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AJR June 2017

Krishna Juluru
Corresponding Author
Department of Radiology, Memorial Sloan Kettering Cancer Center
New York, NY

“Implementation of a Point-of-Care Radiologist-Technologist Communication Tool in a Quality Assurance Program”

Looking for ways to improve communication between radiologists and technologists, a team at Memorial Sloan Kettering Cancer Center designed and implemented an issue-tracking system they called Image Quality Reporting and Tracking Solution (IQuaRTS), accessible directly from the PACS at the point of care that facilitated radiologist-technologist communication. In this interview, Dr. Krishna Juluru discusses ways institutions can use tools like IQuaRTS to continually improve safety and image quality.

1. In the study, 15% of radiologists submitted half of the issues. What can be done to improve participation rates?

The success of a quality improvement program is highly dependent on participation. Members of any given organization will have varying motivations to participate in a quality improvement effort. In this regard, one of the keys to success is having a system that is easy to use, and also making sure the system is well advertised. Importantly, participants also need to feel that the issues they are reporting are being heard and addressed.

2. The discussion mentions that the institution needs to develop an environment of quality improvement, so that the reporting system is not seen as punitive and threatening to job security. What steps can institutions take to develop that kind of quality-focused environment?

The culture of an institution is largely set by its leadership. In the launch of IQuaRTS, we established a common goal: improve imaging quality and safety through improving communication between radiologists and technologists. Making sure that the leadership shared that message repeatedly and consistently helped make this project successful. We also encouraged radiologists to submit excellent work when observed, so that critiques were balanced with compliments.

3. What considerations are involved in putting together a successful quality-improvement team?

All the members of the team have to share in the spirit of the quality improvement effort. They have to be invested, and they have to be excited. In the launch of IQuaRTS, two of our MRI technologists leads fortuitously approached radiology leadership on their own volition, asking about ways to improve the quality reporting process. We then added into the team additional technologist leads at our various imaging centers, always emphasizing and restating our message of quality improvement. The project grew with regular meetings and close involvement of the entire team at every stage, which further reinforced their investment in this project.

4. Do you see a conflict between making the tool easy to use and ensuring that the system provides useful quality-control information?

We are fortunate in radiology that there has been long-standing commitment to information standardization in our specialty. The quality control information needed in this project largely resided in the PACS DICOM headers and databases, which could be readily contextually passed into the IQuaRTS application using industry standard interfaces. Technologies exist that allow tools to be both easy-to-use and information-rich. As radiologists, we shouldn’t feel shy about asking for both.

5. In deploying a tool like this, are there cybersecurity issues about which radiologists and institutions should be concerned?

Security is always important. All tools, whether industry-developed or custom-developed, need to conform to institutional privacy and security policies and best-practices.


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