Radiology Stewardship and Quality Improvement: The Process and Costs of Implementing a CT Radiation Dose Optimization Committee in a Medium-Sized Community Hospital System

Abstract

The aims of this study were to measure the effectiveness of a multidisciplinary CT dose optimization committee and estimate its costs and to describe a radiation stewardship quality improvement initiative in one CT department at a medium-sized community hospital system that used a participatory design committee methodology. A CT dose optimization committee was conceived, funded, and formed, consisting of the following stakeholders: radiologists, technologists, consultant medical physicists, and an administrator. Volume CT dose index (CTDIvol) and repeat rate were monitored for 1 month, for one scan type, during which iterative protocol adjustments were made through committee interaction. Effects on repeat rate and CTDIvol were quantified and benchmarked against national diagnostic reference levels after retrospective medical record review of 100 consecutive patients before and after the intervention. Labor hours were reported and wage resources estimated. Over 3 months, the committee met in person twice and exchanged 128 e-mails in establishing a process for protocol improvement and measurement of success. Repeat rate was reduced from 13% (13 of 100) to 0% (0 of 100). Scans meeting the ACR reference level for CTDIvol (75 mGy) improved by 34% (38 of 100 before, 51 of 100 after; Fisher's exact 2-tailed P = .09), and those meeting ACR pass/fail criterion (80 mGy) improved by 29% (58 of 100 before, 75 of 100 after; Fisher's exact 2-tailed P = .01). Committee evolution and work, and protocol development and implementation, required 57 person-hours, at an estimated labor cost of $12,488. An efficient process was established as a proof of concept for the use of a multidisciplinary committee to reduce patient radiation dose, repeat rate, and variability in image quality. The committee and process ultimately improved the quality of patient care, fostered a culture of safety and ongoing quality improvement, and calculated costs for such an endeavor.