Contrast ureteropyelography in theatre: standardised flowchart reporting

Ma Harris,T Marsh,A West,A Llewellyn,G Naisby,Bdr Gowda

doi:10.1308/003588412x13171221500385

Abstract

INTRODUCTIONUrologists 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 communication system (PACS) for subsequent multidisciplinary review.METHODSThree 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 product is a flowchart and reporting template for use by urologists in the operating theatre.RESULTSPhase 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%).CONCLUSIONSIntroduction 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.

Highlights

Urologists perform retrograde contrast studies of the ureters and pelvicalyceal systems in the operating theatre, both for diagnostic purposes and to guide instrumentation
The images stored on picture archiving and communication system (PACS) were assessed by a third party observer (AL), who recorded: the number of stored images; control images taken over pelvis, sacroiliac joints, upper ureters and kidneys; the presence of contrast in pelvic ureters, over sacroiliac joints, mid-ureters and kidneys; the degree of collecting system filling; post-procedure images; the presence of bubbles; and the duration of screening
Contrast image recording improved significantly, with the treatment category achieving the audit standard (80%) and the diagnostic category improving to 65%

Summary

Introduction

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 communication system (PACS) for subsequent multidisciplinary review. An independent reviewer rated image quality and screening times. The results demonstrate significant improvements in the number of good quality studies and in the recording of control, contrast and post-procedure images. 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

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