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Resident PGY 2
Henry Ford Hospital
Object or Purpose of Study: State of the art sequences and specialized hardware are beginning to allow for the reduction of the acquisition time of musculoskeletal (MSK) Magnetic Resonance (MR) scans. Shorter acquisition times should allow for more patients to be scanned in a day; however, implementing these rapid scans into the imaging workflow required changing the whole MR scheduling system. We report the challenges and benefits after incorporating rapid scan protocols into our imaging workflows.
Methods: Multichannel coils were utilized, enabling the use of parallel imaging techniques to reduce routine total joint scan times to under 10 minutes . MSK MR schedule slot times were reduced from 45 minutes to 30 minutes. The institution’s MR schedule was changed from a basis of 45 minute slots to 30 minute slots. After implementing the new rapid MSK scans and 30 minute slot scheduling system in 2018, we collected the scan volume, scheduling lead time, and technologist feedback for July of 2018. This data was compared to data from July of 2017. Data was obtained from a single scanner to control for extraneous factors such as technologist experience, facility workflow, schedule saturation, and patient compliance.
Results: The total number of MR studies performed on the scanner increased from 261 in July of 2017 to 289 in July of 2018. Rapid MSK MR image quality was determined to be adequate for the clinical workflow. The two most prominent issues experienced were scheduling and technologist performance difficulties. 20 minute scheduling slots did not allow sufficient time for patient preparation. However, 30 minute slots were found to be ideal. The MR schedule was reorganized to be based on 30 minute slots from 45 minute slots used previously. 51 studies were reassigned 30 minute slots from 45 minute slots. 30 studies were reassigned 1 hour slots from 45 minutes. 19 studies were reassigned 1 hour slots from 1.5 hour slots. Even though many studies were increased from 45 minutes to 1 hour, we found an overall time savings from studies being reduced to 30 minutes and from 1.5 hours to 1 hour. A surprising benefit of moving to a 30-minute time slot schedule was a decrease in the lead time in scheduling for MR. By having more time slots per day available, MR studies were allowed be scheduled sooner. The mean weekly lead time for July 2017 was 15.4 days and for July 2018 was 9.2 days (p<0.05). Shortened 30 minute time slots place additional burdens on the MR technologists, and highlighted differences in speed and efficiency. With the 30 minute slot workflow, there is much less buffer time for patient preparation tasks such as acquiring screening radiographs. Technologists were required to be more flexible and efficient. These changes resulted in differences in patient experience, with some patients feeling rushed.
Significance: Implementing rapid MSK MR scans allowed for our institution to switch from 45-minute time slots to 30 minutes time slots for MR scheduling. As a result, our MR study volume increased and our lead time for scheduling decreased, allowing our patients to obtain their MR studies more quickly.
Laucis, Nicholas C.; Klochko, Chad L; and Siegal, Daniel, "Solving the Logistical Issues of Rapid MSK MR Scanning" (2019). Quality Improvement. 23.