Quality management in musculoskeletal imaging: form, content, and diagnosis of knee MRI reports and effectiveness of three different quality improvement measures.

Abstract

The purpose of this article is to evaluate the quality of reports of knee MRI examinations in form, content, and diagnosis and to assess the effect of three different quality improvement measures. Reports of 500 knee MRI examinations (first round, or baseline) were reviewed retrospectively by five musculoskeletal radiologists. Fifteen different criteria were assessed for formal and content-related quality of reports. Diagnostic discrepancies were categorized using a 5-point scale, as follows: I, no deviation; II, undetected finding, clinically irrelevant; III, wrong interpretation of finding, clinically irrelevant; IV, undetected finding, clinically relevant; and V, wrong interpretation of finding, clinically relevant. Then three different quality improvement measures were applied prospectively to a total of 510 consecutive reports: a quiet work environment, double reading, and the use of a structured report template. These 510 knee MRI reports (second round) were evaluated using the same criteria. A statistically significant improvement in 13 of 15 criteria was found in the second-round reports: orthographic errors improved from 32.4% to 22.0% (p < 0.001) of reports and digital speech recognition errors improved from 8.4% to 7.6% (p = 0.660). Missing anatomic structures decreased from 6.3% to 0.4%. Diagnostic discrepancies were less frequently found (12.9% vs 20.8%; p = 0.001), along with the following changes in categorization (first-round results are in parentheses): I, 87.1% (79.2%); II, 9.2% (16.8%); III, 2.3% (1.0%); IV, 1.0% (2.6%); and V, 0.4% (0.4%). Quality improvement was found in all three measure groups, without statistical significance among the groups, except for the orthographic errors (p < 0.001), which were most common in the template group. All three quality improvement measures significantly improved the quality of the knee MRI reports, but no measure was clearly superior to the others.