Assessing Z-Axis Coverage Compliance in Common CT Scans Across Saudi Arabian Hospitals: A Clinical Audit
Submission Type:Original Research Article
Authors
1 Department of Radiology, Imam Abdulrahman bin Faisal University, Saudi Arabia.
2 Department of Radiology, King Fahad Specialist Hospital, Saudi Arabia.
3 Department of Radiology, King Faisal University, Saudi Arabia
4 Department of Radiology, King Faisal University, Saudi Arabia
5 Department of Radiology, Imam Abdulrahman bin Faisal University, Saudi Arabia.
6 Department of Radiology, Imam Abdulrahman bin Faisal University, Saudi Arabia
7 Department of Radiology, King Fahad Hospital Hofuf, Saudi Arabia
8 Department of Radiology, King Fahad University Hospital, Saudi Arabia
9 Department of Radiology, King Fahad Specialist Hospital, Saudi Arabia.
DOIAbstract
Objectives: This study aimed to evaluate the adherence to the standard CT examination scanning length and investigated the degree of any over- or under-scanning field.
Methods: Computed Tomography (CT) scout images of the head, neck, chest, and abdomen/pelvis from three hospitals (A-C) were retrospectively obtained from the PACS system and reviewed. The scan range protocol was determined and compared to the actual scan range. Incidence of over-scanning and under-scanning were assessed and calculated.
Results: Over-scanning occurred in a substantial number of the four CT examinations among the three hospitals. Almost 50% of the collected examinations showed over-scanning superiorly at start point. Moreover, a 19% under-scanning and 47% over-scanning at scanning end points. Dose-length product (DLP) and CT dose index (CTDIvol) were collected, however, this data wasn’t adequate to calculate unneeded radiation received in each scan for patients included in the samples as a result of over-scanning.
Conclusion: A high percentage of over-scanning and under-scanning indicates that many technologists aren’t complying with the protocol parameters which proposes the necessity to educate and increase radiation dose awareness for technologists. Their awareness regarding the importance of complying with the protocol starts and end-scanning field should be also raised. Written protocols manual for all examinations, the routine, and modified protocols should be provided for technologists to minimize the problem of over-scanning field.
Main Subjects
Keywords
References
- 1.Goske MJ, Applegate KE, Boylan J. The ‘Image Gently Campaign: increasing CT radi- ation dose awareness through a national education and awareness program. Pediatr Radiol. 2008;38:265–9.
- 2.Zarb F, Rainford L, Foley S, Mcentee MF. Rationale for national and local dose refer- ence levels and collective effective dose in CT. Journal of Medical Imaging and Radi- ation Sciences. 2009;40(3):109–15.
- 3.Kalra MK, Maher MM, Toth TL, Hamberg LM, Blake MA, Shepard JA et al. Strategies for CT radiation dose optimization. Radiology. 2004;230(3):619–28.
- 4.Badawy MK, Galea M, Mong KS, U. Computed tomography overexposure as a conse- quence of extended scan length. Journal of medical imaging and radiation oncology. 2015;59(5):586–9.
- 5.Badawy MK, Lane H, Galea M. Radiation Dose Associated with Over Scanning in Neck CT. Current problems in diagnostic radiology. 2019;48(4):359–62.
- 6.Kasi A, Steffens T, Starkey D, Braithwaite V. The proportion of computed tomography kidneys, ureters and bladder (CTKUB) scans that comply with scan extent protocol in an emergency department: a clinical audit and dose ramification study. Journal of Medical Radiation Sciences. 2021;68(1):13–20.
- 7.Romans L. Computed Tomography for Technologists: A comprehensive text. 2nd ed; 2018. Lippincott Williams & Wilkins.
- 8.Seeram E, Tomography EC, Book. Computed Tomography-E-Book: Physical Princi- ples, Patient Care, Clinical Applications, and Quality Control. 5th ed; 2022. Elsevier Health Sciences.
- 9.Goo HW. CT radiation dose optimization and estimation: an update for radiologists. Korean journal of radiology. 2012;13(1):1–1.
- 10.Mcnitt-Gray MF. AAPM/RSNA physics tutorial for residents: topics in CT: radiation dose in CT. Radiographics. 2002;22(6):1541–53.
- 11.Uldin H, Mcglynn E, Cleasby M. Using the T11 vertebra to minimise the CT-KUB scan field. The British journal of radiology. 2020;93(1110):20190771.
- 12.Zanca F, Demeter M, Oyen R, Bosmans H. Excess radiation and organ dose in chest and abdominal CT due to CT acquisition beyond expected anatomical boundaries. European radiology. 2012;22:779–88.
- 13.Schwartz F, Stieltjes B, Szucs-Farkas Z, Euler A. Over-scanning in chest CT: com- parison of practice among six hospitals and its impact on radiation dose. European journal of radiology. 2018;102:49–54.
- 14.Gervaise A, Teixeira P, Hossu G, Blum A, Lapierre-Combes M. Optimizing z- axis coverage of abdominal CT scans of the urinary tract: A proposed alterna- tive proximal landmark for acquisition planning. The British Journal of Radiology. 2016;89(1067):20160197.
- 15.Atalay MK, Walle NL, Egglin TK. Prevalence and nature of excluded findings at reduced scan length CT angiography for pulmonary embolism. Journal of Cardio- vascular Computed Tomography. 2011;5(5):325–32.
- 16.Schegerer AA, Nagel HD, Stamm G, Adam G, Brix G. Current CT practice in Ger- many: Results and implications of a nationwide survey. Eur Radiol. 2017;90:114–142.
- 17.Salimi Y, Shiri I, Akhavanallaf A, Mansouri Z, Manesh AS, Sanaat A et al.; 2021.
- 18.Yar O, Onur MR, İdilman İS, Akpınar E, Akata D. Excessive z-axis scan coverage in body CT: frequency and causes. European Radiology. 2021;31:4358–66.
- 19.Zhang M, Wellnitz C, Cui C, Pavlicek W, Wu T. Automated detection of z-axis cov- erage with abdomen-pelvis computed tomography examinations. Journal of Digital Imaging. 2015;28:362–369.
- 20.Inoue Y, Itoh H, Nagahara K, Hata H, Mitsui K. Relationships of Radiation Dose Indices with Body Size Indices in Adult Body Computed Tomography. Tomography. 2023;9(4):1381–1392. Chicago.