Nisha Hosadurg, Kara Harrison, Joseph Dan Khoa Nguyen, Patricia Rodriguez Lozano, Christopher M Kramer, Patrick T Norton, Amit R Patel, Todd C Villines
{"title":"采用收缩末期冠状动脉 CTA 采集和自动剂量选择的机构流程变革对患者吞吐量和图像质量的影响。","authors":"Nisha Hosadurg, Kara Harrison, Joseph Dan Khoa Nguyen, Patricia Rodriguez Lozano, Christopher M Kramer, Patrick T Norton, Amit R Patel, Todd C Villines","doi":"10.1016/j.jcct.2024.10.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Guidelines recommend prospective ECG-triggered mid-diastolic coronary computed tomographic angiography (CCTA) acquisition after achieving optimal heart rate (HR) control in order to optimize scan image quality. With dual-source CCTA, prospective end-systolic acquisition has been shown to be less prone to motion artifacts at higher heart rates and may improve scan and CT laboratory efficiency by allowing CCTA without routine pre-scan beta-blocker (BB) administration.</p><p><strong>Methods: </strong>We implemented an institutional process change in CCTA performance effective January 2023, comprising a transition from prospective ECG-triggered mid-diastolic acquisitions individually supervised by a physician at the scanner to an algorithmic approach predominately utilizing prospective end-systolic acquisition (200-400 ms after R peak), employing an automated dose selection algorithm, without BB administration. All scans were performed on a third-generation 192-slice dual-source scanner. We reviewed 300 consecutive CCTAs done pre- and post-process change in Jan 2022 (phase 0), Jan 2023 (phase 1), and in May 2023 (phase 2) after implementation of a process improvement involving more selective utilization of automated tube potential/current algorithms (CARE kV) to optimize image quality. Coronary segmental image quality was assessed by two experienced CCTA readers by consensus using an 18-segment SCCT model on a 5-point Likert scale (1 = non-interpretable; 2 = poor; 3 = acceptable; 4 = good; 5 = excellent). Measures of radiation dose, medication administration, and time required for patient scanning were compared. Logistic regression was used to determine factors associated with patient-level reduction in image quality (IQ) and with repeat scans.</p><p><strong>Results: </strong>Post-process change, there was a significant reduction in the median overall patient appointment [phase 0: 95 (75-125) min vs. phase 1: 68 (52-88) min and phase 2: 72 (59-90) min; P < 0.001] and scan times [phase 0: 13 (10-16) min vs. phase 1: 8 (6-13) min and phase 2: 9 (7-13) min; P < 0.001]. Median IQ score in both post-process change phases was 4 (4-5) compared to a median score of 5 (4-5) pre-process change (P for comparison <0.001). The majority of segments post-process change had \"good\" IQ (Phase 1 segmental IQ scores: 5 = 36.7 %, 4 = 46.8 %, 3 = 13 %, 2 = 2.6 %, 1 = 0.9 %; Phase 2 segmental IQ scores: 5 = 26 %, 4 = 49.7 %, 3 = 16.3 %, 2 = 6.1 %, 1 = 1.9 %), whereas pre-process change, the majority of segments had \"excellent\" IQ (Phase 0 segmental IQ scores: 5 = 56 %, 4 = 34.3 %, 3 = 7.5 %, 2 = 1.8 %, 1 = 0.4 %) There was no significant increase in non-interpretable scans at the patient level. The 22 % re-scan rate in phase 1 (vs. 6 % in phase 0, P = .002) improved to 15 % in phase 2. While patient related factors of body mass index [adjusted OR obese 2.64, 95 % CI 1.12-6.51, P = 0.03; aOR morbidly obese 6.94, 95 % CI 2.21-23.52, P = 0.001] and average HR [aOR (per 10 bpm increase) 1.51, 95 % CI 1.21-1.9, P < 0.001] were associated with the scoring of any segment as ≤ 3 at the patient level in a fully adjusted model, the improved phase 2 of the process change was not [aOR 1.61, 95 % CI 0.78-3.32].</p><p><strong>Conclusion: </strong>Implementation of an institutional process change utilizing prospective ECG-triggered dual-source end-systolic acquisition avoided the use of beta-blockers, significantly reduced patient appointment and scan times with acceptable diagnostic performance.</p>","PeriodicalId":94071,"journal":{"name":"Journal of cardiovascular computed tomography","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of an institutional process change adopting end-systolic coronary CTA acquisition and automated dose selection on patient throughput and image quality.\",\"authors\":\"Nisha Hosadurg, Kara Harrison, Joseph Dan Khoa Nguyen, Patricia Rodriguez Lozano, Christopher M Kramer, Patrick T Norton, Amit R Patel, Todd C Villines\",\"doi\":\"10.1016/j.jcct.2024.10.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Guidelines recommend prospective ECG-triggered mid-diastolic coronary computed tomographic angiography (CCTA) acquisition after achieving optimal heart rate (HR) control in order to optimize scan image quality. With dual-source CCTA, prospective end-systolic acquisition has been shown to be less prone to motion artifacts at higher heart rates and may improve scan and CT laboratory efficiency by allowing CCTA without routine pre-scan beta-blocker (BB) administration.</p><p><strong>Methods: </strong>We implemented an institutional process change in CCTA performance effective January 2023, comprising a transition from prospective ECG-triggered mid-diastolic acquisitions individually supervised by a physician at the scanner to an algorithmic approach predominately utilizing prospective end-systolic acquisition (200-400 ms after R peak), employing an automated dose selection algorithm, without BB administration. All scans were performed on a third-generation 192-slice dual-source scanner. We reviewed 300 consecutive CCTAs done pre- and post-process change in Jan 2022 (phase 0), Jan 2023 (phase 1), and in May 2023 (phase 2) after implementation of a process improvement involving more selective utilization of automated tube potential/current algorithms (CARE kV) to optimize image quality. Coronary segmental image quality was assessed by two experienced CCTA readers by consensus using an 18-segment SCCT model on a 5-point Likert scale (1 = non-interpretable; 2 = poor; 3 = acceptable; 4 = good; 5 = excellent). Measures of radiation dose, medication administration, and time required for patient scanning were compared. Logistic regression was used to determine factors associated with patient-level reduction in image quality (IQ) and with repeat scans.</p><p><strong>Results: </strong>Post-process change, there was a significant reduction in the median overall patient appointment [phase 0: 95 (75-125) min vs. phase 1: 68 (52-88) min and phase 2: 72 (59-90) min; P < 0.001] and scan times [phase 0: 13 (10-16) min vs. phase 1: 8 (6-13) min and phase 2: 9 (7-13) min; P < 0.001]. Median IQ score in both post-process change phases was 4 (4-5) compared to a median score of 5 (4-5) pre-process change (P for comparison <0.001). The majority of segments post-process change had \\\"good\\\" IQ (Phase 1 segmental IQ scores: 5 = 36.7 %, 4 = 46.8 %, 3 = 13 %, 2 = 2.6 %, 1 = 0.9 %; Phase 2 segmental IQ scores: 5 = 26 %, 4 = 49.7 %, 3 = 16.3 %, 2 = 6.1 %, 1 = 1.9 %), whereas pre-process change, the majority of segments had \\\"excellent\\\" IQ (Phase 0 segmental IQ scores: 5 = 56 %, 4 = 34.3 %, 3 = 7.5 %, 2 = 1.8 %, 1 = 0.4 %) There was no significant increase in non-interpretable scans at the patient level. The 22 % re-scan rate in phase 1 (vs. 6 % in phase 0, P = .002) improved to 15 % in phase 2. While patient related factors of body mass index [adjusted OR obese 2.64, 95 % CI 1.12-6.51, P = 0.03; aOR morbidly obese 6.94, 95 % CI 2.21-23.52, P = 0.001] and average HR [aOR (per 10 bpm increase) 1.51, 95 % CI 1.21-1.9, P < 0.001] were associated with the scoring of any segment as ≤ 3 at the patient level in a fully adjusted model, the improved phase 2 of the process change was not [aOR 1.61, 95 % CI 0.78-3.32].</p><p><strong>Conclusion: </strong>Implementation of an institutional process change utilizing prospective ECG-triggered dual-source end-systolic acquisition avoided the use of beta-blockers, significantly reduced patient appointment and scan times with acceptable diagnostic performance.</p>\",\"PeriodicalId\":94071,\"journal\":{\"name\":\"Journal of cardiovascular computed tomography\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of cardiovascular computed tomography\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jcct.2024.10.003\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiovascular computed tomography","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.jcct.2024.10.003","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Impact of an institutional process change adopting end-systolic coronary CTA acquisition and automated dose selection on patient throughput and image quality.
Introduction: Guidelines recommend prospective ECG-triggered mid-diastolic coronary computed tomographic angiography (CCTA) acquisition after achieving optimal heart rate (HR) control in order to optimize scan image quality. With dual-source CCTA, prospective end-systolic acquisition has been shown to be less prone to motion artifacts at higher heart rates and may improve scan and CT laboratory efficiency by allowing CCTA without routine pre-scan beta-blocker (BB) administration.
Methods: We implemented an institutional process change in CCTA performance effective January 2023, comprising a transition from prospective ECG-triggered mid-diastolic acquisitions individually supervised by a physician at the scanner to an algorithmic approach predominately utilizing prospective end-systolic acquisition (200-400 ms after R peak), employing an automated dose selection algorithm, without BB administration. All scans were performed on a third-generation 192-slice dual-source scanner. We reviewed 300 consecutive CCTAs done pre- and post-process change in Jan 2022 (phase 0), Jan 2023 (phase 1), and in May 2023 (phase 2) after implementation of a process improvement involving more selective utilization of automated tube potential/current algorithms (CARE kV) to optimize image quality. Coronary segmental image quality was assessed by two experienced CCTA readers by consensus using an 18-segment SCCT model on a 5-point Likert scale (1 = non-interpretable; 2 = poor; 3 = acceptable; 4 = good; 5 = excellent). Measures of radiation dose, medication administration, and time required for patient scanning were compared. Logistic regression was used to determine factors associated with patient-level reduction in image quality (IQ) and with repeat scans.
Results: Post-process change, there was a significant reduction in the median overall patient appointment [phase 0: 95 (75-125) min vs. phase 1: 68 (52-88) min and phase 2: 72 (59-90) min; P < 0.001] and scan times [phase 0: 13 (10-16) min vs. phase 1: 8 (6-13) min and phase 2: 9 (7-13) min; P < 0.001]. Median IQ score in both post-process change phases was 4 (4-5) compared to a median score of 5 (4-5) pre-process change (P for comparison <0.001). The majority of segments post-process change had "good" IQ (Phase 1 segmental IQ scores: 5 = 36.7 %, 4 = 46.8 %, 3 = 13 %, 2 = 2.6 %, 1 = 0.9 %; Phase 2 segmental IQ scores: 5 = 26 %, 4 = 49.7 %, 3 = 16.3 %, 2 = 6.1 %, 1 = 1.9 %), whereas pre-process change, the majority of segments had "excellent" IQ (Phase 0 segmental IQ scores: 5 = 56 %, 4 = 34.3 %, 3 = 7.5 %, 2 = 1.8 %, 1 = 0.4 %) There was no significant increase in non-interpretable scans at the patient level. The 22 % re-scan rate in phase 1 (vs. 6 % in phase 0, P = .002) improved to 15 % in phase 2. While patient related factors of body mass index [adjusted OR obese 2.64, 95 % CI 1.12-6.51, P = 0.03; aOR morbidly obese 6.94, 95 % CI 2.21-23.52, P = 0.001] and average HR [aOR (per 10 bpm increase) 1.51, 95 % CI 1.21-1.9, P < 0.001] were associated with the scoring of any segment as ≤ 3 at the patient level in a fully adjusted model, the improved phase 2 of the process change was not [aOR 1.61, 95 % CI 0.78-3.32].
Conclusion: Implementation of an institutional process change utilizing prospective ECG-triggered dual-source end-systolic acquisition avoided the use of beta-blockers, significantly reduced patient appointment and scan times with acceptable diagnostic performance.