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

Abstract

Introduction To assess computed tomography kidneys, ureters and bladder (CTKUB) scan extent protocol compliance and associated doses in the Emergency Department (ED) of an Australian tertiary hospital. Methods A retrospective clinical audit of 150 consecutive ED CTKUB cases was completed. For each patient, scan extent compliance at the superior (kidneys) and inferior (pubic symphysis) borders, in reference to the protocol was recorded. Compliance and non‐compliance (over‐/under‐scanning) was identified, described (superior/inferior), quantified (via IMPAX measurements) and recorded via a purpose‐built audit tool. In addition, a PBU40 phantom was scanned to assess the percentage of dose (DLP) increase per centimetre of over‐scanning to contextualise results. Results A notable non‐compliance with department protocol was noted. Eight cases (5.3%) demonstrated overall CT scan extent compliance. The remaining 142 cases (94.7%) demonstrated some form of non‐compliance; superiorly, inferiorly or both. Analysing the 150 superior and 150 inferior data points independently, the most common non‐compliance was over‐scanning at the kidneys by 4 cm to5 cm (19 cases, ~10% extra DLP) beyond tolerance and over‐scanning inferiorly at the pubic symphysis by 1 cm to 2 cm (29 cases, ~6.4% extra DLP). Estimated dose increases of up to 35% to 45% were found when clinical audit results were simulated using a PBU40. Conclusions Over‐scanning is a predominant occurrence in CTKUB scans in this department. Reasons for over‐scanning weren't investigated. It's anticipated this audit will lead to greater awareness of scan extent compliance and dose ramifications of non‐compliance. The usage of more easily identified anatomical landmarks and a follow‐up audit is suggested.

Assessing Z-Axis Coverage Compliance in Common CT Scans Across Saudi Arabian Hospitals: A Clinical Audit

“…The results of our study align with the high rate of CT over-scanning demonstrated in previous studies of current literature [5,6,[11][12][13]. The increase in scanning range results in unnecessary radiation dose to the patients.…”

“…For abdomen/pelvis CT scans, just above diaphragm is used as the start point of the scan. The inferior aspect of the pubic symphysis is used as the endpoint of the scan to measure the over and under-scanning length [4,[6][7][8]. and confirmed to be within acceptable range.…”

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

“…However, in adults, the ACR and AUA both recommend CT as the first-line investigation for symptoms of obstructive nephrolithiasis. The sensitivity and specificity of CT scans are 95% and 98% respectively, which is proved by a recent review to be of higher values than all other imaging modalities, including MRI, ultrasound, or plain radiographs [ 9 ].…”

“…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 study by Kasi et al, IMPAX measurements were integrated as part of the assessment [ 9 ].…”

Imaging in stone diagnosis and surgical planning

“…Despite proven accuracy, adoption of this technology has been slow [18 ▪ ,19,20], with an increase from 2% in 2011 to only 7.6% in 2015 [21]. Unnecessary radiation exposure is a result of incorrectly protocolled imaging with multiple phases or over-scanning above or below the area of interest [18 ▪ ,22]. Further, there is wide variation both within and between hospitals [20].…”