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Tracking and Resolving CT Dose Metric Outliers Using Root-Cause Analysis.

Yingming Amy Chen¹, Kate MacGregor², Iris Li³

¹Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Journal of the American College of Radiology : JACR

|March 9, 2016

Summary

This study analyzed computed tomography (CT) dose outliers using root-cause analysis (RCA). Patient motion and protocol errors were key reasons for high radiation dose outliers, while low-dose protocols caused low outliers.

Keywords:

Automated dose tracking causal analysis computed tomography outliers radiation dose

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Area of Science:

Medical Imaging
Radiology
Radiation Safety

Background:

Computed tomography (CT) examinations are widely used in medical diagnostics.
Monitoring radiation dose metrics is crucial for patient safety and optimizing imaging protocols.
Identifying and analyzing dose outliers helps in understanding variations in radiation exposure.

Purpose of the Study:

To investigate the frequency and types of outlier radiation dose metrics in common CT examinations.
To perform a root-cause analysis (RCA) on identified dose outliers.
To establish a basis for corrective actions in CT radiation dose management.

Main Methods:

A retrospective observational study analyzing 34,615 CT examinations (noncontrast CT head, CT pulmonary angiography, renal colic) from January 2010 to December 2013.
Dose outliers were identified using volumetric CT dose index and dose-length product, flagging values outside the 1st and 99th percentiles.
Root-cause analysis was conducted on flagged outlier examinations.

Main Results:

Outliers were identified in noncontrast CT head (397), CT pulmonary angiography (52), and renal colic (80) examinations.
High-dose outliers were primarily caused by repeat scans due to patient motion (31%) and mislabeled protocols (18%).
Low-dose outliers were mainly due to low-dose protocols (29%) and aborted examinations (2%).

Conclusions:

Systematic root-cause analysis of CT dose outliers effectively identifies sources of variation and dose excess.
The findings pinpoint specific protocol and technical shortcomings that require corrective action.
Implementing systematic RCA is essential for improving radiation dose management in CT imaging.