Higher Level of Oversight Results in Greater Harmonization of Imaging Protocols

A centrally organized radiology practice with higher-level oversight of imaging protocols can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices, according to a study published in the Journal of the American College of Radiology.

Researchers from Brigham and Women’s Hospital in Boston, Mass., sought to determine how to reduce CT and MRI protocol variation across a multisite radiology practice at an academic medical center so that patients with similar clinical presentations are examined the same way.

The researchers reviewed data from a five-month period at a large academic radiology practice that performed approximately 800,000 radiology examinations annually. To diminish variability across the two general radiology divisions and 10 subspecialty imaging divisions, the researchers created a Harmonization Oversight Committee, which was tasked with ensuring patients with similar clinical presentations undergo the same CT or MRI protocol, regardless of where they are imaged.

The primary outcome measure was standardization of CT and MRI protocols across all sites. Secondary outcome was percent reduction of CT and MRI protocols postharmonization.

The results showed that over the five-month review period, most conflicts were found with abdominal imaging protocols because they are performed in four distinct subspecialty divisions. All were addressed effectively through the conflict resolution process. The number of unique CT or MRI protocols  following the review period went from 481 (221 CTs and 260 MRIs) to 331 (125 CTs and 206 MRIs), a 31.1 percent decrease overall. There was significant variation in reduction of protocols per workgroup with the largest reduction in workgroups that overlapped multiple divisions.

The researchers concluded that by using a structured, organ system– and consensus-based quality improvement process with unambiguous decision-making, conflict resolution processes can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices, providing patients with similar clinical presentations that are imaged with the same imaging protocol.