Accreditation targeted for MR and ultrasound

The American College of Radiology is preparing MRI and ultrasoundpractice accreditation programs that could also impact technologydevelopment, as has been the case in mammography. The programsare being created simultaneously and could be in effect by theend of next year.

"That is a goal we're shooting for," said Marie Zinninger,ACR senior director.

Like the ACR's mammography accreditation program, whose developmentZinninger directed, the MRI and ultrasound programs will be voluntary.The objective of each will be to improve the overall quality ofMR and ultrasound images.

The college emphasizes quality assurance in procedures thathave high patient volumes, are high-risk, or impose high cost,Zinninger said. Both ultrasound and MRI meet the criterion ofhigh volume, as does chest imaging, another area the ACR willfocus on for the development of a future accreditation program.

A committee has been established for each modality, as havesubcommittees on physics and clinical images. Dr. William Bradleyof the University of California at Irvine chairs the committeeon MRI accreditation. Dr. John McGahan of the University of Californiaat Davis chairs the ultrasound accreditation committee.

The ACR is using the mammography accreditation program as atemplate for the MRI and ultrasound versions, adjusting the contentand approach to fit each modality. While these new programs havemany similarities to the mammography accreditation program, thereare differences as well.

Establishing mammography standards was relatively straightforwardcompared to the task ahead for MRI and ultrasound. Every mammographymachine intended for diagnostic use could be held to a singlestandard of image quality. Both MRI and ultrasound scanners, onthe other hand, operate at varying technical levels--for instance,field strengths in MRI--and are used in a wide spectrum of applications.

The ACR does not intend to compare the relative merits of systemsoperating at different field strengths in MRI or levels of capabilityin ultrasound, Zinninger said. The accreditation programs willinstead seek to assure levels of quality for the various examinationsperformed. This will be accomplished through the development ofcriteria specific to applications and body sites.

The point of these programs is education, she said. The collegewill not seek to force facilities to change their methods or theirequipment. But change is likely to come at some facilities, shesaid.

"Certainly, even in mammography, we found that there wassome equipment that needed to be replaced and that's happened,"Zinninger said. "We'll see the same type of thing (in MRIand ultrasound)."

These two projects will collect extensive data on the practiceof MRI and ultrasound. The primary use of the data will be tosupport accreditation of facilities. There will likely be otherapplications, however.

For instance, one byproduct of the mammography accreditationprogram was an enhanced ability to write recommendations for thedesign of new equipment. Another was the development of a breastimaging data and reporting system that has standardized the languageused in the practice of mammography.

Referring-physician owners who might be considering the saleof their MRI centers might benefit from having ACR accreditation,although its value for that purpose will be fleeting.

"Accreditation doesn't go with the facility," Zinningersaid. "The facility gets accredited at one point in time.If anything changes, such as the physicians who are interpretingthe exams, the facility has to come back to us. (Accreditation)is not something that is for sale."

In terms of installed base, the ultrasound accreditation effortwill dwarf mammography, while MRI may be somewhat less demanding.The ACR has accredited 5773 mammography facilities and 7342 systemsover the past seven years. There are about 35,000 ultrasound systemsand more than 3000 MRI scanners operating in the U.S.