Emerging research suggests that implementation of automated computed tomography (CT) protocols may lead to significant efficiencies in radiology workflows.
For the retrospective study, recently published in the American Journal of Roentgenology, researchers reviewed 317,597 CT examinations (mean patient age of 61.8 years) to assess the impact of automated CT protocols on process times and error rates for inpatients, outpatients, and emergency department patients.
The three phases of the study included an initial six-month deployment phase with basic rules for automated protocols, a year-long implementation period that included numerous updates to the automated protocoling rules, and a six-month post-implementation phase, according to the study.
The study authors found that automated CT protocols resulted in 99.9 percent of emergency department (ED) and inpatient CT exams being assigned a protocol within one hour after placement of the CT order in comparison to 75.9 percent of CT exams with manual protocoling.
“This difference is crucial because, for ED and inpatient CT examinations at the study institution, the technologist calls for patient transportation only after protocol assignment. … By decreasing the time to examination completion, this rapid protocoling of ED and inpatient examinations using the automated system may also decrease delays in downstream care,” wrote lead study author Ryan Chung, M.D., an instructor of radiology in the Division of Abdominal Radiology in the Department of Radiology at Massachusetts General Hospital in Boston, and colleagues.
Researchers noted 12.1 percent, 22 percent, and 56.8 percent increases in the frequency of automated CT protocols between pilot and post-implementation phases for ED patients (from 53.2 to 65.3 percent), inpatients (from 37.8 to 59.8 percent), and outpatients (from 9 to 65.8 percent) respectively.
The study authors found a greater than 36 percent growth in the overall frequency of automated CT protocols from the initial deployment phase (27.4 percent) to the post-implementation phase (64.6 percent). The researchers also noted 12.1 percent, 22 percent, and 56.8 percent increases in the frequency of automated CT protocols between pilot and post-implementation phases for ED patients (from 53.2 to 65.3 percent), inpatients (from 37.8 to 59.8 percent), and outpatients (from 9 to 65.8 percent) respectively.
The reduction in the use of manual CT protocols can result in significant time savings for radiologists, according to the study authors.
“The system also reduces such non-interpretive tasks by reducing the frequency with which the technologist interrupts the radiologist to promptly provide a missing protocol,” added Chung and colleagues. “Such non-interpretive work can occupy a substantial amount of radiologists’ time.”
Three Key Takeaways
1. Significant efficiency gains. Implementation of automated computed tomography (CT) protocols led to notable efficiencies in radiology workflows. The study found that 99.9 percent of emergency department (ED) and inpatient CT exams were assigned a protocol within one hour after placement of the CT order, compared to 75.9 percent with manual protocoling.
2. Significant increases in automated CT protocol frequency. The study reported a substantial shift towards automated CT protocols, revealing over a 36 percent growth in overall frequency. Specifically, there were noteworthy increases in automated CT protocol frequency of 12.1 percent for emergency department (ED) patients, 22 percent for inpatients, and 56.8 percent for outpatients. This surge in adoption underscores the widespread acceptance and preference for automated protocols, highlighting their role in streamlining radiology workflows and enhancing efficiency.
3. Increased standardization of CT protocols? Automated CT protocols were suggested to facilitate improved standardization in the face of a radiologist shortage and increasing imaging volume. The system reliably enforced rules that incorporated a greater number of patient and order factors, potentially leading to more frequent utilization of specialized protocols and avoiding oversight of important patient factors.
In the midst of a radiologist shortage and increasing imaging volume, the study authors also suggested that the advent of automated CT protocols may facilitate improved standardization.
“Radiologists may miss important patient factors (allergies, renal function) and less readily apparent order details (specific diagnoses or requests) when protocoling high volumes of cases. Radiologists may also develop tendencies to select preferred protocols by default unless identifying one of a small number of exceptions to their patterns,” pointed out Chung and colleagues.
“The automated system reliably enforces rules incorporating a more substantial number of patient and order factors, potentially leading to more frequent utilization of specialized protocols.”
(Editor’s note: For related content, see “Study Finds Non-Contrast CT 30 Percent Less Accurate than CECT for Abdominal Pain in the ER,” “Study Shows Significant Overutilization of Head and Neck CT Angiography in the ER” and “Should Dual-Source CT be the New Standard for ER CCTA Assessment of Acute Chest Pain?”)
In regard to study limitations, the authors conceded that the rules-based approach for automated CT protocoling requires ongoing maintenance to stay on top of complexities in CT ordering and terminology changes that must also be reflected in a given facility’s EHR system. The researchers noted that institution proprietary software was utilized for the automated CT protocoling, which was also modified during the study period to exclude use in children.