How one large hospital standardized its MRI protocols in 6 steps

Delivering consistent MRI testing across a vast clinical enterprise can be a tall task, but one Atlanta-based hospital may have discovered the secret recipe.

Emory University Hospital and its school of medicine recently devised a detailed process to ensure that such exams are delivered in a more uniform fashion. Collaboration between radiologists, physicists and technologists has been crucial during the project, experts wrote Wednesday in Current Problems in Diagnostic Radiology.

Emory delivers some 70,000 MRI exams annually, using 25 imaging systems across 14 centers. Doing so wasn’t easy, but neuroradiologist Amit Saindane, MD, believes the system is starting to make headway on their imaging project. They’ve focused on keeping magnetic resonance services personalized to each patient, but also delivered within a “framework of standardization.”

“A patient receiving an MRI should rightly presume equal outcomes at any MRI site within an institution,” wrote Saindane and coauthor Puneet Sharma, PhD, a professor and MRI physicist at the school. “It is our charge as clinical and technical providers to ensure the underlying structure is in place to facilitate that expectation.”

To help radiologists elsewhere, the authors broke down their process into five easy steps (which have been boiled down and condensed by Radiology Business):

1) Take inventory: Emory began this process by taking account of its MRI technology and personnel, Saindane noted. It formed a committee of key stakeholders to aid in this process, incorporating radiologists, MRI physicists and technologists.

2) Devise a document: Radiologists from each division then formed work groups to begin reviewing and discussing the existing MRI protocols. If a formal protocol was not already in place, each group would begin crafting one with the goal of defining clinical needs, observing accepted standards and adhering to the principles of exam efficiency.

3) Collaborate with coworkers: Another important step, the authors noted, was conferring with MRI physicists before radiologists finalized any MRI protocols. Such experts could then comment on any new content, or propose alternate imaging techniques for specific systems that are not capable of a particular MR method.

“These technical experts have intimate knowledge of MRI system capability throughout our enterprise, which is non-trivial considering the scope of vendors, coils, field strengths, pulse sequence methods, and system age,” Saindane wrote.

4) Target implementation: Once this collaboration between radiologists and scientists wraps up, the teams then work with site-lead technologists to implement the new protocols, addressing any concerns about workflow and education. MR physicists also programmed and carefully reviewed the translation of each protocol into the system, making sure they are compatible and optimize performance.

5) Open communication channels: After scientists standardize and install these protocols, Emory then opened communication channels between site supervisors/technologists and the radiologists/physicists, relaying image quality workflow, exam times and concerns about protocol execution.

“The urgency of issues drives the mode of communication, with email and phone as the primary tools, with more advanced methods, like real-time chat, currently being evaluated. In our view, this is vital to maintain standardization and continually optimize methods,” the authors wrote.

6) Check in annually: Afterward, Emory has ensured that each division—including abdominal, neuroradiology, musculoskeletal and breast imaging—reconvene yearly to review the MRI protocols again. This is usually slated over the summer, as new residents and fellows arrive and begin getting acquainted with the organization. Radiologists vote on any protocol changes using an online survey tool, with controversies mulled over as a team to reach consensus. Authors also emphasized that they have worked to preserve clinician autonomy.

“The radiologist maintains authority to augment the protocol at vetting to best meet the needs of the patient,” they noted. “This application has greatly improved exam efficiency by reducing tech confusion and radiologist intervention.”

At the time of writing this piece, Emory had established 230 MRI protocols across its various specialties. The authors believe this process is beginning to bear fruit, and encourage other leaders to dive in.

“In total, these process achievements have allowed our institution to operate with the mentality that all patients receive our standardized MR protocols, regardless of the location within the enterprise,” they noted. “Our overall experience with protocol standardization has been positive. But it is also a work in progress, as new tools and ideas become known. A connected team is vital for success, along with an intimate understanding of a system's capability,” they added later.