FROM
THE
GUEST EDITOR
Quality and Safety in Cardiothoracic Imaging: a Meaningful Opportunity to Enhance Radiology Practice and Patient Care Jeffrey P. Kanne, MD
T
he practice of radiology continues to change rapidly in the current era of healthcare reform. Emphasis on quality, safety, value, accountability, and patient–centered care remains on the forefront, often driven by hospitals, patient advocacy groups, and governmental and other regulatory bodies. Meanwhile, because of declining reimbursements, many radiologists are facing continued pressure to increase productivity in order to prevent decreased practice revenues and subsequent drop in personal income. Thus, unless they see real value, radiologists may resent or disregard activities such as quality improvement and peer review, which require professional time yet do not add to the pervasive “Relative Value Unit (RVU) bucket.” This issue of JTI includes a selection of review articles focused on quality and safety in radiology with attention to relevance in cardiothoracic imaging. It is my hope that readers will gain further insight into improving their practices through defining ways to add value to patient care through improved safety, quality improvement, and acting as advocates for patients when it comes to appropriate use of diagnostic imaging. The first article in this symposium focuses on patient safety. Dr. Daniel Ocazionez and colleagues review safety in magnetic resonance imaging (MRI), covering implanted devices, intravenous use of gadolinium based contrast material, and safety around the MRI suite.1 With an increasing number of patients with implantable devices, radiologists and technologists must be conscious of properly screening patients with these devices before determining whether or not MRI can be safely performed. Furthermore, radiologists and technologists must work together to establish stringent safety measures and protocols designed to minimize risks of patient and staff injury from potentially dangerous materials entering the MR suite. Practice guidelines aim to provide healthcare providers with guidance in management of a wide range of diseases and preventive services. Ideally, guidelines should be based on scientific evidence, but often such data are lacking and expert opinion may weigh in as well. Because imaging is central to modern medicine, it is not surprising that guidelines frequently include recommendations for the use of imaging in screening, diagnosis, and follow-up. Drs. Jacobo Kirsch and Daniel Vargas describe how incorporating published guidelines into one’s practice can lead to improved patient care through proper patient selection and appropriate use of diagnostic imaging, specifically focusing on guidelines for cardiovascular imaging.2 Peer review continues to be one of the first quality improvement activities to be adopted into a radiology practice. In a symposium article on peer review,3 I describe the variety of peer review models that exist in radiology and provide insight into the advantages and shortcomings of each method. Furthermore, I address specific challenges faced by cardiothoracic radiologists with respect to performing peer review and for using the results in a meaningful manner. The final article in this symposium takes a broader perspective on the radiologist in the context of modern healthcare, focusing on our role as physicians who deliver patient care. Dr. Anne Leung stresses that radiologists need to play an active role in determining the appropriateness of diagnostic imaging tests and help the system as a whole reduce waste.4 Building rapport with patients and referring physicians through direct consultation can protect patients from unnecessary diagnostic imaging studies and help them understand which diagnostic imaging studies will yield the most useful information for the clinical question at hand. Moreover, as lung cancer screening with CT moves from research to practice, radiologists need to be prepared to discuss not only the risks, benefits, and alternatives to screening, but also the implications of the results. These types of interactions with patients may help move the general public perception of the radiologist from technician to that of a highly specialized medical doctor. I want to personally thank the authors for their contributions to this symposium. I hope that readers will be able to reflect on their own respective practices and consider how some of the tools provided in this symposium can be incorporated into daily practice. Specifically, it is my ultimate goal that readers will see effort given to quality improvement and patient safety not as a burden hampering productivity but rather as an opportunity to make meaningful changes in practice that demonstrate value and can improve the lives of our patients. REFERENCES 1. Ocazionez D, Dicks DL, Favinger JL, et al. Magnetic resonance imaging safety in cardiothoracic imaging. J Thorac Imaging. 2014;29:262–269. 2. Kirsch J, Vargas D. Cardiothoracic imaging guidelines in quality improvement. J Thorac Imaging. 2014;29:280–284. 3. Kanne JP. Peer review in cardiothoracic radiology. J Thorac Imaging. 2014;29:270–279. 4. Leung AN. Professionalism in radiology. J Thorac Imaging. 2014;29:285–290.
The author declares no conflicts of interest. Copyright r 2014 by Lippincott Williams & Wilkins
260 | www.thoracicimaging.com
J Thorac Imaging
Volume 29, Number 5, September 2014
THE
GUEST EDITOR
Quality and Safety in Cardiothoracic Imaging: a Meaningful Opportunity to Enhance Radiology Practice and Patient Care Jeffrey P. Kanne, MD
T
he practice of radiology continues to change rapidly in the current era of healthcare reform. Emphasis on quality, safety, value, accountability, and patient–centered care remains on the forefront, often driven by hospitals, patient advocacy groups, and governmental and other regulatory bodies. Meanwhile, because of declining reimbursements, many radiologists are facing continued pressure to increase productivity in order to prevent decreased practice revenues and subsequent drop in personal income. Thus, unless they see real value, radiologists may resent or disregard activities such as quality improvement and peer review, which require professional time yet do not add to the pervasive “Relative Value Unit (RVU) bucket.” This issue of JTI includes a selection of review articles focused on quality and safety in radiology with attention to relevance in cardiothoracic imaging. It is my hope that readers will gain further insight into improving their practices through defining ways to add value to patient care through improved safety, quality improvement, and acting as advocates for patients when it comes to appropriate use of diagnostic imaging. The first article in this symposium focuses on patient safety. Dr. Daniel Ocazionez and colleagues review safety in magnetic resonance imaging (MRI), covering implanted devices, intravenous use of gadolinium based contrast material, and safety around the MRI suite.1 With an increasing number of patients with implantable devices, radiologists and technologists must be conscious of properly screening patients with these devices before determining whether or not MRI can be safely performed. Furthermore, radiologists and technologists must work together to establish stringent safety measures and protocols designed to minimize risks of patient and staff injury from potentially dangerous materials entering the MR suite. Practice guidelines aim to provide healthcare providers with guidance in management of a wide range of diseases and preventive services. Ideally, guidelines should be based on scientific evidence, but often such data are lacking and expert opinion may weigh in as well. Because imaging is central to modern medicine, it is not surprising that guidelines frequently include recommendations for the use of imaging in screening, diagnosis, and follow-up. Drs. Jacobo Kirsch and Daniel Vargas describe how incorporating published guidelines into one’s practice can lead to improved patient care through proper patient selection and appropriate use of diagnostic imaging, specifically focusing on guidelines for cardiovascular imaging.2 Peer review continues to be one of the first quality improvement activities to be adopted into a radiology practice. In a symposium article on peer review,3 I describe the variety of peer review models that exist in radiology and provide insight into the advantages and shortcomings of each method. Furthermore, I address specific challenges faced by cardiothoracic radiologists with respect to performing peer review and for using the results in a meaningful manner. The final article in this symposium takes a broader perspective on the radiologist in the context of modern healthcare, focusing on our role as physicians who deliver patient care. Dr. Anne Leung stresses that radiologists need to play an active role in determining the appropriateness of diagnostic imaging tests and help the system as a whole reduce waste.4 Building rapport with patients and referring physicians through direct consultation can protect patients from unnecessary diagnostic imaging studies and help them understand which diagnostic imaging studies will yield the most useful information for the clinical question at hand. Moreover, as lung cancer screening with CT moves from research to practice, radiologists need to be prepared to discuss not only the risks, benefits, and alternatives to screening, but also the implications of the results. These types of interactions with patients may help move the general public perception of the radiologist from technician to that of a highly specialized medical doctor. I want to personally thank the authors for their contributions to this symposium. I hope that readers will be able to reflect on their own respective practices and consider how some of the tools provided in this symposium can be incorporated into daily practice. Specifically, it is my ultimate goal that readers will see effort given to quality improvement and patient safety not as a burden hampering productivity but rather as an opportunity to make meaningful changes in practice that demonstrate value and can improve the lives of our patients. REFERENCES 1. Ocazionez D, Dicks DL, Favinger JL, et al. Magnetic resonance imaging safety in cardiothoracic imaging. J Thorac Imaging. 2014;29:262–269. 2. Kirsch J, Vargas D. Cardiothoracic imaging guidelines in quality improvement. J Thorac Imaging. 2014;29:280–284. 3. Kanne JP. Peer review in cardiothoracic radiology. J Thorac Imaging. 2014;29:270–279. 4. Leung AN. Professionalism in radiology. J Thorac Imaging. 2014;29:285–290.
The author declares no conflicts of interest. Copyright r 2014 by Lippincott Williams & Wilkins
260 | www.thoracicimaging.com
J Thorac Imaging
Volume 29, Number 5, September 2014
