Magnetic Resonance Imaging Technologist Breast Subspecialty Program; a Quality Improvement Project Gone Right.

We describe a Lean based Quality Improvement Project (QIP) to improve the defect rate of breast magnetic resonance imaging (MRI) studies by developing a MRI Technologist Breast Sub-specialization Program. Key stakeholders (physician and technologist) drove the QIP. Both the overall defect rate and the callback rate (severe defects requiring patients return for repeat imaging) were measured over a 2-month period as 17% and 6%, respectively. Lean visualization tools of Pareto Chart & Fishbone Diagram identified lack of multiple trends, but discerned that most defect causes were within the responsibility of the technologists. Lean Value Stream Map identified technologists' useless work (muda), which was subsequently eliminated. Radiologists collectively defined what made a quality study in a Quality Checklist. Key stakeholders limited the number of technologists based on the study volume (50 studies/technologist/2 years) and reviewed 5 studies recently performed by each technologist. If all 5 studies were defect free per the Quality Checklist, then the technologist was certified to perform breast MRI's by himself/herself. Otherwise, the technologist was on probation. Key stakeholders selected SuperTechs with advanced skill and interest from the certified pool to cover all shifts. Technologists on probation had to complete 5 additional studies defect-free under the supervision of a SuperTech to achieve certification. In addition, SuperTechs were available to backup certified technologists, as needed. Software was implemented at the PACS workstation to flag defective and callback studies. 6 months after the initiation of the QIP, the defect rate decreased from 17% to 2% (p>0.02), and the callback rate decreased from 6% to 0, thus confirming this MRI Breast Program was a QIP gone right.

Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program.

BACKGROUND: Assess patient adherence to radiologist recommendations in a clinical CT lung cancer screening program. METHODS: Patients undergoing CT lung cancer screening between January 12, 2012, and June 12, 2013, were included in this institutional review board-approved retrospective review. Patients referred from outside our institution were excluded. All patients met National Comprehensive Cancer Network Guidelines Lung Cancer Screening high-risk criteria. Full-time program navigators used a CT lung screening program management system to schedule patient appointments, generate patient result notification letters detailing the radiologist follow-up recommendation, and track patient and referring physician notification of missed appointments at 30, 60, and 90 days. To be considered adherent, patients could be no more than 90 days past due for their next recommended examination as of September 12, 2014. Patients who died, were diagnosed with cancer, or otherwise became ineligible for screening were considered adherent. Adherence rates were assessed across multiple variables. RESULTS: During the study interval, 1,162 high-risk patients were screened, and 261 of 1,162 (22.5%) outside referrals were excluded. Of the remaining 901 patients, 503 (55.8%) were male, 414 (45.9%) were active smokers, 377 (41.8%) were aged 65 to 73, and >95% were white. Of the 901 patients, 772 (85.7%) were adherent. Most common reasons for nonadherence were patient refusal of follow-up exam (66.7%), inability to successfully contact the patient (20.9%), and inability to obtain the follow-up order from the referring provider (7.8%); 23 of 901 (2.6%) were discharged for other reasons. CONCLUSIONS: High rates of adherence to radiologist recommendations are achievable for in-network patients enrolled in a clinical CT lung screening program.

Transarterial embolization of a hepatic arteriovenous malformation in an infant using Onyx: a case report and review of the differential diagnosis imaging findings.

Hepatic arteriovenous malformations are rare congenital lesions associated with significant morbidity and mortality, most commonly from high output cardiac failure. Efficient diagnosis and treatment demands an interdisciplinary approach, and the interventional radiologist plays a pivotal role in both. Imaging is important for diagnostic accuracy and treatment planning, and transcatheter embolization has become an established primary therapy. We report the clinical and imaging findings of a rare hepatic arteriovenous malformation in an infant presenting with high-output cardiac failure and pulmonary artery hypertension that was successfully treated by transarterial embolization using Onyx.