High-level support and a consensus-based decision-making process are the keys to standardizing CT and MRI protocols across large healthcare centers, a team of Harvard Medical researchers report in current edition of the Journal of the American College of Radiology (JACR).
As U.S. healthcare transitions from a model of volume-based care to one centered around value, hospital administrators are expecting more from radiologists now than ever, first author Daniel I. Glazer, MD, and co-authors wrote in JACR. In the case of Brigham and Women’s Hospital in Boston, where Glazer and his colleagues work, the lack of a uniform set of CT and MRI protocols is placing further stress on already-overworked physicians.
“Although there are many individual aspects of the imaging value chain, an important source of unwarranted variation and waste is at the level of individual imaging protocols,” Glazer et al. wrote. “Previous studies have reported significant differences both in imaging protocols as well as radiation dose delivered for a variety of examinations across the country.”
Each institution and entity at Brigham and Women’s created their own CT and MRI guidelines, the authors wrote, which have been maintained over the years but remain distinct from one another. Because of this, patients who present with similar symptoms may be imaged differently based only on where they were originally scanned.
“This variation in protocols decreases value and leads to increased waste and suboptimal patient outcomes,” Glazer and his team said, noting differences could be anything from MR slice thickness to the number of postcontrast phases.
In an attempt to standardize those protocols, Brigham and Women’s created a 13-person board known as the Harmonization Oversight Committee, which employed chairs from each of 13 organ system or modality workgroups to create a uniform set of protocols for CT and MRI exams. The committee decided on a process for decision-making and conflict resolution that was tested over a five-month period.
“Through a structured radiology enterprise-wide quality improvement initiative aimed at CT and MRI protocol optimization, we eliminated unwarranted variations in CT and MRI protocols, eliminated redundant and discordant protocols across the radiology enterprise and reduced the total number of CT and MRI protocols by nearly one-third to ensure that patients with the same clinical presentation are imaged the same way, regardless of where they present for care,” the authors wrote.
Glazer and colleagues said the average number of CT and MRI protocols per imaging workgroup decreased by 31.1 percent after optimization efforts, with the mean number decreasing from 31 to 22. The greatest variations in protocols were noted when imaging studies were performed and interpreted by multiple groups of radiologists.
The team said its effort to render decision-making unambiguous and unify imaging protocols was successful, though they can’t be sure their results will apply to smaller practices or those with less centralized leadership.
“Our results suggest that having a centrally organize radiology practice with higher-level oversight of imaging protocols, along with collaborative, consensus-based decision-making and conflict resolution processes, can lead to greater standardization, thus reducing variation,” they wrote. “Whenever possible, decisions regarding protocols should be made by a small group with representatives from all involved stakeholders rather than being made on an ad hoc basis at the local level.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.