Proper image acquisition and documentation can be an overlooked part of an imaging practice’s workflow, according to an article published in the American Journal of Roentgenology. It’s an important transitional step that requires excellent communication between radiologists and technologists at the risk of downstream consequences.
Researchers from the department of radiology at Memorial Sloan Kettering Cancer Center tracked improvements after implementing an image quality reporting system in their clinical practice. The PACS-integrated software allowed radiologists to quickly and easily fill out incident reports for a variety of issues, including missing images, incomplete documentation and labeling, and problems with the image library.
The previous system used a PDF form that was voluntarily filled out and passed on to a modality supervisor when a radiologist recognized a problem. However, the form was tedious to fill out and difficult to locate on the hospital intranet, disincentivizing radiologists from using it.
The new system—called IQuaRTS—automatically transfers data from the hospital’s PACS to its web-based interface, cutting out duplicative data entry. Radiologists can select from displayed issue categories and enter comments, at which point the report is passed to a database and the relevant individuals are notified. A ticketing system tracks the entire process, including issue stages (identified, resolved, etc.) and communications among department members.
“For instance, a missing series from an examination may in fact have been acquired by the technologist but may not have been pushed to the PACS,” the authors wrote. “Once recognized, the issue of the missing series can be corrected by a request made by the radiologist to the technologist to push the missing series, which is still available on the scanner, to the PACS.”
The reporting system was first deployed in the MRI department in May 2015, expanding to all subspecialties after a two-week testing period. Data points were culled over the next five months and compared to the preceding five, including date of issue submission, identity of submitter, examination site, examination modality, examination subspecialty and category of problem as determined from final resolution.
The results were striking: Memorial Sloan Kettering saw a 635 percent increase in reporting of image quality issues. While a six-fold spike in adverse events could be cause for consternation, the streamlined system allowed most issues to be resolved within 72 hours. According to the authors, the fact all issues were closely tracked to completion by the ticketing system boosted radiologist participation.
“The radiologist participation rate was high (62 percent), probably because of the ease of use and also the relatively quick response times from the technologist quality control team members (55 percent of issues were resolved in the first 24 hours after submission),” they wrote. “The knowledge that submitted issues are being reviewed and addressed encourages participation in a quality control program.”
The real kicker to this system is its low cost: Ong et al. estimates the total cost of the program was about $10,000, mostly going toward 100 hours of developer labor. It’s a small price to pay for quicker resolution to image quality issues and actionable metrics, according to the authors.
“Tools that can easily be accessed from the PACS at the point of care and that enforce a closed-loop communication will encourage radiologists to provide feedback about quality issues, pertaining to both technical excellence and needs for improvement,” wrote Ong et al. "These tools can be developed at relatively low cost and can enable robust data collection and analytics.”