Is there an effective intervention to reduce radiation doses in patients undergoing computed tomography (CT) to enhance patient safety?
In this randomized clinical trial of 864 080 adults undergoing CT at 100 facilities, audit feedback with tailored suggestions, educational seminars, and sharing of best practices was more effective for reducing the organ doses associated with CT compared with audit feedback alone, and radiologists’ satisfaction with CT image quality was unchanged.
Medical imaging facilities can use detailed feedback on CT doses combined with specific suggestions and an educational quality improvement program to reduce radiation doses without compromising the quality of images.
Computed tomography (CT) radiation doses vary across institutions and are often higher than needed.
To assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT.
Design, Setting, and Participants
This randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017. Data analysis was performed from October 4, 2017, to December 14, 2018.
Imaging facilities received audit feedback alone comparing radiation-dose metrics with those of other facilities followed by the multicomponent intervention, including audit feedback with targeted suggestions, a 7-week quality improvement collaborative, and best-practice sharing. Facilities were randomly allocated to the time crossing from usual care to the intervention.
Main Outcomes and Measures
Primary outcomes were the proportion of high-dose CT scans and mean effective dose at the facility level. Secondary outcomes were organ doses. Outcomes after interventions were compared with those before interventions using hierarchical generalized linear models adjusting for temporal trends and patient characteristics.
Across 100 facilities, 864 080 adults underwent 1 156 657 CT scans. The multicomponent intervention significantly reduced proportions of high-dose CT scans, measured using effective dose. Absolute changes in proportions of high-dose scans were 1.1% to 7.9%, with percentage reductions in the proportion of high-dose scans of 4% to 30% (abdomen: odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001; chest: OR, 0.92; 95% CI, 0.86-0.99; P = .03; combined abdomen and chest: OR, 0.49; 95% CI, 0.41-0.59; P < .001; and head: OR, 0.71; 95% CI, 0.66-0.76; P < .001). Reductions in the proportions of high-dose scans were greater when measured using organ doses. The absolute reduction in the proportion of high-dose scans was 6.0% to 17.2%, reflecting 23% to 58% reductions in the proportions of high-dose scans across anatomical areas. Mean effective doses were significantly reduced after multicomponent intervention for abdomen (6% reduction, P < .001), chest (4%, P < .001), and chest and abdomen (14%, P < .001) CT scans. Larger reductions in mean organ doses were 8% to 43% across anatomical areas. Audit feedback alone reduced the proportions of high-dose scans and mean dose, but reductions in observed dose were smaller. Radiologist’s satisfaction with CT image quality was unchanged and high during all periods.
Conclusions and Relevance
For imaging facilities, detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, particularly organ doses. Effects of audit feedback alone were modest.
ClinicalTrials.gov Identifier: NCT03000751
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Smith-Bindman R, Chu P, Wang Y, et al. Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial. JAMA Intern Med. 2020;180(5):666–675. doi:10.1001/jamainternmed.2020.0064
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