MRI Image Quality Root Cause Analysis
Vellore Kumar (Project Leader); Erin Gooch: Coach, Project Sponsor: Karen Buttery,
Team Members: Dr.Cliff Belden; Dawn Mead; Leslie Mansfield; Misty Fox; Skye Kerr.
Define
Measure
Problem/Opportunity Statement
Current Status
Tech Surveys (Sample Responses)
If the Radiologist finds an exam to be sub-optimal, how
often do you feel the following (communication,
training, protocol, scripting) were an issue?
Scripting
9
8
Process Overview SIPOC
Number of Respondents
7
6
5
4
3
2
MD Surveys (Sample Responses)
Primary Themes:
• Concern about quality
control
• Protocols not
sufficient/protocol sheet
confusing
• Skill variation
• Inconsistent use of coil
type
Sample protocol sheet
1
0
Series1
Never
0
Rarely
2
Occasionally
8
Frequently
6
Analyze
Voice of the Customer (VOC)
SURVEY RESPONSES:
MRI-Technologists
 Communication (including feedback on why a scan was
sub-optimal)
 Programmed protocols (lacking)
 Desire more experience /training working with Siemens
MRI scanners
 Not enough information on non-standard /complex
exams
Radiologists:
 Concern about quality control
 Protocols not sufficient/protocol sheet confusing
 Skill variation
 Inconsistent use of coil type
Survey comments:
MRI-Technologists:
“We lack proper training! Dealing with new software,
unfamiliar exams, trying to figure out when patient on
table!!”
“It would be helpful if radiologist communicate clearly
what they want --like slice thickness FOV etc.”
Radiologists:
“ There is marked variation in image quality due to
difference in skill levels of technologists”
“ It is extremely difficult when scans were not performed
as scripted! Often—techs “forget” to do a sequence, we
should have a system in place that would ensure the
exams are completed as scripted”
“Difficult and complex exams are done well by more
experienced technologists”
Improve
Action Plan
Root Causes
 Develop a Quality control process as part of work-flow
Done, implemented
 Develop advanced application training for MRI-Technologists
Done, completed
 Arrange advanced continuing education in complex MRI imaging
Ongoing
 Develop MRI protocol optimization plan
In progress
 Develop a control plan
Done
MRI POST-EXAM VERIFICATION “CHECKLIST”
VERIFICATION STATUS
NAME/MRN #
YES
NO
NA
o
o
o
o
o
o
o
o
o
o
o
o
ALL SEQUENCES COMPLETED—IF YOU ANSWER
“NO”—EXPLAIN
PATIENT MOTION/ TECHNICAL DIFFICULTY
CONTRAST LISTED ON SYSEM
MRI STUDY COMPLETED ON RIS
 No QC process in place
 No standard protocols in system
 Lack of Clinical application training for MRI Technologists
o
o
o
o
o
o
o
o
ALL SEQUECES SENT OVER TO PACS
TECH NOTES FOR ADDITIONAL SEQUENCES
DONE
WAS THE MAGNET RUNNING ON
SCHEDULE AT THE TIME OF
COMPLETION OF EXAM?
TECHNOLOGIST SIGNATURE
Process
Improvements
• MRI Protocol
Sequence
Standardization
• MRI Technologist
Application
Training and
Education
Established
• QC Process
Verification
Checklist Created
o