Radiologists gripe more freely on web-based quality control system

When faced with the tall task of interpreting a set of poor-quality images, radiologists may grumble in their dark rooms or lambaste their techs in person. Imagers may feel their complaints disappear into a black hole and that it isn't worthwhile to file a formal quality control complaint.

But radiologists at the University of Maryland say an automated web-based issue reporting system compatible with most PACS helps dramatically improve communication between radiologists and technologists, while effectively monitoring and improving quality control.

With this system, radiologists need to click only one button to make a quality complaint by e-mail. Details such as radiologist name, modality, session number, and patient ID are automatically entered by the web tool. The interpreting radiologist then just checks off the technical problem, such as patient positioning or grid artifact.

"Two button clicks, and you are done," said Dr. Paul Nagy, an assistant professor of radiology.

An e-mail with the description of the problem is sent directly to the digital pagers of tech supervisors, and the radiologist is notified when the problem is resolved. About 40% of technical problems are now resolved within one hour, Nagy reported at the RSNA meeting on Wednesday.

Radiologists typically are not very likely to fill out paper-based quality control reports or even web-based processes that involve too many steps, such as manual entry of basic information, Nagy said. The radiologist then might call a tech supervisor, which can be disruptive to workflow. The effect on the technologist's future performance remains unclear.

Before the system was implemented, only about 10 quality control issues per month were reported out of about 25,000 studies performed. Afterward, 250 complaints were lodged per month, equivalent to about 1% of the monthly study volume.

Reports in the literature indicate an error rate of 0.2% using a web-based system that requires more manual data entry and .04% with a paper-based system.

"We are getting a much more accurate reading of quality control. If you don't get many complaints, that does not necessarily mean you have superlative quality," Nagy said.

The transition to PACS has "sterilized the relationship between radiologists and technologists," according to Nagy.

"There's no more hanging films, no more hallway conversations. You are no longer getting to know techs the way you had in previous years. In some ways, IT has put a barrier between you and your techs, and the challenge now is how can we bridge that barrier?" he said.

Data provided in the web-based issue reporting system can be used effectively in performance appraisals to modify behavior and improve quality. At the University of Maryland, performance of the three worst-performing techs was improved dramatically through feedback based on hard figures.

"Radiologists think techs won't like this, but in fact they prefer this to being yelled at by a radiologist. This is data-driven, constructive information, and techs are responsive to this. Radiologists think they don't care, but I am here to tell you they do care, as long as you provide them with information they can work with," he said.