ACR CT Accreditation Program and the Lung Cancer Screening Program Designation.

The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer screening should be performed at sites providing high-quality low-dose CT examinations overseen and interpreted by qualified physicians using a structured reporting and management system. The ACR has developed a set of tools necessary for radiologists to take the lead on the front lines of lung cancer screening. The ACR Lung Cancer Screening Center designation is built upon the ACR CT accreditation program and requires use of Lung-RADS or a similar structured reporting and management system. This designation provides patients and referring providers with the assurance that they will receive high-quality screening with appropriate follow-up care.

ACR CT accreditation program and the lung cancer screening program designation.

The ACR recognizes that low-dose CT for lung cancer screening has the potential to significantly reduce mortality from lung cancer in the appropriate high-risk population. The ACR supports the recommendations of the US Preventive Services Task Force and the National Comprehensive Cancer Network for screening patients. To be effective, lung cancer screening should be performed at sites providing high-quality low-dose CT examinations overseen and interpreted by qualified physicians using a structured reporting and management system. The ACR has developed a set of tools necessary for radiologists to take the lead on the front lines of lung cancer screening. The ACR Lung Cancer Screening Center designation is built upon the ACR CT accreditation program and requires use of Lung-RADS or a similar structured reporting and management system. This designation provides patients and referring providers with the assurance that they will receive high-quality screening with appropriate follow-up care.

The ACR BI-RADS experience: learning from history.

The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future.

Pay for performance in radiology: ACR white paper.

During the next few years, some portion of physician reimbursement will be increasingly based on the quality and efficiency of service, a practice commonly referred to as pay for performance (P4P). Performance benchmarks are the discrete parameters of structure, process, or outcome metrics whose attainment defines good quality care. Private payers are already rewarding primary care physicians for practices that adhere to quality standards, are efficient, involve information technology, and result in high patient satisfaction. The Centers for Medicare and Medicaid Services will have completed the development of performance measures to be used in Medicare payment strategies for all specialties by the end of 2006 and anticipates phasing in the program fully by 2008. This article describes P4P, its importance to the ACR, the organizations involved in developing it, the ACR's activities to date, and the steps the ACR must take to ensure that radiologists are remunerated fairly as physician payment becomes based, in part, on performance.

ACR MRI accreditation: yesterday, today, and tomorrow.

The ACR's Magnetic Resonance Imaging (MRI) Accreditation Program has generated controversy and debate since the Committee on MRI Accreditation began the development of the program in the early 1990s. This article discusses the motivation and development process for the program. It also presents outcomes from the MRI Accreditation Program, including passing and failing statistics by field strength and body part. The on-site survey process and outcomes are presented, and a case study is described.

The ACR's Mammography Accreditation Program: ten years of experience since MQSA.

The ACR's Mammography Accreditation Program has been helping facilities improve the quality of mammography through peer review and professional feedback since 1987. Initially conceived as a voluntary program, accreditation became mandatory when the Mammography Quality Standards Act (MQSA) of 1992 required all U.S. mammography facilities to become accredited and certified by October 1, 1994. Currently, the ACR is the largest of four accrediting bodies approved by the U.S. Food and Drug Administration, accrediting 12,729 units at 8325 facilities by October 1, 2004. Between 1987 and 1991, 70% of the mammography units applying for accreditation with the ACR passed on their first attempts. In 2003, 88.3% of the units passed on their first attempts, indicating a marked improvement in the quality of mammography in the United States since MQSA went into effect 10 years ago.

Practice guidelines: the radiology perspective.

Clinical practice guidelines have emerged as a reality for medical practitioners over the past 20 years. Although virtually all groups interested in the development of practice guidelines hope for improvements in patient care, secondary expectations vary widely among those using them. Their use in daily practice by physicians has met with resistance from barriers including concerns of "cookbook" medicine, a loss of autonomy, and increased professional liability. The recent experience of the ACR in addressing these challenges illustrates that physicians are receptive to steps perceived to mitigate the risks accompanying the use of guidelines as well as to efforts to increase their understanding of implementing guidelines in clinical practice. The experiences of other medical societies and an inventory of future trends reveal additional challenges associated with the use of practice guidelines, as third parties look to guidelines as points of reference for gauging the performance of health care providers.

How do training, education, and experience affect quality in radiology?

The quality of care is attracting increasing attention from payers, regulators, and consumers. The assumption that training, education, and experience are major determinants of quality and safety permeates the health care delivery system. However, the relationship between quality and training, education, and experience is neither straightforward nor well documented, particularly for the practice of radiology. A recent Institute of Medicine report questioned the effectiveness of the existing system for the education and training of health care professionals. In this article, "quality" in radiology is defined, and evidence for a relationship between quality care and experience and traditional continuing medical education is reviewed. Alternative approaches to education and training, with an emphasis on systems rather than individuals, are elucidated. The nature of radiologist training, education, and experience should be reexamined and adjusted to meet the changing demands of the health care delivery system.