Quality management in radiology is essential but often difficult to implement in busy clinical environments, especially for medium-sized departments with limited resources. While much of the literature focuses on large-scale quality programmes, smaller facilities often lack the capacity for such expansive systems. Despite these challenges, a radiology department in the Netherlands has developed a practical, scalable approach that integrates change management into daily operations. By focusing on collaboration, streamlined feedback and structured implementation cycles, they demonstrate how consistent quality improvements can be achieved. Their recent initiative to reduce intravenous contrast dose using dual-layer spectral CT illustrates how change can be implemented safely without compromising patient care.
Balancing Innovation and Feasibility in Radiology Quality Management
In the realm of radiology, technological advancements are constant, yet implementation often lags behind. Although vast amounts of medical literature are published each year, only a small fraction finds its way into clinical use. For departments outside large academic centres, integrating this new knowledge can seem unattainable due to limitations in staffing, funding and infrastructure. The described department operates across four hospitals with 29 radiologists and emphasises a bottom-up philosophy. This inclusive structure enables any team member—from radiographers to students—to propose and participate in quality improvement initiatives.
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A key to their success is a two-tiered meeting structure: biweekly unit-level meetings for hands-on implementation and biweekly departmental meetings for broader operational planning. The quality management process follows the Plan-Do-Check-Act (PDCA) model, ensuring that each change is carefully discussed, implemented with oversight, monitored thoroughly and reviewed after implementation. This structured yet flexible framework allows the team to adapt swiftly without requiring large administrative overheads. It also reduces delays in translating evidence-based recommendations into clinical practice.
Implementing Contrast Medium Reduction Using Spectral CT
Reducing the dose of intravenous contrast medium (CM) is a critical issue, touching on patient safety, cost control and environmental sustainability. Spectral CT technologies such as dual-layer CT (DLCT) allow lower energy monoenergetic image reconstructions, which can enhance iodine visibility and potentially reduce the required CM dose. However, implementing such changes in practice demands a cautious approach to avoid compromising image quality.
The department began by selecting a protocol with limited diagnostic risk—follow-up chest CTs in stable patients—as the starting point for their contrast reduction. A 20% reduction in CM dose was tested, with the lost volume replaced by saline to maintain injection parameters. Patients were stratified by weight, and scans were evaluated both objectively and subjectively. Objective metrics included vessel attenuation values measured in Hounsfield Units, while subjective quality was assessed by a radiologist using a Likert scale.
No degradation in diagnostic quality was observed, with all images maintaining acceptable or better ratings. These outcomes enabled the department to proceed with wider implementation of the lower-dose protocol and to plan further expansion into more complex scans. Importantly, the entire project—from concept to execution—was led by radiographers and incorporated into existing workflows without requiring additional resources or external oversight.
Embedding Quality Culture in Daily Clinical Operations
Central to the department’s success is its culture of inclusivity and responsiveness. Rather than relegating quality to sporadic audits or top-down mandates, the process is embedded in daily operations. Radiographers lead unit-level meetings, maintain meeting records and oversee protocol implementation. Feedback is collected through PACS-integrated pop-ups, daily debriefs and monthly review meetings. These mechanisms allow rapid detection and resolution of quality issues.
Follow-up reviews are scheduled at six and twelve months after any protocol change to ensure long-term safety and effectiveness. Although this informal approach lacks rigid decision-making criteria, it ensures that changes are continuously monitored and adjusted as needed. This system has already demonstrated its adaptability, as seen when prior attempts to lower radiation dose were reversed following PACS feedback indicating a decline in image quality.
While this framework may still be too resource-intensive for very small departments, its modularity allows for scaling. The biweekly structure and multidisciplinary collaboration promote accountability and empower staff to contribute meaningfully to continuous improvement. The approach underscores the importance of open communication, a supportive environment and shared responsibility for clinical quality.
Radiology departments often face the challenge of balancing the adoption of innovative imaging practices with limited resources. The Dutch department’s experience shows that a structured yet adaptable approach to quality management can yield significant benefits without extensive administrative burden. By anchoring quality initiatives in daily routines, promoting radiographer leadership and using simple yet effective feedback tools, the department achieved a safe 20% reduction in contrast dose while preserving image quality. This case provides a practical model for similar departments seeking to enhance care delivery, demonstrating that meaningful improvements are possible even outside the world’s largest hospitals.
Source: European Journal of Radiology
Image Credit: iStock
