Harmonizing CT Quality Control, Protocols, and Dose Thresholds across a Multi-Institution Enterprise with Shared Radiology Services
Abstract
Purpose
Large multi-institution healthcare networks often operate diverse fleets of CT scanners while sharing the same radiology practice for clinical interpretation. Variability in CT protocols, quality control (QC) processes, and dose thresholds across separate institutions can lead to inconsistent image quality, workflow inefficiencies, and challenges in maintaining unified diagnostic expectations for radiologists. This project aimed to develop and implement a standardized framework for harmonizing CT protocols, QC benchmarks, and dose thresholds across two independent healthcare systems served by a single radiology group.
Methods
CT scanners across both healthcare systems were systematically reviewed for protocol design, acquisition parameters, reconstruction techniques, and vendor-specific implementation differences. A unified QC framework was established to standardize daily and periodic QC metrics, including water CT number accuracy, image noise, uniformity, spatial resolution, low-contrast detectability, and CTDIvol performance. Protocol harmonization focused on aligning clinical indications, scan geometry, tube potential, tube current modulation strategies, reconstruction algorithms, and slice thickness across scanners where clinically feasible. Protocol-specific dose thresholds were developed using historical dose data, scanner capabilities, institutional practices, and published guidance. QC data and dose metrics were aggregated and analyzed before and after harmonization to assess variability across scanners and institutions.
Results
Substantial protocol variability, inconsistent QC interpretation, and dose-reporting discrepancies were identified across the two institutions. Harmonizing protocols and QC metrics improved image quality consistency and allowed the creation of unified dose thresholds. The standardized framework improved communication across physics, technologist, and leadership teams and supported more uniform clinical imaging performance across the shared radiology service.
Conclusion
Harmonizing CT protocols, quality control benchmarks, and dose thresholds across independent healthcare systems served by the same radiology group improves image quality consistency, strengthens patient safety practices, and enhances enterprise-level quality and dose governance. This structured, physicist-led approach provides a scalable model for multi-institution CT standardization within large healthcare networks.