United Healthcare’s decision to require MRI accreditation after March 1, 2008, initiated a trend among payers that is likely to gain steam. It has also sent hospitals and freestanding imaging centers scrambling to secure MRI accreditation from the American College of Radiology, which has accredited over to 5,000 MRI units since beginning its MRI program in 1996.
The accreditation process is no cause for panic. A majority of applicants passed on their first attempt, and most of those that did not went on to attain accreditation. So the odds of undergoing a successful accreditation are in your favor. But before initiating the accreditation process, it is important to designate a champion who will accept responsibility for this task and then to give that person the time and support to accomplish it. The following guidelines will help ensure success.
Construct a timeline. Your site’s champion should begin by studying the information on the ACR website and constructing a timeline identifying the anticipated needs for critical stages. Remember that even after you submit your application it may take the ACR up to two months to process it and award accreditation. You may also want to leave at least a two-month cushion in the unlikely event that you fail a portion of the process and need to appeal or resubmit. Presuming a site desires accreditation as of December 1, 2007, it would be wise to submit the application no later than the beginning of October. This also means the application has to be started no earlier than the middle of August since there is only a 45 day window once the application file is opened (once you pay the fee and the accreditation materials are sent to you).
Get the help you need. Parts of the application refer to peer review and to the date of your system’s most recent technical review (physics test). Take questions on peer review to the physicians at your site responsible for clinical interpretation. The MRI scientist or medical physicist who conducts your annual MRI performance testing and assists with your local quality control (QC) program can address the issues on instrument testing. The ACR will not accept an application without proof of an MRI scientist’s or medical physicist’s report on your system dated within twelve months of submission.
Initiate a QC program if you do not have one. Most new sites (and a number of previously accredited sites) have not maintained their QC programs properly and have not had their systems tested. The first step is to find an MRI scientist or a medical physicist with MRI experience to help you get on track. (See sidebar on how to hire an MR scientist or medical physicist.) QC is considered a nuisance by some imaging center personnel, but the alternative is worse. I have tested over 1,000 MRI units in the past twenty years and have encountered problems in about 80% of those systems, including bad head and body coils, poor homogeneity, faulty gradient amplifiers, intermittent RF systems, and monitors that don’t meet specifications. Independent annual testing and on-site quality control can help to identify issues before they become catastrophic.
When your application is accepted, get busy! You have 45 days to complete you submission. The first thing you should do on receipt of your packet and MRAP number is order the ACR MRI phantom from the manufacturer. Phantoms are subject to periodic shortages due to the requirements of the manufacturing process. The paperwork is self-explanatory, but the project leader should distribute appropriate parts to the appropriate people with a deadline.
The most common source of failure is the selection of clinical cases for review. Each applicant must submit an exam of the brain, C-spine, L-spine, and knee. These should demonstrate your standard scan techniques and do not have to include pathology. Be advised that the ACR has requirements for in-plane resolution and slice thickness In the knee, for instance, slice thickness must be less than or equal to 4mm and in-plane resolution is less than or equal to 0.75mm. Remember that in-plane resolution is the field of view (FOV) divided by the acquisition matrix (for example, if you use a 16cm FOV you will have to use phase and frequency matrices exceeding 213 to meet this requirement). If you submit a 5mm-thick knee exam or if it has a resolution greater than 0.75mm, you will fail the clinical portion of the review. Be sure to have the physician selecting the clinical exams verify