Minimizing Unnecessary Irradiation from Renal Colic CT Scans in the United States

在美国最大限度地减少肾绞痛 CT 扫描的不必要辐射

• 批准号: 9042947
• 负责人: Christopher L Moore
• 金额: $ 24.31万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9042947
• 关键词: Minimizing; Unnecessary; Irradiation; Renal; Colic

 DESCRIPTION (provided by applicant): There are over 2 million emergency department visits annually in the U.S. for back or flank pain concerning for kidney stone, and more than 70% of patients diagnosed with urolithiasis receive a CT scan. While CT is an excellent diagnostic test for kidney stone, it delivers ionizing radiation that may cause cancer at a later time and has not been shown to improve patient-centered care. It is estimated that as many as 3-5% of future malignancies may occur due to radiation from medical imaging procedures, with risk of malignancy being linearly related to CT dose. Prior work by our group suggests that radiation dosing for renal colic CT in the U.S. is higher than it needs to be, extremely variable, and does not incorporate reduced dose techniques that are known to be effective. We propose an innovative multi-faceted approach that leverages our prior work and existing infrastructure to disseminate and demonstrate best practices for appropriately reducing dose in renal colic CT. Our specific aims are: 1) to nationally disseminate best practices in radiation dose optimization for renal colic CT and 2) Determine if best practice is being implemented by comparing radiation dose indices for renal colic CTs in institutions participating in our educational outreach compared with non- participating institutions. We will first work with stakeholders (primarily the American College of Radiology and the American College of Emergency Physicians) to reach a consensus on CT dose benchmarking based on data from the Dose Imaging Registry (DIR, an established national registry with more than 500 participating facilities). In parallel, we will develop a Multimedia Educational module to enable best practices in Protocol and Radiation Optimization for CT (ME-PROC, currently funded by the Radiologic Society of North America and to be expanded and targeted specifically to renal colic CT in this proposal). We will reach out to institutions via the DIR and engage them to participate in our educational and consultative program to appropriately reduce dose. Finally, we will work towards incentivizing best dose practices by developing a performance measure for which we will seek National Quality Forum (NQF) endorsement, as well as integrating this into the existing Practice Quality Improvement (PQI) initiative. Our approach will be iterative over the course of the project in attempting to reach facilities, refine our educational initiative, to achieve optimal doses while maintaining quality of care. We anticipate engaging more than 100 facilities and showing a significant change towards more appropriate dosing in renal colic. Ultimately, this could prevent thousands of future malignancies, improving population health while maintaining the quality of acute care for this condition.

 描述（由申请人提供）：在美国，每年有超过 200 万人因肾结石引起的背部或胁腹疼痛而到急诊室就诊，超过 70% 的诊断为尿石症的患者接受了 CT 扫描。虽然 CT 是一种出色的肾结石诊断测试，但它所产生的电离辐射可能会在以后导致癌症，并且尚未被证明可以改善以患者为中心的护理。据估计，未来多达 3-5% 的恶性肿瘤可能是由于医学成像程序的辐射而发生的，而恶性肿瘤的风险与 CT 剂量呈线性相关。我们小组之前的工作表明，美国肾绞痛 CT 的辐射剂量高于所需剂量，变化很大，并且没有采用已知有效的减少剂量技术。我们提出了一种创新的多方面方法，利用我们之前的工作和现有基础设施来传播和展示适当减少肾绞痛 CT 剂量的最佳实践。我们的具体目标是：1) 在全国传播肾绞痛 CT 辐射剂量优化的最佳实践，2) 通过比较参与我们教育推广的机构与未参与机构的肾绞痛 CT 辐射剂量指数，确定是否正在实施最佳实践。我们将首先与利益相关者（主要是美国放射学会和美国急诊医师学会）合作，根据剂量成像登记处（DIR，一个拥有 500 多家参与机构的既定国家登记处）的数据，就 CT 剂量基准达成共识。与此同时，我们将开发一个多媒体教育模块，以实现 CT 协议和辐射优化的最佳实践（ME-PROC，目前由北美放射学会资助，并在本提案中专门针对肾绞痛 CT 进行扩展和针对）。我们将通过 DIR 联系各机构，让他们参与我们的教育和咨询计划，以适当减少剂量。最后，我们将通过制定绩效衡量标准来努力激励最佳剂量实践，我们将寻求国家质量论坛（NQF）的认可，并将其整合到现有的实践质量改进（PQI）计划中。我们的方法将在项目过程中迭代，试图到达设施，完善我们的教育计划，以在保持护理质量的同时实现最佳剂量。我们预计将有超过 100 家机构参与其中，并显示出针对肾绞痛更合适剂量的重大改变。最终，这可以预防未来数以千计的恶性肿瘤，改善人口健康，同时保持这种疾病的急性护理质量。