The pre-CT checklist: A simple tool to improve workflow and patient safety in an outpatient CT setting.

PURPOSE: We aim to share our experience with implementation of a simple checklist to improve workflow and safety in patients scheduled for outpatient CT. METHODS: After identification of several recurrent problems leading to study delays or cancellation, a pre-CT checklist to be used by designated CT technologist in advance of patients' scheduled appointment was designed with input from CT technologists, radiologists, schedulers and nurses. RESULTS: Implementation of the checklist led to further actions in 25.9% of cases. The most common actions were calls to referring providers to modify or clarify an order (24.3%), followed by verification of proper premedication in patients with allergy to iodinated contrast (12.7%) and contacting the radiologist for protocolling (12.7%). CONCLUSIONS: Implementation of a pre-CT checklist that can be tailored to individual practices has potential to improve patients' safety and experience as well as providing a more efficient clinical operation. SUMMARY SENTENCE: We present an easy-to-implement checklist to maximize CT throughput in an outpatient setting that can be customized to the needs of individual institutions and has the potential to improve patients' safety and experience.

Prospective CT screening for lung cancer in a high-risk population: HIV-positive smokers.

BACKGROUND: Epidemiological evidence suggests that HIV-infected individuals are at increased risk of lung cancer, but no data exist because large computed tomography (CT) screening trials routinely exclude HIV-infected participants. METHODS: From 2006 to 2013, we conducted the world's first lung cancer screening trial of 224 HIV-infected current/former smokers to assess the CT detection rates of lung cancer. We also used 130 HIV-infected patients with known lung cancer to determine radiographic markers of lung cancer risk using multivariate analysis. RESULTS: Median age was 48 years with 34 pack-years smoked. During 678 person-years, one lung cancer was found on incident screening. Besides this lung cancer case, 18 deaths (8%) occurred, but none were cancer related. There were no interim diagnoses of lung or extrapulmonary cancers. None of the pulmonary nodules detected in 48 participants at baseline were diagnosed as cancer by study end. The heterogeneity of emphysema across the entire lung as measured by CT densitometry was significantly higher in HIV-infected subjects with lung cancer compared with the heterogeneity of emphysema in those without HIV (p ≤ 0.01). On multivariate regression analysis, increased age, higher smoking pack-years, low CD4 nadir, and increased heterogeneity of emphysema on quantitative CT imaging were all significantly associated with lung cancer. CONCLUSIONS: Despite a high rate of active smoking among HIV-infected participants, only one lung cancer was detected in 678 patient-years. This was probably because of the young age of participants suggesting that CT screening of high-risk populations should strongly consider advanced age as a critical inclusion criterion. Future screening trials in urban American must also incorporate robust measures to ensure HIV patient compliance, adherence, and smoking cessation.