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Building a comprehensive quality infrastructure in a large radiography practice
Z Long1, S J Dean1, A K Forney1
1Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Introduction:
Modern radiography practice faces challenges related to high examination volume, technologist staffing, variability in image acquisition and processing, and heterogenous equipment. This study describes the design, implementation, and longitudinal performance of a radiography infrastructure for imaging standardization and quality improvement.
Methods:
A quality infrastructure has been developed and implemented in a large radiography practice by a multidisciplinary team since 2019. Four main components include clinical image quality scoring using a standardized four-point scale across five categories with ongoing monitoring, a closed-loop radiologist feedback mechanism, digital radiography DICOM metadata analytics using custom MATLAB programs, and a radiographic equipment scoring and ranking system.
Results:
Over six years, 87,437 (4.8 %) clinical radiographs were scored across 161 (76.3%) image projections. The overall monthly average score was 13.4 ± 0.3 with no month below the monitoring threshold. Linear regression analyses revealed that only the onset of the SARS-CoV-2 pandemic was associated with an estimated 0.7-point drop in the monthly average scores (p = 0.006). Radiologist feedback averaged 20 entries/month with imaging technique identified as the most common constructive feedback (21.7%). DICOM analytics extracted imaging details from over six million images. A targeted investigation of portable anteroposterior proximal femur imaging demonstrated a significant reduction in exposure index values following intervention (p < 0.001). Over 190 radiographic systems were scored and ranked using a formula-based system.
Conclusion:
The quality infrastructure integrates clinical image quality assessment, radiologist feedback, DICOM metadata analytics, and equipment scoring. It has proven feasible and essential for technologist education, image quality standardization and improvement, and equipment replacement prioritization.
Implications For Practice:
The quality infrastructure supported by quantitative analysis provides invaluable insights into modern radiography practice and is adaptable to other clinical settings.
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