RSNA chief calls 2009 quality theme future for radiology

RSNA president Dr. Gary J. Becker opened with a sports quotation. “Today we are going to learn how to put on our socks and lace our shoes.” With that he exhorted attendees at the opening session to join a drive for quality in radiology that could bolster the specialty in the face of the challenges that are to come.

The phrase, spoken by legendary college basketball coach John Robert Wooden, was a reference to what lies ahead for radiologists, Becker said. Wooden revisited these fundamentals before sending out to the court any of the teams that won him a record 10 National Collegiate Athletic Association titles. Sock wrinkles inside improperly laced shoes could turn to blisters that would keep the young stars from practicing and, ultimately, from shining. Wooden believed such minutiae could affect a team's ability to win and thus required a focus on quality improvement starting from the very first day of practice.

“Today we radiologists find ourselves in a similar situation. One of the most vital priorities for our profession is the adoption of a new focus on quality improvement,” Becker said. “I believe quality and our commitment to it will be a key factor in determining our future.”

Issues such as disregarding quality improvement principles, holding on to preconceived notions and attitudes, and the lack of a culture of improvement could wreak havoc in the field unless radiologists acknowledge and deal with them soon, Becker said. If radiologists choose to ignore them, they do so at their own risk because the demand for individual transparency and accountability from patients, families, and public and private healthcare organizations is only going to grow.

“All this means we are going to need to increase our focus on safety, quality, performance measurement and improvement, and value,” he said.

According to Becker, the most efficient care, and the end to a culture of preventable medical error, waste, and service fragmentation, will depend to a significant degree on the implementation of quantitative imaging and informatics. Big gains in quality improvement can be achieved through the use of computerized radiology order entry and decision support systems and through the use of structured reporting and computer-aided diagnosis.

The quantitative potential of the latest imaging technologies will give radiologists a central role in the new age of personalized, preemptive, predictive, and participatory, or “P-4,” medicine, Becker said. He encouraged attendees to check the meeting program and other resources available through rsna.org for information on quality improvements.

A number of studies have shown that quality can be improved, but complacency can ultimately spoil any gains. Radiologists should strive for ways to effectively measure and maintain quality beyond economics in order to earn the public trust once again, Becker said.

“When price is the differentiator for quality, quality pays the price,” he said.

A scientific paper presented at the RSNA meeting provided an example of one of many quality issues plaguing radiology today. Researchers from Massachusetts General Hos-pital in Boston found the number of unidentified and uncorrected errors in radiology reports of spine MRIs is significantly higher than that of corrected errors.

The investigators reviewed more than two million radiology reports of spine MRIs performed at their institution from January 2006 through December 2007. They found 14 reports with addended errors, or errors identified after the report was signed, and 20 with errors that had never been identified until their review. They also found that, in 2006, it took between five and seven days to correct an error and nearly twice as long the following year. Almost half the errors occurring in all the reports were probably or definitely clinically important.

According to the researchers, radiologists should check for errors and encourage colleagues to correlate the level of radiological lesions with clinical complaints and images. One of the most important implications of the study, they said, is a potential role for software applications like natural language processing to identify errors at the time of dictation or final signoff.

Dr. Steven Swenson, director of qua-lity at the Mayo Clinic in Rochester, MN, and chair of the American College of Radiology's quality metrics committee, made his contribution to the topic with a presentation on patient-centered radiology. Swenson reminded his audience that Hippocrates set the bar high for physicians when he made patient care the centerpiece of the medical profession. But, as Swenson pointed out, the same demand offers radiologists hope.

“If we live that patient-centeredness, the risk of commoditization goes away,” Swenson said.

Swenson also shared the conclusions from a group of 14 academic deans and medical officers he joined in 2008. One of them was that academic medical centers could not be patient-centered because this role conflicted with their academic mission. Even if it did not, the research mission funded by big pharmaceutical and device manufacturing companies would, he said.

Radiology could meet the challenge by granting patients five wishes: the information to make a choice, the right exam, open communication, a fair cost, and a safe exam.

“A key part of improvement is starting with a baseline,” Swenson said. “If you don't know where you're at, you don't have an opportunity to improve.”