Scientific Session 15 — SS15: Efficacy/Administration/Informatics - Quality and SafetyWednesday, May 8, 2019
2146. Stop Breathing Command: Technologist Education vs Patient Participation to Reduce Motion Artifacts and Expiratory Phase Chest CT
Doda Khera R, Singh R*, Shepard J, Digumarthy S, Kalra M. Massachusetts General Hospital, Harvard Medical School, Boston, MA
Address correspondence to R. Doda Khera (email@example.com)
Objective: With many emergent and critically ill patients at our quaternary hospital, motion artifacts and expiratory phase imaging in chest CT is a substantial issue. We hypothesized that CT technologist education and patient participation can reduce frequency of motion artifacts and unintentional expiratory phase imaging in chest CT.
Materials and Methods: To establish baseline prevalence, we reviewed consecutive 826 chest CT (mean age, 62 ± 16 years; 421 women, 405 men) performed between April 2017 and May 2017 for presence of motion artifacts and expiratory phase scanning. Per clinical process improvement guidelines, we brainstormed corrective measures and priority-pay-off matrix in group meetings with radiologists and CT technologists. The first plan, design, study, act (PDSA) cycle to reduce the frequency of motion artifacts included awareness and education of CT technologists (n>80). A fast chest CT protocol (scan time, 0.5-1.5 seconds) was also created for patients who could not follow breathing instructions. Data were collected after the first PDSA on the same attributes on consecutive 795 chest CT (mean age, 62 ± 15 years; 397 women, 398 men) over two months. For the second PDSA cycle, short instructional videos were created as per specific chest CT protocols and shown to patients just before they underwent chest CT. Patients were asked if the videos helped them understand and follow breathing instructions during their chest CT. Data on motion artifacts from after the second PDSA were collected for 247 patients (mean age, 66 ± 14 years; 127 women, 120 men) over two months. Pareto charts and run charts were created for baseline and post-PDSA data.
Results: In the baseline data, 35% (292/826) of chest CT examinations either had motion artifacts or were performed in expiratory phase. Both the inpatients (60%, 152/252) and outpatients (24%, 140/574) had substantial motion artifacts on chest CT. There was no change in the incidence of motion artifacts or expiratory phase scanning with the implementation of the first PDSA cycle (36%, 283/795) (p>0.1). Following implementation of the second PDSA cycle, there was a significant reduction in motion artifacts and expiratory phase scanning relative to the baseline and after the first PDSA cycle (8.5%, 21/247 patients) (p< 0.05). Most patients reported that the predesigned didactic videos helped them follow breath-hold instructions during their scan (88%, 217/247).
Conclusion: Awareness and education of CT technologists failed to reduce the frequency of motion artifacts or unintentional expiratory phase chest CT. Patient participation and video-based instructions are more effective than education of CT technologists for reducing motion and expiratory phase scanning in chest CT. Process improvement beyond caregiver education and training are necessary to reduce the incidence of motion-impaired and suboptimal expiratory chest CT.