every CT examination. Siegle C.L., Kofler J.M., Torkelson J., et al.. Home-grown and commercial software solutions have been developed to track radiation exposure by machine, CT protocol, geographic location, and patient, which is important to document processes and have data to promote quality improvement. including CT dose descriptors; radiation doses from CT proce-dures; and factors and technologies that affect radiation dose and image quality, including their use in creating dose-saving protocols. Yes, I want to Image Wisely. Network radiology exam databases and software to load outside examinations into regional PACs have been developed to prevent unnecessary duplication of CT exams. Be aware that publicizing your commitment to the issue may raise questions in the minds of the parents of your pediatric patients. Due to logistic and data privacy issues, we did not obtain CT image datasets or assess image quality with different CT protocols used at the participating sites. Smith-Bindman R, Moghadassi M, Wilson N, et al. Make sure the exam is truly clinically indicated. All of these attempts to reduce dose adhere to the “As Low As Reasonably Achievable” (ALARA) principle. Image Wisely encourages practitioners to optimize the amount of radiation used in Michael F. McNitt-Gray, PhD, David Geffen School of Medicine, UCLA, Los Angeles, CA Suspicious features on CT, MRI or US include signs of local invasion, and the presence of abnormal lymph nodes (enlarged nodes, nodes with cystic change, calcification, or increased enhancement). Continue reading U.S. Center the patient carefully in the CT gantry. • Modality-specific (CT, nuclear medicine, and fluoroscopy) information including links to vendor microsites for model-specific imaging protocols. In 2008, Image Gently posted a set of simple protocols to “child-size” radiation dose for children. Image Wisely is a joint initiative of the American College of Radiology, Radiological Society of North America, American Society of Radiological Technologists and American Association of Physicists in Medicine. Rego S.L., Yu L., Bruesewitz M.R., et al.. Bruesewitz M.R., Yu L., Vrieze T.J., et al., Coursey C., Frush D.P., Yoshizumi T., et al., “Pediatric Chest MDCT Using Tube Current Modulation: Effect on Radiation Dose With Breast Shielding,”, Geleijns J., Salvadó Artells M., Veldkamp W.J., et al., “Quantitative Assessment of Selected In-Plane Shielding of Tissues in Computed Tomography Through Evaluation of Absorbed Dose and Image Quality,”, Geleijns J., Wang J., McCollough C., “The Use of Breast Shielding for Dose Reduction in Pediatric CT: Arguments Against the Proposition,”. Image Gently - CT Scan Radiation, CT Scan Radiation Risk, CT Scan X Ray, There's no question: CT helps us save kids' lives. Standardization of protocols across sites. Educational Materials. The efficacy of an Image Gently ® /Image Wisely ® radiology departmental campaign consisting of the optimization of CT protocols to reduce dose while maintaining quality, and an educational effort to alter the ordering patterns of referring physicians at a multihospital academic center, was evaluated. We invite you to use the logo wisely as an indication you are increasing awareness of CT and radiation in children in your practice and local medical community and that your practice or institution has taken steps to “child-size” your pediatric protocols. • Direct links to RSNA scientific posters addressing radiation exposure that have been vetted by the Image Wisely executive committee. Standard Imaging Protocols This document includes typical imaging protocols for diagnostic imaging. Center the patient carefully in the CT gantry. But when we image, radiation matters! Given the rapid evolution of CT technology in the past decade, the number of applications for CT has expanded greatly and the techniques for performing the optimal exam have also increased. An example is a renal split bolus where injection of contrast is performed first, then after, a set delay, a second bolus of contrast is administered and imaging is performed once. Have a technologist meet with the patient before the exam to confirm that symptoms match the indications for the CT exam. Make sure the exam has not been performed recently at another location — ask the patient. Changes to protocols are implemented only with consensus of the core team, with consideration of all aspects of the CT examination, including image quality, radiation dose, patient care and safety, and workflow. More is not better; adult-size KV and mAs are not always necessary for small bodies. Have a medical physicist run regular periodic quality improvement (QI) sessions on CT exams to make sure dose is within prescribed ranges. CT vendors have developed multiple technical options to reduce the dose from CT exams. Nuclear Medicine Radiation Dose Tool; Pediatric Injected Activity Tool; About Quality & Practice; Dosimetry; Advertisement. Consider the use of “split bolus” techniques with a power injector to gain different physiologic information (as in multiphase exams) with one radiation exposure. Confirm that CT techniques for adult head, abdomen-pelvis, chest, and pediatric head and pediatric abdomen exams are at or below the reference levels suggested by the ACR (currently 75, 25, 21, 40, and 20 mGy respectively). Image Wisely and Choosing Wisely: Importance of Adult Body CT Protocol Design for Patient Safety, Exam Quality, and Diagnostic Efficacy. vRad teleradiologists expect to see imaging resulting from the use of these or substantially similar protocols in situations where there is no contraindication or facility requirement that requires a different protocol. Updated September 2016 | Download PDF. Protocols, or scan instructions, are the core of every CT examination. Articles ; CT Protocol Design Developing CT protocols to maximize diagnostic yield while minimizing dose. All aspects of the exam should be included in the protocol, including patient positioning, nursing instructions, scan parameters, reconstruction/reformatting instructions, and any other information necessary for the imaging team to complete the CT study successfully. Tailoring CT Protocols to the Patient's Age, Size, and Clinical Scenario Image Gently is… An Education, Awareness, and Advocacy Campaign The mission of the Image Gently Alliance is, through advocacy, to improve safe and effective imaging care of children worldwide. However, achieving these goals may also result in increased radiation exposure for our patients. Patel MD, Ascher SM, Paspulati RM, et al. Johnson PT, Mahesh M, Fishman EK. Image Safely Resources; Protocols; Parents; CT in Minor Head Injuries; Cardiac Imaging; MRI. We lacked data on clinical features and disease severity, particularly from sites with multiple follow-up CT examinations. Outpatients presenting with chronic back/leg pain without red flags should begin with an L3-S1 CT Lumbar Spine Protocol unless otherwise stated. 2. Some general information and philosophies on protocol design and optimization can be found at the following sites: http://mayoresearch.mayo.edu/mayo/research/ctcic/upload/ct-protocol-managment.pdf. The ACR and American Society of Neuroradiology Statement on CT Protocols and Radiation Dose. Minimize “image creep” so only the area requested is imaged. AB - To reduce the radiation dose associated with CT scans, much attention is focused on CT protocol review and improvement. These include but are not limited to: X-ray beam filtration, X-ray beam collimation, tube current modulation, peak kilovoltage optimization, improved detector efficiency, and noise-reduction reconstruction algorithms. Image Wisely is a joint initiative of the American College of Radiology, Radiological Society of North America, American Society of Radiological Technologists and American Association of Physicists in Medicine. Image Gently; Image Wisely; Scope of Practice; Webinars; Journals Articles; Dose Optimization. In addition, the campaign stressed a broad and aggressive initiative to inform, educate, and disseminate the concepts of Image Gently and Image Wisely to referring physicians, house staff members, and medical students. Judicious Use of Multiphase Abdominal CT Protocols. The protocols represent a sampling of currently available scanner models and are not intended to provide comprehensive information for all available scanner models. Be involved with your patients. 2015 Nov;12(11):1185-90. doi: 10.1016/j.jacr.2015.02.021. AAPM - CT Scan Protocols, CT Dose Check and Education Slides; FDA - Computed Tomography; NEMA XR-29 Updated 6/26/18; Pediatric Radiation Safety. Communicating Risks and Benefits of Patient Shielding in Radiology. Image Wisely home page.
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