Radiology Quality Research Articles

Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma.

Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma.

S01.15 Service Requirements; Staff and Platforms Availability

Lung cancer screening encompasses a pathway that includes several integral elements. It starts with the active recruitment of individuals and their risk assessment. The pathway continues into radiology, with the actual scanning using low dose computed tomography (LDCT), as well as standardized reporting that focuses on the follow up of both lung nodules and incidental findings. At the end of the pathway is the seamless integration into a diagnostic assessment program for confirmation and timely and appropriate treatment of the detected lung cancer. High quality, and quality assurance of the radiology performance is the central piece in this pathway, to decrease the harm from radiation and false positives. Since lung cancer screening is most often a newly established program in an institution, this presents a unique opportunity to build robust quality standards for radiology. Radiology quality assurance comes with requirements regarding acquisition, interpretation and reporting of the low-dose computed tomography (LDCT) scans. The facility standards need to provide equipment that does allow low dose data acquisition. Scanning protocols need to be defined, and protocol compliance needs to be assured, radiation exposure needs to be regularly measured with phantoms, and image storage needs to be properly identified. Personnel requirements cover both the technologists and the reporting radiologists. Both have to provide the necessary training and certification. Radiologists need to document their ongoing experience in chest reporting, participate in a workshop or alternative training regarding nodule follow up, and get familiar with the respective reporting template. Radiologists training programs have received positive feedback on content, their goal is to increase confidence in reading lung cancer screening LDCTs and appropriate recommend follow up for screen-detected nodules. Complex cases are collected and their discussion fosters mutual learning. Ongoing quality assurance measures include peer review and double reads, to minimize false positive. An adjudication process can provide expert opinion and support learning where consensus cannot initially be reached. Report completeness should be confirmed with regular audits. All these requirements should be available and met by a facility planning to engage in lung cancer screening using LDCT. All above standards are available; they need to be monitored, must be met at baseline and during tailored annual assessments, ensuring compliance across screening sites. In summary, the implementation of a robust quality assurance program assures a high standard around the radiology workflow, from LDCT scanning to image interpretation and follow up recommendations. Radiologist training programs, centre minimum requirements, and standardized reporting can ensure that quality standards are consistently high

The Application of Machine Learning to Quality Improvement Through the Lens of the Radiology Value Network

Recent advances in machine learning and artificial intelligence offer promising applications to radiology quality improvement initiatives as they relate to the radiology value network. Coordination within the interlocking web of systems, events, and stakeholders in the radiology value network may be mitigated though standardization, automation, and a focus on workflow efficiency. In this article the authors present applications of these various strategies via use cases for quality improvement projects at different points in the radiology value network. In addition, the authors discuss opportunities for machine-learning applications in data aggregation as opposed to traditional applications in data extraction.

American Urological Association, American College of Emergency Physicians and American College of Radiology Quality Improvement Summit 2017: Challenges and Opportunities for Stewardship of Urological Imaging.

Since 2014 the AUA (American Urological Association) has convened several Quality Improvement Summits to provide education and promote dialogue around issues of quality improvement and patient safety. The 2017 Summit, Challenges and Opportunities for Stewardship of Urological Imaging, organized in partnership with the American College of Radiology and the American College of Emergency Physicians, highlighted opportunities for collaborative improvement in the value, safety and quality of imaging for patients with urological conditions. The Summit was held at AUA headquarters in Linthicum, Maryland on October 21, 2017. Each talk, panel and working group held during the summit highlighted gaps in care being addressed by physician led stewardship initiatives in imaging, in general, as well as multiple specific examples related to prostate cancer and urinary stone disease. Presentations facilitated information exchange on quality efforts between clinicians across disciplines and care settings and served to educate urology practitioners, primary care physicians, and specialists about existing patient centered quality improvement programs. This exchange serves to accelerate adoption of evidence-based practices and brings together stakeholder organizations to form partnerships that facilitate the further development of research and policy agendas to advance physician led stewardship of advanced imaging across emergency medicine, radiology and urology. In parallel, this meeting established a consortium to develop and disseminate tools for facilitating organizational improvement activities needed to enhance the quality and safety of medical care.

Radiology Editorial Board: Changes for 2019

<i>Radiology</i> Editorial Board: Changes for 2019

UJI KINERJA PESAWAT MAGNETIC RESONANCE IMAGING MERK SIEMENS MAGNETOM CONCERTO 0,2T DI INSTALASI RADIOLOGI RSUD. DR. KANUJOSO DJATIWIBOWO BALIKPAPAN

Background : Radiology quality control is a part of radiology quality assurance which is directly linked with physical measurements of facility performance and indirectly linked with the expected image quality. The advantage of proceeding with the performance test on MRI device are the consistency of operational testing that integrated of all MRI system and producing high quality image, reducing the possibility of artifact appearance, and also preemptive identification of potential problems. Methods : The method of this Research is Qualitative Survey. The researchers are doing the survey on Quality Control test on MRI device brand Siemens Magnetom Concerto 0,2T on Radiology department of RSUD. DR. Kanujoso Djatiwibowo Balikpapan. Results : The whole result of this research shows that MRI device on RSUD. DR. Kanujoso Djatiwibowo Balikpapan has yet to fulfill the international standard. Conclusion : The whole result of this research shows that MRI device on RSUD. DR. Kanujoso Djatiwibowo Balikpapan has yet to fulfill the international standard on 5 parameter, such as the SNR testing, Artifact Analysis, Geometric Accuracy, High Contrast Resolution and Low Contrast Resolution. On the other hand, 2 other parameter such as slice thickness accuracy and slice position accuracy of the MRI device has already fulfill the standard and have to improve on the 5 parameter which hasn’t fulfill the factory and international standards

Imaging Quality Control in the Era of Artificial Intelligence

The advent of artificial intelligence (AI) promises to have a transformational impact on quality in medicine, including in radiology. However, experience has shown that quality tools alone are often not sufficient to bring about consistent excellent performance. Specifically, rather than assuming outcome targets are consistently met, in quality control, managers assume that wide variation is likely present unless proven otherwise with objective performance data. In this article, we discuss what we consider to be the eight essential elements required to achieve comprehensive process control, necessary to deliver consistent quality in radiology: a process control framework, performance measures, performance standards and targets, monitoring applications, prediction models, optimization models, feedback mechanisms, and accountability mechanisms. We consider these elements to be universally applicable, including in the application of AI-based models. We also discuss how the lack of specific elements of a quality control program can hinder widespread quality control efforts. We illustrate the concept using the example of a CT radiation dose optimization and process control program previously developed by one of the authors and provide several examples of how AI-based tools might be used for quality control in radiology.

Survey of peer review programs among pediatric radiologists: report from the SPR Quality and Safety Committee.

During the last 15years, peer review has been widely incorporated into radiology quality improvement programs. However, current implementations are variable and carry concerns, including subjectivity of numerical scores and a sense of merely satisfying regulatory requirements. The Society for Pediatric Radiology (SPR) Quality and Safety Committee sought to evaluate the state of peer review programs in pediatric radiology practices, including implementation methods, perceived functions, strengths and weaknesses, and opportunities for improvement. We distributed an online 16-question survey to SPR members. Questions pertained to the type of peer review system, the use of numerical scores and comments, how feedback on discordances is given and received, and the use of peer learning conferences. We collected 219 responses (15% of survey invitations), 80% of which were from children's hospitals. Fifty percent of respondents said they use a picture archiving and communication system (PACS)-integrated peer review system. Comment-enhanced feedback for interpretive discordances was either very important or somewhat important to performance improvement in 86% of responses, compared to 48% with a similar perception of numerical scores. Sixty-eight percent of respondents said they either rarely or never check their numerical scores, and 82% either strongly or somewhat agreed that comments are more effective feedback than numerical scores. Ninety-three percent either strongly or somewhat agreed that peer learning conferences would be beneficial to their practice. Forty-eight percent thought that their current peer review system should be modified. Survey results demonstrate that peer review systems in pediatric radiology practices are implemented variably, and nearly half of respondents believe their systems should be modified. Most respondents prefer feedback in the form of comments and peer learning conferences, which are thought to be more beneficial for performance improvement than numerical scores.

Machine learning concepts, concerns and opportunities for a pediatric radiologist.

Machine learning, a subfield of artificial intelligence, is a rapidly evolving technology that offers great potential for expanding the quality and value of pediatric radiology. We describe specific types of learning, including supervised, unsupervised and semisupervised. Subsequently, we illustrate two core concepts for the reader: data partitioning and under/overfitting. We also provide an expanded discussion of the challenges of implementing machine learning in children's imaging. These include the requirement for very large data sets, the need to accurately label these images with a relatively small number of pediatric imagers, technical and regulatory hurdles, as well as the opaque character of convolution neural networks. We review machine learning cases in radiology including detection, classification and segmentation. Last, three pediatric radiologists from the Society for Pediatric Radiology Quality and Safety Committee share perspectives for potential areas of development.

Quality and safety in pediatric radiology.

Quality and safety in pediatric radiology.

Advanced Quality Training in Radiology: Inaugural Report of a 2-Year Program.

OBJECTIVE. The purpose of this study is to describe and analyze the outcomes of a 2-year advanced quality training program for radiology residents. MATERIALS AND METHODS. In 2016, the radiology quality committee of a quaternary health system created a hands-on 2-year advanced quality training curriculum for diagnostic and interventional radiology residents. Internal candidates with the following prerequisites submitted competitive applications: registration for a 2-day lean health care management course, completion of four or more Radiological Society of North America (RSNA) quality essentials certificates, identification of faculty mentor(s), selection of one quality improvement project to champion, and completion of a two-page essay summarizing interest in quality improvement, the proposed project, and its potential impact. Residents were required to attend monthly quality meetings, pursue their project and its derivatives, submit completed work for consideration to a national meeting and for publication, and present at departmental grand rounds. Outcomes were summarized using descriptive statistics. RESULTS. Five residents submitted four projects for consideration, and all five were selected. In addition to the four submitted projects, seven additional projects were pursued. Participants worked on nine local and three multicenter process improvements, gave one to two grand rounds each, presented three oral and five poster presentations, generated eight publications, received three awards, formed 14 mentor-mentee relationships, and influenced local and multisite practice patterns. Participants reported gaining firsthand experience in quality improvement principles and developing real-world leadership skills. CONCLUSION. A targeted 2-year curriculum emphasizing hands-on quality improvement experience with rich mentor-mentee relationships can produce meaningful results.

Neuroradiology in Azerbaijan and in the Netherlands: A healthcare assessment from the neurologist’s perspective

Background. Referring physicians are valuable sources of information for radiologist to improve quality in radiology. In differenthealthcare systems neuroradiology has developed differently. Healthcare in Azerbaijan is developing and investmentstake place both in infrastructure and knowledge. Tools to compare healthcare in Azerbaijan and western countries can help toguide these improvements by providing detailed information about a specific field resulting in a more focused approach.Methods. A survey covering the field of neuroradiology was developed, with a variety of items including the availability ofequipment, the contentment with the radiological report, the experience of the neurologist, and factors omitting neurologicalimaging. Data was collected both in Azerbaijan and the Netherlands.Results. In both countries most neurologist do not receive formal neuroradiology training. The data demonstrate a higher availabilityof advanced computed tomography (CT) and magnetic resonance imaging (MRI) machines in the Netherlands comparedwith Azerbaijan, and a higher experience with requesting imaging and case reading for the Dutch respondents. The financialsituation of the patient can be a reason for Azerbaijan neurologists to omit imaging (due to the establishment of CT and MRIin most cases in specialized and private centers).Conclusion. The presented survey allows comparison of neuroradiological healthcare between countries in general, and identificationof required preconditions to improve collaboration between neurologists and radiologists. A future lower financialthreshold for imaging and a future increase in availability of PACS (picture archiving and communication system) will facilitatethe improvement of neuroradiological skills of Azerbaijan neurologists. Both Dutch and Azerbaijan neurologists considerweekly clinical neuroradiological conferences together with radiologists useful to improve their skills.

Clinicians' perceptions of the quality of outsourced radiology and actions taken around perceived imaging errors in practice.

Outsourcing of radiological reporting services has fundamentally altered communication between radiologists and clinicians in clinical decision making, which relies heavily on diagnostic imaging. The aim of this study was to understand clinicians' perspectives and experiences of interpretation of outsourced reports in clinical practice, if the author of imaging reports matters to clinicians, and actions taken to deal with perceived errors. A printed survey was distributed to a purposive sample of 50 of the 250 senior medical and surgical staff of a large National Health Service hospital in the UK who regularly engaged with the Radiology Department between May and October 2017, representing 20% of this hospital workforce. The survey consisted of ten questions examining clinicians' opinions on radiology reporting, with comment options to encourage respondents to give further detail. Participants were requested to return the survey to the study investigators. The survey elicited a 100% response rate (n = 50). A constant comparative framework was used to guide analysis, revealing themes relevant to the ongoing inter-professional relationship between clinicians and radiologists. The disparity between in-house and externally sourced radiology reports and underlying issues of trust surrounding outsourced reports were the most significant themes identified. This study found outsourcing of radiology reporting needs multi-disciplinary team availability regarding the interpretation and discussions around capacity for effective communication. It raises important issues around often under-acknowledged additional workloads imposed on in-house radiologists. There are financial and pragmatic clinical aspects in pathways of radiology practice which require further research and examination. • Utilisation of outsourcing is increasing in practice in response to imaging demands. • Outsourcing increases departmental primary reporting capacity but may increase the workload of the local radiologist. • The development of strategies for outsourcing examinations may lessen demands on the in-house workforce.

PENERAPAN PENJAMINAN MUTU RADIOLOGI PADA KENDALI MUTU PERALATAN BUCKY GRID PESAWAT DIGITAL RADIOGRAPHY

The research about grid performance testing in Radiology Installation RA Kartini Jepara have been done using X-ray digital radiography type Multix Select DR. X-ray digital radiography hasn’t been re-tested after acceptance testing in 2016. Based the frequency, it’s often use. The purpose of this study to know the implementation of radiology quality assurance and quality control and to determine the result testing. Research conducted in the examination room in radiology installation RA Kartini Jepara with depth interviews, two radiographers as a respondents. Then, put a Grid Allignment Test Tool in the middle of center beam, with vertical rays. Afterthat, all the holes exposed by a factor using 45 kVp and mAs setting 1 and 5. Then do the processing and measure the optical density using densitometer three times each holes. In the analysis of data from measurement should determine the value of highest density on the 3rd or center hole and getting decreases to the lateral. The result show the quality assurance and quality control aren’t going well because there is none about QA Committe. Density measurement data show, on the first hole has 2,48 and 2,56. On the second hole has 2,66 and 2,74. On the third hole has 2,71 and 2,81. On the fourth hole has 2,69 and 2,72. The fifth hole has 2,71 and 2,78. The first hole show lowest density value and getting decreases to the lateral side. It means bucky is missalignment with central rays.&#x0D;

Costs of Quality and Safety in Radiology.

With the movement toward at-risk population health management-related payment models, a core factor for the success and survival of health care organizations has become understanding and decreasing costs. In medical specialties such as radiology, understanding models for procedure-based costing will become increasingly important. Using bottom-up models for procedure-based costing, such as time-driven activity-based costing, is more advantageous than using the inaccurate ratio of costs to charges approach; however, these approaches are more resource intensive when compared to top-down approaches. Understanding the costs of quality is also important for creating an accounting and budgeting process that reflects the total cost of quality. The costs of quality are divided into two main categories: the cost of control (also referred to as the costs of conformance) and the costs of failure of control (also referred to as the costs of nonconformance). The costs of control are the expenditures that occur to ensure quality. The costs of noncontrol are the expenses that arise from the lack of quality and safety. The cost of control has two subcategories: prevention costs and appraisal costs. The cost of noncontrol also has two subcategories: internal failure costs and external failure costs. Adopting a mind-set that takes into account the costs of control, or the costs to ensure high-quality care, and the costs of noncontrol, or the hidden costs of poor-quality care, will be essential for successful health care organizations in the future. ©RSNA, 2018.

Stratification of Integrated Cancer Center in Indonesia to Improve the Access to Care

Background and context: Indonesia as one of the low- and middle-income countries has not had a classification of cancer services yet. This classification will be very important for standardization and equalization of cancer services for all Indonesian people to access the cancer services provided. Based on Social Security Administering Agency of Health report, advanced stage of cancer have absorbed ∼17% national health budget (the third largest in financing National Health Insurance) but the outcome of the services still not good enough. Dharmais National Cancer Center (NCC) has the task of establishing cancer services system in stages throughout Indonesia by arrange the cancer services strata in Indonesia and develop its roadmap of achievement to improve the access to care. Aim: To build the stratification of integrated cancer center (ICC) in Indonesia by Health Ministerial Decree to improve access to care as a part of cancer control planning. Strategy/Tactics: 1. Build the concept of integrated cancer center stratification in Indonesia by assess the instrument of Director General of Health Services, Ministry of Health that conduct a comprehensive stratification of cancer services especially for diagnostic radiology services, nuclear medicine and radiotherapy to support the cancer services development plan in Indonesia. Currently, internal audit of radiology quality management has been developed by adopt the International Atomic Energy Agency (IAEA) standards issue with 3 instruments used to assess the radiology quality management, namely: a. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL). b. Quality Management Audits in Nuclear Medicine Practices (QUANUM). c. Quality Assurance Team of Radiation Oncology (QUATRO). 2. Conducted an audience with Minister of Health to present the concept of integrated cancer center stratification in Indonesia and to initiate Ministry of Health decree as a regulation. The decree will be follow up by disseminate to all national, provincial and regional referral hospitals so they will have internal audit by IAEA to be mapping. Program/Policy process: 1. Dharmais NCC offer a model of cancer referral networking capabilities as a part of integrated national referral systems that includes preventive, promotive, curative and rehabilitative services for various levels of health care facilities with level strata as ICC strata 1, strata 2, strata 3 and NCC. 2. Encouraging the immediate issuance of Ministry of Health policy in the form of decree or regulation as the legal aspects of implementation. Outcomes: The Minister of Health agree with the proposed stratification of integrated cancer center and process the ministerial decree. What was learned: The stratification of integrated cancer center in Indonesia is very important needed to promote the NCCP especially in access to care so the cancer cases will find and treat in early stage due to closer access.

Creating a Radiology Quality and Safety Program: Principles and Pitfalls.

All radiology departments are now expected to create organized and comprehensive quality and safety (QS) programs. No matter the department size, there are fundamental principles that should be at the core of each program. "Just culture" and culture of safety are essential principles in establishing effective programs. Physician leaders of QS programs must involve stakeholders, define program goals, and develop an effective program structure. QS programs should establish reliable quality assurance and patient safety systems. Integrating continuous quality improvement and learning into the department and prioritizing patient and referring clinician experiences will enhance outcomes. Physician QS leaders will face common obstacles in program development and management. Heightened awareness of these obstacles and understanding potential solutions will help programs succeed. Leveraging resources offered by professional societies and engaging in radiology QS community networks will provide ongoing support for program leaders. ©RSNA, 2018.

NEURORADIOLOGY IN AZERBAIJAN AND THE NETHERLANDS: A HEALTHCARE ASSESSMENT FROM THE NEUROLOGIST’S PERSPECTIVE

Background. Referring physicians are valuable sources of information for radiologist to improve quality in radiology. In different healthcare systems neuroradiology has developed differently. Healthcare in Azerbaijan is developing and investments take place both in infrastructure and knowledge. Tools to compare healthcare in Azerbaijan and western countries can help to guide these improvements by providing detailed information about a specific field resulting in a more focused approach. Methods. A survey covering the field of neuroradiology was developed, with a variety of items including the availability of equipment, the contentment with the radiological report, the experience of the neurologist, and factors omitting neurological imaging. Data was collected both in Azerbaijan and the Netherlands. Results. In both countries most neurologist do not receive formal neuroradiology training. The data demonstrate a higher availability of advanced computed tomography (CT) and magnetic resonance imaging (MRI) machines in the Netherlands compared with Azerbaijan, and a higher experience with requesting imaging and case reading for the Dutch respondents. The financial situation of the patient can be a reason for Azerbaijan neurologists to omit imaging (due to the establishment of CT and MRI in most cases in specialized and private centers). Conclusion. The presented survey allows comparison of neuroradiological healthcare between countries in general, and identification of required preconditions to improve collaboration between neurologists and radiologists. A future lower financial threshold for imaging and a future increase in availability of PACS (picture archiving and communication system) will facilitate the improvement of neuroradiological skills of Azerbaijan neurologists. Both Dutch and Azerbaijan neurologists consider weekly clinical neuroradiological conferences together with radiologists useful to improve their skills.

Improving and Maintaining Radiologic Technologist Skill Using a Medical Director Partnership and Technologist Coaching Model.

Consistent excellence in radiologic technologist performance, including ensuring high technical image quality, patient safety and comfort, and efficient workflow, largely depends on individual technologist skill. However, sustained growth in the size and complexity of health care organizations has increased the difficulty in developing and maintaining technologist expertise. In this article, we explore underlying organizational structures that contribute to this problem and propose organizational models to promote continued excellence in technologist skill. We have found that a relatively modest investment in medical directorship combined with a coaching model can bring about a significant level of improvement in skilled clinical performance. We believe that widespread implementation of similar programs could contribute to substantial improvements in quality in radiology and other health care settings.

Can visual analogue scale be used in radiologic subjective image quality assessment?

BackgroundAssessment of qualitative or subjective image quality in radiology is traditionally performed using a fixed-point scale even though reproducibility has proved challenging.ObjectiveImage quality of 3-T coronary magnetic resonance (MR) angiography was evaluated using three scoring methods, hypothesizing that a continuous scoring scale like visual analogue scale would improve the assessment.Materials and methodsAdolescents corrected for transposition of the great arteries with arterial switch operation, ages 9–15 years (n=12), and healthy, age-matched controls (n=12), were examined with 3-D steady-state free precession magnetic resonance imaging. Image quality of the coronary artery origin was evaluated by using a fixed-point scale (1–4), visual analogue scale of 10 cm and a visual analogue scale with reference points (figurative visual analogue scale). Satisfactory image quality was set to a fixed-point scale 3=visual analogue scale/figurative visual analogue scale 6.6 cm. Statistical analysis was performed using Cohen kappa coefficient and agreement index.ResultsThe mean interobserver scores for the fixed-point scale, visual analogue scale and figurative visual analogue scale were, respectively, in the left main stem 2.8, 5.7, 7.0; left anterior descending artery 2.8, 4.7, 6.6; circumflex artery 2.5, 4.5, 6.2, and right coronary artery 3.2, 6.3, 7.7. Scoring with a fixed-point scale gave an intraobserver κ of 0.52–0.77 while interobserver κ was lacking. For visual analogue scale and figurative visual analogue scale, intraobserver agreement indices were, respectively, 0.08–0.58 and 0.43–0.71 and interobserver agreement indices were up to 0.5 and 0.65, respectively.ConclusionQualitative image quality evaluation with coronary 3-D steady-state free precession MR angiography, using a visual analogue scale with reference points, had better reproducibility compared to a fixed-point scale and visual analogue scale. Image quality, being a continuum, may be better determined by this method.