Suboptimal CT Scan Studies of the Chest, Abdomen and Pelvis. What Went Wrong? A Tertiary Hospital Experience.

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1 Suboptimal CT Scan Studies of the Chest, Abdomen and Pelvis. What Went Wrong? A Tertiary Hospital Experience. Poster No.: C-1911 Congress: ECR 2017 Type: Authors: Keywords: DOI: Scientific Exhibit A. Al-Taie, M. Mafraji, F. Al-Khafaji, S. Al Hilli; Doha/QA Trauma, Quality assurance, Artifacts, Technical aspects, Contrast agent-oral, Contrast agent-intravenous, Image manipulation / Reconstruction, CT-Angiography, CT, Thorax, Pelvis, Abdomen /ecr2017/C-1911 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Aims and objectives Suboptimal studies are a challenging practice in all imaging institutes. In our daily practice, it is not uncommon to confront a suboptimal CT scan study which may affect the radiologist decision, accurate diagnosis and report. Suboptimal CT study/sub-optimality refers to less than high standard/international guidelines image quality (i.e. noisy images or images with artifacts) affecting the diagnostic yield of the CT study, Sub-optimality generally classified into avoidable and adjustable causes. Avoidable: Preventable causes; like pulling the NGT before the start of the scan affecting the yield of the CT scan study. Adjustable: Modifiable causes; modifying scanning parameters, technical factors and patient positioning affecting the yield of the CT scan study. Unavoidable: Causes that cannot be modified or altered to avoid their effect on the study quality like patients with arm fracture and couldn't raise his arm during the CT scan. The aim of the study is to elaborate causes of suboptimal computed tomography scans in Hamad General Hospital, Doha, Qatar (one of the biggest tertiary hospital in the Middle East). Up to our knowledge we are the first in Qatar and Middle East to tackle this issue. Images for this section: Page 2 of 12

3 Fig. 1: Sample cases to illustrate some of the confronted sub-optimal CT scan studies. Clinical imaging, Hamad medical corporation, Hamad General hospital - Doha/QA Page 3 of 12

4 Fig. 2: Sample cases to illustrate some of the confronted sub-optimal CT scan studies. Clinical imaging, Hamad medical corporation, Hamad General hospital - Doha/QA Page 4 of 12

5 Methods and materials Data collection: Retrospective review and analysis had been conducted on the documented suboptimal CT scans by radiologists in their final reports at Hamad General Hospital, categorizing them into two main groups; avoidable/adjustable and unavoidable as well as sorting the causes for each study individually into patient related, technique related, protocol and others. Sample size: Total of 397 CT scan studies had been reported suboptimal in Hamad General Hospital in 2 years duration from January 2014 to January Inclusion criteria: All patients from both genders who underwent CT scan examinations for chest, abdomen, pelvis or combination of these studies for all clinical indications referred to our Clinical Imaging Department include inpatient, outpatient and emergency services. Exclusion criteria: Patient younger than 18 years old. CT scan studies for the head, neck and extremities are excluded. Results A total of cases of chest, abdomen and pelvis CT scan studies, each or in combination done during the period of the data analysis from January 2014 to January 2016 out of which reported suboptimal CT scan studies were 397 (0.87 %). Out of the 397 cases of reported suboptimal CT scans, 272 cases were avoidable (69%) while (31%) 125 cases were unavoidable. Radiologist mentioned the causes of sub optimality in 364 (92%) cases and reasons were not mentioned in the report in 33 cases (8%) out of the total 397 cases. 14% (62 out of 397 cases) of the suboptimal cases were reported to be multifactorial in nature. Main reasons of avoidable/adjustable sub optimal CT scans are gathered into 12 groups: Page 5 of 12

6 Oral/Rectal contrast related causes came first with total of 80 cases(22%) followed by motion artifact with 76 cases(21%). Metallic artifact came third with 64 cases(17%), fourth is protocol related causes with 39 cases(11%), fifth is body habitus (obese or very thin patients) with 37 cases(10%). Sixth is oral contrast intolerance by the patient seen in 28 cases(8%), seventh is intravenous contrast related with 24 cases(7%) followed in the eighth place is high creatinine with 10 cases(3%). Last 3 causes were positioning, machines malfunction (CT machine or IV contrast injector related) and finally miscommunication with 3,2 and 1 cases respectively(less than 2 % collectively). Images for this section: Fig. 3: sub-optimal cases from the total and percentage of avoidable versus unavoidable causes. Clinical imaging, Hamad medical corporation, Hamad General hospital - Doha/QA Page 6 of 12

7 Fig. 4: Pie charts demonstrated the multi factorial or single cause of suboptimality and percentage of suboptimality causes reported by the radiologists. Clinical imaging, Hamad medical corporation, Hamad General hospital - Doha/QA Page 7 of 12

8 Fig. 5: Main reasons of suboptimality grouped into main categories. Clinical imaging, Hamad medical corporation, Hamad General hospital - Doha/QA Page 8 of 12

9 Conclusion Identifying the causes of sub optimal CT scan studies and minimizing the avoidable causes will lead to reduction in the number of repeated studies; improve their diagnostic yield and patient care. Oral/Rectal contrast related factors are the commonest mentioned factors to affect study quality this include non-opacification of bowel and minimal amount of contrast intake. Patient related artifacts, which are caused by patient movement or the presence of metallic materials is a common encountered cause of artifact. Body habitus and study protocol are evident causes affecting study quality although they can be easily tackled by applying the proper machine setting for the right patient and the suitable protocol for the clinical indication. Radiologists are recommended to clearly state in the report if study quality is suboptimal and further more specifically mention causes of study sub optimality. Images for this section: Page 9 of 12

10 Fig. 6: A driver diagram to show the main primary change drivers and changes ideas to avoid or reduce causes of CT scan suboptimality. Clinical imaging, Hamad medical corporation, Hamad General hospital - Doha/QA Page 10 of 12

11 Personal information A. Al-Taie: Alaa Abdulsattar Al-Taie, M.B.Ch.B, CABMS-RAD, MSK radiology clinical fellow, Clinical Imaging Department, Hamad General Hospital, P.O box: 3050, Doha/ Qatar. Fatima Al-Khafaji and Mustafa Mafraji: Radiology residents. Clinical Imaging Department, Hamad General Hospital, P.O box: 3050, Doha/Qatar. Shatha Al Hilli: Senior consultant, Head of emergency radiology section, Clinical Imaging Department, Hamad General Hospital, P.O box: 3050, Doha/Qatar. References Artifacts in CT: Recognition and Avoidance; November 2004; Julia F. Barrett, MSc, and Nicholas Keat, MSc. CT in Abdominal. 1 and Pelvic Trauma; John L. Roberts, MD Kenneth Dalen, MD CaroiM. Bosanko, MD S. Zafar H. Jafir, MD ; radiographics Whole-body CT in polytrauma patients: The effect of arm position on abdominal image quality when using a human phantom; Pil-Hyun Jeon, Hee-Joung Kim, Chang- Lae Lee, Dae-Hong Kim, Won-Hyung Lee, Sung-Su Jeon: article/ %2fjkps Patient-size-dependent radiation dose optimisation technique for abdominal CT examinations. Ngaile JE, Msaki P, Kazema R. pubmed/ Organ and effective dose reduction in adult chest CT using abdominal lead shielding. Iball GR 1, Brettle DS. Page 11 of 12

12 Gonadal shield cuts scatter radiation from MDCT By Eric Barnes, AuntMinnie.com-staff-writer; sec=ser&sub=def&pag=dis&itemid= Page 12 of 12