Observations of an ACR CT Accreditation Program Reviewer

Abstract

As a reviewer for the ACR CT accreditation program for about 4 years, I have had the opportunity to observe a broad spectrum of work from across the country that I would otherwise have not been privy to in my private radiology practice. Unfortunately, communication with the submitting group is only available through the ACR evaluation. Because there is no mechanism to discuss my overall mpressions with the radiology ommunity at large, I have taken his opportunity to discuss my bservations of submitted mateial with the goal of improving mage quality, decreasing radiaion exposure, and passing ACR ccreditation. Most of the submissions to the CR CT accreditation program hat I review take advantage of the ewer features available on curent-generation scanners (under arious names depending on the anufacturer), such as dose modlation, contrast bolus detection, nd acquisition of multiple thinection images with multiplanar eformatting. Regrettably, basic eatures of the scanners are undeused. A recurrent example is the imited use of different recontruction algorithms. Most curent and recent generation scaners offer different reconstruction lgorithms (or filters) to maxiize soft tissue or bony detail or ptimize for lung imaging. Scaners can reconstruct the same imge data set with multiple algoithms, often automatically. Yet, ead CT scans are filmed with soft tissue and bone windows from the same soft tissue reconstruction. Chest CT scans are filmed at soft tissue and lung windows from the same soft tissue reconstruction without the benefit of a separate lung reconstruction. Field of view is initially set at the time of scanning but can be adjusted after image acquisition to optimally display anatomy, yet sinus CT scans are submitted with large fields of view, minimizing the anatomy of interest. Temporal bone CT scans can be reconstructed bilaterally with a field of view as small as 9 to 10 cm (using a bone algorithm) to maximize the display of small anatomic structures. Submitted cases often do not take advantage of this capability. As mentioned above, many of the body CT cases use some type of dose modulation technique to minimize radiation exposure to the patient. Other simpler methods to reduce radiation exposure are overlooked, such as protocols with multiple series. Many scans submitted have 3 or even 4 acquisitions, such as routine abdomen CT protocols consisting of noncontrast, arterial, venous, and delayed acquisitions. Eliminating one or more acquisitions would decrease radiation dose by 25% to 75%. One or two acquisitions, depending on the indication, are usually sufficient. Many scans acquire images beyond the area of interest, such as axial sinus CT obtaining images above the frontal sinuses or head CT scans with images acquired below the