- Implementation of Low-Dose Renal Colic Protocol CT
- Reducing Potentially Avoidable Staging Imaging in Lower Risk Prostate Cancer
- Clinical Decision Support for Advanced Imaging (R-SCAN)
- Development and Implementation of Prostate MRI Programs
- American College of Radiology Programs to Support Imaging Stewardship
- Implementation of Ultrasound in Urology Practice
- Imaging Stewardship QI Project Library
Dose Optimization for Stone Evaluation (DOSE)
The DOSE initiative is funded by the Agency for Healthcare Research and Quality to disseminate understanding and implementation of institutional practices that adhere to the “as low as reasonably achievable” (ALARA) principle when performing a CT for possible or known kidney stone. This initiative’s overall aim is to reduce radiation dose and dose variability for kidney stone CT and thereby improve quality and patient safety.
Kidney stones affect 10% of the US population over their lifetime leading to one million emergency department visits annually for stone evaluation. Nearly 80% of patients receive a CT scan when presenting to the ED with symptoms. Current recommendations of the American College of Radiology Appropriateness Criteria for Acute Onset Flank Pain states that “reduced-dose techniques are preferred” for kidney stone CT. Despite this, Weisenthal et al showed less than 8% of 2015-2016 kidney stone CT exams nationwide met the reduced dose criteria of DLP<200mGy*cm.
DOSE’s intervention allows institutions to create and implement reduced-dose CT for kidney stone. Joining is free and will provide you:
- Reduced Dose CT protocols individualized to CT scanner and current stone protocol
- DOSE’s Practice Quality Improvement template for implementation guidance
- Access to online CME modules
The AUA has been at the vanguard of efforts supporting stewardship of imaging, with the organization’s first Choosing Wisely recommendation stating that “A routine bone scan is unnecessary in men with low risk prostate cancer.”
Dr. Jim Montie presented the Michigan Urologic Surgery Improvement Collaborative (MUSIC) experience with reducing potentially avoidable staging imaging in prostate cancer to the QI Summit. The MUSIC Appropriateness Criteria are available as a downloadable PDF, and more information, including video links is available online.
The American College of Radiology’s Radiology Support, Communication and Alignment Network (R-SCAN) is a collaborative action plan that brings radiologists and referring clinicians together to improve imaging appropriateness based on a growing list of imaging Choosing Wisely topics. R-SCAN delivers immediate access to web-based tools and clinical decision support (CDS) technology that can help you optimize imaging care, reduce unnecessary imaging exams and lower the cost of care. There is no cost to participate, and R-SCAN participants may earn up to seven Improvement Activity credits under the CMS Quality Payment Program. R-SCAN is an easy (and free) way to try out CDS, which current legislation (the Protecting Access to Medicare Act of 2014) will require for most advanced imaging orders for Medicare patients. More information is available on the R-SCAN website or via Nancy Fredericks, MBA, R-SCAN Director.
Magnetic Resonance Imaging (MRI) is assuming an increasingly important role in prostate cancer care. The American College of Radiology (ACR) has taken an active role in the development of standards and educational resources to support the implementation of quality imaging programs. A foundation of these efforts is the Prostate Imaging and Reporting and Data System (PI-RADS), currently in version 2.0. In addition, the ACR offers educational courses to support the implementation of these standards.
In addition to the R-SCAN and PIRADS programs, the ACR provides a number of additional practical resources to support the stewardship of advanced imaging services. The ACR Appropriateness Criteria are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. The ACR has also published frequently asked questions related to the NEMA XR-29 (MITA Smart Dose) Standard to assist providers and facilities with compliance with requirements for CT dose optimization and management under the Protecting Access to Medicare Act.
Ultrasound Accreditation Program for Urology Practices
The AUA and the American Institute of Ultrasound in Medicine (AIUM) have collaborated to develop ultrasound accreditation program for urology practices
Urology practices now have a pathway for accreditation for the performance of ultrasound in the practice of urology. The accreditation program was developed by a joint task force consisting of members from the AUA and the AIUM. The accreditation program is offered by the AIUM. This is a voluntary program developed so that urology practices can demonstrate through an objective third party (AIUM) that high quality imaging is being performed in a safe environment by trained providers.
The AUA/AIUM Joint Ultrasound Task Force have created:
- Practice Guideline for the Performance of an Ultrasound Examination in the Practice of Urology
- Standards and Guidelines for the Accreditation of Ultrasound Practices
- Training Guidelines for the Performance of Ultrasound Examinations in the Practice of Urology
These documents provide the framework for the AIUM accreditation program for the performance of ultrasound in the practice of urology.
The AUA/AIUM Practice Guideline on the use of ultrasound in the practice of urology for accreditation purposes is separate and distinct from, and should not be confused with AUA's Clinical Practice Guidelines that involve a process of systematic review and analysis, ranking of evidence, development of guideline statements linked to strength of evidence, and thorough peer review.
In addition to the above-outlined resources, the Imaging Stewardship Workgroup of the AUA Quality Improvement and Patient Safety Committee has assembled a number of resources available for practices and urology residency programs to utilize as supporting material for local quality improvement activities.
- Multiple CT Scenarios [pdf]
- Framework for Conducting a Quality Assessment and Improvement Project in Urology Practice [pdf]
- Impact of a Clinical Pathway for Acute Nephrolithiasis in a Pediatric Emergency Department [pdf]
- Balancing Diagnostic Efficacy and Radiation Modulation for MDCT Imaging of Renal Cell Carcinoma [pdf]