Magnetic Resonance Imaging Technologist Breast Subspecialty Program; a Quality Improvement Project Gone Right.

We describe a Lean based Quality Improvement Project (QIP) to improve the defect rate of breast magnetic resonance imaging (MRI) studies by developing a MRI Technologist Breast Sub-specialization Program. Key stakeholders (physician and technologist) drove the QIP. Both the overall defect rate and the callback rate (severe defects requiring patients return for repeat imaging) were measured over a 2-month period as 17% and 6%, respectively. Lean visualization tools of Pareto Chart & Fishbone Diagram identified lack of multiple trends, but discerned that most defect causes were within the responsibility of the technologists. Lean Value Stream Map identified technologists' useless work (muda), which was subsequently eliminated. Radiologists collectively defined what made a quality study in a Quality Checklist. Key stakeholders limited the number of technologists based on the study volume (50 studies/technologist/2 years) and reviewed 5 studies recently performed by each technologist. If all 5 studies were defect free per the Quality Checklist, then the technologist was certified to perform breast MRI's by himself/herself. Otherwise, the technologist was on probation. Key stakeholders selected SuperTechs with advanced skill and interest from the certified pool to cover all shifts. Technologists on probation had to complete 5 additional studies defect-free under the supervision of a SuperTech to achieve certification. In addition, SuperTechs were available to backup certified technologists, as needed. Software was implemented at the PACS workstation to flag defective and callback studies. 6 months after the initiation of the QIP, the defect rate decreased from 17% to 2% (p>0.02), and the callback rate decreased from 6% to 0, thus confirming this MRI Breast Program was a QIP gone right.

Radiographic findings after treatment with balloon brachytherapy accelerated partial breast irradiation.

The use of accelerated partial breast irradiation (APBI) following breast-conserving surgery is rapidly gaining popularity as an alternative to whole-breast irradiation (WBI) in selected patients with early-stage breast cancer. Although data on the long-term effectiveness and safety of APBI accelerated partial breast irradiation are still being gathered, the shorter treatment course and narrowed radiation target of APBI accelerated partial breast irradiation provide an attractive alternative for carefully selected patients. These patients include those with relatively small tumors (≤3 cm), negative or close margins, and negative sentinel lymph nodes. Possible long-term complications include telangiectasia and the development of a palpable mass at the lumpectomy site. Mammographic findings in patients who have undergone APBI accelerated partial breast irradiation are distinct from those in patients who have undergone conventional WBI whole-breast irradiation . The most common post-APBI accelerated partial breast irradiation radiographic findings include formation of seromas at the lumpectomy site, focal parenchymal changes such as increased trabeculation and parenchymal distortion, fat necrosis, and skin changes such as thickening or retraction. Given the continued evolution of breast cancer treatment, it is important that radiologists have a comprehensive understanding of APBI accelerated partial breast irradiation in terms of rationale, patient selection criteria, common postprocedural radiographic findings (and how they differ from post-WBI whole-breast irradiation findings), and advantages and potential complications.

A comparison of acetate vs digital templating for preoperative planning of total hip arthroplasty: is digital templating accurate and safe?

The purposes of this study were to compare the accuracy of acetate and digital templating for primary total hip arthroplasty (THA) and to determine if digital templating is safe. Preoperative planning was performed on 50 consecutive preoperative radiographs during 2005. Templating results were compared with the actual hip implants used. Interrater reliability of acetate templating and accuracy of acetate and digital templating were recorded. Digital measurement overestimated acetabular size (P < .001) and underestimated the femoral size (P = .03). The absolute errors were larger for digital compared with acetate templating; however, mean absolute errors did not differ significantly (acetabulum, P = .090; femur, P = .114). Acetate and digital templating can accurately predict the size of THA implants. Digital templating was determined to be acceptably safe for preoperative planning of primary THA operations.

Can peer review contribute to earlier detection of breast cancer? A quality initiative to learn from false-negative mammograms.

Although Mammography Quality Standards Act requires tracking true positives, tracking false negatives is not required. We describe a peer review process implemented at Lahey Clinic to identify false-negative mammograms. We defined a false-negative mammogram as one which was read as negative within 12 months of a cancer diagnosis, and in which two of three radiologists correctly identified the site of cancer. Reviewing radiologists were blinded to each other and to computer-aided design (CAD), but were aware that somewhere in the mammogram was cancer. 25/64, 983, or 0.038% were classified as misses. The false-negative rate of any one radiologist averaged <0.1% without outliers. Of the false negatives, 60% were in heterogeneously dense tissue, 72% were asymmetries or masses rather than calcifications, and 24% were correctly identified by CAD in two views. We use these data for quality assurance, educational purposes, and to help identify patterns of undetected cancers to aid in earlier and improved detection of breast cancers.