CASE STUDIES IN CLINICAL PRACTICE MANAGEMENT The Effect of a Technologist-Centered Electronic Review and Feedback System on Image Quality Jonathan H. Chung, MD, Kateland Haas, MA, Lili Liu, MASc, Wendy Zhu, MSc, Monica Geyer, MBA, CNMT, Paul J. Chang, MD, Gregory L. Katzman, MD, MBA DESCRIPTION OF THE PROBLEM Reduction of errors should be a goal of any service-related industry including radiology. Proper image acquisition is essential for accurate diagnosis. There is much evidence on perceptual and cognitive errors in imaging diagnosis; however, there is a relative paucity of literature on the key role technologists play in obtaining optimal images for diagnosis. In an effort to achieve high image quality at our medical center, we have long had a retrospective system for reviewing examination quality and completeness. In this system, a predetermined number of random imaging studies from each technologist were systematically reviewed by the manager, lead technologist, or imaging technical coordinator (ITC) for image quality and completeness, and then sub- jectively “graded.” However, it became apparent that this process was problematic. First, there was heterogeneity in the evaluation system each modality group and often each individual reviewer employed. In addition, there was variation in the manner in which the manager, lead technolo- gist, and ITC would “score” the same examinations. Finally, col- lecting data results for analysis was laborious and inefficient given that the scoring was performed using various tools that required separate tabulation steps whenever data summaries were required. We sought a more efficient, less het- erogeneous workflow that would help improve image quality in the long term. WHAT WAS DONE In an attempt to address these shortcomings as well as reduce the overall burden on each modality’s reviewers, a new IT-based system was created (“PACS retrospective review tool”). All modalities were required to use the same quality report system that was managed by each modality ITC and overseen by the manager to mitigate the issue of heterogeneity in scoring. The IT- based system generates quarterly re- ports for each individual technologist as a means of constructive feedback. The full implementation of this quality IT workflow began at the beginning of the second quarter of fiscal year 2016-2017 (October 2016). Imaging studies from each mo- dality were randomly selected for each individual technologist for scoring by the modality ITC each quarter. The image quality of an examination was categorized sub- jectively as excellent, acceptable, and not acceptable. If the study was deemed not acceptable, one or more of the following causative processes were flagged: quality (eg, incom- plete examination, artifacts, poor positioning, patient motion), pro- tocol (eg, physician protocol not followed, wrong protocol selected, field of view or coverage issue), or process (eg, incorrect patient imaged, wrong examination per- formed). Free text could also be entered for further clarification or if the specific issue at hand was not addressed in one of the selectable options. Data entered into the PACS retrospective review tool were stored in a department database, and the data could be accessed by a visuali- zation module in the department’s analytics web portal. This portal was accessible to the modality managers, assistant directors, and the director for review. Rather than requiring manual and repeated tabulation of data for analysis at the end of each quarter, the system automatically summarized all pertinent data organized by tabs: image quality ª 2018 American College of Radiology 1546-1440/18/$36.00 n https://doi.org/10.1016/j.jacr.2018.01.014 1