As technologies improve and awareness of radiation dose grows, more and more facilities are implementing new CT protocols that expose patients to lower amounts of radiation. According to a recent report published in the Journal of the American College of Radiology, however, such implementation in an academic setting can often be challenging.
Lead author Robert Gene Parden, MS, department of radiology at Mayo Clinic Arizona in Phoenix, and colleagues explain that the difficulty can be boiled down to three specific sources: technology that changes quickly, a diverse assortment of patients, and a group of physicists, technologists and radiologists who are all “highly educated and opinionated individuals.”
So what’s the secret to getting everyone on board with your new protocols? Unfortunately, there isn't one. But Parden et al. provided a few tips to speed up implementation and make it as smooth as possible.
1. Get organized
At Mayo Clinic Arizona, the first step they took to implement new protocols was forming a new committee. The CT Protocol committee was made up of three CT technologists, three radiologists, and medical physics representatives. They met for one hour each week, the authors noted, but that slowed down to bimonthly meetings once everything was in order.
2. Start simple
Parden and colleagues started off with their “most common and basic protocol,” single-phase CT of the abdomen and pelvis.
“At our institution, we consulted with our radiology colleagues internally as well as at other academic sites with the same scanners, sharing ideas and protocols,” the authors wrote. “In addition, we referenced articles describing application of dose-saving features, such as kilovolt and milliampere modulation schemes.”
3. Evaluate changes one at a time
Small pilots were carried out and evaluated for each parameter change along the way, and the team would compare unlabeled images to avoid bias. They also looked to reduce bias by putting a rule in place that helped keep everyone honest. “If someone (in or outside the committee) did not like the new protocol but others were in favor, the person objecting to the new protocol was responsible for evaluating another sample of 20 cases to present to the group to prove his or her conclusion,” the authors wrote. “This was important to eliminate decisions based on a single outlier case or inherent bias. The human element affected by incorporating new software applications must be taken into account and can be challenging.”
4. Give technologists and radiologists the power to act
When the new CT protocols were implemented at their own institution, the authors explained, algorithms were added that warn technologists when they are about to exceed the new limits that have been put in place. The technologist can then evaluate what caused the situation—sometimes, the algorithm is thrown off by a large patient size, for instance—and decide what to do next.
It also helps for radiologists to have an easy method for reporting examinations where protocols weren’t followed. This helps hold technologists accountable and keeps the CT Protocol committee aware of what is going on within the group.