How imaging protocol variation can be reduced at multisite radiology practices

A structured, quality improvement process consisting of collaborative, consensus-based decision-making and conflict resolution strategies can eliminate unwarranted variation in CT and MRI protocols at academic medical centers with multisite radiology practices, according to research published online Aug. 3 in the Journal of the American College of Radiology.  

As the effort to move medical imagers from volume-based care to a more value-based system, protocol variation for CT and MRI is prominent among large medical institutions across the country, wrote lead author Daniel Glazer, MD, a radiologist at Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues.  

The team created the Harmonization Oversight Committee at a large academic radiology practice that performs 800,00 radiology exams annually. The committee was responsible for ensuring that patients with similar clinical cases underwent the same CT or MRI protocol during a five-month harmonization process.   

A Primary outcome measure was standardization of CT and MRI protocols across all sites. Percent reduction of CT and MRI protocols post harmonization was a secondary measure outcome, according to the researchers.  

Overall, the researchers noted the average CT and MRI protocols per imaging workgroup reduced by 31 percent at the end of the five-month harmonization process. Most conflicts noted were present for abdominal imaging protocols because they were performed in four subspecialty divisions and interpreted by a variety of radiologists.  

The researchers suggested that when able, protocol decisions should be made by a small group consisting of representatives from all involved stakeholders.  

“A structured, organ system- and consensus-based quality improvement process with unambiguous decision-making and conflict resolution processes can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices so that patients with similar clinical presentations are imaged with the same imaging protocol,” the researchers wrote.