Scheduling Musculoskeletal MRI for Patients With Metallic Hardware: Initial Observations on Decreasing Nondiagnostic and Repeat Examinations at a Multisite Academic Medical Center

Abstract

As healthcare delivery systems expand to include multiple imaging centers, the process of scheduling patients at the site which best meets their needs continues to become more complex. This quality improvement study aims to create a protocol for patients with metallic hardware at sites with metallic artifact reduction sequences (MARS), increasing the proportion of exams that are diagnostic and reducing the need for repeat imaging. The study population included 322 patients with metallic hardware receiving an MRI at a large multisite healthcare system, divided into a pre-intervention and postintervention cohort. A retrospective PACS query was performed using several keywords in musculoskeletal MRI reports indicating the presence of metallic hardware. This cohort was studied to better understand the existing system failures. An intervention was then implemented by meeting with the departmental RIS and scheduling teams to discuss workflow when scheduling exams for patients with metallic hardware System changes were implemented and results were again studied retrospectively. Before protocol implementation, 134/244 (55%) of exams were performed at sites with metallic artifact reduction sequences which improved to 54 of 78 (69%) in the postintervention cohort (P=0.02). Additionally, the number of exams performed on 3T MRI machines pre-intervention was 14 of 244 (5.7%) compared to 1 of 78 (1.2%) postintervention (P=0.13). The rate of nondiagnostic exams in the preintervention cohort was significantly higher at 41 of 244 (16.8%) when compared to the postintervention cohort at 4 of 78 (5.1% P=0.01). The implementation of this quality improvement protocol reduced the rate of nondiagnostic MSK MRI exams and reduced the inappropriate use of 3T scanners, ultimately saving time and cost for both patients and the health care system.