ACR Ultrasound Accreditation

Transcription

1 ACR Ultrasound Accreditation Presented to: The Imaging Conference and Expo Presented by: Jennifer Walter RDMS,RVT, RT(R) ACR Quality & Safety July 24,

2 Accreditation Update 2

3 Disclosures NONE 3

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5 Objectives By the end of this presentation: Understand the impact accreditation may have on your practice Be aware of requirements and updates to the ACR Ultrasound Accreditation program Be able to apply for and successfully achieve ACR ultrasound accreditation 5

6 WHO ARE WE? The American College of Radiology, founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care. Core Purpose of the ACR To serve patients and society by empowering members to advance the practice, science and professions of radiological care. Leadership Integrity Quality ACR Core Values Innovation 6

7 QUALITY AND SAFETY OF PATIENT CARE Membership Advocacy Research Education Quality and Safety Economics 7

8 Advocacy The ACR advocates on behalf of the radiology profession and ACR membership with Congress, federal agencies, state legislative and regulatory bodies. Education ACR offers a comprehensive array of educational options to best meet learning needs in all fields of radiology Economics ACR Economics and Health Policy focuses on issues related to how radiologists and radiation oncologists are reimbursed for their services under the guidance of the Commission on Economics. Quality & Safety Improving the quality and safety of patient care is a core element of the ACR mission. The College takes a proactive and aggressive approach on key issues impacting Q&S in radiology. Clinical Research The ACR produces scientific and health policy research to advance the practice of medical imaging and radiation oncology. Membership ACR membership offers exclusive services, benefits, and opportunities. Whether you re looking to advance your career, further your education, or sharpen your clinical skills, the ACR is your one-stop resource. 8

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13 ACR Quality & Safety over 39,000 accredited medical imaging facilities Radiology lexicons ACR BI-RADS Lung-RADS Practice Parameters and Technical Standards ACR Appropriateness Criteria RADPEER Founding member of Image Wisely & Image Gently Choosing Wisely participant ACR Designated Lung Cancer Screening Center Pay-for-Performance resources National Radiology Data Registry Lung Cancer Screening Registry Dose Index Registry ACR Manual on Contrast Media 13

14 What is ACR Accreditation? Peer review process developed and monitored by experts Concept must be approved by the ACR Council Assesses specific parameters for each imaging modality Based on ACR Practice Parameters and Technical Standards Pilot tested before being launched Ongoing review of accreditation program by the committee 14

15 ACR Accreditation Requirements Staff qualifications Policies and procedures Protocols Equipment specifications Diagnostic image quality Therapeutic treatment quality 15

16 ACR s Accreditation History 1986 Radiation Oncology 1987 Mammography Accreditation 1992 FDA adopts ACR s mammography accreditation program 1995 Ultrasound 1996 Stereotactic Breast Biopsy 1996 MRI 1998 Breast Ultrasound 1999 Nuclear Medicine 2002 CT, radiography/fluoroscopy, and PET CMS accepts ACR as accrediting organization for MIPPA, Breast MRI program launched 16

17 Since 1987, the ACR has accredited more than 39,000 facilities in 10 different programs. The ACR offers accreditation for CT, MRI, breast MRI, nuclear medicine and PET as mandated under the Medicare Improvements for Patients and Providers Act (MIPPA) Accreditation for modalities mandated under the Mammography Quality Standards Act (MQSA). Our streamlined application process has cut approval time in half, with accreditation evaluation typically completed within 90 days of image submission. 17

18 ACR Nationally Recognized Accreditation Programs: 18

19 MODALITY ACCREDITED FACILITIES MAMMOGRAPHY 8417 MRI 7347 CT 7211 ULTRASOUND 5302 Nuclear Medicine 3657 Breast Ultrasound 2324 PET 1559 Stereotactic Breast Biopsy 1536 Breast MRI 1781 Radiation Oncology 687 Total 39,821 19

20 Goals of ACR Accreditation Set quality standards for imaging practices Provide recommendations for improvement Help sites improve quality of patient care Recognize quality imaging practices 20

21 Why Seek ACR accreditation? Peer-reviewed, educationally focused evaluation of practice Expert assessment of image quality Validate good practice through peer-review May document need for new or dedicated equipment, continuing education or qualified personnel Accreditation may be used to meet criteria of state government, federal government or third party payers 21

22 Self assessment of practice quality Marketing tool set a practice apart from the rest Patient confidence Better informed patients are seeking high quality care 72% of Internet users say they looked online for health information * 68% say the information they found influenced their medical decisions * 22

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25 Diagnostic Imaging Center of Excellence (DICOE) Is your medical imaging getting the recognition it deserves? Your team can now receive well-deserved recognition for outstanding diagnostic imaging and patient care. The ACR Diagnostic Imaging Center of Excellence achievement is a one-of-akind program that takes your department or practice to the next level of imaging efficiency, safety and quality care. 25

26 DICOE: Eligibility Criteria ACR accreditation in all modalities provided Participate in Dose Index Registry (DIR) and General Radiology Improvement Database (GRID) Pledge to Image Gently and Image Wisely Site survey (radiologist, a medical physicist and a radiologic technologist or ACR senior accreditation staff) 26

27 Areas of Assessment Governance Personnel Facility organization and management Physical environment Equipment and IT infrastructure Radiation and general safety Quality management Policies and procedures Patient rights Medical records 27

28 DICOE: Benefits Comprehensive assessment of the medical imaging facility, including structure and outcomes Participation in ACR registries at no cost Ongoing process for self-assessment Recognition that distinguishes your facility to providers, payers, patients and administrators Three-year status Customizable materials for local public relations and marketing 28

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30 Accreditation Process Site applies for accreditation online ACR staff processes application and sends Testing Materials Site is allowed 45 days to submit images Once all Testing Materials received, images are sent for review Clinical images are reviewed by 2 radiologists Submitted QC is reviewed by ACR staff Our streamlined application process has cut approval time in half, with accreditation evaluation typically completed within 90 days of image submission. 30

31 Accreditation Outcome Radiologist Reviewers Scoring based on ACR Practice Parameters/Evaluation Attributes Each category must pass for site to be accredited Final report issued to site A certificate, gold seal and Media Kit are issued (if approved) Accreditation is granted for three years 31

32 If the site does not pass the first time Repeat A facility will have the option to retest the deficient area Appeal Sites have the option to appeal the final outcome The original films are reviewed by a senior reviewer, not involved with the first review Withdraw from accreditation process 32

33 If the site does not pass the second time: Reinstate with Corrective Action Plan Site will submit a corrective action plan that ACR staff must approve prior to image submission All testing to be resubmitted Appeal Withdraw 33

34 If the site does not pass the reinstate cycle Reinstate with Accreditation Consultation (AC) Physicist (if applicable) Radiologist Technologist Post-Reinstate AC cycle 34

35 Compliance Monitoring After Accreditation Granted Random On-Site Surveys Targeted Film Checks Validation Site Surveys Required by MIPPA for CT, MRI, NM, PET Ultrasound is now being evaluated as well 35

36 Validation Survey Outcomes

37 Validation Survey Outcomes

38 Validation Survey Outcomes

39 Validation Survey Outcomes

40 Validation Survey Outcomes

41 ACR Practice Parameters and Technical Standards serve as the foundation for accreditation programs 41

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43 Practice Parameters Practice Parameters describe recommended conduct in specific areas of clinical practice. They are based on analysis of current literature, expert opinion, open forum commentary and formal consensus. Practice Parameters are not intended to be legal standards of care or conduct and may be modified as determined by individual circumstances and available resources. 43

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46 Technical Standards Technical Standards describe technical procedures or practices that are quantitative or measurable. They often include specific recommendations for patient management, equipment specifications or settings. Technical Standards are based on analysis of current literature, expert opinion, open forum commentary and formal consensus. Technical Standards are intended to set a minimum level of acceptable technical proficiencies and equipment performance and may be modified as determined by individual circumstances and available resources. 46

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48 . The ACR AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Real Time Ultrasound Equipment was adopted May

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52 The Practice Parameters Being revised for 2017: ACR AIUM SPR SRU Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination ACR SPR SRU Practice Parameter for Performing and Interpreting Diagnostic Ultrasound Examinations ACR AIUM SPR SRU Practice Parameter for the Performance of Transcranial Doppler Ultrasound ACR AIUM SPR SRU Practice Parameter for the Performance of an Ultrasound Examination of the Abdomen and/or Retroperitoneum ACR AIUM SIR SRU Practice Parameter for the Performance of Physiologic Evaluation of Extremity Arteries 52

53 The Practice Parameters Being revised for 2018: ACR AIUM SPR SRU Practice Parameter for the Performance of the Ultrasound Examination for Detection and Assessment of Developmental Dysplasia of the Hip New title: ACR AIUM SPR SRU Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Neck replaces the existing title of: ACR AIUM SPR SRU Practice Parameter for the Performance of a Thyroid and Parathyroid Ultrasound Examination ACR ACOG AIUM SRU Practice Parameter for the Performance of Obstetrical Ultrasound ACR AIUM SPR SRU Practice Parameter for the Performance of Peripheral Venous Ultrasound Examination ACR AIUM SPR SRU Practice Parameter for the Performance of Native Renal Artery Duplex Sonography 53

54 The Technical Standards Being revised for 2017: ACR AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Computed Tomography (CT) Equipment ACR AAPM SIIM Technical Standard for Electronic Practice of Medical Imaging 54

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56 Preparing for ACR Accreditation Applying for and achieving ACR accreditation is a team process that involves everyone in the facility

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58 Dedicated Accreditation webpage 58

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60 Lead technologist should be account login! 60

61 ACRedit Database Start by reading the Home page Read each screen completely before continuing to the next Pay ATTENTION to everything in RED Extra information by clicking on the icon 61

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65 Ultrasound Evaluation Attributes Outlines accreditation image requirements 65

66 Mandatory Physician Accreditation Requirements: Participation in RADPEER or similar physician peer review program CME appropriate to physician practice Requirements for continuing physician experience over a specified time 66

67 RADPEER Easy to use QA tool Cost effective Summary statistics and comparisons for each radiologist by modality Summary data for your facility by modality 67

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69 Alternative peer review program: Double reading assessment Randomly selected studies, reviewed regularly Exams representing each physician s work Original report assessment Classification for level of quality concerns of peer review findings Policies and procedures for actions on significant discrepancies Summary statistics and comparison for each physician by modality 69

70 All renewing sites: CME Requirement Currently meets the Maintenance of Certification (MOC) for ABR or ABNM OR Completes 150 hours (includes 75 hours of Category 1 CME) in prior 36 months pertinent to the physician s practice patterns OR Completes 15 hours CME in prior 36 months specific to the modality or organ system (1/2 of which Cat. 1) 70

71 Continuing Experience All renewing sites: Currently meets the Maintenance of Certification (MOC) for ABR or ABN OR Read a minimum of 200 studies/3 years in specific modality OR 71

72 Continuing Experience For physicians reading organ system specific exams (i.e., body, abdominal, musculoskeletal, head) across multiple modalities must read a minimum of 60 organ system specific exams per modality (CT, MRI or ultrasound) in 36 months. However, they must read a total of 200 cross-sectional imaging (MRI, CT, PET/CT and ultrasound) studies over the prior 36 month period 72

73 Continuing Experience: Double-reading (two or more physicians interpreting the same examination) acceptable. May also re-interpret a previously interpreted exam as long as he/she did not do the initial interpretation. Exams reviewed and evaluated for RADPEER or an alternative physician peer review program may count toward continuing experience numbers. 73

74 Occasional Reader Occasional readers not required to meet interpreting physician initial qualifications or continuing experience requirements. All occasional readers combined should not exceed 5% of the total volume of reads per practice and per modality. Must be an active written review process in place at the institution for occasional readers based on each institutions credentialing requirements. Validation of this process will take place during any site visits by the ACR. 74

75 Sonographer Requirements Initial: Registered or registry eligible* American Registry of Diagnostic Medical Sonographers (ARDMS) American Registry of Radiologic Technologists, Sonography (ARRT) (S) Breast (BR) credential earned prior to June 30, 2010 only will be accepted MSK alone is not acceptable Renewal: All sonographers must be certified and currently registered as RDMS (OB or AB), RT(S), RT (VS), RVT, or RVS.* *All sonographers should obtain certification within 24 months of eligibility Initial and Renewal Vascular Accreditation Sites RVT (Registered Vascular Technologist) by the ARDMS Vascular Sonographer (VS) by the ARRT Registered Vascular Specialist (RVS) by Cardiovascular Credentialing International (CCI) Vascular tech must be on-site during the performance of ROUTINE vascular examinations. 75

76 Ultrasound Accreditation Program Quality Control Requirements Eff. June 1, 2014, documentation of QC is required Includes acceptance testing, annual survey, routine QC tests, and preventive maintenance Initial applications & renewal submissions require annual survey reports Physicist involvement is strongly recommended 76

77 An Ultrasound QC Manual does not yet exist Specific testing methods are not prescribed (subjective and objective methods are acceptable) Use of phantom(s) or test object(s) is required, but no specific vendor or model is given, and custom test objects are acceptable No specific pass/fail performance criteria are prescribed 77

78 Items to be tested for QC annually Ultrasound unit Ultrasound unit monitor Transducers - ALL probes in regular use must be tested including endovaginal probes Primary Interpretation Display (optional) A period of up to 14 months is acceptable 78

79 Specific tests required for Annual Survey: Physical and Mechanical Inspection Assures the mechanical integrity of the equipment, and the safety of patient and operator Are all cords and cables intact? Are all transducers intact and without crack or delamination? Are all transducers cleaned after each use? Are the monitors clean? Are the air filters clean? Are the wheel locks in working condition? Are the wheels fastened securely to the unit and rotate easily? Are accessories fastened securely to the unit? 79

80 Specific tests required for Annual Survey: Image Uniformity and Artifact Survey Identifies the presence of artifacts, often axial or lateral streaks in scans of uniform sections of a phantom. 80

81 Specific tests required for Annual Survey: System Sensitivity Methods relying on visual determination of the maximum depth of visualization of speckle patterns or phantom targets, and quantitative measurements of signal-to-noise ratio (SNR), have been reported. 81

82 Specific tests required for Annual Survey: Ultrasound Scanner Electronic Image Display Performance Maintaining the performance of the image display is critical for providing the greatest diagnostic benefit of the scanner. Display characteristics that are evaluated may include gray scale response and luminance calibration, presence of pixel defects, and overall image quality. These evaluations are typically performed using specialized test pattern images, and may also require photometric equipment. 82

83 optional Annual Survey Tests optional optional optional 83

84 Routine QC program A continuous QC program is essential to assure the proper functioning of all ultrasound equipment and to identify problems before the diagnostic utility of the equipment is significantly impacted All machines and transducers in routine clinical use should be tested semiannually 84

85 Routine QC Program Typically performed by: Equipment service engineer Appropriately trained sonographer Biomed 85

86 Routine QC tests Likely performed by sonographer(s) in the clinical practice twice per year (quarterly testing is recommended) 86

87 Why perform Routine QC?? Most failures were spontaneous i.e. occurred after a previous perfect uniformity evaluation Maximize the value of QC investment Provides an opportunity for education and practice quality improvement Once detected, subcritical artifact severity remains stable 87

88 Submission of Images Electronic Upload CD Film 88

89 Benefits of Electronic Submission Reduces errors in incorrect submission format Reduces translation problems Cuts costs associated with burning and shipping CDs Reduces delays in shipping images among facilities, the ACR and reviewers Mitigates the risk of losing images Ensures compliance with HIPAA regulations throughout the process 89

90 Transfer of Images and Data 90

91 Three choices to upload images! 1. Web client choose images 2. Windows client choose folders 3. Windows client connect to your PACS 91

92 Web Client 1. Choose images directly through ACRedit 2. No software downloads 3. Can view thumbnail images of what you ve uploaded 4. Print patient summary 92

93 Windows Client - Folders or PACS 93

94 Why choose TRIAD? TRIAD central server Secured server ACR supported Files encrypted TRIAD 94

95 Cuts cost of shipping Shortens turn around times 95

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98 Exam Submission - Clinical Images Only Modules: Obstetrical 1st, 2nd, 3rd, or any combination of trimesters Gynecological General N e Pediatric w Vascular Peripheral Cerebrovascular Abdominal Deep Abdominal 98

99 OF NOTE: ALL modules/submodules performed must be included Facilities must apply for ALL modules routinely performed at that site in order to be accredited. 99

100 General Module Complete Upper Abdominal Ultrasound (if performed)* Select 1 different exam from the following list: Complete Upper Abdominal Ultrasound Renal/urinary Transrectal/prostate Shoulder Small parts (select only one exam): Scrotum OR Thyroid/parathyroid *If Upper Abdominal US not performed, a total of 2 exams must be selected from the remaining exam options 100

101 Gynecological Module Endovaginal Required for 1 st exam 1 additional exam Choose endovaginal or transabdominal Combination of transabdominal/endovaginal allowed 2 SEPARATE patients Submit ALL the images 101

102 Obstetrical Module All Trimesters - One exam from each trimester First Trimester Exam MUST be endovaginal Second Trimester Exams between 18 - < 26 weeks Third Trimester- Must include growth and major organs Trimester Specific 2 exams (if 1st trimester, both must be endovaginal) Any combination of two trimesters 1 exam of each trimester (if 1st trimester selected, exam must be endovaginal) 102

103 Vascular Module Peripheral Cerebrovascular Abdominal Deep Abdominal One Normal exam Diagnostic & physiologic criteria for each exam type (brief summary of criteria used to determine normal vs. abnormal exams) Carotid criteria should include velocity table 103

104 Vascular Module - Peripheral Peripheral Arterial Exams Arterial occlusive disease Bypass Graft 104

105 Vascular Module - Peripheral Peripheral Venous Exams Thrombosis - lower extremities Thrombosis - upper extremity Vein mapping Incompetence 105

106 Vascular Module - Cerebrovascular Carotid 106

107 Vascular Module - Abdominal Liver Liver Vasculature Liver Transplantation TIPS 107

108 Vascular Module - Abdominal Renal Renal Artery Stenosis Renal Artery Thrombosis (Renal Transplant) Renal Vein Thrombosis 108

109 Vascular Module - Deep Abdominal Aorta and Branches 109

110 Pediatric ( 18 years) If performing 2 or more types of the exams listed, 2 exam types must be selected. If only one exam type selected, 2 exams must be submitted. Pediatric Neurosonology Pediatric Hip Pyloric Stenosis Intussusception 110

111 Ultrasound Submission Review: Review Sheet Attributes A. Report Identification B. Exam Identification C. Image Quality D. Anatomic Coverage E. Additional Recommendations F. Additional Comments 111

112 Ultrasound Scoring 5 Excellent 4 Good 3 Satisfactory 2 Marginal 1 Poor 112

113 C. IMAGE QUALITY DEFICIENCIES Poor gray scale Inappropriate exam specific preset Overall image quality unacceptable Technical factors preclude image interpretation Other POSSIBLE CAUSE(S) Improper image size or field of view too shallow Improper image size or field of view too deep Improper focal zone Improper gain or TGC Improper transducer frequency Other 113

114 D. ANATOMIC COVERAGE DEFICIENCIES Inadequate documentation of fetal number Inadequate documentation of presentation/position Inadequate documentation of amniotic fluid Inadequate imaging of placenta Inadequate imaging of biparietal diam./head circumference Inadequate imaging of femur length Inadequate imaging of abdominal circum./diameter Estimated fetal weight inadequate Inadequate imaging of 4 chamber view of heart Inadequate imaging of stomach Inadequate imaging of kidneys Inadequate imaging of urinary bladder Other 114 POSSIBLE CAUSE(S) Technical factors Inadequate standard routine Patient factors Inadequate data set (all images not submitted) Other

115 Common Pitfalls in Ultrasound Accreditation Failure to review required attributes/testing instructions Technical imaging errors Submitting cine loops in place of required static images Incomplete Annual Survey report Lack of credentialed personnel Failure to send complete set of clinical images Submitting tech worksheets in place of physician reports Failure to submit diagnostic criteria for vascular exams Failure to perform annual QC 115

116 DON T SUBMIT THIS!! 4w5d gestation 116

117 An exam with a nonviable fetus is not an acceptable 1st trimester endovaginal study to submit for accreditation. 117

118 Don t Submit studies with missing organs 118

119 DO NOT SUBMIT A FEMALE PELVIC STUDY WITH AN INTRAUTERINE DEVICE (IUD). 119

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121 There is incorrect angle correction on numerous images rendering the velocities inaccurate; the angle must be adjusted to 60 degrees or less while also remaining parallel to the vessel wall for the velocities to be accurate. The angle was improperly fixed at 60 degrees regardless of vessel course throughout the study. 121

122 The angle of insonation needs to be 60 degrees or less while maintaining axis parallel to vessel wall. Not meeting these criteria makes the obtained velocity reading inaccurate 122

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124 There is no angle correction applied to the aorta or the extrarenal arteries rendering the velocities invalid. Proper angle correction must be applied to obtain accurate velocities. 124

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126 This is an incomplete examination for liver vasculature. Gray scale, color and spectral Doppler images must be obtained of the IVC, all three hepatic veins, the main portal vein and the hepatic artery. The overall image quality is suboptimal. Please refer to the ACR Ultrasound Evaluation Attributes for what is required to submit for accreditation: tes.pdf 126

127 Accreditation Questions???? 127

128 Keep up to date on Quality & Safety news! 128

129 Ultrasound Accreditation Reviewers Send CV to if interested 129

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131 Thank You! Lake Thoreau Reston, VA 131

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