ACR Unveils a Modular MRI Accreditation Process

The ACR is set to launch a new modular MRI accreditation program designed to meet the specific practice patterns of individual facilities. Sometime this month, the current general MRI accreditation program will transition to the new program—which includes brain, spine, musculoskeletal, body, MR angiography, and cardiac modules—opening the door to specialty magnets and modifying two of the physics tests for 3T MRI. A program for breast MRI is currently under development, but will be folded into the breast imaging accreditation program.

“This new approach offers facilities a more flexible accreditation program that recognizes that facility practice patterns vary, depending on the patient population served and the number of magnets used.” —Theresa Branham, RT, ACR MRI/CT accreditation program manager

Branham continues, “Facilities will have six modules to choose from, so they can match their accreditation to their practice on each magnet.” As in the existing MRI accreditation program, the new modular process includes a combination of self-assessment and independent external audit, based on ACR guidelines and technical standards. The qualifications of personnel, policies and procedures, equipment specifications, quality-assurance activities, and patient safety are similarly assessed. The key difference is that facilities can accredit their magnets for one or more (or even all) of the modules; multimagnet facilities have the option of accrediting different magnets for different purposes. Prices will be listed on the Web site when the program is launched. Some facilities, Branham notes, have multiple magnets and prefer a particular magnet for a particular type of exam. She says, “Other facilities may have a limited patient flow due to several factors, such as the type of physicians they receive referrals from; they may also be specialty or even subspecialty practices.” How It Works Facilities must submit a minimum of four exams if applying for accreditation in just one module, including at least one specialty exam and three basic exams, or a maximum of 6 exams if applying in all six modules, including one specialty exam for each module (see Table 1.) “A basic examination is one that is routinely performed, and of a routine difficulty,” Branham explains. Specialty examinations, she adds, are more difficult to perform at a high level of quality. Facilities may chose from the following specialty exams for each module:

• Brain Exams Brain, for transient ischemic attack
• Internal auditory canal (IAC/temporal bone), for hearing loss
• Brain, for suspected demyelinating disease
• Pituitary, with dynamic contrast enhancement
• Orbits, for vision loss

Spine Exams Lumbar spine

• Thoracic spine
• Cervical spine
• Cervical spine, with contrast for intramedullary disease

Musculoskeletal Exams

• Knee, such as for internal derangement
• Shoulder, such as for internal derangement
• Wrist, such as for internal derangement
• Elbow, such as for internal derangement
• Forefoot, such as for internal derangement

Body Exams

• Male pelvis, such as for prostate cancer
• Renal
• Hepatobiliary, to include MR cholangiopancreatography
• Female pelvis, such as for uterine or adnexal disease

MR Angiography Exams

• Brain
• Carotid
• Thoracic aorta
• Distal peripheral runoff
• High-resolution arch and carotid
• Abdomen, for renal stenosis

Cardiac Exams

• Black blood
• Basic
• Delayed enhanced cine 1
• Delayed enhanced cine 2
• Delayed enhanced cine plus black blood

The new process features a Clinical Image Quality Guide intended to provide additional direction to facilities in producing high-quality images that meet program criteria. “The ACR CT accreditation program has a Clinical Image Quality Guide, and now the ACR has expanded that to the MRI accreditation program,” Branham notes. “The Clinical Image Quality Guide will assist facilities in understanding the requirements and recommendations of the ACR MRI accreditation program as they pertain to image quality for specific examinations. It also covers the scoring categories used by the accreditation reviewers for the clinical images.” The ACR has accepted applications to accredit 3T magnets since July of 2005, but two of the physics tests performed for accreditation have been assigned different pass/fail criteria for 3T magnets in the modular process. The online application will guide users through the process, calculating the number of exams that need to be submitted as well as the cost. “Facilities fill out the application based on the clinical use of the magnet,” Branham explains. “They choose the modalities for which examinations are performed on that magnet; then, the online application process will lead them through selecting the correct number of examinations to submit.” The Specialty Magnets Because the new program provides the option of accrediting a magnet for a narrow range of exams, the program can now accommodate specialty magnets for accreditation. This idea proved controversial when it was first considered, several years ago, because self-referring physicians own a good percentage of specialty magnets. The increasing clamor for accreditation and certification from payors, however, will be likely to muffle any criticism of this aspect of the new program. “Specialty magnets will benefit from ACR accreditation in the same ways that whole-body magnets currently do,” Branham says. “A specialty magnet is defined as a magnet that is not capable of performing MRI examinations on the whole body due to hardware or software limitations, or that is limited by the documented policies and procedures of the facility stating only certain examinations will be performed on that particular unit.” Branham emphatically states, however, that the new modular process does not represent a dumbing down of the accreditation process. “The criteria for ACR MRI accreditation have not been softened for the new modular process,” she says. “On the contrary, the criteria are now more stringent for clinical examinations.” According to Branham, the ACR has responded to the growing demand from payors for accreditation by increasing staff and IT resources. Twelve FTEs are currently dedicated to ACR MRI and CT accreditation alone, 60 to 65 employees are directly involved in the college’s accreditation programs, and a number of other employees provide support assistance. “The ACR has augmented its staff of certified radiologic technologists, associates, and reviewers (both radiologists and medical physicists/MR scientists) in order to help ensure that the accreditation process takes place in a timely manner,” she reports. “We are also developing a new database to carry all of our accreditation programs into the future.” This demand is likely to increase with the recent passage of the Medicare Improvements for Patients and Providers Act of 2008. “The new legislation requires CMS to select accrediting organizations by 2010,” Branham notes. “As a national accrediting body under the current Mammography Quality Standards Act of 1992, we hope to participate as an accrediting body under the new legislation as well.”