Peer review in MRI: A quality improvement programme and pilot study

Abstract

Introduction: The aim of this pilot study was to implement a peer review programme to evaluate MRI images and protocols, with the goal of improving quality and standardising protocols.

Method: A plan-do-check-act method of action research was adopted. A checklist was designed and two radiographers scored the images (Optimal, Diagnostic or Suboptimal). A sample of five Lumbar Spine examinations were selected and reviewed on two separate occasions, one month apart. A consultant radiologist also scored the selected examinations.

Results: There was excellent intra-rater reliability for both observers. At first assessment, Cohen's weighted Kappa analysis indicated moderate inter-rater agreement (0.457) rising to substantial agreement (0.606) at second assessment. Variations in sequence parameter settings by the radiographers were noted. Feedback via educational sessions were implemented and enhancement of protocols were made.

Conclusions: Radiographers manipulate many parameters during MRI examinations, and image quality can be degraded if sequences are not optimised. This may lead to misinterpretation. Initial results suggest peer review can result in improved image quality, better protocols, and improved staff confidence. There are opportunity costs involved in releasing staff from clinical work and time and resources required for image appraisal training, however we suggest this model can be extended to other departments and modalities as a healthcare improvement initiative.

Implications for practice: Initial results suggest peer review processes performed by radiographers can result in improvement to protocols and image quality in MRI. With appropriate training, radiographers can implement and undertake appraisal of image quality in MRI as part of clinical governance. The purpose of feedback must be made clear, and good professional relationships should be forged to allow candid and supportive feedback with a focus on development and education.

Keywords: Action research; Clinical governance; Feedback; MRI; Peer-review; Quality improvement.