JACR: Collaboration boosts MRI image quality
 | |
| Image source: Cedars-Sinai Medical Center |
Rapid advances in imaging technology have created an increasingly complex environment that requires extensive protocol optimization, offered Michael Recht, MD, of the department of radiology at New York University Langone Medical Center in New York City, and colleagues. However, departments have become increasingly fragmented since the introduction of digital, filmless radiology, making it difficult for various stakeholders to employ a team-based approach to practice.
Recht and colleagues developed the Best in Practice (BIP) program to address these issues, selecting MRI as the initial target department because of its large size and significant variability in specifications, protocols and image quality.
Launched in the summer of 2009, the program leveraged two advanced practice specialists (APS), a newly created position that pairs internal application support with educational responsibilities. Another key player was the APS radiologist coordinator, a body imager charged with supporting program development throughout the radiology sections and research department.
After attending advanced vendor trainings, the APS focused on the operational plan to optimize scanning protocols and communicate the revisions to MRI technologists at all sites.
The lesson plan emphasized one topic for a two-month period, exploring problems during the first month and developing and communicating solutions in the second month. Sample topics included MRA hand, neck MRI and vascular malformation.
APS communicated solutions via one-page emails that examined subtopics related to the problem and 10 to 15 minute clinical lessons at the scanner. Finally, monthly in-services revisited each topic and reviewed key points.
The second component of the educational program gathered radiologists, technologists and physicists and researchers and provided a forum for the various groups to share information about best practices.
The committee devised a collaborative model, “in which a radiologist, technologist and physicist were selected to create a team that would prepare a unified and cohesive lecture on a specific MR examination,” wrote Recht. The radiologists focused on clinical background and imaging features required for diagnosis, techs focused on patient preparation and positioning and the physicist reviewed the physics underlying the imaging protocol.
After completing six learning plans, “the APS, MR technologists and involved radiologists all believe that imaging quality has been significantly improved by each learning plan,” shared the authors. For example, before and after liver imaging studies showed improved visualization of articular cartilage achieved by optimized coil choice, positioning and imaging parameters.
Techs enthusiastically attended the formal monthly education symposia, with participation rates in the 85 percent range. However, attendance was lower among house staff and radiology faculty members, with rates hovering between 35 percent and 45 percent.
The BIP committee is attempting to develop a more convenient schedule and plans to present grand rounds presentations at the end of a workday three to four times annually. Another option currently under consideration is an online presentation for staff members who cannot attend the symposia.
Recht and colleagues admitted that they have not developed a metric to measure one of the initial goals of the program: to increase interaction and teamwork among MRI stakeholders. However, he emphasized, “there is a strong consensus in the department that there has been more frequent and improved communication and collaboration between radiologists, technologists and physicists since the BIP program began.”
The other key outcome, continued the authors, is the definable improvement in MRI protocols and image quality.