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Chest and cardiac computed tomography (CT) are more susceptible to motion artifacts than any other body region. These artifacts generate from inadequate or suboptimal breath-hold and cardiac pulsations. So, the conclusion is that the motion artifacts are a patient-based artifact that occurs with voluntary or involuntary patient movement during image acquisition. Motion-impaired chest CT contributes considerably to wrong diagnosis and interpretation while detecting lesions and their characteristics. It may also lead to overdiagnosis (such as bronchiectasis and pulmonary embolism). We have investigated the issue to define the clinical process improvement strategies that reduce the frequency of motion artifacts and expiratory phase scanning in chest CT. The cause and effect diagram for motion impaired and expiratory phase chest CT examinations is demonstrated below.

Motion-impaired chest CTs
  Non-cooperative patients

•         Assisted ventilation
•         Unconscious/ disoriented
•         Very sick/ restless
•         Severe pain/ shortness of breath
•         Pediatric patient

Staff issues

•         Not taking corrective action
•         Not following safeguards
•         Lack of clear instructions
•         Inadequate skills/ training
•         Staff shortage/ fatigue

Cooperative patients

•         Understanding barrier
•         Language barrier
•         Coughs/ hiccups
•         Movement during scan

 Equipment issues

•         Damaged scanners
•         Lack of maintenance
•         Outdated/ obsolete scanners
•         Inadequate equipment

The root cause analysis is a structured and organized approach to define the strategies for remediation of any problem. This fishbone describes the issues responsible for motion-impaired chest CT visually.

Who should use the Motion-impaired chest CTs template?

• This template provides most of the reasons for motion artifacts in the chest or cardiac CTs. It is a sample incident analysis to analyze similar or different issues. It targets the audience who wants to perform a root cause analysis/ incident analysis of a motion artifact in chest computed tomography. We welcome all interested people to work with our templates.

 Why use this template?

• It has a set of potential factors that generate motion artifacts in chest CTs.
• Imparts and shares knowledge on incident analysis.
• Design and modify your template or apply this for your own problem-solving.

Curated from community experience and public sources:

•  https://www.researchgate.net/figure/Ishikawa-Fishbone-Diagram-The-cause-and-effect-diagram-for-motion-impaired-and_fig2_335164182