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Implementation of an aortic dissection CT protocol with clinical decision support aimed at decreasing radiation exposure by reducing routine abdominopelvic imaging

  • Author Footnotes
    1 Role: Contributions to the conception and design of the work, the analysis, and interpretation of data for the work, and drafting the work.
    Vishal K. Patel
    Correspondence
    Corresponding author.
    Footnotes
    1 Role: Contributions to the conception and design of the work, the analysis, and interpretation of data for the work, and drafting the work.
    Affiliations
    Department of Radiology, Montefiore Medical Center, Bronx, NY 10467, United States

    Albert Einstein College of Medicine, Bronx, NY 10467, United States
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  • Author Footnotes
    2 Role: Contributions to the acquisition, analysis and interpretation of data for the work.
    Alana Fruauff
    Footnotes
    2 Role: Contributions to the acquisition, analysis and interpretation of data for the work.
    Affiliations
    Albert Einstein College of Medicine, Bronx, NY 10467, United States
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  • Author Footnotes
    3 Role: Contributions to the conception, design of the work and drafting the work.
    David Esses
    Footnotes
    3 Role: Contributions to the conception, design of the work and drafting the work.
    Affiliations
    Albert Einstein College of Medicine, Bronx, NY 10467, United States

    Department of Emergency Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
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  • Author Footnotes
    4 Role: Contributions to the conception, intellectual content, design of the work and drafting the work.
    Evan C. Lipsitz
    Footnotes
    4 Role: Contributions to the conception, intellectual content, design of the work and drafting the work.
    Affiliations
    Albert Einstein College of Medicine, Bronx, NY 10467, United States

    Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY 10467, United States
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  • Author Footnotes
    5 Role: Contributions to the conception, design of the work and drafting the work.
    Jeffrey M. Levsky
    Footnotes
    5 Role: Contributions to the conception, design of the work and drafting the work.
    Affiliations
    Department of Radiology, Montefiore Medical Center, Bronx, NY 10467, United States

    Albert Einstein College of Medicine, Bronx, NY 10467, United States

    Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
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  • Author Footnotes
    6 Role: Substantial contributions to the conception and design of the work, the analysis, and interpretation of data for the work and drafting the work.
    Linda B. Haramati
    Footnotes
    6 Role: Substantial contributions to the conception and design of the work, the analysis, and interpretation of data for the work and drafting the work.
    Affiliations
    Department of Radiology, Montefiore Medical Center, Bronx, NY 10467, United States

    Albert Einstein College of Medicine, Bronx, NY 10467, United States

    Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States
    Search for articles by this author
  • Author Footnotes
    1 Role: Contributions to the conception and design of the work, the analysis, and interpretation of data for the work, and drafting the work.
    2 Role: Contributions to the acquisition, analysis and interpretation of data for the work.
    3 Role: Contributions to the conception, design of the work and drafting the work.
    4 Role: Contributions to the conception, intellectual content, design of the work and drafting the work.
    5 Role: Contributions to the conception, design of the work and drafting the work.
    6 Role: Substantial contributions to the conception and design of the work, the analysis, and interpretation of data for the work and drafting the work.

      Highlights

      • The majority of CT exams in patients imaged for acute aortic syndrome are negative.
      • With a monitored ‘aortic dissection screening’ protocol there is a reduction in contrast and radiation dose.
      • Using clinical decision support to guide the ordering clinician in choosing the best imaging test has a high clinical impact
      • The implementation of an ‘aortic dissection screening’ provides all the imaging necessary for TEVAR planning.

      Abstract

      Patients suspected of having an acute aortic syndrome in the ED typically undergo CT of the chest/abdomen/pelvis. However, the overwhelming majority of these exams are negative. With the help of clinical decision support, we implemented a new radiologist monitored ‘aortic dissection screening protocol’ that forgoes routine abdominopelvic imaging in order to reduce radiation dose without compromising diagnostic accuracy. The purpose of the present study is to assess the performance of this protocol. A retrospective analysis was performed to study the effect of the dissection screening protocol on the diagnostic yield, radiation and contrast dose on a total of 835 ED patients who underwent CT scans for suspected aortic dissection over a 48-week study period immediately before and after implementation of the protocol. 3.4% (28/835) of examinations were positive for an acute aortic syndrome over the 48-week study period with no difference in positivity before and after implementation of the ‘aortic dissection screening’ protocol, 3.0% vs. 3.7%, respectively (p = 0.57). There was a 14.6% reduction in median radiation dose and a 16% decrease in contrast volume utilization for the total ED population who underwent CT for aortic dissection using any protocol in the period after implementation of the ‘aortic dissection screening’ protocol. Aortic dissection CT in the ED is negative in the overwhelming majority of cases. A monitored ‘aortic dissection screening’ protocol that initially images the chest only significantly reduced contrast and radiation dose without reducing diagnostic accuracy for ED patients who underwent CT for aortic dissection.

      Keywords

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