Current State of Peer Learning in Radiology: A Survey of ACR Members.

PURPOSE: Peer learning (PL) programs seek to improve upon the limitations of score-based peer review and incorporate modern approaches to improve patient care. The aim of this study was to further understand the landscape of PL among members of the ACR in the first quarter of 2022. METHODS: Members of the ACR were surveyed to evaluate the incidence, current practices, perceptions, and outcomes of PL in radiology practice. The survey was administered via e-mail to 20,850 ACR members. The demographic and practice characteristics of the 1,153 respondents (6%) were similar to those of the ACR radiologist membership and correspond to a normal distribution of the population of radiologists and can therefore be described as representative of that population. Therefore, the error range for the results from this survey is ±2.9% at a 95% confidence level. RESULTS: Among the total sample, 610 respondents (53%) currently use PL, and 334 (29%) do not. Users of PL are younger (mode age ranges, 45-54 years for users and 55-64 years for nonusers; P < .01), more likely to be female (29% vs 23%, P < .05), and more likely to practice in urban settings (52% vs 40%, P = .0002). Users of PL feel that it supports an improved culture of safety and wellness (543 of 610 [89%]) and fosters continuous improvement initiatives (523 of 610 [86%]). Users of PL are more likely than nonusers to identify learning opportunities from routine clinical practice (83% vs 50%, P < .00001), engage in programming inclusive of more team members, and implement more practice improvement projects (P < .00001). PL users' net promoter score of 65% strongly suggests that users of PL are highly likely to recommend the program to colleagues. CONCLUSIONS: Radiologists across a breadth of radiology practices are engaged in PL activities, which are perceived to align with emerging principles of improving health care and enhance culture, quality, and engagement.

Get With the Guidelines on MS Imaging by Leveraging Peer Learning.

OBJECTIVES: To achieve consensus on the performance, interpretation and reporting of MS imaging according to up-to-date guidelines using the Peer Learning Methodology. MATERIALS AND METHODS: We utilized the Peer Learning Methodology to engage our clinical and radiology colleagues, review the current guidelines, acheive consensus on imaging techniques and reporting standards. After implementing changes, we collected radiologist feedback on the impact of the optimized images on their interpretation. RESULTS: Survey responders indicated a strong preference for the new protocol in terms of overall image quality, individual lesions conspicuity and confidence in the ability to detect an MS lesion. The new protocol was preferred for both MS diagnosis and MS surveillance in 25 of 28 responses. CONCLUSION: The Peer Learning Methodology is an effective tool to standardize and improve MR imaging quality, interpretation and reporting for Multiple Sclerosis in accordance with current guidelines.

Abdominal peer learning: advantages and lessons learned.

In 2017, our tertiary hospital-based imaging practice transitioned from score-based peer review to the peer learning methodology for learning and improvement. In our subspecialized practice, peer learning submissions are reviewed by domain experts, who then provide feedback to individual radiologists, curate cases for group learning sessions, and develop associated improvement initiatives. In this paper, we share lessons learned from our abdominal imaging peer learning submissions with the assumption that trends in our practice likely mimic others', and hope that other practices can avoid future errors and elevate the level of the quality of their own performance. Adoption of a nonjudgmental and efficient method to share peer "learning opportunities" and "great calls" has increased participation in this activity and increased transparency into our practice, thus allowing for visualization of trends in performance. Peer learning allows us to bring our own individual knowledge and practices together for group review in a collegial and safe environment. We learn from each other and decide how to improve together.

Leveraging the Peer Learning Conference to Establish and Maintain a Peer Learning Program.

Peer learning is a model of continuous feedback, learning, and improvement that is now well-recognized as a method to address radiologist errors. The peer learning conference is the most public facing cornerstone of any peer learning program, and is critical in establishing and maintaining the "Just Culture" that allows the program to thrive. We describe here our 5-step approach to organizing and moderating peer learning conferences for continued growth and participation over the past 4 years, including: achieving group buy-in, setting expectations, preparing the conference, moderating the conference, and post-conference documentation.

Step by Step: A Structured Approach for Proposing, Developing and Implementing a Radiology Peer Learning Program.

Similar to the experiences of other radiology practices, our radiology staff members felt that scored peer review identified few errors/learning opportunities while undermining team collegiality. They desired a more effective way to promote team collegiality and foster lifelong learning. We describe the steps our department took to transition from a peer review system to a peer learning program.

A case of vaginal adenosis with gastric differentiation.

•Vaginal adenosis is a non-obligate pre-cursor for vaginal clear cell carcinoma.•Vaginal adenosis is rare and presents with a variety of signs and symptoms.•Unclear link between adenosis and carcinoma without diethylstilbestrol exposure.•Surveillance with physical examinations, imaging and biopsies is recommended.

Transitioning From Peer Review to Peer Learning: Report of the 2020 Peer Learning Summit.

Since its introduction nearly 20 years ago, score-based peer review has not been shown to have meaningful impact on or be a valid measurement instrument of radiologist performance. A new paradigm has emerged, peer learning, which is a group activity in which expert professionals review one another's work, actively give and receive feedback in a constructive manner, teach and learn from one another, and mutually commit to improving performance as individuals, as a group, and as a system. Many radiology practices are beginning to transition from score-based peer review to peer learning. To address challenges faced by these practices, a 1-day summit was convened at Harvard Medical School in January 2020, sponsored by the ACR. Several important themes emerged. Elements considered key to a peer-learning program include broad group participation, active identification of learning opportunities, individual feedback, peer-learning conferences, link with process and system improvement activities, preservation of organizational culture, sequestration of peer-learning activities from evaluation mechanisms, and program management. Radiologists and practice leaders are encouraged to develop peer-learning programs tailored to their local practice environment and foster a positive organizational culture. Health system administrators should support active peer-learning programs in the place of score-based peer review. Accrediting organizations should formally recognize peer learning as an acceptable form of peer review and specify minimum criteria for peer-learning programs. IT system vendors should actively collaborate with radiology organizations to develop solutions that support the efficient and effective management of local peer-learning programs.

How We Do It: Operationalizing Just Culture in a Radiology Department.

OBJECTIVE. The purpose of this article is to describe how establishing routine practice sessions facilitates adoption by modality operations managers of the just culture model of error management in a radiology department. CONCLUSION. Implementation of ongoing just culture training among radiology operations managers can help them approach uniformity, equity, and transparency in managing errors. Managers see the just culture method as an effective tool that helps improve the safety of patient care.

Creating a Radiology Quality and Safety Program: Principles and Pitfalls.

All radiology departments are now expected to create organized and comprehensive quality and safety (QS) programs. No matter the department size, there are fundamental principles that should be at the core of each program. "Just culture" and culture of safety are essential principles in establishing effective programs. Physician leaders of QS programs must involve stakeholders, define program goals, and develop an effective program structure. QS programs should establish reliable quality assurance and patient safety systems. Integrating continuous quality improvement and learning into the department and prioritizing patient and referring clinician experiences will enhance outcomes. Physician QS leaders will face common obstacles in program development and management. Heightened awareness of these obstacles and understanding potential solutions will help programs succeed. Leveraging resources offered by professional societies and engaging in radiology QS community networks will provide ongoing support for program leaders. ©RSNA, 2018.

Developing Quality Measures for Diagnostic Radiologists: Part 2.

The ACR convened a cross-specialty, multidisciplinary technical expert panel to identify and define new measures for quality improvement. These measures can be included in the ACR's National Radiology Data Registry and potentially used in the CMS quality reporting programs. The technical expert panel was tasked with developing measures that reflect the most rigorous clinical evidence and address areas most in need of performance improvement. The measures described in these articles represent a new phase in the ACR's efforts to develop meaningful measures for radiologists that promote population health through diagnostic accuracy, clinical effectiveness, and care coordination.

Developing Quality Measures for Diagnostic Radiologists: Part 1.

The ACR convened a cross-specialty, multidisciplinary technical expert panel to identify and define new measures for quality improvement. These measures can be included in the ACR's National Radiology Data Registry and potentially used in the CMS quality reporting programs. The technical expert panel was tasked with developing measures that reflect the most rigorous clinical evidence and address areas most in need of performance improvement. The measures described in these articles represent a new phase in the ACR's efforts to develop meaningful measures for radiologists that promote population health through diagnostic accuracy, clinical effectiveness, and care coordination.

Emergency Magnetic Resonance Imaging 3-Tiered Prioritization.

BACKGROUND/PURPOSE: Traditional methods for prioritization are limited and insufficient for today's magnetic resonance imaging (MRI) demands. In particular, the discrepancy in urgency of the heterogeneous emergency department (ED) patient population necessitates risk stratification to meet different degrees of urgency. The purpose of this study is to more effectively prioritize the MRI imaging needs of ED patients commensurate with the severity of their presenting illness. METHODS: A 3-level tiered classification system (tier 1: critical, tier 2: emergent, and tier 3: urgent) of ED patients with unambiguous hierarchically defined numerical classifications was implemented to replace a traditional method of MRI orders. Each tier was accompanied by guiding consensus-driven clinical definitions and common qualifying examples. Lastly, each tier imaging order was tied to a specific target "order to imaging start time" (OTST). After implementation, a month-by-month 1-year retrospective analysis of ED MRI imaging order volume was conducted to assess the percentage distribution of each category. In addition, a month-by-month 1-year retrospective analysis of the OTST for each tier was conducted. The OTST outcome measure was used to monitor the ability of the system to meet tier target times based on severity. RESULTS: The system effectively prioritized ED patients into 3 tiers based on acuity. An inverse relationship existed between ED MRI OTST and the tier severity into which the patient was stratified. We found that only 4% of the ED-specific volume is truly critical (tier 1). In addition, tier 3 MRI examinations constituted 75% of the ED volume. Month-by-month quality assurance analysis demonstrated consistent completion of examinations under or close to the target times tied to each tier. The average overall wait time from order time to begin scan time for all ED MRIs decreased from 245 minutes (4.1 hours) at baseline to less than 136 minutes (2.7 hours). CONCLUSIONS: We implemented and evaluated a 3-tiered system of ED MRI imaging orders based on patient severity. The system was unambiguous due to its numerical hierarchy, and each of the 3 tiers was accompanied by explicit guiding definitions for each category. A quality assurance process following implementation allowed us to monitor the ability of the system to meet target times tied to each tier. Our current ability to accurately predict a target performance time allows us to set accurate expectations for both providers and patients.

Ileal pouch-anal anastomosis surgery: imaging and intervention for post-operative complications.

Ileal pouch-anal anastomosis (IPAA) surgery preserves fecal continence for improved quality of life in patients who require proctocolectomy for treatment of severe bowel diseases such as inflammatory disease and familial adenomatous polyposis. In IPAA surgery, an ileal reservoir, or pouch, is created and anastomosed to the anal canal. Awareness of the surgical technique and the postoperative anatomy of the IPAA is important to identify complications at computed tomography (CT), magnetic resonance (MR) imaging, and fluoroscopy. Complications include anastomotic leak, abscess, pouchitis, venous thrombus, pouch fistula, and stricture. Leaks from the blind end of the pouch and the pouch-anal anastomosis often result in pelvic abscesses, which may require ultrasonography- or CT-guided drainage; judicious catheter management can help improve clinical outcomes and avoid excessive imaging. Pouchitis may be identified by the presence of a thickened enhancing pouch wall and associated inflammatory changes and lymphadenopathy. The venous system must be scrutinized for thrombi secondary to surgical manipulation and sepsis. Fistulas are likely because of the presence of chronic inflammation or infection and may be seen at MR imaging, CT, or fluoroscopy. Strictures appear as areas of focal luminal narrowing with proximal dilatation, which can lead to obstruction. To avoid repeated exposure to radiation, MR imaging may be performed in patients who must undergo frequent imaging.

Assessment of factors that affect the quality of performance and interpretation of sonography of adnexal masses.

OBJECTIVE: The purpose of this study was to assess factors that affect the quality of performance and interpretation of sonography of adnexal masses. METHODS: Two gynecologic sonographers performed blinded reviews of up to 3 sonograms within 5 years before surgery in 325 consecutive women who underwent oophorectomy (610 sonograms). Three 5-point quality scores were assigned (with 5 being the best score) on the basis of the technical quality of the images, accurate description of findings, and summary impression in the report. The location of the examination (on-site, remote, or emergency department), type of fellowship, practice experience (<5, 5-10, or >10 years), and specialty (women's imaging, abdominal imaging, or other) of the radiologists were recorded. Analysis of variance was used to assess the impact of these multiple factors on quality. RESULTS: No significant differences were found among 31 radiologists on the basis of the type of training, years in practice, or number of examinations read. Average scores among radiologists for technical quality, findings, and impressions were 4.96, 4.88, and 4.83, respectively. Radiologists who specialized in women's imaging performed best in the quality of their impressions (4.86 versus 4.79; P = .029). There were no significant differences in scores with respect to the examination location. CONCLUSIONS: Within this sample of radiologists, the technical quality of the examinations was not affected by the type of training or subspecialty practice. Reports of adnexal mass findings were accurately described by all radiologists, although specialization in women's imaging improved the ability to provide an accurate impression.

Maternal sensory sensitivity, mother-infant 9-month interaction, infant attachment status: predictors of mother-toddler interaction at 24 months.

At 24-months of age, toddlers (N=62) and their mothers were observed in a free-play session to determine the contribution of (a) maternal sensory sensitivity to positive and negative infant facial expressions as measured in a signal detection task at 6 months, (b) maternal behavior and affect, infant behavior and affect, and dyadic interaction at 9 months, and (c) infant attachment status at 12 months in predicting maternal, toddler, and dyadic measures at 24 months. Hierarchical regression analyses revealed that over and above early maternal behavior, which was predictive of later maternal behavior at 24 months, sensory sensitivity to the positive infant expression at 6 months predicted maternal behavior at 24 months and sensory sensitivity to both the positive and negative expression was associated with later maternal affect. Infant attachment status emerged as the variable which predicted toddler behavior and dyadic interaction at 24 months.