Society president issues call for quality improvement in radiology

"Today we are going to learn how to put on our socks and lace our shoes."

RSNA president Dr. Gary J. Becker drew upon these words of wisdom from legendary college basketball coach John Robert Wooden before a lively audience at the Arie Crown Theater on Sunday, Nov. 29.

"Don't worry. I'm not going to tell you how to dress," Becker said. "But there is a metaphor. Wooden's wrinkled socks offer a lesson for all of us in radiology."

Wooden revisited these fundamentals before sending out to the court any of the teams that won him a record 10 National Collegiate Athletic Association titles. Sock wrinkles inside improperly laced shoes could turn to blisters that would keep the young stars from practicing and, ultimately, from shining. Wooden believed such minutiae could affect a team's ability to win and thus required a focus on quality improvement starting from the very first practice.

"Today we radiologists find ourselves in a similar situation. One of the most vital priorities for our profession is the adoption of a new focus on quality improvement. I believe quality and our commitment to it will be a key factor in determining our future."

A number of issues, such as disregarding quality improvement principles, holding on to preconceived notions and attitudes, and the lack of a culture of improvement, could wreak havoc in the field unless radiologists acknowledge and deal with them soon, Becker said. If radiologists choose to ignore them, they do so at their own risk because the demand for individual transparency and accountability from patients, families, and public and private healthcare organizations is only going to grow.

"All this means we are going to need to increase our focus on safety, quality, performance measurement and improvement, and value," Becker said.

According to Becker, the most efficient care, and the end to a culture of preventable medical error, waste, and service fragmentation, will depend significantly upon the implementation of quantitative imaging and informatics. Big gains in terms of quality improvement can be achieved through the use of computerized radiology order entry and decision support systems as well as through the use of structured reporting and computer-aided diagnosis.

The quantitative potential of the latest imaging technologies will give radiologists a central role in the new age of "P-4 medicine," which will be personalized, preemptive, predictive, and participatory, Becker said. He encouraged attendees to check this year's program for information on quality improvements, as well as other resources available through rsna.org.

A number of studies have shown that quality can be improved, but complacency can ultimately spoil any gains. Radiologists should strive for ways to effectively measure and maintain quality beyond economics in order to earn the public trust once again, Becker said.

"When price is the differentiator for quality, quality pays the price," he said.