CT DOSE Collaboratory

描述(申请人提供)：计算机断层扫描(CT)经常用于医学扫描，可以向患者提供高剂量的辐射。然而，由于CT检查的标准很少，患者在CT检查过程中受到的辐射剂量差别很大。通常情况下，剂量高于医学诊断所需的剂量--而且高到足以增加癌症风险。拟议的项目是一个多地点合作，研究改进的CT标准，包括使用的辐射剂量，并制定战略，在不同的诊所和医院应用(实施)和传播(传播)这些标准。该项目将使用多种方法，包括随机对照试验、观察数据和关键线人访谈。这项工作致力于通过降低患者接受的剂量来提高CT的安全性和与CT辐射相关的癌症。该项目包括一项实施试验，以学习如何广泛地向诊所和医院传授最佳和最安全的CT实践。变化的过程将随着不同的医疗保健环境和不同的组织结构而有所不同。这项研究试图通过了解哪些因素改善最佳实践指南的实施和传播，来了解适应CT安全干预的最佳战略。我们的项目是与美国、加拿大和欧洲的不同医疗保健提供组织合作，并与拜耳健康合作。这些公共、私人、学术和基于社区的护理系统既包括按服务收费的护理组织，也包括预付费护理组织，将作为我们的试验场。非美国机构被包括在内，因为在这些国家，医学成像周围的辐射安全是一个非常令人关注的问题，而且他们的医院和研究人员在CT辐射剂量监测和优化方面有经验。我们的研究团队包括在生物统计学、放射学、辐射物理学以及传播和实施科学方面拥有专业知识的科学家，以及专注于质量改进并在优化医学成像剂量方面处于领先地位的卫生系统领导者。所有参与的医疗保健系统都已经使用了用于辐射剂量监测的拜耳健康软件Exposure。购买曝光量显示了卫生保健组织对收集临床实践中使用的辐射剂量的数据并使用数据优化医学成像剂量的兴趣和承诺。因此，这些网站是该项目的理想合作伙伴。每个项目都有项目冠军，但没有优化CT辐射剂量的专业知识或战略。围绕已经可以从一系列软件平台安全地收集数据的现有关系组织项目，将数据收集的复杂性降至最低，从而克服了开发可广泛实施的质量改进计划的主要障碍。这将使我们的研究团队将重点放在传播和实施变革的拟议研究目标上。我们将1)进行一项采用阶梯式楔形设计的随机对照实用型试验，以比较作为CT辐射剂量设施级优化策略的简单审计和反馈与量身定制的多组分干预策略；2)评估实施程度，并确定实施剂量优化并在干预后2年内持续改进CT辐射剂量的促进者、障碍和成功与失败的策略；3)广泛传播和评估干预在几个机构的传播情况，重点关注来自务实试验的最有效的解决方案。

DESCRIPTION (provided by applicant): Computed tomography (CT) is frequently used for medical scanning and can deliver high doses of radiation to patients. Yet because few standards exist for CT examinations, the radiation doses that patients receive during CT vary widely. Routinely, doses are higher than needed for medical diagnoses-and high enough to be associated with increased cancer risk. The proposed project is a multisite collaboration studying improved standards for conducting CT, including the radiation doses used, and developing strategies to apply (implement) and spread (disseminate) these standards in different clinics and hospitals. The project will use a mixture of methods including a randomized controlled trial, observational data, and key informant interviews. The work strives to improve CT safety and cancers associated with radiation from CT by lowering the doses that patients receive. The project includes an implementation trial to learn how to broadly teach clinics and hospitals about the best and safest CT practices. The process of change will vary with different health care settings and different organizational structures. This study seeks to understand the best strategies to adapt CT safety interventions by learning what factors improve both implementation and dissemination of the best practice guidelines. Our project is a partnership with diverse healthcare delivery organizations in the US, Canada, and Europe in collaboration with Bayer Health. These public, private, academic, and community-based care systems include both fee-for-service and prepaid care organizations and will serve as our test bed sites. Non-US institutions are included since radiation safety around medical imaging is a great concern in these countries, and their hospitals and researchers have experience in CT radiation dose monitoring and optimizing. Our research team includes scientists with expertise in biostatistics, radiology, radiation physics, and dissemination and implementation sciences, and health system leaders who focus on quality improvement and are champions for optimizing medical imaging doses. All participating health care systems already use eXposure, the Bayer Health software for radiation dose monitoring. The purchase of eXposure shows the interest and commitment of the health care organizations to collecting data on the radiation doses used in clinical practice and using data to optimize medical imaging doses. The sites are thus ideal partners for this project. Each has project champions, but not the expertise or strategy to optimize CT radiation dosages. Organizing the project around existing relationships that can already collect data securely from a range of software platforms minimizes data collection complexity, overcoming a main hurdle in developing a widely implementable quality improvement program. This will allow our research team to focus on the proposed study aims of disseminating and implementing change. We will 1) conduct a randomized controlled pragmatic trial with a stepped-wedge design to compare simple audit with feedback vs. a tailored, multicomponent intervention as strategies for facility-level optimization of CT radiation dose, 2) assess the degree of implementation and identify facilitators, barriers and successful and failed strategies for implementing dose optimization and sustaining improvements in CT radiation dosing over 2 years following intervention, and 3) broadly disseminate and evaluate dissemination of the intervention at several institutions, focusing on the most effective solutions from the pragmatic trial.