Educational Intervention Can Reduce CT Scans, Radiation Exposure in the ER

RESTON, Va -- January 27, 2010 -- A large New York medical center reduced the number of computed tomography (CT) scans and radiation dose delivered to patients presenting to the emergency department with suspected pulmonary emboli (PE) by holding collaborative educational seminars for staff and routing patients to CT pulmonary angiography (CTPA) or ventilation perfusion (V/Q) scanning based solely on their chest x-ray results.

The study is published in the February issue of the American Journal of Roentgenology.

"The total effective radiation dose from CTPA is approximately 5 times greater than that from V/Q scanning, and the dose is 20 to 40 times greater to the female breast," said lead author Linda B. Haramati, MD, Montefiore Medical Center, Bronx, New York. "Most physicians are not aware of these differences."

Collaborative educational seminars were held among the radiology, nuclear medicine, and emergency medicine departments regarding the radiation dose and accuracies of V/Q scanning and CTPA for diagnosing PE at Montefiore Medical Center.

In addition, an imaging algorithm was introduced in which emergency department patients with a clinical suspicion of PE underwent chest radiography. If the chest radiograph was normal, V/Q scanning was recommended, otherwise CTPA was recommended.

As a result of the educational intervention and new algorithm, "the number of CTPA examinations performed at our center decreased from 1,234 in 2006 to 920 in 2007, and the number of V/Q scans increased from 745 in 2006 to 1,216 in 2007," said Dr. Haramati. "The radiation was reduced by 20%, from 8.0 mSv in 2006 to 6.4 mSv in 2007."

"The purpose of our study was to decrease radiation exposure to emergency department patients with suspected PE, for whom imaging was clinically warranted, by safely increasing the use of V/Q scanning and decreasing the use of CTPA through an educational intervention," she said.

"We have shown that a simple, collaborative educational intervention and routing of patients to CTPA or V/Q scanning based on the results of chest radiography can change the practice pattern in the emergency department for patients with suspected PE," said Dr. Haramati. The use of V/Q scanning in patients with normal chest radiographs results in considerably lower patient radiation exposure."


SOURCE: American Roentgen Ray Society