There are over 2 million emergency department visits annually in the U.S. for back or flank pain concerning for kidney stone, and more than 70% of patients diagnosed with urolithiasis receive a CT scan. While CT is an excellent diagnostic test for kidney stone, it delivers ionizing radiation that may cause cancer at a later time and has not been shown to improve patient-centered care. It is estimated that as many as 3-5% of future malignancies may occur due to radiation from medical imaging procedures, with risk of malignancy being linearly related to CT dose. Prior work by our group suggests that radiation dosing for renal colic CT in the U.S. is higher than it needs to be, extremely variable, and does not incorporate reduced dose techniques that are known to be effective. We propose an innovative multi-faceted approach that leverages our prior work and existing infrastructure to disseminate and demonstrate best practices for appropriately reducing dose in renal colic CT.
Our specific aims are: 1) to nationally disseminate best practices in radiation dose optimization for renal colic CT and 2) Determine if best practice is being implemented by comparing radiation dose indices for renal colic CTs in institutions participating in our educational outreach compared with non- participating institutions. We will first work with stakeholders (primarily the American College of Radiology and the American College of Emergency Physicians) to reach a consensus on CT dose benchmarking based on data from the Dose Imaging Registry (DIR, an established national registry with more than 500 participating facilities). In parallel, we will develop a Multimedia Educational module to enable best practices in Protocol and Radiation Optimization for CT (ME-PROC, currently funded by the Radiologic Society of North America and to be expanded and targeted specifically to renal colic CT in this proposal). We will reach out to institutions via the DIR and engage them to participate in our educational and consultative program to appropriately reduce dose. Finally, we will work towards incentivizing best dose practices by developing a performance measure for which we will seek National Quality Forum (NQF) endorsement, as well as integrating this into the existing Practice Quality Improvement (PQI) initiative. Our approach will be iterative over the course of the project in attempting to reach facilities, refine our educational initiative, to achieve optimal doses while maintaining quality of care. We anticipate engaging more than 100 facilities and showing a significant change towards more appropriate dosing in renal colic. Ultimately, this could prevent thousands of future malignancies, improving population health while maintaining the quality of acute care for this condition.

Public Health Relevance

Kidney stones will affect approximately 10% of the population during their lifetime, and most people that are diagnosed with kidney stones will get a CT scan, which delivers ionizing radiation that may cause cancer later in life. Accurate reduced dose techniques are available but are not being used. We propose to disseminate and demonstrate effective dose reduction techniques nationally, ultimately reducing cancer on a population basis while maintaining quality of care.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Healthcare Patient Safety and Quality Improvement Research (HSQR)
Program Officer
Nix, Mary
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Yale University
Emergency Medicine
Schools of Medicine
New Haven
United States
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Weisenthal, Karrin; Karthik, Priyadarshini; Shaw, Melissa et al. (2018) Evaluation of Kidney Stones with Reduced-Radiation Dose CT: Progress from 2011-2012 to 2015-2016-Not There Yet. Radiology 286:581-589