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AUDIT: CT PULMONARY ANGIOGRAPHY REPORTING TEMPLATE TO MONITOR TECHNICAL QUALITY OF CTPA
EP34281
Poster Title: AUDIT: CT PULMONARY ANGIOGRAPHY REPORTING TEMPLATE TO MONITOR TECHNICAL QUALITY OF CTPA
Submitted on 28 Oct 2020
Author(s): Lawman Chiwome, Suvarna Latha Penukonda, Alasdair Taylor
Affiliations: University Hospitals Of Morecambe Bay NHS Foundation Trust
This poster was presented at BIR ANNUAL CONGRESS 2020
Poster Views: 603
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Poster Information
Abstract: BACKGROUND
Computed tomography pulmonary angiography (CTPA) is a common examination performed to detect pulmonary embolism (PE). The technical quality of CTPA is important in making a decision to treat or not to treat for PE. The aim of this audit is to monitor adherence to use of standardized elements in CTPA reports and monitoring the technical quality of CTPA.

STANDARDS
Published theoretical minimum attenuation of blood in the pulmonary arterial system required to identify PE is 211HU. Prior research suggest up to 10.8% of all CTPAs maybe sub-optimal, with motion artifact and poor enhancement being the most commonly cited reasons for indeterminism; hence our target is no more than 10.8% CTPAs to be sub-optimal.

METHODS
100 CTPAs were analysed. A circular region of interest was measured in the largest axial image of the main pulmonary artery to obtain the opacification in Hounsfield units. CTPAs that were sub-optimal due to movement artifact were recorded. We looked at reports checking use of CTPA standardized technical quality elements. On re-audit we used a sample size of 60.

RESULTS
27% of CTPAs were sub-optimal. Inadequate pulmonary enhancement contributed 14% and movement artifact contributed 13%. On the mentioning of quality metrics in the reports, 100% of CTPA reports mentioned the overall result as positive, inconclusive or negative, and only 22% of reports mentioned the technical quality of the CTPA.
Re-audit saw an improvement of the quality of CTPA with an improvement to 10% where motion artifact contributed 4% and inadequate enhancement 6%. Reports mentioning technical quality of CTPA improved to 33%.


RECOMMENDATIONS ADOPTED
1. Reporting template adopted. - [Pulmonary artery opacification - Optimal/Sub-optimal (..........HU), Breath hold - Optimal/Sub-optimal, Overall scan quality - Optimal/Sub-optimal.
2. CT contrast injector changed from the previous syringe driven to new syringeless smart connector Flowsens injector.
3. Breathing instructions - Radiographers to rehearse with patients twice before scanning.

Summary: Audit to monitor the technical quality of CTPA. The aim of the audit was to assess adequacy of pulmonary artery enhancement in CTPA and monitor the presence of motion artifact affecting diagnostic capability of CTPA.References: 1. Jones SE, Wittram C. The indeterminate CT pulmonary angiogram: imaging characteristics and patient clinical outcome. Radiology 2005; 237: 329-337.​
2. Wittram C, Maher MM, Halpern E, Shepard JO. Hounsfield unit values of acute and chronic pulmonary emboli. Radiology 2005: 235; 1050-1054.​
​3. Matthew D. Gilman, Ella A. Kazerooni, Standardized Reporting of CT Pulmonary Angiography for Acute Pulmonary Embolism. Radiology
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