New MRI accreditor could give ACR a run for its money

MRI providers seeking to accredit their facilities will soon have an option other than the American College of Radiology to provide that accreditation. Industry played an important part in developing this choice.

The Intersocietal Accreditation Commission (IAC) is putting the final touches on an accreditation program that addresses MRI capabilities in body, cardiovascular, musculoskeletal, and neurological imaging. The program is scheduled to launch in March.

The International Commission for the Accreditation of Magnetic Resonance Laboratories (ICAMRL) will run the program. The nonprofit organization was established with the support of five sponsoring organizations: the American Academy of Neurology, American Academy of Orthopaedic Surgeons, American Association of Neurological Surgeons/Congress of Neurological Surgeons, American College of Cardiology, and American Society of Neuroimaging. A radiologist and two technologists are also involved as at-large representatives of the imaging community.

"Our philosophy is that a single specialty should not set the standards for interpretation, performance, indications, and equipment," said Tamara Sloper, director of marketing for the IAC in Columbia, MD. "All specialties that use a particular modality should put their turf issues aside and work together to come up with standards that ultimately benefit the patient."

Representatives from cardiology, neurology, orthopedic surgery, and radiology were involved in developing the accreditation process and associated documents. Industry also became involved when the IAC contacted the National Electrical Manufacturers Association, which responded enthusiastically.

"Accreditation tries to ensure image quality, which is something we all strive for in medicine," said Karen Pearson, a NEMA representative to the IAC and manager of luminary accounts at Toshiba America Medical Systems. "The process with the ACR was a painful one. But it's been a pleasure working with the IAC in that they wanted our helpÑsomething the ACR didn't want."

Industry representatives provided input on quality assurance standards and reinforced the need to avoid overdependence on one or more specific phantoms, Sloper said.

ICAMRL officials are reviewing applications from five pilot sites. The review is intended to ensure that the application process is valid and elicits the responses needed to properly evaluate a site. Necessary adjustments will then be made and the program will be formally introduced to the MRI community.

"This will help us ensure before we publish the documents and distribute them throughout the MR community that the process works," Sloper said.

The next step will be to educate the MRI community, partly by getting the word out at professional meetings. Sloper and her colleagues will make presentations to the leadership and groups within the Society for Cardiovascular Magnetic Resonance and the American Society of Neuroimaging, for example. ICAMRL also intends to play its hole card: reaching out to vendors.

The IAC hopes to involve industry in its marketing process. Commission officials will ask vendors to distribute brochures about the program to their customers.

"This is an ideal way to get the message out," Sloper said. "But it's fairly informal. We have always left it to the vendors to decide how much they are willing to help us."

The IAC will also ask manufacturers to sponsor accreditation workshops for users, a strategy that has been used effectively for other types of accreditation. Industry involvement has been key to successful workshops in echocardiography, for which the IAC has provided accreditation since 1996. Agilent Technologies, for example, has sponsored "Getting Started" workshops throughout the country to introduce the staff of echo labs to the mechanism of accreditation. The IAC also offers accreditation programs for nuclear medicine sites and vascular labs.

The impetus for establishing the MRI accreditation program came from specialists outside radiology, she said. Neurologists, cardiologists, and orthopedic surgeons indicated an interest in having a multidisciplinary program about two years ago.

Representatives of the International Society for Magnetic Resonance in Medicine and the ACR were invited to ICAMRL's first board of directors meeting in February 2000. The ISMRM indicated an interest in monitoring the development process, Sloper said, but the ACR declined the invitation because it has its own program.

One reason MRI facilities might prefer to apply for accreditation from ICAMRL rather than from the ACR is the interdisciplinary nature of the new program. The various specialties involved in MRI were brought together to determine standards and evaluate applications. During its development, substantial effort has been expended to make the application process user-friendly.

"But it is in no way a lesser process in terms of identifying quality facilities," Sloper said.

ICAMRL is flexible in its requirements, she said. Whereas the ACR requires the use of a phantom, ICAMRL does not. Instead, the applicant documents and attests to the quality assessment program in place at the facility. Another difference is that filmed images, or videotape in the case of cardiovascular MRI, must accompany the application, rather than DICOM-compatible images.

There are three paths that an application might follow. Facilities may be accredited as being substantially compliant with established standards. Along with their accreditation, sites will receive a critique that outlines strengths and weaknesses identified by the reviewers. This critique will become part of the records kept at ICAMRL and will be examined at the end of the three-year accreditation period, if and when the site reapplies.

"The idea is that each time they apply, the requirements will get tighter and tighter, so the sites continue to improve," Sloper said.

The second path would involve an on-site visit. This would be done to clarify discrepancies in the application. A third possibility is that the accreditation is delayed because of deficiencies. The delay would last until the deficiencies were resolved and standards substantially met.

"We will come back to them with a letter of additional items that need to be submitted or corrected. They would then have until the next accreditation decision to correct and submit documentation," she said.

ICAMRL charges a base fee of $1500 for the first scanner to be reviewed and $1000 for each additional scanner at the same site. It will also consider charging $1000 per scanner at additional sites, if the facilities meet criteria designed for a multiple-site application.

Accreditation is voluntary at present, Sloper noted, but the incentive to become accredited could grow. Aetna U.S. Healthcare requires that its MRI providers be accredited and other third-party payers are expected to follow suit. The experience of the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) suggests how this scenario might play out for MRI. Since beginning operations in 1989, ICAVL has accredited more than 1400 vascular laboratories. The major impetus for these sites to seek accreditation has been the establishment of requirements in some 30 states that providers must be accredited to conduct vascular studies, according to Sloper. MRI is still in the early part of that curve, she said, but the curve could quickly start to move upward.