Quality and Safety in Imaging

In 2024, I was selected to participate in the 2024–2025 Leaders of Choice Cohort. As I entered the program, I was uncertain what my capstone project would be, given the largely regulatory nature of my role.

Earlier that summer, our system executive director retired, and the organization chose not to refill the position. Imaging directors transitioned to reporting through campus leadership, while my team remained the only system-based group, reporting to a system vice president over ancillary services.

As the Leaders of Choice cohort began in the fall, our system began identifying concerning trends. For the first time in my five years in this role, we started formally tracking and trending imaging-related events across the system. This work led to the development of an imaging quality and safety dashboard. While the dashboard provides a system-level view, it also allows us to analyze performance at the individual campus level.

Quality and safety in imaging are often defined by radiation safety, turnaround times, and technical quality. However, our work demonstrated that the scope is much broader. As we planned for 2026, I partnered with imaging leadership and system quality and safety teams to define shared goals and increase visibility with executive leadership.

We now share dashboard results across multiple forums, including monthly radiology manager meetings, modality-specific meetings, and quarterly system Quality Assurance and Radiation Safety Committee meetings. This transparency and collaboration have increased awareness of quality and safety issues and fostered shared accountability across teams.

While our dashboard is large, we focus on certain aspects of it in review for our system safety steering committee. Our safety metrics include contrast extravasations across CT, MRI, and Mammography; NM/PET infiltrations; MRI near misses; and the “wrongs,” wrong patient, wrong site, and wrong exam/procedure. While our goal is to have zero harm and no events, we also realize that mistakes do occur.

While some look at our increases as potentially a greater safety issue, we also realize that an increase in reporting of events also indicates that our staff feels safe in reporting mistakes or patient issues, without punitive consequences. This goes to the culture of safety that we all strive for on a daily basis.

We continue to develop feedback mechanisms for our leadership teams with regards to the dashboard and its results. Once the results have been compiled for the previous month, that information is sent by way of PowerPoint to our radiology directors highlighting our monthly and year-to-date results, while also specifically calling out the wrongs and the reasons for those wrong exams. This gives the leaders the added information needed to share with their local quality and safety teams during campus-level discussions.

At the AHRA Annual Meeting in July, I will present “It’s Not Just about Radiation Safety: Quality and Safety in Imaging” (Sunday, July 12 at 11:00 AM ET). This session will highlight our 18-month journey of data transparency, collaboration, and system alignment across imaging, nursing, and other departments. I look forward to sharing our experience and connecting with colleagues in Orlando.