Pilot Study: Introducing a Quality Assurance Process for a Team-Centered Approach Involving Nonphysician Providers in Radiology  Ania Z. Kielar, MD, FRCPC, Heather Ritchie, BSc, Matthew D. McInnes, MD, FRCPC, Joseph O'Sullivan, MD, FRCPC  Canadian Association of Radiologists Journal  Volume 66, Issue 1, Pages 86-93 (February 2015) DOI: 10.1016/j.carj.2014.09.002 Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 1 Standardized email template for a quality initiative program (QUIP). Canadian Association of Radiologists Journal 2015 66, 86-93DOI: (10.1016/j.carj.2014.09.002) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 2 Example of Kudos quality initiative program (QUIP) regarding an astute identification of a pancreatic neoplasm when it was less than 1 cm in size. Subsequent surgical resection and discussion at multidisciplinary rounds identified that the diagnosis was correct based on the original computed tomography (CT) scan. Canadian Association of Radiologists Journal 2015 66, 86-93DOI: (10.1016/j.carj.2014.09.002) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 3 (A) Example of a Kudos quality initiative program (QUIP) related to computed tomography (CT) interpretation. (B) Corresponding images of the CT scan which initiated the Kudos QUIP. The radiologist noted the thickening of the lesser curvature of the stomach in this patient with nonspecific abdominal pain (arrows) and suggested that this could represent malignancy. Endoscopic evaluation was suggested. (C) Follow up barium study in the same patient who had a biopsy proven gastric adenocarcinoma. There is irregularity of the wall along the lesser curvature (arrows). GI = gastrointestinal. Canadian Association of Radiologists Journal 2015 66, 86-93DOI: (10.1016/j.carj.2014.09.002) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 4 Example of a protocol under question (PUQ) related to sonography. In this case, the reporting radiologist sent a PUQ to the protocoling radiologist who did not review prior imaging for this patient and thus was not aware that this patient already imaging of the area of concern by a different requesting physician. Thus, the radiologist sending the PUQ felt this was a redundant imaging test and could have been avoided if prior imaging were regularly reviewed. Canadian Association of Radiologists Journal 2015 66, 86-93DOI: (10.1016/j.carj.2014.09.002) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 5 Example of a protocol under question (PUQ) related to a computed tomography (CT) technologist. This was sent to the technologist performing a CT scan by the reporting radiologist since the radiologist felt that the technologist scanned the patient differently from what was requested by a protocoling radiologist (and wanted by the reporting radiologist). The technologist responded that the protocol was confusing and as a result, changes were made to the protocol option in the Computerized Physician Order Entry (CPOE) system to reduce this type of error in the future. EREQ = electronic requisition. Canadian Association of Radiologists Journal 2015 66, 86-93DOI: (10.1016/j.carj.2014.09.002) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 6 Example of technical quality initiative program (QUIP) sent to a computed tomography (CT) technologist by a radiologist. The reporting radiologist felt that the study had high noise (too low dose) in order to confidently make the requested diagnosis. As a results of a number of similar Technical QUIPs of this nature, there has been an internal audit performed identifying specific types of studies where the prescribed radiation dose will be increased (eg, for oncology follow-up imaging). Canadian Association of Radiologists Journal 2015 66, 86-93DOI: (10.1016/j.carj.2014.09.002) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions

Figure 7 Flow chart describing the steps involved in sending, receiving, and closing the loop of a technical quality initiative program (QUIP). mAs = milliampere-second. Canadian Association of Radiologists Journal 2015 66, 86-93DOI: (10.1016/j.carj.2014.09.002) Copyright © 2015 Canadian Association of Radiologists Terms and Conditions