Project Summary

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is adapting feedback reports that provide information about the amount of radiation in different types of computed tomography, or CT, scans for use across all healthcare settings.

Each year, patients in the United States receive 90 million CT scans. CT scans provide images that can help detect injury or disease inside the body or that can guide medical procedures. However, CT scans expose patients to radiation, which can increase the risk of cancer. Lowering the amount of radiation patients receive during a CT scan can reduce unnecessary health risks.

What is the goal of this implementation project?

CT scans can help find a wide range of health problems such as fractures or cancers. But these scans also expose the patient to a certain amount of radiation, called a CT dose. A PCORI-funded research study found that CT doses varied by hospital. Hospital policies, such as who could change CT scanning procedures, were more important than other factors, such as the type of scanner, in determining why doses varied. Sharing feedback reports with hospitals about their own practices and optimal CT doses for different types of scans reduced the average radiation per scan for all patients. Patients at these hospitals were also less likely to get a CT scan with a high dose of radiation.

This project will adapt the CT radiation feedback reports for use in different healthcare settings.

What will this project do?

The project team is working with 13 health systems and hospitals. Using the feedback reports, the team is helping these organizations optimize the doses used for CT scanning. The project team is:

  • Creating an approach for categorizing the reasons for CT scans and determining the right radiation dose and image quality for each type of scan
  • Simplifying the feedback report provided to doctors to help them reduce the use of high-dose CTs
  • Adding information on CT image quality to the feedback report
  • Organizing the information to help sites respond to other patient safety efforts

During the project, the team is reviewing CT scan records from each site and providing the feedback reports. They are also developing online training for staff to help interpret the reports. The team is then sharing the feedback by posting it online and sharing it at an online course. The team is creating standards for how routine exams should be performed.

Participating staff at sites include radiologists, radiological technologists, medical physicists, doctors who perform CTs, and administrators. The team is also working with professional societies and others to encourage use of the tools.

What is the expected impact of this project?

This project will initiate use of the radiation feedback reports in different healthcare settings. The refinements to the feedback report, materials developed during the project, and the support of professional groups and others working with the project will help with further scale-up.

The project evaluation will confirm use of the feedback reports and that the process works as intended to improve CT safety.

More about this implementation project:

Stakeholders Involved in This Project

  • Representatives from the American Colleges of Cardiology, Emergency Physicians, and Radiology
  • Representatives from the Society of Cardiovascular Computed Tomography
  • American Urological Association
  • American Association of Physicists in Medicine
  • The Joint Commission
  • LeapFrog
  • American Cancer Society
  • Patient representatives

Implementation Strategies

  • Adapt the dose optimization program to be more accessible, automated, and useful.
  • Adapt dose optimization protocols for different types of body scans.
  • Develop and use online training courses on quality improvement and best practices for radiation dose optimization.
  • Train radiologists, medical specialists, radiological technologists, and administrators to interpret and use feedback reports.
  • Use a phased implementation approach, refining the program with a small number of sites and then expanding to remaining sites.
  • Provide sites with audit and feedback reports.
  • Provide technical assistance to sites, including consultation.
  • Partner with national stakeholder organizations to promote implementation.

Evaluation Outcomes

To document implementation:

  • Number of patients, scans, scanners, and institutions using feedback reports
  • Barriers to implementation of feedback reports

To assess healthcare and health outcomes:

  • Changes over time in CT radiation doses

Project Information

Rebecca Smith-Bindman, MD
University of California, San Francisco
SAFE CT: Software, Actionable Feedback, and Education for Computed Tomography to Help Institutions Optimize Their Radiation Doses

Key Dates

November 2018
July 2024

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Why Do Radiation Doses in CT Differ across Hospitals and Countries?


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Last updated: September 26, 2023