Quantifying Radiation Safety and Quality in Medical Imaging, Part 3: The Quality Assurance Scorecard

Performance indicators for radiation protection management: suggestions from the European Society of Radiology

In 2013, the new European Basic Safety Standards Directive 2013/59/Euratom (BSS Directive), which defines the new legal framework for the use of ionising radiation in medical imaging and radiotherapy, was published. In 2014, the ESR EuroSafe Imaging Initiative was founded with a goal in mind “to support and strengthen medical radiation protection across Europe following a holistic, inclusive approach”. To support radiology departments in developing a programme of clinical audit, the ESR developed a Guide to Clinical Audit and an accompanying audit tool in 2017, with an expanded second edition released in 2019 and published under the name of Esperanto – ESR Guide to Clinical Audit in Radiology and the ESR Clinical Audit Tool, 2019. Audits represent specific aspects at a certain point in time, usually with retrospective evaluation of data. Key performance indicators (KPIs), on the other hand, are intended to enable continuous monitoring of relevant parameters, for example to provide warnings or a dashboard. KPIs, which can, for example, be recorded automatically and visualised in dashboards, are suitable for this purpose. This paper will discuss a selection of indicators covering different areas and include suggestions for their implementation.

Hidden costs of poor image quality: a radiologist's perspective

Although image quality is a well-recognized component in the successful delivery of medical imaging services, it has arguably declined over the past decade owing to several technical, economic, cultural, and geographic factors. To improve quality, the radiologist community must take a more proactive role in image quality analysis and optimization; these require analysis of not just the single step of image acquisition but the entire imaging chain. Radiologists can benefit through improved report accuracy, diagnostic confidence, and workflow efficiency. The derived data-driven analyses offer an objective means for provider performance analysis, which can help combat commoditization trends and self-referral by nonradiologist providers.

Transforming health care service delivery and provider selection

Commoditization pressures in medicine have risked transforming service provider selection from "survival of the fittest" to "survival of the cheapest." Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented performance metrics which provide patients with objective data related to individual service provider quality, safety, cost-efficacy, efficiency, and customer service. These performance metrics could in turn be customized to the individual preferences and health care needs of each individual patient, thereby providing an objective methodology for service provider selection while empowering health care consumers.