1 Radiology Department, Balgrist Orthopedic University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland.
AJR Am J Roentgenol. 2015 May;204(5):1069-74. doi: 10.2214/AJR.14.13216.
The purpose of this article is to evaluate the quality of reports of knee MRI examinations in form, content, and diagnosis and to assess the effect of three different quality improvement measures.
Reports of 500 knee MRI examinations (first round, or baseline) were reviewed retrospectively by five musculoskeletal radiologists. Fifteen different criteria were assessed for formal and content-related quality of reports. Diagnostic discrepancies were categorized using a 5-point scale, as follows: I, no deviation; II, undetected finding, clinically irrelevant; III, wrong interpretation of finding, clinically irrelevant; IV, undetected finding, clinically relevant; and V, wrong interpretation of finding, clinically relevant. Then three different quality improvement measures were applied prospectively to a total of 510 consecutive reports: a quiet work environment, double reading, and the use of a structured report template. These 510 knee MRI reports (second round) were evaluated using the same criteria.
A statistically significant improvement in 13 of 15 criteria was found in the second-round reports: orthographic errors improved from 32.4% to 22.0% (p < 0.001) of reports and digital speech recognition errors improved from 8.4% to 7.6% (p = 0.660). Missing anatomic structures decreased from 6.3% to 0.4%. Diagnostic discrepancies were less frequently found (12.9% vs 20.8%; p = 0.001), along with the following changes in categorization (first-round results are in parentheses): I, 87.1% (79.2%); II, 9.2% (16.8%); III, 2.3% (1.0%); IV, 1.0% (2.6%); and V, 0.4% (0.4%). Quality improvement was found in all three measure groups, without statistical significance among the groups, except for the orthographic errors (p < 0.001), which were most common in the template group.
All three quality improvement measures significantly improved the quality of the knee MRI reports, but no measure was clearly superior to the others.
本文旨在评估膝关节 MRI 检查报告在形式、内容和诊断方面的质量，并评估三种不同质量改进措施的效果。
回顾性分析 500 例膝关节 MRI 检查报告（第一轮，即基线），由 5 名肌肉骨骼放射科医生进行评估。评估报告的 15 项不同标准，包括形式和内容相关的质量。使用 5 分制对诊断差异进行分类，如下所示：I，无偏差；II，未检出发现，临床无关；III，发现解读错误，临床无关；IV，未检出发现，临床相关；V，发现解读错误，临床相关。然后，将三种不同的质量改进措施应用于 510 例连续报告中：安静的工作环境、双人阅读和使用结构化报告模板。使用相同的标准评估这 510 例膝关节 MRI 报告（第二轮）。
第二轮报告中有 13 项标准的评分显著提高：正字法错误从 32.4%降至 22.0%（p<0.001），数字语音识别错误从 8.4%降至 7.6%（p=0.660）。缺失的解剖结构从 6.3%降至 0.4%。诊断差异的发生率降低（12.9%比 20.8%；p=0.001），分类也发生了以下变化（第一轮结果用括号表示）：I，87.1%（79.2%）；II，9.2%（16.8%）；III，2.3%（1.0%）；IV，1.0%（2.6%）；V，0.4%（0.4%）。所有三组质量改进措施均提高了膝关节 MRI 报告的质量，但组间无统计学差异，仅模板组的正字法错误具有统计学意义（p<0.001）。
所有三种质量改进措施均显著提高了膝关节 MRI 报告的质量，但没有一种措施明显优于其他措施。
