Having so many protocols might suggest a negative impact on workflow, but that’s not the case. Workflow actually improves. The first major advantage is that each protocol is tailored to a particular clinical indication. These are often straightforward (such as a known cancer follow-up) and we only employ a single scan sequence. This eliminates those multiple sequence studies that are not needed for diagnosis. Fewer sequences performed means a lower dose to the patient, and a shorter study length. At many centers, the technologist is left to arbitrarily modify the protocol based on patient weight or BMI. The quality of the scan and dose are then highly dependent on their knowledge and expertise. That’s a big responsibility and our protocols take out the guess work. The scanner user-interface presents the operator with the option of various clinical protocols. Once one is selected and a scout image is obtained, the technologist specifies the body-size-specific protocol based on patient measurements and proceeds with the scan. No time is wasted experimenting with the settings, and the scan is accomplished with the optimal dose for that patient and that clinical indication. Additionally, with timely advanced radiologist protocoling (motivated by insurance pre-approval process), the technologists know exactly how long the patient preparation and the CT scan will take. This benefits patient scheduling and streamlines workflow. The ultimate goal is to provide a scan that allows a confident diagnosis with an appropriately low dose. The focus in CT has shifted. Just a few years ago, it was on increasing the number of slices and getting better resolution. Now it’s time to pull back from the over pursuit of detail. We want to make the diagnosis accurately and quickly, and do it at an appropriate dose.
Experts in CT Protocols Workflow
Szczykutowicz TP, Brunnquell CL, Avey GD, Bartels C, Belden DS, Bruce RB, Field AS, Peppler WW, Wasmund P, Wendt G A General Framework for Monitoring Image Acquisition Workflow in the Radiology Environment: Timeliness for Acute Stroke CT Imaging. the Journal of Digital Imaging (JDI) DOI: 10.1007/s10278-018-0055-1
Brunnquell CL, Avey GD, Szczykutowicz TP, Objective Evaluation of CT Time Efficiency in Acute Stroke Response. Journal of the American College of Radiology 2018 DOI: 10.1016/j.jacr.2018.01.011
Szczykutowicz TP, Malkus A, Ciano A, Pozniak M. Tracking Patterns of Nonadherence to Prescribed CT Protocol Parameters. Journal of the American College of Radiology 2016 DOI: 10.1016/j.jacr.2016.08.029
Szczykutowicz TP, Siegelman J. On the Same Page—Physicist and Radiologist Perspectives on Protocol Management and Review. Journal of the American College of Radiology 2015 DOI: 10.1016/j.jacr.2015.03.042
- Siegelman, Jenifer RQW, and Dustin A. Gress. “Radiology Stewardship and Quality Improvement: The Process and Costs of Implementing a CT Radiation Dose Optimization Committee in a Medium-Sized Community Hospital System.” J Am Coll Radiol. 2013 Jun;10(6): 416-22.
- Cody, Dianna D., et al. “AAPM Medical Physics Practice Guideline 1.a: CT Protocol Management and Review Practice Guideline.” J Appl Clin Med Phys. 2013 Sep 6;14(5):3-12
- Szczykutowicz, Timothy P., et al. “Compliance with AAPM Practice Guideline 1. a: CT Protocol Management and Review—from the perspective of a university hospital.” Journal of Applied Clinical Medical Physics 16.2 (2015).
- Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee FT Jr. “Ionizing Radiation in Abdominal CT: Unindicated Multiphase Scans are an Important Source of Medically Unnecessary Exposure,” J Am Coll Radiol. 2011 Nov;8(11):756-61.