It is time to think inside the (collimation) box; a quality improvement project to reduce over-scanning in CT scanning of the kidneys, ureters and bladder

Abstract

Objective: The Royal College of Radiologists (RCR) recommend CT of the kidneys, ureters and bladder (CTKUB) as the first-line investigation for renal colic, stating that excess scan length above the upper pole of the highest kidney should not exceed 10% of the total scan length. The project aim was to determine what proportion of CTKUB scans performed at a district general hospital (DGH) were meeting this standard and explore improvement options as necessary. Methods: A retrospective study was performed on 100 consecutive patients who attended a Radiology Department with renal colic. The number of CTKUB slices above the upper pole of the highest kidney, relative to scan length, was recorded. The DGH radiographers believed over scanning could be reduced by viewing image acquisition in real-time and manually stopping the scan at the top of the highest kidney. This was implemented and a re-audit of 50 patients was performed. Results: Scan length exceeded the standard on 81% of scans (81/100). Over scanning was reduced to 14% (7/50) post-intervention. Conclusion: This DGH was over scanning a large proportion of patients. Manually stopping the CTKUB significantly reduced over scanning. Advances in knowledge: A small change to CTKUB scanning technique can significantly improve adherence to RCR guidelines.

A Multicentric Audit to Reevaluate the Guidelines Adherence in Computed Tomography of Kidneys, Ureters, and Bladder (CT-KUB) X-ray Imaging in Jordan

“…Previous reviews did not employ identical data collection parameters. Netke et al, in their study employed metrics such as the total number of additional slices, slices encompassing both kidneys, the distance from the beginning of the scan to the upper pole of the highest kidney, along with the resulting percentage of "overscan" [ 8 ]. Identification of the uppermost renal point on axial imaging was performed to calculate additional scans, involving a comparison between slices above this point and the total axial slices.…”

“…In the second audit cycle, Netke et al refined the protocol by enabling radiographers to monitor renal CT images in real-time, manually halting the scanner upon sighting the top of the highest kidney in addition to caudocranial direction images [ 8 ]. Conversely, Kasi et al, employing a single-looped audit, proposed protocol improvement through education, addressing current CT scan range extension in one body region, and implementing anatomical landmarks [ 9 ].…”

“…The structure, processes, and outcomes of care are carefully chosen and systematically evaluated against explicit criteria. If needed, changes are implemented at the individual team or service level, and ongoing monitoring is implemented to confirm improvements in healthcare delivery [ 8 ]. This study aims to reduce the unnecessary scan length and exposure to radiation in patients who undergo CT scans in the process of evaluation for urinary symptoms in 3 teaching hospitals and referral centers in Jordan.…”

Minimising Radiation Dose in Computerised Tomography in the Investigation of Renal Stone Disease: A Teaching Hospital Audit

“…Anatomy imaged cranial to the upper pole of the highest kidney provides no diagnostic benefit in the assessment of renal stone disease. Anatomical landmarks to start a CT KUB are often based on vertebral body [10][11][12] .…”