Integrating medical physics into an EMR-based radiology feedback system for quality improvement

Medical physicists play a critical role in ensuring image quality and patient safety, but their routine evaluations are limited in scope and frequency compared to the breadth of clinical imaging practices. An electronic radiologist feedback system can augment medical physics oversight for quality improvement. This work presents a novel quality feedback system integrated into the Epic electronic medical record (EMR) at a university hospital system, designed to facilitate feedback from radiologists to medical physicists and technologist leaders.

The feedback system was designed to enable radiologists to report quality issues directly through a streamlined survey during report dictation. The feedback encompasses technical details including image noise, artifact, and contrast issues, as well as acquisition-related concerns such as positioning errors or protocol deviations. Submissions are routed to modality-specific teams consisting of technologist leaders and medical physicists, who investigate and address reported issues. The roles of medical physicists in this feedback system were evaluated over a 31-month period.

Physicists addressed 9.3% of 515 tickets that warranted follow-up, with greater involvement in resolving technical quality issues including artifacts and issues related to noise and image contrast. Examples of physicist-led interventions included correcting radiography image processing settings, optimizing computed tomography dose settings, and identifying trends in ultrasound quality issues that prompted protocol updates and staff training.

This work demonstrates the value of radiology quality feedback systems and the opportunity to address issues not typically identified during routine medical physics quality assurance. By leveraging radiologist feedback, physicists can enhance clinical practice, promote continuous improvement, and ensure consistent, high-quality imaging and safety for patients.