Case study

Jul 12, 2022, by Philips

Reading time: 7 minutes

Boston Medical Center shortens MR exams and increases radiology workflow efficiency

Boston Medical Center's Moakley Building in Boston, MA. image

Boston Medical Center (BMC) operates a busy MR department, with 40 radiologists and 21 full-time technologists conducting approximately 575-625 studies per week on three MR systems. The department schedules 30 minutes per exam, but long and varied protocols pushed many exams beyond 30 minutes, wreaking havoc on department scheduling and resulting in undesirable patient waiting times. In this case study, you will learn how they optimize and standardize their MR protocols to reduce exam times while increasing volume and revenue.

When Kevin J. Chang, MD, was appointed Director of MRI, his focus was on getting better control over runaway exam lengths and bringing more consistency to imaging. “Neuro exams were complex and long because a different attending physician often requested multiple optional, time-intensive pulse sequences,” Dr. Chang says.

Off-line protocol editing avoids clinical schedule disruption

Philips PerformanceBridge Protocol Manager is designed to improve standardization across a fleet of MR systems and save time by managing protocols from a central repository. Authorized users access a browser-based protocol portal on their computers to remotely view protocols, edit more than 400 scan parameters and distribute protocols over connected MR systems. The analytics dashboards help identify protocol optimization and standardization opportunities and help users monitor protocol use and performance.

BMC had begun optimizing and limiting protocols before using PerformanceBridge Protocol Manager but found the process very cumbersome. “If we wanted to edit a protocol, we had to schedule it in advance by either finding an unused time slot or blocking off time, so we had access to the scanner interface,” Dr. Chang explains. “It disrupted our clinical schedule. Trying to schedule time on the scanner to make these protocol changes was a nightmare, much less test out the protocol changes after the fact. With Protocol Manager, we can edit protocols at any time, without disrupting scanner use.”

Since installing Protocol Manager, volume has increased by 3 studies per day, which translates to an additional $324,000 per year. 1

Involvement of all parties is key to protocol selection

Only a small group, consisting of Dr. Chang, Jude Ierardi, Manager of MRI, and Sara Martin, the department’s quality assurance specialist, are authorized to edit protocols. However, all the radiologists and technologists were involved in the selection process. Ierardi credits having the radiologists review and agree to the protocols as key to the successful implementation of Protocol Manager. She adds that she and Dr. Chang facilitated communication between the radiologists and the technologists, which helped solidify common goals.

The team’s first step confirmed which exams were ordered most often. Next, they prioritized standardization for those exams. “Neuro exams make up 70% of the exams conducted on the Philips scanners, so that became our top priority,” Dr. Chang explains. “I’d like to thank Dr. Osamu Sakai, Chief of Neuroradiology, whose dedication to finding ways to decrease neuro exam times without impacting quality was instrumental to the success of this project.

“In every category, we checked how often exams were over the time limit to determine which protocols needed to be shortened. Then we reviewed those protocols with section radiologists to learn which pulse sequences they thought were least important or the most redundant. Finally, we marked those specific pulse sequences either for elimination or acceleration.” Once the new protocols were chosen, they were tested, edited if needed, and made available on the scanners. The standardized protocols are locked in to prevent unauthorized changes.

Refresher training increases proficiency and comfort level

Ierardi states that the number of sequences and the choice of sequences had the most impact on exam length. Technologists often chose sequences they were most familiar with rather than using more recently developed options. For example, incorporating Philips Compressed SENSE and mDIXON in protocols helped shorten exam time while also reducing artifacts.

Ierardi instituted refresher training to help the technologists feel more comfortable with newer sequences and acceleration techniques to remedy this problem

Median number of sequences before and after PerformanceBridge Protocol Manager

Median number of sequences before and after PerformanceBridge Protocol Manager

Median total sequence time for MR spine exams before and after PerformanceBridge Protocol Manager

Median total sequence time for MR spine exams before and after PerformanceBridge Protocol Manager

Brain studies shortened by 10 minutes

After three months with PerformanceBridge Protocol Manager, the results are already clear. Sequence time has dropped by nearly 10 minutes for brain studies and 3.4 minutes for all exams. L-spine and T-spine studies have decreased by 3 minutes, and C-spine studies have reduced by 8 minutes.

In addition, volume has increased by three studies per day, which translates to an additional $324,000 per year. The volume increase was measured between February and April 2021, after elective exams volume had begun to return. 1

Dr. Chang points out that the new protocols also shortened reading time and increased workflow efficiency because at least one sequence was eliminated from all routine spine and brain exams.

Median exam times of PerformanceBridge Protocol Manager

Median exam times of PerformanceBridge Protocol Manager

If we wanted to edit a protocol, we had to schedule it in advance by either finding an unused time slot or blocking off time so we had access to the scanner interface. Now, we can edit protocols at any time, without disrupting scanner use."

Kevin J. Chang, MD

Director of MRI, Boston Medical Center

Shorter exams reduce artifacts in abdominal studies

Dr. Chang and Ierardi note that while the goal was to shorten exams, the new protocols do not sacrifice image quality and often improve it.

“Our goal is for the referrers to not notice any protocol changes, except to be pleasantly surprised by improvements in image quality. For abdominal imaging, the referrers noticed that the image quality has gotten better and that more patients can get through the scans as well, with fewer breathing artifacts,” says Dr. Chang, who specializes in body imaging. “One of the biggest advantages of pulse sequence acceleration in abdominal imaging is that it reduces respiratory motion artifacts.”

Consistent imaging supports teaching

Locking in exams also improved consistency. “Before we standardized protocols, I had some technologists who always obtained stellar images, but it wasn’t consistent among technologists. It certainly wasn’t consistent between the scanners,” Ierardi explains.

Dr. Chang, who is also an associate professor of radiology at Boston University School of Medicine and an adjunct associate professor at Brown University Alpert Medical School, adds that consistency is essential because BMC is a teaching hospital.

“MRI is one of the most daunting modalities to learn during residency and fellowship education, mostly because of the sheer number of pulse sequences involved,” he says. “The more consistent the protocols are, the easier it is for residents and fellows to interpret a scan. And often the more complex a protocol is, the less apparent it is to a resident or a fellow when the protocol hasn’t been done correctly, or when there’s a missing pulse sequence.”

Supports hospital’s mission

Implementing PerformanceBridge Protocol Manager also serves a larger patient goal. “Many of our patients have limited access to healthcare, and an MRI appointment can be difficult to get because we have only three scanners for this large population,” Dr. Chang points out.

“Shortening scan times and improving workflow efficiency increases access to MRI for patients who otherwise may not have been able to get an exam in a timely fashion. I think all patients should have equal access to the imaging services they need for their clinical care, regardless of their insurance status and ability to pay. So, anything I can do to shorten the time from scheduling to examination to increase the number of patients who can get timely medical care is better. And I think that’s what serves our hospital’s mission to the city of Boston.”

Boston Medical Center shortens MR exams with PerformanceBride Protocol Manager

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At a glance

Partner

Boston Medical Center (BMC) offers 70 medical specialties and sees over one million patients a year in Boston, MA.

Challenge

Boston Medical Center's busy MR department schedules 30 minutes per exam, but unstandardized protocols push these exams well beyond the allotted 30 minutes. This not only wreaks havoc on department scheduling but also results in undesirable patient waiting times.

Solution

Boston Medical Center implemented Philips PerformanceBridge Protocol Manager to optimize and standardize its MR protocols to reduce exam times. Analysis of brain and spine exams shows that the use of Protocol Manager led to decreased exam time and number of scans per exam and increased volume and revenue.

Results

  • Since installing Philips PerformanceBridge Protocol Manager, patient volume has increased by three studies per day, which translates to an additional $324,000 per year.

  • Sequence time has dropped by nearly 10 minutes for brain studies, and 3.4 minutes for all exams. L-spine and T-spine studies have decreased by 3 minutes and C-spine studies have decreased by 8 minutes.

  • 1. Increase in volume can also be attributed to a schedule change that resulted in more efficient scheduling of MR patients requiring anesthesia.

  • Results from case studies are not predictive of results in other cases. Results in other cases may vary.

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