Structured cardiac MRI workflow is within reach

An effective and organized cardiac MRI workflow is attainable in any modern imaging environment with RIS and PACS, and it can have positive results on department throughput and resident education, according to an article published online June 10 in the Journal of the American College of Radiology.

Case in point: the radiology department at the University of Mississippi in Jackson developed an interdisciplinary cardiac imaging program that bridged a number of previous gaps, explained Christina Marks, MD, and colleagues.

Prior to the new workflow, the department relied on a single protocol for all cardiac MR exams, with image acquisition lasting about two hours, according the authors.

Marks and colleagues leveraged existing hospital and radiology IT to create an intranet order set for cardiac MRI. The order sets were approved by the hospital performance committee and a radiologist committee, and a physicist entered the scanner protocols into the scanner exam folders.

“Cardiac MRI paper-based orders were then scanned or electronically entered into a legacy radiology information system,” wrote the authors. “Scheduled examinations were printed at midnight and protocolled by the cardiac radiologist on the morning of the scheduled examination.”

After arrival to the unit and registration, patients are assigned one or more of 14 protocols by the cardiac radiologist based on history and indications. Protocol instructions are located next to the scanner workstation in a 3-ring binder for technologists, according to Marks and colleagues.

Data are pushed to PACS, and dictation occurs using one of five prepopulated structured reports, with signed reports forwarded back to the RIS, PACS and hospital information system. “Other than the 3-ring binders, file folders, and printer paper, no additional funding resources were needed to develop this workflow,” wrote the authors.

The new process cut cardiac MRI exam times to less than one hour, and custom tailoring protocols in advance reduced the number of repeated exams due to inadequate imaging techniques.

Marks and colleagues also noted that the process was beneficial for residents, both to allow them to participate in a quality improvement project during training, but also to help them learn how and why to protocol exams. “Although not all rotations require custom tailoring of MRI examinations on the basis of patients' clinical findings, rotations that do require highly specialized imaging to answer clinical questions provide residents with the opportunity not only to interpret examinations but also to discern why certain sequences, reconstructions, and so on are obtained.”