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

 描述（由申请人提供）：在美国，每年有超过200万人次因与肾结石有关的背部或腰部疼痛而到急诊科就诊，超过70%的诊断为尿石症的患者接受CT扫描。虽然CT是肾结石的一种很好的诊断测试，但它提供的电离辐射可能在以后的时间内导致癌症，并且尚未显示出改善以患者为中心的护理。据估计，多达3-5%的未来恶性肿瘤可能由于医学成像程序的辐射而发生，恶性肿瘤的风险与CT剂量线性相关。我们小组之前的工作表明，在美国，肾绞痛CT的辐射剂量高于需要的剂量，变化极大，并且没有采用已知有效的减少剂量技术。我们提出了一个创新的多方面的方法，利用我们以前的工作和现有的基础设施，传播和展示适当降低剂量的肾绞痛CT的最佳实践。我们的具体目标是：1）在全国范围内传播肾绞痛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中肾绞痛CT的辐射剂量指数，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（Dose Imaging Registry，一个拥有500多家参与机构的已建立的国家登记处）的数据，就CT剂量基准达成共识。同时，我们将开发一个多媒体教育模块，以实现CT方案和辐射优化的最佳实践（ME-PROC，目前由北美放射学会资助，并将在本提案中专门针对肾绞痛CT进行扩展）。我们将通过辐射防护中心与各机构联系，让他们参与我们的教育和咨询计划，以适当减少剂量。最后，我们将努力通过制定一项绩效指标来激励最佳剂量实践，我们将寻求国家质量论坛（NQF）的认可，并将其纳入现有的实践质量改进（PQI）计划。我们的方法将在项目过程中反复进行，以尝试接触设施，完善我们的教育计划，在保持护理质量的同时实现最佳剂量。我们预计将有100多家机构参与，并将在肾绞痛中显示出更合适的剂量的显着变化。最终，这可以预防数千种未来的恶性肿瘤，改善人口健康，同时保持这种疾病的急性护理质量。

 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.