- Email: [email protected]
Prostate MRI - audit of pre-scan and reporting parameters
Abstracts / Clinical Radiology 67 (2012) S11–S20
1st action plan: Standards were met for this audit. However, we believe that not all excised specimens from USS guided localisations had X-rays. Recommendations from this audit: All image guided localisations should have a specimen x-ray with wire in place. The X-ray should be hot reported to improve accuracy of excisions. Specimens should be excised in 1 piece. Re-audit in 1 year after departmental agreement on these recommendations.
Prostate MRI - audit of pre-scan and reporting parameters Authors: Asif Mahmood, Charles Mullan Background to the audit: Prostate cancer is second commonest cause of male cancer deaths after lung cancer. Lifetime risk of developing prostate cancer is 18-19%, and 25-33% of men will die of the disease. MRI is pivotal for radiological staging as it ensure disease is confined to the prostate i.e. T2 (exclude extracapsular spread and lymph node metastasis) and help in treatment planning. Standard, indicator and target: Minimum of four weeks interval after prostate biopsy to reduce effects of haemorrhage on scan quality - 100% Serum PSA result documented on MRI requests - 100% MRI reports explicitly stating 'T' stage - 100% Prostate MRI 'T' stage accuracy ranges between 66-83% Methodology: Review of radiology, laboratory and clinical records of all 46 patients having MRI prostate in 6 month period i.e. 01/07/2010 – 31/12/2010 Results of 1st audit round: Four weeks time interval between prostate biopsy and MRI - 100% PSA level documented on MRI requests - 52% MRI reports clearly stating 'T' stage - 22% MRI 'T' stage accuracy was 50% (2/4). Only 4/46 patients had radical prostatectomy 1st action plan: Discuss with urologists to include most recent PSA level on all MRI requests ‘T’ stage should be documented in all MRI reports MRI ‘T' stage accuracy was 50% however, study sample was small. Reaudit should include at least 20 patients who had radical prostatectomy for true radiological and pathological correlation. Re-audit in 12 months to assess change in practice
S17
1st action plan: Patients will have ultrasound prior to herniography to reduce adverse events. (2) Surgical trainee's advised to discuss these patients with the Consultant. A re-audit is recommended for 2 years time.
Implementing a modified WHO surgical checklist for interventional radiology procedures Authors: Nikolaos Papadakos, Susan Shelmerdine, Gerrard Goh, AnnaMaria Belli. Background to the audit: The modified WHO surgical safety checklist for IR was introduced in the UK in 2010. We report the uptake of the checklist and changes made to improve compliance in our IR department. Standard, indicator and target: The target was to achieve a 100% completion of the checklist for all IR cases performed. Methodology: The audit cycle was repeated 3 times between 06/2010 and 6/2011. All IR procedures which required a WHO checklist were analysed. The correct site marking check was sub-analysed. Results of 1st audit round: 47 of 104 (45.2%) of procedures had a WHO checklist recorded. Of these 2.2% had all 29 checks fully completed. 76.6% had the correct safe site marking appropriately recorded. 1st action plan: Educational and feedback sessions were conducted, elearning and departmental guidelines were introduced to improve compliance. All IR team members were encouraged to be involved with completion of the checklist, with the nursing staff taking the lead. Results of 2nd round: The 2nd and 3rd audit cycles revealed; 106 of 125 (85.0%) vs. 224 of 237 (90.6%) of procedures had a checklist recorded. Of these 49.5% vs. 95.5% had all 29 checks completed. 83.0% vs. 100% had the correct safe site marking appropriately recorded. Between each study period there was a significant improvement (p <0.0001). 2nd action plan: The checklist has the potential to greatly improve patient care but involves a cultural change within busy IR departments to attain 100% compliance, which we will continue to work towards.
Re-audit of reporting times for emergency department CT requests Authors: Amit Patel, Waleed Al-Obaydi, Said Habib
Herniography: a stab in the dark? Authors: Vinesh Mistry, Kevin Vallance, Kalimuthu Marimuthu, Pritesh Mistry, Sadiq Hussain Background to the audit: Herniography is an invasive procedure. This audit was to evaluate herniography at our trust as this has not been looked at previously. This audit looked at the safety and clinical efficacy of herniography. Standard, indicator and target: Current literature suggests herniography has a sensitivity ranging from 81 – 100% and specificity ranging from 92 – 98.4%. With complication rates of around 7.8%. Methodology: The audit was performed using the trusts radiology software; 86 patients were identified that had undergone herniography over a 24 month period. Retrospective analysis of clinical notes and clinical data systems were used to obtain data. Results of 1st audit round: Out of the 86 patients, 2 suffered minor adverse affects including irritation to the dye and 1 patient suffered a major complication, with aortic puncture and injection of dye. No deaths arose from herniography. Minor and major complication rates were 2.33% and 1.16% respectively. 24 patients underwent surgery and herniography correctly identified the presence or absence of a hernia on the symptomatic side of 22 patients. Surgical exploration demonstrated 1 false positive and 1 false negative result. Herniography at our trust has sensitivity of 95.65% (95% confidence interval 0.76 – 0.99) and specificity of 98.46% (95% confidence interval 0.90 – 0.99).
Background to the audit: There is an increasing demand for CT imaging in A&E with added pressure for radiologists to adhere to 4-hour targets. Standard, indicator and target: In our centre, mandatory time standards from CT request to CT report (Request Report Interval; RRI) is < 60 minutes for CT head and < 90 minutes for CT body. Methodology: Prospective data collection by radiologists over 3 week period, October 2011. Clinical and time data was acquired from CRIS and EDIS databases. The primary outcome was the mean RRI. Results of 1st audit round: 2 week prospective audit in September 2009 included 210 CT requests (145 Head and 65 Body). Mean CT head RRI ¼ 51 minutes. Mean CT Body RRI ¼ 69 minutes. Significant delays were identified in A&E assessment, contacting radiology staff and patient transfer. 1st Action Plan: Implemented changes included encouraging prompt CT requests from ED, introduction of wireless telephony for radiology SPRs, employment of CT portering staff and introduction of a second dedicated A&E CT scanner. Results of 2nd round: 340 patients over 3 week period ¼ 236 CT Head and 104 CT Body. Mean RRI for CT heads ¼ 69 minutes (failing to meet standard). Mean RRI for CT body ¼ 82 minutes. Delays identified due to A&E assessment, portering, inadequate radiographer staffing levels and reporting of imaging by junior registrars (ST1/ST2). 2nd action plan: Changes included training for ED doctors, a second increase in portering and radiographer staffing levels, direct supervision of junior registrars and implementation of an escalation policy.
1st action plan: Standards were met for this audit. However, we believe that not all excised specimens from USS guided localisations had X-rays. Recommendations from this audit: All image guided localisations should have a specimen x-ray with wire in place. The X-ray should be hot reported to improve accuracy of excisions. Specimens should be excised in 1 piece. Re-audit in 1 year after departmental agreement on these recommendations.
Prostate MRI - audit of pre-scan and reporting parameters Authors: Asif Mahmood, Charles Mullan Background to the audit: Prostate cancer is second commonest cause of male cancer deaths after lung cancer. Lifetime risk of developing prostate cancer is 18-19%, and 25-33% of men will die of the disease. MRI is pivotal for radiological staging as it ensure disease is confined to the prostate i.e. T2 (exclude extracapsular spread and lymph node metastasis) and help in treatment planning. Standard, indicator and target: Minimum of four weeks interval after prostate biopsy to reduce effects of haemorrhage on scan quality - 100% Serum PSA result documented on MRI requests - 100% MRI reports explicitly stating 'T' stage - 100% Prostate MRI 'T' stage accuracy ranges between 66-83% Methodology: Review of radiology, laboratory and clinical records of all 46 patients having MRI prostate in 6 month period i.e. 01/07/2010 – 31/12/2010 Results of 1st audit round: Four weeks time interval between prostate biopsy and MRI - 100% PSA level documented on MRI requests - 52% MRI reports clearly stating 'T' stage - 22% MRI 'T' stage accuracy was 50% (2/4). Only 4/46 patients had radical prostatectomy 1st action plan: Discuss with urologists to include most recent PSA level on all MRI requests ‘T’ stage should be documented in all MRI reports MRI ‘T' stage accuracy was 50% however, study sample was small. Reaudit should include at least 20 patients who had radical prostatectomy for true radiological and pathological correlation. Re-audit in 12 months to assess change in practice
S17
1st action plan: Patients will have ultrasound prior to herniography to reduce adverse events. (2) Surgical trainee's advised to discuss these patients with the Consultant. A re-audit is recommended for 2 years time.
Implementing a modified WHO surgical checklist for interventional radiology procedures Authors: Nikolaos Papadakos, Susan Shelmerdine, Gerrard Goh, AnnaMaria Belli. Background to the audit: The modified WHO surgical safety checklist for IR was introduced in the UK in 2010. We report the uptake of the checklist and changes made to improve compliance in our IR department. Standard, indicator and target: The target was to achieve a 100% completion of the checklist for all IR cases performed. Methodology: The audit cycle was repeated 3 times between 06/2010 and 6/2011. All IR procedures which required a WHO checklist were analysed. The correct site marking check was sub-analysed. Results of 1st audit round: 47 of 104 (45.2%) of procedures had a WHO checklist recorded. Of these 2.2% had all 29 checks fully completed. 76.6% had the correct safe site marking appropriately recorded. 1st action plan: Educational and feedback sessions were conducted, elearning and departmental guidelines were introduced to improve compliance. All IR team members were encouraged to be involved with completion of the checklist, with the nursing staff taking the lead. Results of 2nd round: The 2nd and 3rd audit cycles revealed; 106 of 125 (85.0%) vs. 224 of 237 (90.6%) of procedures had a checklist recorded. Of these 49.5% vs. 95.5% had all 29 checks completed. 83.0% vs. 100% had the correct safe site marking appropriately recorded. Between each study period there was a significant improvement (p <0.0001). 2nd action plan: The checklist has the potential to greatly improve patient care but involves a cultural change within busy IR departments to attain 100% compliance, which we will continue to work towards.
Re-audit of reporting times for emergency department CT requests Authors: Amit Patel, Waleed Al-Obaydi, Said Habib
Herniography: a stab in the dark? Authors: Vinesh Mistry, Kevin Vallance, Kalimuthu Marimuthu, Pritesh Mistry, Sadiq Hussain Background to the audit: Herniography is an invasive procedure. This audit was to evaluate herniography at our trust as this has not been looked at previously. This audit looked at the safety and clinical efficacy of herniography. Standard, indicator and target: Current literature suggests herniography has a sensitivity ranging from 81 – 100% and specificity ranging from 92 – 98.4%. With complication rates of around 7.8%. Methodology: The audit was performed using the trusts radiology software; 86 patients were identified that had undergone herniography over a 24 month period. Retrospective analysis of clinical notes and clinical data systems were used to obtain data. Results of 1st audit round: Out of the 86 patients, 2 suffered minor adverse affects including irritation to the dye and 1 patient suffered a major complication, with aortic puncture and injection of dye. No deaths arose from herniography. Minor and major complication rates were 2.33% and 1.16% respectively. 24 patients underwent surgery and herniography correctly identified the presence or absence of a hernia on the symptomatic side of 22 patients. Surgical exploration demonstrated 1 false positive and 1 false negative result. Herniography at our trust has sensitivity of 95.65% (95% confidence interval 0.76 – 0.99) and specificity of 98.46% (95% confidence interval 0.90 – 0.99).
Background to the audit: There is an increasing demand for CT imaging in A&E with added pressure for radiologists to adhere to 4-hour targets. Standard, indicator and target: In our centre, mandatory time standards from CT request to CT report (Request Report Interval; RRI) is < 60 minutes for CT head and < 90 minutes for CT body. Methodology: Prospective data collection by radiologists over 3 week period, October 2011. Clinical and time data was acquired from CRIS and EDIS databases. The primary outcome was the mean RRI. Results of 1st audit round: 2 week prospective audit in September 2009 included 210 CT requests (145 Head and 65 Body). Mean CT head RRI ¼ 51 minutes. Mean CT Body RRI ¼ 69 minutes. Significant delays were identified in A&E assessment, contacting radiology staff and patient transfer. 1st Action Plan: Implemented changes included encouraging prompt CT requests from ED, introduction of wireless telephony for radiology SPRs, employment of CT portering staff and introduction of a second dedicated A&E CT scanner. Results of 2nd round: 340 patients over 3 week period ¼ 236 CT Head and 104 CT Body. Mean RRI for CT heads ¼ 69 minutes (failing to meet standard). Mean RRI for CT body ¼ 82 minutes. Delays identified due to A&E assessment, portering, inadequate radiographer staffing levels and reporting of imaging by junior registrars (ST1/ST2). 2nd action plan: Changes included training for ED doctors, a second increase in portering and radiographer staffing levels, direct supervision of junior registrars and implementation of an escalation policy.