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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2009.09.018 Byline: Bruce I. Reiner Keywords: Quality; medical imaging; contrast agents; adverse drug events Abstract: The Institute of Medicine has determined that adverse drug events (ADEs) are the number one cause of medical errors in the United States and that additional efforts are required to improve patient safety. Medical imaging plays an important role in ADEs, most commonly related to the administration of imaging contrast agents. For medical imaging providers to assume a proactive role in patient safety, the creation of objective, data-driven quality metrics is advocated, which analyze all steps in the drug delivery chain, including procurement, prescription, dispersal, administration, monitoring, and management. These metrics would lead to the creation of a quality scorecard, developed to create objective accountability measures for all actors involved in this chain of events, including pharmacists, radiologists, clinicians, physicists, technologists, administrators, nurses, vendors, and patients. The ultimate goal of such an endeavor is to improve patient safety through the reduction of ADEs and the creation and refinement of data-driven best-practice guidelines. Author Affiliation: Department of Diagnostic Imaging, Baltimore VA Medical Center, Baltimore, Maryland

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2009.05.009 Byline: Bruce I. Reiner Keywords: Quality assurance; data mining; evidence-based medicine Abstract: The practice of medical imaging is fraught with inconsistency as it relates to quality assurance, which is due in part to the lack of standardization and objective quality-centric data. By applying the scientific methods of Shewhart and Deming to medical imaging quality assessment, one can devise an objective, data-driven quality model, encompassing the various steps and processes that take place within the medical imaging chain. Through automated recording, tracking, and analysis of these quality data elements, a quantitative scorecard can be derived that provides an objective measure of quality performance, relating to each individual process, participating stakeholder, and technology being used. Through meta-analysis of these quality-centric data, best practice guidelines can be created, which in turn promote quality as the major differentiating feature of service providers. Author Affiliation: Department of Diagnostic Imaging, Baltimore VA Medical Center, Baltimore, Maryland

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2009.05.008 Byline: Bruce I. Reiner Keywords: Patient safety; radiation dose optimization; image quality Abstract: As the utilization of medical imaging services continues to expand, so does the delivery of ionizing radiation. Although recent efforts within the medical imaging community have begun to focus on radiation dose reduction for computed tomography, very few objective data related to radiation dose are currently being prospectively collected, tracked, or analyzed. Without a comprehensive program aimed at objective and reproducible radiation data analysis, ongoing efforts at dose optimization will, in all likelihood, remain marginalized. The proposed radiation scorecard provides an analysis of events within the imaging chain, attempts to involve all stakeholders, and addresses the various technologies being utilized. The combined data can in turn be used for education and training, certification, research, development of best practice guidelines, and new technology development. Author Affiliation: Department of Diagnostic Imaging, Baltimore VA Medical Center, Baltimore, Maryland

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2009.04.007 Byline: Bruce I. Reiner Keywords: Radiation; safety; quality; data mining Abstract: An integral part of cost-benefit analysis within medicine is the comparative assessment of the clinical gains introduced by a service or application compared with the patient costs, which can be measured in economic or clinical terms. When analyzing medical imaging, a number of factors must be included, the most important of which include issues pertaining to patient safety, image quality, and clinical outcomes. Although ionizing radiation has long been recognized as a potential carcinogen capable of introducing harm to patients, the long-term derived benefits have been accepted because of the diagnostic and therapeutic benefits derived from its use. With the increased utilization of high-dose ionizing radiation examinations (such as multidetector computed tomography), it is essential that the medical community create data-driven methodologies to quantify risk in objective terms, develop community-wide radiation standards and 'best practice' guidelines (evidence-based medicine), develop new technologies and applications to proactively minimize radiation dose while maintaining quality, and create accountability measures for all pertinent stakeholders. Author Affiliation: Department of Diagnostic Imaging, Baltimore VA Medical Center, Baltimore, Maryland

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2008.12.008 Byline: Bruce I. Reiner Keywords: Quality assurance; digital radiography; automated workflow Abstract: The existing practice of quality assurance (QA) in medical imaging is problematic because of the subjective manner in which it is performed, the lack of community and industry-wide QA standards, a paucity of supporting technology, and an overall lack of accountability. The solution for optimizing QA lies in the creation of objective and reproducible QA metrics, whose analysis can be automated through the creation of computerized QA software algorithms. The QA data derived from these computerized programs would in turn create the infrastructure for a comprehensive QA database, which can serve as a valuable resource for QA education and training, research, decision support, and technology innovation. The ability to objectively track and analyze QA practice across the wide spectrum of imaging providers creates a mechanism for the creation and refinement of objective QA standards and 'best practice' guidelines. Author Affiliation: Department of Diagnostic Imaging, Baltimore VA Medical Center, Baltimore, Maryland

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2008.11.004 Byline: Bruce I. Reiner, Eliot L. Siegel Keywords: Quality assurance; commoditization; pay for performance Abstract: The current focus on the economic bottom line in health care creates the potential for radiology to become a commodity, devoid of qualitative differentiation. This trend toward commoditization has been accelerated by the globalization of imaging services (teleradiology), increased information exchange (eg, Digital Imaging and Communications in Medicine, Integrating the Healthcare Enterprise), and new technology development (eg, picture archiving and communication systems, computer-aided diagnosis). The optimum strategy for avoiding commoditization is the creation of objective quality metrics and standards throughout the medical imaging practice, which will provide a reproducible and objective means with which to differentiate imaging service deliverables on the basis of quality and clinical outcomes. These quality measures can in turn be directly tied to economic incentives (pay for performance), providing further incentive for proactive quality assurance, qualitative differentiation, and technology development centered on quality. Author Affiliation: Department of Diagnostic Imaging, Baltimore VA Medical Center, Baltimore, Maryland

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jacr.2007.01.015 Byline: Bruce I. Reiner (a), Nancy Knight (b), Eliot L. Siegel (a)(b) Keywords: Radiology reporting; structured reporting; quality assurance; pay for performance Abstract: Although imaging technologies have undergone dramatic evolution over the past century, radiology reporting has remained largely static, in both content and structure. Existing free-text (prose) reports have been criticized for a number of inherent deficiencies, including inconsistencies in content, structure, organization, and nomenclature. A number of new initiatives and technologies now present the radiology community with the unique opportunity to fundamentally change the radiology report from free to structured text. These new developments include a standardized nomenclature (RadLex), automated information technologies (picture archiving and communications systems and electronic medical records), and automated data tracking and analysis software (natural-language processing). Despite the increasing availability of these tools and technologies for revolutionizing reporting, clinical, psychologic, legal, and economic challenges have collectively limited structured reporting to mammography. These challenges are most evident in the current environment of heightened expectations for improved quality, timeliness, and communication, along with increasing stress, fatigue, and malpractice concerns. In conclusion, the authors present an alternative to traditional reporting that attempts to address some of these diverse challenges while incorporating the aforementioned initiatives and technologic developments. This approach uses a graphical symbol language that is directly mapped to a standardized lexicon (RadLex) and is automatically converted into a structured hierarchical text report, which can then be much more easily searched and analyzed. Author Affiliation: (a) Baltimore Veterans Affairs Medical Center, Baltimore, Md. (b) University of Maryland School of Medicine, Baltimore, Md.