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Developing a CTKUB scanning protocol based on vertebral landmarks
Poster Title: Developing a CTKUB scanning protocol based on vertebral landmarks
Submitted on 28 Aug 2019
Author(s): Hasaam Uldin, Eunan McGlynn, Morgan Cleasby
Affiliations: UHB NHS Foundation Trust
This poster was presented at BIR Annual Congress 2019
Poster Views: 664
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Poster Information
Abstract: Background: CT-KUB investigations are crucial in investigating urinary pathology but impart significant radiation doses. Radiation can be limited by minimising the scanning field to the necessary area (i.e. from the kidneys to urethra). Before auditing, the superior limit of CT KUB scans had not been formally clarified at our trust. Commencing scans at or below T10 has been shown to be a suitable level to commence CT-KUB scans.

Aims & Standards: This study aimed to assess the overscan length of CT-KUB investigations and modify practice accordingly to minimise it. Performance was assessed against the following standards:
1) The mean percentage overscan length (i.e. percentage of the scan above the kidneys) should be <15%.
2) 100% of scans should include the superior borders of both kidneys.

Methodology: Ninety consecutive scans were retrospectively investigated in the first cycle, and 105 in the re-audit. The analysis parameters were: percentage overscan, distance between diaphragm and upper border of kidneys, vertebral level at which the scan commenced, and whether both kidneys were fully included.

Results (Pre-intervention): Overscan was present in 94.4% of scans. The mean overscan length percentage was 28.2%. 41% of scans started above T10. Lowering the vertebral level correlated with decreasing overscan. 99% of scans fully included both kidneys.

First cycle outcome: A newly-devised protocol using T11 as the superior scan limit was delivered to radiographers in the department. The re-audit was repeated 3 months later.

Results (Re-audit): The mean overscan percentage reduced to 10.6% (SD=4.4%). 84% of scans started at T10 or below. 100% of scans fully included both kidneys.

Conclusions: Excessive overscanning was due to inconsistent technique in capturing CT KUB scans. By successfully standardising the process with a reproducible method, the overscan target was comfortably met. Therefore, patient dose was minimised without compromising scan quality.

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