This article clearly shows that taking responsibility for community education and publishing optimized protocols has considerable impact on CT patient dose – and without compromising the diagnostic power of CT. Of course, the best people to execute that responsibility are radiologists – we know the facts and we are motivated toward quality and safety in ways no other group is. Optimization, education, and motivation are the functions of good consultants.
This article discusses how researchers assessed the use of low tube potentials for CCTA in worldwide clinical practice and the resulting influence on radiation exposure and image quality.
As reported by AuntMinnie staff writer Abraham Kim, “CCTA exams performed using low tube voltages (either 90 to 100 kVp or ≤ 80 kVp) were associated with reductions exceeding 50% for CT dose index (CTDIvol) and dose-length product, compared with the conventional tube-voltage range of 110 kVp to 120 kVp. These reductions led to statistically significant decreases in median radiation dose and volume of contrast agent required.”
This study published online February 13 in Radiology discusses information patients want before they have an imaging exam. Many look for information about the procedure on their own before their exams, and about 20% have not received any information from their healthcare provider in preparation for the imaging.
The preferred source for information about imaging exams is the referring provider. For this reason, radiology providers should reach out to referring providers with educational resources for patients. Most patients want to know how to prepare for their exam.
RadiologyInfo.org is an important online resource jointly sponsored by RSNA and the American College of Radiology (ACR). This resource contains information on various imaging exams for patients. Not only is information presented in an easy-to-understand format, but there are also videos of radiologists explaining common imaging exams.
GIGO applies here, but with much greater consequences. Conversely, good information in results in more valuable consultation out in the form of the Radiology reports. See this article for how the authors “found improvement in quality of histories provided on requisitions for unenhanced head CT after a fairly simple intervention in the ED. In addition to aiding interpretation, improved clinical information significantly reduced time in receiving payment for the studies.” This results in a “win” for all, including likely improved quality of care for patients.
In this era when spoken English can be translated into heard French in real time by an app, perhaps translating radiologists reports into lay language (as demonstrated by this article) might also be accomplished – also in real time. Patients would love to have this ability, and it would serve to better engage them in their care.
The authors raise this question from a patient-centered approach: “What would patients choose if given the option to drink or not drink oral contrast material, and why? Some patients might prefer a risk-averse approach and prioritize diagnostic accuracy, whereas other patients might prefer a comfort-based approach and prioritize examination comfort. Asking patients how they value these trade-offs can inform an optimal imaging strategy.”
Modern oral contrast (diluted Omnipaque) is tasteless and odorless. Most patients think they are drinking water. But, it significantly increases diagnostic accuracy, particularly in cases involving GI questions.
These authors concluded, “If oral contrast material has any diagnostic benefit, most outpatients (89%) would rather drink it than accept any risk for missing an important finding.”
There is no question that a radiologist who consults directly adds substantial value for both referring physicians and patients. As we make exams more appropriate, we should probably plan on spending more time as consultants and meet the patients, as this article explains.
Pictured above: UW Medicine Radiology Chief Resident Jennifer Favinger and Resident Derek Khorsand consulting with patients at the Seattle/King County Clinic