3DR Labs’ quality metrics were developed by its Chief Medical Officer Dr. Robert Falk in partnership with its QA team. Together they identified all the different scenarios that could occur when reviewing the image series in their protocols. They discussed each potential error and determined whether it would affect patient care.
The team ultimately identified 400 quality metrics, which it assigned to seven pillars representing the different types of work that the company’s RTs undertake. They include:
Multiplanar reconstruction (MPR) – A stacked series of images that are reconstructed from the original CT volumetric data to provide high resolution images in any desired plane or projection. These are submitted by 3DR Labs for the radiologist to review.
Volume-rendering technique (VRT) – Converting raw data into a 3D picture for radiologist review. This is 3DR Labs’ specialty.
Curved planar reformation (CPR) – Plotting a vessel so that the radiologist can see its entire structure. This is often used to identify signs of stenosis or an aneurysm.
Snapshots – Reviewing images focused on a specific pathology.
Measurements – Verifying measurements taken all over the body to evaluate whether the measurement was taken in the correct location, and displays the disease as expected.
Quantitative Reports – Many of 3DR Labs’ protocols include a quantitative report containing measurements and volumetric analysis. Some are pre-populated by the software, and others require the RT to enter values manually.
Overview – Relates to the case as a whole to determine if the correct protocol was processed based on the order/patient history.
To ensure patient privacy, 3DR Labs follows the Health Insurance Portability and Accountability Act (HIPAA). It also uses unique patient identifiers, no patient names or accession numbers.
3DR Labs’ QA specialists evaluate against the 400 metrics approved by Dr. Falk. This is a significant undertaking as the company employs more than 200 ARRT* registered RTs and they process more than 50,000 cases per month.
It is a very thorough process. The QA specialists begin by pulling a randomized, diverse case mix for review across all technologists, all protocols, and all facilities’ cases from the prior week. Then, they compare the series that were sent back to a customer against the 400 metrics to make sure that it meets the company’s acceptability standards. That includes verifying that any values that were entered manually into the reports are accurate. Once the QA review is complete, a feedback report is sent to the RT.
Errors are classified as either a minor infraction, which should not impact patient care, or a major infraction, which has the potential to impact the radiologist’s ability to accurately read an exam. The QA team also flags opportunities for improvement (OFIs). OFIs have no impact on patient care, but represent ways to improve the company’s internal standards through changes to internal operations or processes.
Highlighting the vessels in a coronary computed tomography angiography (CCTA) CPR is one of the most important series that 3DR Labs provides for a cardiac case because it identifies whether there is stenosis within the vessel and if the patient is at risk for a heart attack.
The QA specialist must make sure that the RT placed all the seed points tracing each artery on the CCTA image accurately. If a seed point is slightly off the mark, but the vessel still displays as it should, that is considered a minor infraction. If a seed point misses the artery, that is a major infraction because it could resemble stenosis or disease that was not present when a radiologist reviews the image. It could lead to a false positive.
The importance of maintaining high-quality standards is instilled into new 3DR Labs employees as soon as they join the company. The QA team provides a high-level view of the company’s quality standards during its RT training program. This training helps to ensure that its RTs know how to perform their own QA when they are working on cases.
If an RT wants to become a QA specialist, they must receive additional training and build upon the knowledge that they have already acquired at 3DR Labs to become a subject matter expert (SME). They will also work closely with Dr. Falk and senior members of the QA team to learn more about the clinical relevance of their work. As a result, when they see an error, they will know why it is an error, and understand its potential to impact patient care.
Customer satisfaction is of paramount importance to 3DR Labs. The QA team’s goal is to ensure the company meets both its internal quality standards and its customers’ expectations, keeping them aligned. To that end, it has established a 24/7 callback service that allows customers to provide direct, immediate feedback in the rare instance that their expectations are not met right away.
If a radiologist opens an exam and finds that 3DR Labs’ work does not meet their needs, they can call or email one of the company’s lead technologists, who is an SME, at any time, day or night, to discuss their results. Callbacks are flagged as top priority and are viewed immediately. An SME will review the case, evaluate it from a quality perspective, rework any aspects of the case that did not meet the company’s standards, and resend it to the customer.
More often though, the radiologist’s callback is not regarding an error but instead a request for further information, possibly an additional series that is not included in their facility’s dedicated protocol. The SME will endeavor to provide the information that the radiologist requires either by running a new series or reworking part of the image. Then, the QA team will collaborate with 3DR Labs’ protocol development team to ascertain whether it is possible to include that additional series in the customer’s protocol moving forward.
Underscoring its commitment to exceeding customer expectations, 3DR Labs has a senior quality specialist dedicated to reviewing callback responses. That data is compiled and evaluated monthly to make sure that there are no trends appearing that may need to be corrected with a change to internal metrics or possibly through additional training. If a trend does start to appear, the specialist will also check whether the image quality of the raw data they are receiving is up to market standards.
3DR Labs’ QA team is cognizant that there are new advances in healthcare every day. Its specialists work closely with Dr. Falk, and collaborate with outside physicians, to ensure that they stay on top of industry trends and that the processes they follow internally are up to market standards. They believe the more they know, and the more opinions they can get, the better.
*3DR is an independent organization and is not authorized by, sponsored by, or affiliated with The American Registry of Radiologic Technologists, which is the owner of the trademark ARRT.
