AHRA 2019: What it takes to become an ACR Diagnostic Imaging Center of Excellence

Earning the American College of Radiology (ACR) Diagnostic Imaging Center of Excellence (DICOE) designation can help imaging providers stand out among the competition—if they’re willing to do what it takes to achieve that goal. A two-part presentation at the AHRA 2019 Annual Meeting in Denver, Colorado, examined the DICOE assessment process from the perspective of a hopeful applicant and a medical physicist who helps perform on-site evaluations.

Joyce Timko, MBA, CRA, RT(R)(CT)(M), spoke first, sharing her experience as the director of diagnostic imaging at Orange Regional Medical Center (ORMC) in Middletown, New York. Timko led ORMC through its journey to earn the DICOE designation, noting that it took more than two years of hard work. It was well worth the effort, though, distinguishing ORMC as “a leader in diagnostic imaging.”

“Our competitors can’t say they are a DICOE,” Timko said. “They may have a Breast Imaging Center of Excellence, they may be certified by the ACR, but they are not a DICOE. They are not the best of the best. We’re the best of the best.”

To become a DICOE, a department or practice has to meet certain requirements. All modalities that are offered must receive ACR accreditation, for example, and active participation in the Dose Index Registry and General Radiology Improvement Database are mandatory. Each individual technologist must also pledge to both Imaging Gently and Image Wisely.

Once those baseline criteria are met, Timko explained, a three-person team performs an on-site assessment focused on the facility’s imaging quality, policies, personnel and more. You then generally find out how you did at the end of that assessment, though you may still be given a list of required changes you have to make within a certain amount of time.

Lessons learned

Timko also reviewed some of the issues the assessment team found with ORMC—and how she and her team quickly resolved them. For example, the emergency department (ED) had moved its crash cart at some point to another location, so when technologists were asked about its location, they provided an incorrect answer. In the crash cart’s place? A cart full of linens. Timko quickly worked with the ED to get the crash cart back where it needed to be and everyone back on the same page—but had the assessment not occurred, it’s possible the ED’s original decision to move the crash cart could have impacted patient care at a later date.

Another issue found during the assessment involved a missing sign in an important location.

“We have signs about pregnancy all over our building and in our changing rooms,” Timko said. “But we did not have a sign in the waiting room of our brand new outpatient building saying, ‘If you’re pregnant, please let us know.’ There are times when a patient may not even go into the waiting room—they could go straight to the changing room—so we had to put a sign there.”

ORMC did receive its DICOE designation, Timko noted, and celebrated with a party for everyone involved and a press release to help spread the good news.

A different perspective

Melissa C. Martin, MS, president of Therapy Physics, Inc, spoke next, providing attendees with the perspective of someone who carries out the on-site evaluations and helps make the final decision. The DICOE teams sent out to make these evaluations include a technologist, a medical physicist and a radiologist, and Martin serve as the groups’ medical physicist.

The teams are primarily looking at four key areas, Martin explained: quality, safety, procedures and personal requirements/qualifications. And they review a lot of images and physics reports in advance, so the team already knows quite a bit about the practice before it even arrives.

“It is impossible to review everything on site,” Martin said. “By the time your medical physicist comes to review you, they are aware of every piece of equipment they will be evaluating. Part of what they want to do is make sure it all matches.”  

Martin also noted that evaluations aren’t designed to scare or intimidate providers—it’s to help them learn and track all of their hard work.

“We want to use this as an educational tool,” she said. “We are probably some of the few people who truly appreciate what technologists do to acquire quality control data, and we always make an attempt to let them know that.”