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Q&A with Dr. Donald P. Frush; A more personalized approach to pediatric CT exams

by John R. Fischer, Senior Reporter | March 09, 2018
CT Pediatrics X-Ray
From the March 2018 issue of HealthCare Business News magazine

The protocols are not always mindful of all of those things. Generally, I think protocols take into account indication, so if you’re looking for a small liver lesion, you would do it differently than looking for a kidney stone, than looking for a valve obstruction, than doing an evaluation of the lumbar spine, which would also necessitate an abdomen scan. I think those are different protocols or set-ups and people understand that.

I would say that oftentimes, that if you have a 110-pound young man versus a 250-pound individual, sometimes the adjustments are not made or made appropriately to account for differences in size in those individuals with respect to certain parameters. The machine does some of those things. We’ll look at it and say, ‘OK. This is a bigger person. We need to X versus Y.’

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The first thing is different protocols for different indications, such as kidney stones versus kidney lesions versus something else. Then, it goes down the list on these other three things, and I think there is successfully less attention paid and less modifications done in protocols.

What we did was simply to say all of these elements are important and we created a model where all of these elements are simply blended together to provide a framework or a roadmap to set your scan depending on how you want to emphasize the image quality. It was sort of a little bit of a tool kit for the individual to not have to do the fine evaluation of image quality, to not have to look at radiation dose. We sort of provided those elements to craft a tool for the range of sizes for this desired image quality. This is what the settings would be.

To the best of my knowledge, there’s no protocol or widely available set of protocols that combine all those elements for you. There are variable contributions of maybe one, two, three elements, but those aren’t all put in there. It’s usually just manufacturer-based protocols with some modifications that university-based programs or people might do, but generally, a protocol for an abdomen CT, giving it a meaning or when equipment is put in, the manufacturer will say, ‘Well, these are protocols that this institution is using and people just sort of put these on and use them.’

It’s not to say that’s bad. Many places do quite good work, providing diagnostic information at doses that are very reasonable, but what our model does is say, ‘OK. What is everything that we’re accountable for, and how do we put all of these things together in a tool kit where we would work to get these protocols across many indications out there?’ It’s fine-tuning it a little bit and developing something where a private community practice doesn’t need to go through what was done to develop this. What were the various components, how they affected scan quality, and so on.

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