How consistent is the technical quality of breast MRI exams?

The technical quality of breast MRI examinations in the United States is inconsistent, according to new findings published in Academic Radiology. What can providers do to help remedy this trend?

The study’s authors represent a facility that performs second-read interpretations of outside MRI examinations. To track the quality of these outside scans, the team examined data from 100 consecutive breast MRI examinations submitted for a second opinion in 2013. Four fellowship-trained breast imaging specialists evaluated the quality of each scan.

“Patients are referred to our institution for second opinions from institutions within the United States and outside the United States,” wrote Lorell Ruiz-Flores, MD, University of Texas MD Anderson Cancer Center in Houston, and colleagues. “The purpose of this study was to determine the quality of the outside MRI studies and to identify which technical deficiencies were most prevalent.”

Overall, the researchers focused on 88 outside examinations performed within the United States. Eleven percent of those examinations featured more than five “technical deficiencies,” and 68% had at least one such deficiency. Artifacts were the most common deficiencies observed, occurring in 74% of all cases. Deficient T2-weighted sequences (38%), deficiencies in the delayed-phase postcontrast T1-weighted sequence (27%) and deficiencies in the early-phase postcontrast T1-weighted sequence (23%) were also common. A low signal-to-noise (SNR) ratio was the primary culprit for these deficiencies.

Also, the facility’s radiologists recommended that 47% of patients undergo a repeat breast MRI examination. Image artifacts other than “motion, ghosting, shimming or wrap-around” were associated with a recommendation to undergo a repeat examination.

“We found that more than two-thirds of outside breast MRI studies subjected to second-opinion review at our institution had at least one technical deficiency,” the authors wrote. “Furthermore, our findings regarding the frequency of different types of deficiencies indicated that attention to artifacts and optimizing the SNRs in the T1- and T2-weighted sequences represent the greatest opportunity for quality improvement by radiologists.”

Ruiz-Flores et al. noted that being familiar with the American College of Radiology’s MRI Accreditation Program requirements is a step radiologists and other providers can take to improve both image quality and patient safety. The program’s guidelines “are widely accepted and originate from the largest professional organization for imagers in the United States,” according to the authors.