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Scholarly Works (4 results)

  • Article
  • Peer Reviewed
UC San Francisco Previously Published Works (2022)
BACKGROUND: Advances in CT have facilitated widespread use of medical imaging while increasing patient lifetime exposure to ionizing radiation. PURPOSE: To describe dose optimization strategies used by health care organizations to optimize radiation dose and image quality. MATERIALS AND METHODS: A qualitative study of semistructured interviews conducted with 26 leaders from 19 health care systems in the United States, Europe, and Japan. Interviews focused on strategies that were used to optimize radiation dose at the organizational level. A directed content analysis approach was used in data analysis. RESULTS: Analysis identified seven organizational strategies used by these leaders for optimizing CT dose: (1) engaging radiologists and technologists, (2) establishing a CT dose committee, (3) managing organizational change, (4) providing leadership and support, (5) monitoring and benchmarking, (6) modifying CT protocols, and (7) changes in equipment and work rules. CONCLUSIONS: Leaders in these health systems engaged in specific strategies to optimize CT dose within their organizations. The strategies address challenges health systems encounter in optimizing CT dose at the organizational level and offer an evolving framework for consideration in dose optimization efforts for enhancing safety and use of medical imaging.
    Cover page: Strategies for Dose Optimization: Views From Health Care Systems.
    • Article
    • Peer Reviewed
    Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 16, Issue 7 (2015)

    Introduction: The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. 

    Methods: Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes.

    Results: We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging.

    Conclusion: ED providers are driven to use HIE when they’re missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.

    • 1 supplemental file
    Cover page: Impact of Health Information Exchange on Emergency Medicine Clinical Decision MakingCreative Commons 'BY' version 4.0 license
    • Article
    • Peer Reviewed
    UC San Francisco Previously Published Works (2021)

    Background

    The use of diagnostic imaging with computed tomography (CT) has risen significantly, increasing cumulative life-time exposure to ionizing radiation for patients and raising concerns about increased cancer risk. Lowering the doses would reduce concerns about associated cancer risks.

    Purpose

    To determine organizational leaders' perceptions of barriers to optimizing radiation dose in CT.

    Materials and methods

    An observational study using semistructured interviews conducted with 26 organizational leaders from 19 health care systems in the United States, Europe, and Japan. Interviews focused on approaches the organizations used to optimize radiation dose and barriers encountered. Data were analyzed using a directed content analysis approach.

    Results

    Analysis identified six primary barriers to dose optimization: (1) resistance to change, (2) limited time and resources, (3) complex organizational structure, (4) lack of leadership support, (5) variations in CT equipment, and (6) variability in CT protocols.

    Conclusion

    Barriers to optimizing CT dose across diverse health care organizations were described by organizational leaders tasked with implementing and improving CT imaging. They identified six consistent themes that reflected barriers to optimizing radiation dose at the organizational level. These barriers impeded efforts by health care organizations to optimize radiation doses to patients from CT imaging. Identifying barriers early in any improvement process is an important first step in making meaningful and sustained change.
      Cover page: Barriers to CT Dose Optimization: The Challenge of Organizational Change
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2020)

      Purpose

      The aim of this study was to identify organizational factors and quality improvement strategies associated with lower radiation doses from abdominal CT.

      Methods

      Cross-sectional survey was administered to radiology leaders, along with simultaneous measurement of CT radiation dose among 19 health care organizations with 100 imaging centers throughout the United States, Europe, and Japan, using a common dose management software system. After adjusting for patient age, gender, and size, quality improvement strategies were tested for association with mean abdominal CT radiation dose and the odds of a high-dose examination.

      Results

      Completed surveys were received from 90 imaging centers (90%), and 182,415 abdominal CT scans were collected during the study period. Radiation doses varied considerably across organizations and centers. Univariate analyses identified eight strategies and systems that were significantly associated with lower average doses or lower frequency of high doses for abdominal CT examinations: tracking patient safety measures, assessing the impact of CT changes, identifying areas for improvement, setting specific goals, organizing improvement teams, tailoring decisions to sites, testing process changes before full implementation, and standardizing workflow. These processes were associated with an 18% to 37% reduction in high-dose examinations (P < .001-.03). In multivariate analysis, having a tracking system for patient safety measures, supportive radiology leaders, and obtaining clear images were associated with a 47% reduction in high-dose examinations.

      Conclusions

      This documentation of the relation between quality improvement strategies and radiation exposure from CT examinations has identified important information for others interested in reducing the radiation exposure of their patients.
        Cover page: Organizational Factors and Quality Improvement Strategies Associated With Lower Radiation Dose From CT Examinations
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