Table 7.

Suggested Independent Practitioner & Advanced Practitioner trainee quality improvement (QI) projects.

Initiation Step	Question to be investigated	Possible Intervention	Possible Indicator of Impact
Clinical information and order entry	Are the CCT studies appropriate for the intended clinical question?	-Increasing awareness about appropriateness criteria for CCT by discussion, lectures and multidisciplinary meetings	Decrease in incorrectly ordered studies
Patient preparation	Are pharmaceutical agents appropriately used for patient preparation based on local CCT scanner technology?	Educating the CCT trainees, CT technologists, and nurses regarding the use of pharmaceutical agents and develop an algorithm	Near 0% non-diagnostic studies due to suboptimal heart rate control or patient preparation
Acquisition or protocol	◦Is the utilization of prospective and retrospective ECG-gating appropriate for the clinical question? ◦What is the understanding of various CT artifacts that can be fixed by post-processing like ECG-gating artifacts?	Educating the CCT trainees and CT technologists regarding appropriate patient selection, ECG-gating, CCT protocols, and ECG-gating artifacts and develop an algorithm	Near 0% of studies repeated due to improper protocol selection or ECG-gating related artifact
Image display	Is multiplanar and centerline analysis being routinely performed for evaluation of coronary artery anatomy and disease?	Implement standardized best-practices for interpretation using centerline and multiplanar analysis	<5% interobserver variability with respect to stenosis severity grading
Interpretation	What is the adherence to standardized reporting system?	Implement standardized reporting utilizing CAD RADS	Increased compliance with reporting utilizing CAD RADS recommendations
Communication	◦Does the CCT report communicate findings to the ordering physicians in a clear and consistent fashion? ◦Does the CCT report make suggestions for further management?	Implement standardized reporting utilizing CAD RADS, including any recommendations for downstream testing or medical intervention	◦Increased compliance with guideline-based primary prevention therapy ◦Increased appropriate ischemic testing, revascularization ◦Decreased normal, nonobstructive invasive angiograms
Radiation Dose Monitoring and Reporting	◦Are radiation dose reduction principles being applied to CCT scans by accreditation standards while maintaining appropriate diagnostic quality?	Implement a body-mass index based protocol to apply dose sparing techniques such as reduced scan range, reduced kV imaging and iterative reconstruction	◦Measure and reduce measured radiation dose by 30%