Computed tomography in the emergency department

Strategies for success

Reducing radiation exposure during CT (children)

• Develop pediatric-specific protocols for imaging with a focus on minimal dose necessary to obtain a quality image.
• Image with radiation only when medically necessary. When ordered appropriately, the risk to benefit medical imaging is excellent. Use alternative modalities (ultrasound or MRI) when appropriate.
• Scan only the affected region. Develop protocols for follow-up examinations (e.g., follow-up of an incidental lung nodule does not require a full chest CT).
• Scan once only. Multiphase scans are rarely indicated in children.
  Involve clinical staff in quality improvement initiatives relative to ordering of medical imaging studies.
• Arkansas Children’s Hospital has developed pediatric-specific imaging protocols. For information about these, you may call and speak with a Pediatric CT Technologist / Radiology Technologist at 501-364-1308.

Reducing radiation exposure during CT (adults)

• Utilize guidelines-based care when making a decision to undertake a medical diagnostic examination that involves medical imaging.
  • American College of Radiology appropriateness criteria
  • American College of Emergency Physicians clinical practice guidelines
• Avoid unnecessary repetition of examinations in patients who have been previously imaged, in your organization or another organization.
• Routinely question patients about other workups that they have completed at other institutions.
• Involve clinical staff in quality improvement initiatives relative to ordering of medical imaging studies.

Improve systems

• Follow Meaningful Use Stage 2
• Adhere to Joint Commission CT Imaging Standards

Educate staff

• Educate emergency department staff:
  • Specific imaging protocols for pediatric/adults
  • Radiation exposure awareness
  • “As low as reasonably achievable” a statement by the American College of Radiology
  • The patient’s rights and the five “rights” of imaging
• Routinely check medical records for previous imaging studies
• Routinely questions patients about other imaging workups
• REMEMBER: Radiation dose is cumulative. Significant radiation doses to children and young adults are associated with increased lifetime risk of cancer.

Educate patients

• Provide patient educational materials
• Utilize teach back
• Educate patients/parents/ caregivers on importance of providing imaging history

Web resources

Computed Tomography (CT) imaging of the head, neck, chest, abdomen and pelvis have led to significant improvements in the diagnosis of disease and injury. The value of CT scanning to diagnose injury, cancer and other health problems is undisputed. However, a national study of CT utilization in United States Emergency Departments (ED) demonstrates significant growth in CT use. In 1995, 2.8% of ED patients received a CT scan during the course of an ED visit. In 2007, this increased to 13.9 %. This represents an approximate 6-fold increase in CT utilization with an annual growth rate of 14.2%. (Radiology. 258(1):164-173, 2011 Jan). Additionally, Emergency department physicians are generally unaware of the risk of radiation exposure from CT scans. A 2012 study demonstrated that fewer than 30% of ED physicians possess accurate knowledge of the lifetime cancer risk attributable to radiation (Am J Roentgenol. 199(6):1328-36, 2012 Dec.).

Provider resources