Department of Radiology, University of Chicago Medicine, Section of Neuroradiology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
Department of Radiology, University of Chicago Medicine, Section of Neuroradiology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
J Am Coll Radiol. 2015 Jan;12(1):90-4. doi: 10.1016/j.jacr.2014.08.017. Epub 2014 Nov 1.
Literature reports indicate that advanced imaging is overutilized, especially in the emergency setting. At our institution, stat spinal MRI for suspected acute spinal cord compression (ASCC) was perceived to be excessively utilized. A continuous quality improvement process was employed to investigate this trend and improve the efficiency of this diagnosis.
Spine imaging in patients with suspected ASCC was retrospectively evaluated for appropriateness of indications and quality of imaging. Based on the results, a new institutional policy for ordering MR for suspected ASCC was implemented, concurrent with development of a new screening spine MRI protocol. Subsequently, indications, efficacy, and imaging utilization of the new strategy were analyzed for improved operational effectiveness.
The initial retrospective study demonstrated only a 1.4% positive rate of ASCC as well as image-quality degradation due to patient motion resulting from prolonged scan times. Based on these results, a new institutional policy for ordering stat ASCC spine MRI was instituted with an updated screening MRI protocol. This policy resulted in a positive rate of ASCC of 4.4%, and decreased scan time by 50%-70%, while preserving diagnostic image quality and decreasing resource utilization.
As suspected, stat spinal MRI for ASCC was excessively utilized at our institution. The study demonstrated that systemic improvements regarding this issue can be achieved by using a multidisciplinary approach and following a continuous quality improvement methodology. A new MRI protocol for identification of ASCC was found to preserve image quality and diagnostic confidence, while simultaneously decreasing scan time and use of valuable health care resources.
文献报道表明，高级影像学检查过度使用，尤其是在急诊环境中。在我们机构，疑似急性脊髓压迫症（ASCC）的紧急脊髓 MRI 被认为过度使用。采用持续质量改进流程来调查这一趋势，并提高该诊断的效率。
回顾性评估疑似 ASCC 患者的脊柱影像学检查，以评估其适应证的适宜性和影像学质量。基于结果，制定了一种新的疑似 ASCC 脊柱 MRI 检查的机构政策，同时制定了新的脊柱 MRI 筛查方案。随后，分析新策略的适应证、疗效和影像学应用，以提高运营效率。
最初的回顾性研究显示，ASCC 的阳性率仅为 1.4%，并且由于扫描时间延长导致患者运动导致图像质量下降。基于这些结果，制定了一种新的疑似 ASCC 紧急脊柱 MRI 检查的机构政策，并采用了更新的筛查 MRI 方案。该政策使 ASCC 的阳性率提高到 4.4%，同时扫描时间减少了 50%-70%，而保留了诊断图像质量并减少了资源利用。
正如预期的那样，我们机构对疑似 ASCC 的紧急脊髓 MRI 检查过度使用。该研究表明，通过采用多学科方法和遵循持续质量改进方法，可以解决这个问题。为识别 ASCC 而制定的新 MRI 方案被发现可以在保留图像质量和诊断信心的同时，减少扫描时间和宝贵医疗资源的使用。
