Establishing a Radiologic Technologist Peer Review Program

PURPOSE Technologists use their scientific knowledge of anatomy, pathology, and physics to produce radiological images. But producing diagnostic images of the highest quality depends on more than knowledge alone – experience, conscientiousness and creativity remain a crucial part of the technologists’ art. The quality of technologist work continues to vary – partly as a result of differences in knowledge and experience, but also due to varying expectations amongst Radiologists who interpret technologists’ work. The need to address variation in Radiologist work quality has long been recognized and addressed by organizations such as the American Board of Radiology, American College of Radiology, and Joint Commission through mandatory peer review requirements. The same cannot be said for technologists: programmatic peer review has not traditionally been applied to technologist work quality. Massachusetts General Hospital Imaging leadership addressed this deficiency by establishing a technologist peer review program in September 2009. Prior to this there had been no emerging consensus between technologist and radiologist, and technologist and technologist, about how to create an ideal image. This report describes implementation of an ongoing program that addresses this deficiency. METHODS Quality and consistence are the two key drivers of excellent technologist work performance. In our program, improving image quality and consistency required a joint technologist-radiologist partnership in an area of focus – in our case initially thyroid sonography. Technologist management and Radiologist clinical leadership then jointly specified the optimal desired information and metrics of thyroid sonography quality. In accordance with ACR guidelines, the group established seven modality specific review criteria for technologists to blindly review one another’s images. After determining best practice standards for these criteria, an Ideal Image Manual was created. Technologists were then selected based upon experience, aptitude, and good departmental standing, to take part in the reviewing process. The reviewer group then used the selected criteria and Ideal Image Manual to review a statistically significant baseline sample set of 33 anonymized randomly selected Thyroid Sonograms. Simultaneously, all technologists completed a baseline survey about their personal confidence and their confidence in their peers’ ability to produce high quality thyroid sonography images. Following the collection of the baseline data, clinical leadership educated the technologists using the Ideal Image Manual. This provided the foundation for adherence to best practice standards. After allowing time for the technologists to acclimate to the new best practice standards, a second round of 33 anonymized randomly selected Thyroid sonograms were reviewed by the original reviewer team. The results were reviewed amongst the team of reviewers and repeated one month later to validate sustainment. At the end of the third review, results were discussed between the radiologists and technologists. A second Likert Scale survey asking the same questions was then presented to the staff to gauge perception of confidence in producing excellent Thyroid Sonogram images. RESULTS The team collected both qualitative and quantitative data for the program. A survey measuring technologists’ subjective confidence and confidence in their peers was taken pre and post implementation by all staff. The Ideal Image Manual and 7 peer reviewing criteria illustrated the agreed upon best standards for Image Protocol, Documentation of Adjacent Abnormalities, Transducer Usage, Image Labeling, Grey Scale/TGC Settings, Placement of Focal Zones, Measurements in Planes. Results prior to education were compared to those post education implementation. Both ordinal logistic regression methods of measurement showed positive changes using due to education and standardization. CONCLUSION Communication, Education, and Standardization all are driving factors leading to increased image quality and all are addressed in this program. Directly engaging technologists in peer review served as a mode of professional development and program maintenance. The results encouraged further interaction between radiologists and technologists and triggered non-punitive and pertinent educational and improvement opportunities for technologists. Peer review complements and can increase the impact and durability of technologist education.

SI24D

Establishing a Radiologic Technologist Peer Review Program