Quality—A Radiology Imperative: Report of the 2006 Intersociety Conference

Biopsy of the same organ within 30 days: a potential radiology performance measure

PURPOSE

To assess the potential value of repeat image-guided biopsy within 30 days as a radiology performance metric.

METHODS

This was a HIPAA-compliant IRB-approved retrospective cohort study of all consecutive ultrasound- and CT-guided core biopsies of the chest, abdomen, and pelvis performed at one institution November 2016 to June 2020. The inclusion criterion was repeat biopsy of the same organ within 30 days of the initial biopsy. Details of both biopsies were recorded, including indication, organ, post-biopsy histology, performing service, performing provider. Histologic concordance between initial and repeat biopsies was calculated. Proportions and 95% confidence intervals were calculated.

RESULTS

Repeat biopsy was performed after 1.9% (95% CI 1.5-2.4% [N = 89]) of 4637 initial biopsies. For structures with ≥ 100 biopsies performed, the repeat biopsy proportion ranged from 1.3% (5/378, US-guided renal biopsy) to 2.7% (11/413, CT-guided retroperitoneal biopsy). The most common indication for initial biopsy was possible malignancy (66% [59/89]). The most common indication for repeat biopsy was radiology-histology discrepancy (36% [32/89]). Repeat biopsies were more likely to show malignant cells and to have diagnostic tissue (Repeat: 48.3% malignant; 20.2% benign; 1.1% nondiagnostic; Initial: 25.8% malignant; 23.6% benign; 14.6% nondiagnostic). The most common histology difference after repeat biopsy was a change in malignant diagnosis (38.2% [34/89]).

CONCLUSION

Repeat percutaneous biopsy within 30 days of the same organ is uncommon (~ 2%), but when indicated, it commonly changes diagnosis and improves diagnostic yield. Repeat biopsy within 30 days is a potential performance measure for radiology procedure services.

Structured reporting of x-rays for atraumatic shoulder pain: advantages over free text?

Background

To analyse structured and free text reports of shoulder X-ray examinations evaluating the quality of reports and potential contributions to clinical decision-making.

Methods

We acquired both standard free text and structured reports of 31 patients with a painful shoulder without history of previous trauma who received X-ray exams. A template was created for the structured report based on the template ID 0000154 (Shoulder X-ray) from radreport.org using online software with clickable decision trees with concomitant generation of structured semantic reports. All reports were evaluated regarding overall quality and key features: content, information extraction and clinical relevance.

Results

Two experienced orthopaedic surgeons reviewed and rated structured and free text reports of 31 patients independently. The structured reports achieved significantly higher median ratings in all key features evaluated (P < 0.001), including facilitation of information extraction (P < 0.001) and better contribution to subsequent clinical decision-making (P < 0.001). The overall quality of structured reports was significantly higher than in free text report (P < 0.001).

Conclusions

A comprehensive structured template may be a useful tool to assist in clinical decision-making and is, thus, recommended for the reporting of degenerative changes regarding X-ray examinations of the shoulder.

Electronic supplementary material

The online version of this article (10.1186/s12880-018-0262-8) contains supplementary material, which is available to authorized users.

Defining Quality in Cardiovascular Imaging: A Scientific Statement From the American Heart Association

The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care. Our proposed statement may serve as the foundation for integrating these quality indicators into establishing designations of quality laboratory practices and developing standards for value-based payment reform for imaging services. We also include recommendations for future clinical research to fulfill quality aims within cardiovascular imaging, including clinical hypotheses of improving patient outcomes, the importance of health status as an end point, and deferred testing options. Future research should evolve to define novel methods optimized for the role of cardiovascular imaging for detecting disease and guiding treatment and to demonstrate the role of cardiovascular imaging in facilitating healthcare quality.

Big Data and Machine Learning-Strategies for Driving This Bus: A Summary of the 2016 Intersociety Summer Conference

The 38th radiology Intersociety Committee reviewed the current state and future direction of clinical data science and its application to radiology practice. The assembled participants discussed the need to use current technology to better generate and demonstrate radiologists' value for our patients and referring providers. The attendants grappled with the potentially disruptive applications of machine learning to image analysis. Although the prospect of algorithms' interpreting images automatically initially shakes the core of the radiology profession, the group emerged with tremendous optimism about the future of radiology. Emerging technologies will provide enormous opportunities for radiologists to augment and improve the quality of care they provide to their patients. Radiologists must maintain an active role in guiding the development of these technologies. The conference ended with a call to action to develop educational strategies for future leaders, communicate optimism for our profession's future, and engage with industry to ensure the ethics and clinical relevance of developing technologies.

The Science of Quality Improvement

Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs. Randomized controlled trials and cluster randomized trials are typically reserved for large-scale research projects evaluating the effectiveness of QI interventions that may be implemented broadly, have more than a minimal impact on patients, or are costly. Systematic reviews of QI studies will play an important role in providing overviews of evidence supporting particular QI interventions or methods of achieving change. We also review the general requirements for developing quality measures for reimbursement, public reporting, and pay-for-performance initiatives. A critical part of the testing process for quality measures includes assessment of feasibility, reliability, validity, and unintended consequences. Finally, publication and critical appraisal of QI work is discussed as an essential component to generating evidence supporting QI initiatives in radiology.

Quality metrics currently used in academic radiology departments: results of the QUALMET survey

OBJECTIVE

We present the results of the 2015 quality metrics (QUALMET) survey, which was designed to assess the commonalities and variability of selected quality and productivity metrics currently employed by a large sample of academic radiology departments representing all regions in the USA.

METHODS

The survey of key radiology metrics was distributed in March-April of 2015 via personal e-mail to 112 academic radiology departments.

RESULTS

There was a 34.8% institutional response rate. We found that most academic departments of radiology commonly utilize metrics of hand hygiene, report turn around time (RTAT), relative value unit (RVU) productivity, patient satisfaction and participation in peer review. RTAT targets were found to vary widely. The implementation of radiology peer review and the variety of ways in which peer review results are used within academic radiology departments, the use of clinical decision support tools and requirements for radiologist participation in Maintenance of Certification also varied. Policies for hand hygiene and critical results communication were very similar across all institutions reporting, and most departments utilized some form of missed case/difficult case conference as part of their quality and safety programme, as well as some form of periodic radiologist performance reviews.

CONCLUSION

Results of the QUALMET survey suggest many similarities in tracking and utilization of the selected quality and productivity metrics included in our survey. Use of quality indicators is not a fully standardized process among academic radiology departments. Advances in knowledge: This article examines the current quality and productivity metrics in academic radiology.

Key Principles in Quality and Safety in Radiology

OBJECTIVE

The purpose of this article is to introduce the reader to basic concepts of quality and safety in radiology.

CONCLUSION

Concepts are introduced that are keys to identifying, understanding, and utilizing certain quality tools with the aim of making process improvements. Challenges, opportunities, and change drivers can be mapped from the radiology quality perspective. Best practices, informatics, and benchmarks can profoundly affect the outcome of the quality improvement initiative we all aim to achieve.

Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process

The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal experience of the members of the MAGNIMS (Magnetic Resonance Imaging in MS) network. We address the indications, timing, coverage, reporting and interpretation of MRI studies in patients with suspected MS. Our recommendations are intended to help radiologists and neurologists standardize and optimize the use of MRI in clinical practice for the diagnosis of MS.

A Simple QI Project to Improve Practice Quality in Neuroradiological CT Angiography

OBJECTIVE

The purpose of this study was continuous quality improvement (CQI) of head and neck CT angiography (CTA) in the neuroradiology practice of a tertiary care medical center.

MATERIALS AND METHODS

We conducted baseline quality audits of 50 consecutive head or neck CTAs, including referrals for a variety of indications from emergency department, ambulatory, and inpatient settings. Neuroradiologists as a group used Likert-type questionnaire items to assess scan quality. Based on identified opportunities for CQI, the group evaluated alternative scanning methods, proposed action items, and implemented changes in scanning methods. After implementing the changes, the group performed follow-up quality audits of 61 consecutive CTAs. Quality of scans was compared for baseline and postimplementation patients using chi-square or McNemar tests.

RESULTS

Several key opportunities for CQI were identified, namely related to coverage levels and timing. These opportunities were translated into protocol changes, standardization of methods, and in-service sessions to implement specific process changes. Using a Likert-type scale with 1 anchored at "excellent" and 5 at "poor," the overall quality of CTAs improved from 2.46 at baseline to 1.64 after implementation of QI measures (P < .01). There were significant improvements in timing and coverage, and fewer scans required quality disclaimers after CQI implementation.

CONCLUSION

Using basic CQI techniques of assessment, analysis, change implementation, and reassessment, the quality of CTA scans in a busy neuroradiology clinical practice can be improved. These techniques are amenable to repeated use, so that CQI can be a routine practice to help optimize the quality of care in radiology.

Stability and infrequency of radiologic technologist malpractice payments: an analysis of the National Practitioner Data Bank

PURPOSE

The aim of this study was to describe characteristics and trends of radiologic technologist (RT) malpractice payments.

METHODS

National Practitioner Data Bank data files were analyzed for details of RT malpractice payments from 1991 through 2008. Payment amounts, sources, and allegations were all identified and summarized, along with geographic and demographic data.

RESULTS

Between 1991 and 2008, a total of 155 RT malpractice payments were reported nationally, ranging from $750 to $11.5 million (median, $57,500; mean, $293,655 +/- $1,305,091), with 153 (99%) <$1 million. Adjusting for outliers and inflation, payments changed little over the 18-year interval. More than half of all cases originated in 8 states, with per capita payments most common in Louisiana and New Jersey. Alleged errors in diagnosis accounted for one third of all cases.

CONCLUSION

Malpractice payments on behalf of RTs are very infrequent (on average, <9 nationally each year) and usually relatively small (almost half <$50,000). Frequency and mean adjusted payment have remained stable over nearly two decades, likely related in part to "deep pocket" shielding by hospitals and radiologists.

Improving quality and patient safety by minimizing unnecessary variation

Quality and safety in health care have proven difficult to precisely define and measure. In other fields, quality is defined as the absence of unnecessary variation and process improvement efforts are gauged by their ability to reduce variation. This article explores how this definition can be applied to various attributes of image-guided procedures.