1 Department of Radiology, Stanford University, 300 Pasteur Dr, Stanford, CA 94305-5105.
2 Diagnostic Imaging, David Grant USAF Medical Center, Travis AFB, Fairfield, CA.
AJR Am J Roentgenol. 2018 Apr;210(4):807-815. doi: 10.2214/AJR.17.18212. Epub 2018 Feb 7.
The purpose of this project was to achieve sustained improvement in mammographic breast positioning in our department.
Between June 2013 and December 2016, we conducted a team-based performance improvement initiative with the goal of improving mammographic positioning. The team of technologists and radiologists established quantitative measures of positioning performance based on American College of Radiology (ACR) criteria, audited at least 35 mammograms per week for positioning quality, displayed performance in dashboards, provided technologists with positioning training, developed a supportive environment fostering technologist and radiologist communication surrounding mammographic positioning, and employed a mammography positioning coach to develop, improve, and maintain technologist positioning performance. Statistical significance in changes in the percentage of mammograms passing the ACR criteria were evaluated using a two-proportion z test.
A baseline mammogram audit performed in June 2013 showed that 67% (82/122) met ACR passing criteria for positioning. Performance improved to 80% (588/739; p < 0.01) after positioning training and technologist and radiologist agreement on positioning criteria. With individual technologist feedback, positioning further improved, with 91% of mammograms passing ACR criteria (p < 0.01). Seven months later, performance temporarily decreased to 80% but improved to 89% with implementation of a positioning coach. The overall mean performance of 91% has been sustained for 23 months. The program cost approximately $30,000 to develop, $42,000 to launch, and $25,000 per year to maintain. Almost all costs were related to personnel time.
Dedicated performance improvement methods may achieve significant and sustained improvement in mammographic breast positioning, which may better enable facilities to pass the recently instated Enhancing Quality Using the Inspection Program portion of a practice's annual Mammography Quality Standards Act inspections.
本项目旨在提高我科的乳腺 X 线摄影定位水平。
从 2013 年 6 月至 2016 年 12 月，我们开展了一项基于团队的绩效改进活动，旨在改善乳腺 X 线摄影定位。该技师和放射科医生团队根据美国放射学院（ACR）标准建立了定位表现的定量衡量标准，每周至少审核 35 张乳腺 X 线片的定位质量，在仪表板上显示绩效，为技师提供定位培训，营造支持性环境，促进技师与放射科医生就乳腺 X 线摄影定位进行沟通，并聘请乳腺 X 线摄影定位指导员来开发、改进和维持技师的定位表现。采用两样本 z 检验比较 ACR 标准通过率变化的统计学意义。
2013 年 6 月进行的基线乳腺 X 线片审核显示，67%（82/122）符合 ACR 定位标准。定位培训和技师与放射科医生对定位标准达成一致后，绩效提高到 80%（588/739；p＜0.01）。通过对个体技师的反馈，定位进一步改善，91%的乳腺 X 线片通过 ACR 标准（p＜0.01）。7 个月后，绩效暂时下降至 80%，但实施定位指导员后提高至 89%。23 个月以来，整体平均绩效保持在 91%。该项目开发费用约 3 万美元，启动费用约 4.2 万美元，每年维持费用约 2.5 万美元。几乎所有费用都与人员时间有关。
专门的绩效改进方法可能会显著且持续地改善乳腺 X 线摄影定位，这可能使医疗机构更好地通过最近实施的质量提升计划部分的年度乳腺钼靶质量标准法案检查。
