Implementation of an aortic dissection CT protocol with clinical decision support aimed at decreasing radiation exposure by reducing routine abdominopelvic imaging
| Autor: | David Esses, Jeffrey M. Levsky, Alana Fruauff, Evan C. Lipsitz, Vishal K. Patel, Linda B. Haramati |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Computed Tomography Angiography Population Contrast Media Dissection (medical) Radiation Dosage Aortography 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Radiology Nuclear Medicine and imaging education Thioguanine Pelvis CT protocol Aged Retrospective Studies Aortic dissection Acute aortic syndrome education.field_of_study business.industry Cytarabine Middle Aged Radiation Exposure medicine.disease Decision Support Systems Clinical Radiation exposure Aortic Dissection medicine.anatomical_structure 030220 oncology & carcinogenesis Abdomen Female Radiology business Tomography X-Ray Computed |
| Zdroj: | Clinical imaging. 67 |
| ISSN: | 1873-4499 |
| Popis: | Patients suspected of having an acute aortic syndrome in the ED typically undergo CT of the chest/abdomen/pelvis. However, the overwhelming majority of these exams are negative. With the help of clinical decision support, we implemented a new radiologist monitored ‘aortic dissection screening protocol’ that forgoes routine abdominopelvic imaging in order to reduce radiation dose without compromising diagnostic accuracy. The purpose of the present study is to assess the performance of this protocol. A retrospective analysis was performed to study the effect of the dissection screening protocol on the diagnostic yield, radiation and contrast dose on a total of 835 ED patients who underwent CT scans for suspected aortic dissection over a 48-week study period immediately before and after implementation of the protocol. 3.4% (28/835) of examinations were positive for an acute aortic syndrome over the 48-week study period with no difference in positivity before and after implementation of the ‘aortic dissection screening’ protocol, 3.0% vs. 3.7%, respectively (p = 0.57). There was a 14.6% reduction in median radiation dose and a 16% decrease in contrast volume utilization for the total ED population who underwent CT for aortic dissection using any protocol in the period after implementation of the ‘aortic dissection screening’ protocol. Aortic dissection CT in the ED is negative in the overwhelming majority of cases. A monitored ‘aortic dissection screening’ protocol that initially images the chest only significantly reduced contrast and radiation dose without reducing diagnostic accuracy for ED patients who underwent CT for aortic dissection. |
| Databáze: | OpenAIRE |
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