Deploying Clinical Process Improvement Strategies to Reduce Motion Artifacts and Expiratory Phase Scanning in Chest CT

Abstract

We hypothesized that clinical process improvement strategies can reduce frequency of motion artifacts and expiratory phase scanning in chest CT. We reviewed 826 chest CT to establish the baseline frequency. Per clinical process improvement guidelines, we brainstormed corrective measures and priority-pay-off matrix. The first intervention involved education of CT technologists, following which 795 chest CT were reviewed. For the second intervention, instructional videos on optimal breath-hold were shown to 245 adult patients just before their chest CT. Presence of motion artifacts and expiratory phase scanning was assessed. We also reviewed 311 chest CT scans belonging to a control group of patients who did not see the instructional videos. Pareto and percentage run charts were created for baseline and post-intervention data. Baseline incidence of motion artifacts and expiratory phase scanning in chest CT was 35% (292/826). There was no change in the corresponding incidence following the first intervention (36%; 283/795). Respiratory motion and expiratory phase chest CT with the second intervention decreased (8%, 20/245 patients). Instructional videos for patients (and not education and training of CT technologists) reduce the frequency of motion artifacts and expiratory phase scanning in chest CT.

Figure 1

Process Map of Chest CT from physician’s request for a chest CT to finalization of the radiology report.

Figure 2

Ishikawa Fishbone Diagram. The cause and effect diagram for motion impaired and expiratory phase chest CT examinations.

Figure 3

Diagnostic data in Pareto chart depicts the most common causes of motion impaired and expiratory phase scanning in chest CT.

Figure 4

The statistical process chart shows high frequency of motion impaired and expiratory phase chest CT at the baseline and in the PDSA-1 cycle, which reduced substantially in the PDSA-2 cycle.