TY - JOUR
T1 - Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography A Randomized Clinical Trial
AU - Smith-Bindman, Rebecca
AU - Chu, Philip
AU - Wang, Yifei
AU - Chung, Robert
AU - Lopez-Solano, Naomi
AU - Einstein, Andrew J.
AU - Solberg, Leif
AU - Cervantes, Luisa F.
AU - Yellen-Nelson, Thomas
AU - Boswell, William
AU - Delman, Bradley N.
AU - Duong, Phuong-Anh
AU - Goode, Allen R.
AU - Kasraie, Nima
AU - Lee, Ryan K.
AU - Neill, Rebecca
AU - Pahwa, Anokh
AU - Pike, Pavlina
AU - Roehm, Jodi
AU - Schindera, Sebastian
AU - Starkey, Jay
AU - Suntharalingam, Saravanabavaan
AU - Jeukens, Cecile R. L. P. N.
AU - Miglioretti, Diana
N1 - Funding Information:
Conflict of Interest Disclosures: Drs Smith-Bindman, López-Solano, and Miglioretti reported receiving grants from the National Institutes of Health (NIH) and the Patient-Centered Outcomes Research Institute (PCORI) during the conduct of the study. Dr Einstein reported receiving grants from Canon Medical Systems USA and Roche Medical Systems and receiving grants and personal fees from W. L. Gore and Associates outside the submitted work. Dr Solberg reported receiving grants from the NIH during the conduct of the study and nonfinancial support from HealthPartners outside the submitted work. Dr Cervantes reported receiving grants from University of California, San Francisco (UCSF) during the conduct of the study. Dr Goode reported receiving grants from the UCSF during the conduct of the study and receiving personal fees from Bayer Healthcare outside the submitted work. Dr Starkey reported receiving personal fees from Bayer Japan outside the submitted work. No other disclosures were reported.
Publisher Copyright:
© 2020 American Medical Association. All rights reserved.
PY - 2020/5
Y1 - 2020/5
N2 - Importance Computed tomography (CT) radiation doses vary across institutions and are often higher than needed.Objective To assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT.Design, Setting, and Participants This randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017. Data analysis was performed from October 4, 2017, to December 14, 2018.Interventions Imaging facilities received audit feedback alone comparing radiation-dose metrics with those of other facilities followed by the multicomponent intervention, including audit feedback with targeted suggestions, a 7-week quality improvement collaborative, and best-practice sharing. Facilities were randomly allocated to the time crossing from usual care to the intervention.Main Outcomes and Measures Primary outcomes were the proportion of high-dose CT scans and mean effective dose at the facility level. Secondary outcomes were organ doses. Outcomes after interventions were compared with those before interventions using hierarchical generalized linear models adjusting for temporal trends and patient characteristics.Results Across 100 facilities, 864 080 adults underwent 1 156 657 CT scans. The multicomponent intervention significantly reduced proportions of high-dose CT scans, measured using effective dose. Absolute changes in proportions of high-dose scans were 1.1% to 7.9%, with percentage reductions in the proportion of high-dose scans of 4% to 30% (abdomen: odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P <.001; chest: OR, 0.92; 95% CI, 0.86-0.99; P = .03; combined abdomen and chest: OR, 0.49; 95% CI, 0.41-0.59; PConclusions and Relevance For imaging facilities, detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, particularly organ doses. Effects of audit feedback alone were modest.
AB - Importance Computed tomography (CT) radiation doses vary across institutions and are often higher than needed.Objective To assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT.Design, Setting, and Participants This randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017. Data analysis was performed from October 4, 2017, to December 14, 2018.Interventions Imaging facilities received audit feedback alone comparing radiation-dose metrics with those of other facilities followed by the multicomponent intervention, including audit feedback with targeted suggestions, a 7-week quality improvement collaborative, and best-practice sharing. Facilities were randomly allocated to the time crossing from usual care to the intervention.Main Outcomes and Measures Primary outcomes were the proportion of high-dose CT scans and mean effective dose at the facility level. Secondary outcomes were organ doses. Outcomes after interventions were compared with those before interventions using hierarchical generalized linear models adjusting for temporal trends and patient characteristics.Results Across 100 facilities, 864 080 adults underwent 1 156 657 CT scans. The multicomponent intervention significantly reduced proportions of high-dose CT scans, measured using effective dose. Absolute changes in proportions of high-dose scans were 1.1% to 7.9%, with percentage reductions in the proportion of high-dose scans of 4% to 30% (abdomen: odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P <.001; chest: OR, 0.92; 95% CI, 0.86-0.99; P = .03; combined abdomen and chest: OR, 0.49; 95% CI, 0.41-0.59; PConclusions and Relevance For imaging facilities, detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, particularly organ doses. Effects of audit feedback alone were modest.
KW - QUALITY IMPROVEMENT COLLABORATIVES
KW - SUBSEQUENT RISK
KW - CANCER-RISKS
KW - BRAIN-TUMORS
KW - CT SCANS
KW - EXPOSURE
KW - OPTIMIZATION
KW - PROTECTION
KW - LEUKEMIA
U2 - 10.1001/jamainternmed.2020.0064
DO - 10.1001/jamainternmed.2020.0064
M3 - Article
C2 - 32227142
SN - 2168-6106
VL - 180
SP - 666
EP - 675
JO - JAMA Internal Medicine
JF - JAMA Internal Medicine
IS - 5
ER -