Two technologists in front of computer
Nuclear Medicine, pictured here, is one of six medical imaging modalities to go-live in the Image Quality Peer Learning Program, which aims to help technologists improve diagnostics and care for patients. (Photo: UHN)

There are always opportunities to change how things are done to improve patient care.

For the Joint Department of Medical Imaging (JDMI), this understanding is the foundation of its practice.

And, in seeking continuous improvement, the program now becomes one of the first in Canada to implement an Image Quality (IQ) Peer Learning Program for all technologists and sonographers.

"The accuracy of a patient's diagnosis is dependent largely on two things: the quality of the image that the technologist produces and the interpretation of the images by the radiologist," says Catherine Wang, Vice President, Clinical Operations and Diagnostic Partnerships, at the University Health Network (UHN) and JDMI, which includes UHN, Sinai Health, and Women's College Hospital.

"Our Peer Learning Program is now integrated in a way that supports technologists to produce the highest level of image quality by enabling anonymous review of our diagnostic images, and most importantly, bringing teams together to learn about how we can collectively improve."

As part of the program, technologists and sonographers are randomly assigned patient cases in order to evaluate the image quality of a peer-conducted diagnostic scan. Approximately two to five per cent of JDMI patient cases will be assigned through the program, and in its first month, more than 1,000 images have been reviewed – translating to numerous learning opportunities for image quality improvement.

The practice will allow teams across nearly all medical imaging modalities, including X-ray, Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Nuclear Medicine, Mammography and Ultrasound, to come together on a quarterly basis to discuss best practices, and share learnings that will improve quality in the future.

Peer Learning Program active in X-ray since piloting in 2016

"It's the first end-to-end peer learning program in medical imaging that loops back to staff, sharing the feedback obtained from peer review, and identifying opportunities for improvement in focused image quality rounds," says Paul Cornacchione, Senior Director, Imaging Operations, JDMI.

"It presents a new opportunity where staff can participate in robust discussion on what makes an image great, and how we can achieve that quality when faced with challenging patient cases."

The JDMI Peer Learning Program has been active in X-ray since piloting in 2016, and through a broad collaboration, the team developed image quality criteria for six additional modalities, and integrated the criteria into JDMI's peer learning software tool, Coral Review.

"Collaboration with external health organizations and regulatory groups is vital because of the ever changing nature of medical imaging technology," says Paul.

"It's also a unique aspect of the Coral Review tool that is not found in other applications. The image criteria is evidence based, and has been validated by nearly 800 technologists and sonographers across the country."

Coral Review users are directed to evaluate the overall trend of image quality for a case, and are prompted to identify whether specific image quality criteria is met throughout the review. The whole process takes less than 10 minutes depending on the modality and case complexity.  

"At its core, the software is designed to support the principle of peer learning in a clinical environment where time is precious and service delivery demands are significant," says Leon Goonaratne, Senior Director, UHN Digital.

"However, we are beginning to explore the software's potential for assisted learning, which could enable us to apply a quality check to all medical imaging captured in the system rather than a portion of the imaging we see today."

Currently, the Coral Review software is used by several health centres in Ontario, including eight organizations and 19 sites, and JDMI's vision is to eventually roll the solution out across the province enabling system-wide improvement.

"It's not enough that we improve our own ability to provide care," says Catherine. "We should now be taking our learnings and supporting our colleagues from across the country and beyond to learn from each other and deliver the highest quality of imaging and care for our patients."

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