Asad Ur Rahman, MD1, Effa Zahid, MBBS2, Elliot Wasser, MD1
1Cleveland Clinic, Weston, FL; 2Services Institute of Medical Sciences, Weston, FL
Introduction: Periodic feedback and use of standardized benchmarks has historically been used to improve quality of various diagnostic studies including screening colonoscopy. Acoustic radiation force impulse (ARFI) elastography is utilized as an important non invasive test to quantify the degree of liver fibrosis. Since this is dependent on obtaining accurate and reliable readings from radiology technicians, we aimed to improve the reliability of clinically significant studies which are defined as at least ten readings with an interquartile range of < 0.3.
Methods: We initially did a retrospective analysis of all ARFI elastography studies performed at our center over the course of January and February 2018 in order to assess baseline performance. We subsequently shared individual data with each radiology technician in March 2018. We also recommended that technicians who performed with < 50% reliability should shadow their colleagues who were able to get reliable readings beyond 75%. We then longitudinally followed the quality of studies over the ensuing few months. We repeated the same intervention in July 2018 to see if there was any attrition in response. Follow up was then done up until December 2018 to assess performance of studies.
Results: 186 ARFI studies were completed over the course of 12 months. 12 radiology technicians were involved in performed these studies (range 5-25 exams). Average BMI of patients undergoing the exam was 29.2 (range 16.3 to 45.2). No difference was seen in terms of reliability in obese patients. The proportion of reliable studies (10 or more readings with IQR < 0.3) was 44% in January. After the first session of feedback, this proportion increased to 78% in April. However, it decreased to 43% in July at which point a second formal session of feedback was done. A subsequent increase was noticed with reliable studies going up to 70% in August. However, this improvement did not remain sustained with decline in performance to 43% in December.
Based on this study spanning a total of 12 months, we demonstrate that providing feedback to individual technicians and tutorials by high performing technicians, leads to improvement in overall performance. Albeit, this effect is not sustained if provided intermittently. This calls for regular feedback and follow up over longer duration to assess for more sustained improvement. This would in turn translate into a diminished need for repeat testing which would curtail cost and patient time as well as need for liver biopsy.
Citation: Asad Ur Rahman, MD; Effa Zahid, MBBS; Elliot Wasser, MD. P1569 - IMPROVEMENT IN RELIABILITY OF ACOUSTIC RADIATION FORCE IMPULSE ELASTOGRAPHY STUDIES USING FEEDBACK AND BENCHMARKING: A SINGLE CENTER EXPERIENCE. Program No. P1569. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.