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Grant Details

Grant Number: 5R01CA181191-05 Interpret this number
Primary Investigator: Smith-Bindman, Rebecca
Organization: University Of California, San Francisco
Project Title: CT Dose Collaboratory
Fiscal Year: 2019


DESCRIPTION (provided by applicant): Computed tomography (CT) is frequently used for medical scanning and can deliver high doses of radiation to patients. Yet because few standards exist for CT examinations, the radiation doses that patients receive during CT vary widely. Routinely, doses are higher than needed for medical diagnoses-and high enough to be associated with increased cancer risk. The proposed project is a multisite collaboration studying improved standards for conducting CT, including the radiation doses used, and developing strategies to apply (implement) and spread (disseminate) these standards in different clinics and hospitals. The project will use a mixture of methods including a randomized controlled trial, observational data, and key informant interviews. The work strives to improve CT safety and cancers associated with radiation from CT by lowering the doses that patients receive. The project includes an implementation trial to learn how to broadly teach clinics and hospitals about the best and safest CT practices. The process of change will vary with different health care settings and different organizational structures. This study seeks to understand the best strategies to adapt CT safety interventions by learning what factors improve both implementation and dissemination of the best practice guidelines. Our project is a partnership with diverse healthcare delivery organizations in the US, Canada, and Europe in collaboration with Bayer Health. These public, private, academic, and community-based care systems include both fee-for-service and prepaid care organizations and will serve as our test bed sites. Non-US institutions are included since radiation safety around medical imaging is a great concern in these countries, and their hospitals and researchers have experience in CT radiation dose monitoring and optimizing. Our research team includes scientists with expertise in biostatistics, radiology, radiation physics, and dissemination and implementation sciences, and health system leaders who focus on quality improvement and are champions for optimizing medical imaging doses. All participating health care systems already use eXposure, the Bayer Health software for radiation dose monitoring. The purchase of eXposure shows the interest and commitment of the health care organizations to collecting data on the radiation doses used in clinical practice and using data to optimize medical imaging doses. The sites are thus ideal partners for this project. Each has project champions, but not the expertise or strategy to optimize CT radiation dosages. Organizing the project around existing relationships that can already collect data securely from a range of software platforms minimizes data collection complexity, overcoming a main hurdle in developing a widely implementable quality improvement program. This will allow our research team to focus on the proposed study aims of disseminating and implementing change. We will 1) conduct a randomized controlled pragmatic trial with a stepped-wedge design to compare simple audit with feedback vs. a tailored, multicomponent intervention as strategies for facility-level optimization of CT radiation dose, 2) assess the degree of implementation and identify facilitators, barriers and successful and failed strategies for implementing dose optimization and sustaining improvements in CT radiation dosing over 2 years following intervention, and 3) broadly disseminate and evaluate dissemination of the intervention at several institutions, focusing on the most effective solutions from the pragmatic trial.


Diagnostic reference levels and median doses for common clinical indications of CT: findings from an international registry.
Authors: Bos D. , Yu S. , Luong J. , Chu P. , Wang Y. , Einstein A.J. , Starkey J. , Delman B.N. , Duong P.T. , Das M. , et al. .
Source: European radiology, 2021-10-13; , .
EPub date: 2021-10-13.
PMID: 34642811
Related Citations

Barriers to CT Dose Optimization: The Challenge of Organizational Change.
Authors: Whitebird R.R. , Solberg L.I. , Bergdall A.R. , López-Solano N. , Smith-Bindman R. .
Source: Academic radiology, 2021 03; 28(3), p. 387-392.
EPub date: 2020-04-09.
PMID: 32278691
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Organizational Factors and Quality Improvement Strategies Associated With Lower Radiation Dose From CT Examinations.
Authors: Solberg L.I. , Wang Y. , Whitebird R. , Lopez-Solano N. , Smith-Bindman R. .
Source: Journal of the American College of Radiology : JACR, 2020 Jul; 17(7), p. 951-959.
EPub date: 2020-03-17.
PMID: 32192955
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Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial.
Authors: Smith-Bindman R. , Chu P. , Wang Y. , Chung R. , Lopez-Solano N. , Einstein A.J. , Solberg L. , Cervantes L.F. , Yellen-Nelson T. , Boswell W. , et al. .
Source: JAMA internal medicine, 2020-05-01; 180(5), p. 666-675.
PMID: 32227142
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Analysis of Computed Tomography Radiation Doses Used for Lung Cancer Screening Scans.
Authors: Demb J. , Chu P. , Yu S. , Whitebird R. , Solberg L. , Miglioretti D.L. , Smith-Bindman R. .
Source: JAMA internal medicine, 2019-12-01; 179(12), p. 1650-1657.
PMID: 31545340
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International variation in radiation dose for computed tomography examinations: prospective cohort study.
Authors: Smith-Bindman R. , Wang Y. , Chu P. , Chung R. , Einstein A.J. , Balcombe J. , Cocker M. , Das M. , Delman B.N. , Flynn M. , et al. .
Source: BMJ (Clinical research ed.), 2019-01-02; 364, p. k4931.
EPub date: 2019-01-02.
PMID: 30602590
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Joint Indirect Standardization when Only Marginal Distributions are Observed in the Index Population.
Authors: Wang Y. , Tancredi D.J. , Miglioretti D.L. .
Source: Journal of the American Statistical Association, 2019; 114(526), p. 622-630.
EPub date: 2018-10-29.
PMID: 31452558
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Optimizing Radiation Doses for Computed Tomography Across Institutions: Dose Auditing and Best Practices.
Authors: Demb J. , Chu P. , Nelson T. , Hall D. , Seibert A. , Lamba R. , Boone J. , Krishnam M. , Cagnon C. , Bostani M. , et al. .
Source: JAMA internal medicine, 2017-06-01; 177(6), p. 810-817.
PMID: 28395000
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Predictors of CT Radiation Dose and Their Effect on Patient Care: A Comprehensive Analysis Using Automated Data.
Authors: Smith-Bindman R. , Wang Y. , Yellen-Nelson T.R. , Moghadassi M. , Wilson N. , Gould R. , Seibert A. , Boone J.M. , Krishnam M. , Lamba R. , et al. .
Source: Radiology, 2017 Jan; 282(1), p. 182-193.
EPub date: 2016-07-20.
PMID: 27438166
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Authors: Shah A.D. , McHargue C. , Yee J. , Rushakoff R.J. .
Source: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2016 Apr; 22(4), p. 502-5.
EPub date: 2016-01-20.
PMID: 26789340
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Radiation Doses in Consecutive CT Examinations from Five University of California Medical Centers.
Authors: Smith-Bindman R. , Moghadassi M. , Wilson N. , Nelson T.R. , Boone J.M. , Cagnon C.H. , Gould R. , Hall D.J. , Krishnam M. , Lamba R. , et al. .
Source: Radiology, 2015 Oct; 277(1), p. 134-41.
EPub date: 2015-05-19.
PMID: 25988262
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