Radiologists Rarely Know How Patients Experience Breast MRI

Radiologists need to raise their awareness towards patients’ experience during breast MRI examinations, demanded Lale Umutlu, Essen University, Germany. “It is not nice to have, it’s mandatory”, she said.

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Umutlu confessed that she had not focused on patient experience related to MRI, before she was assigned to the topic. When she did the research, the findings were as clear as they were astounding:

  1. Patients focus on a rather different set of quality parameters than radiologists (Brook 2017). Patients base their understanding of MRI quality on
    1. The examination environment, including aspects like cleanliness of a department or
    2. The cost, including the cost for the exam, but also transportation and parking at the hospital;
    3. Convenience, e.g. how fast does a patient get the appointment, or how close is the scanner
    4. Patient factors, e.g. fasting, comorbidities or poor prior experience, and most importantly
    5. Communication before, during and after the procedure, and
    6. Human factors, like friendly and compassionate staff.
  2. Radiologists are almost invisible for patients (Rosenkrantz 2016). They usually remember talking to the technologist (50%) and the receptionist (31%).
  3. Negative comments were more frequent in low-performing centers (Doshi 2016). “This means you can work fast and efficient and still get positive comments”, noted Umutlu.

Bridging the Gap Between Knowing and Doing

In order to incentivize a positive patient experience, the US Medicare Access and CHIP Reauthorization Act law has already linked a patient experience with physician reimbursement (Kapoor 2019). “If you link something to money, it usually works”, commented Umutlu.

The Kapoor study showed that patient experience can be influenced anytime between travels to the imaging site up to the time the patient leaves the department.

Based on this, Umutlu identified a couple of touch points radiologists could use to improve patient experience.

#1 Before the Exam –Staff and Schedule

Front desk staff and technologists should be aware of their role as hospital ambassadors and act accordingly. Waiting times should be as short and pleasant as possible. This is useful for all of radiology.

Breast MRI scheduling is crucial for a correct diagnosis, as hormonal activity impairs diagnostic quality. The wrong time slot during the menstrual cycle may cause rescheduling. Make sure the examination is scheduled during the second week  of the menstrual cycle”, emphasized Umutlu.

#2 Before the Exam – Patient Preparation

Patient blogs like “how to survive an MR exam” demonstrate the negative connotation of breast MRI among patients. “If you look at some of the coverage, it seems as if breast MRI is worse than the cancer”, said Umutlu. It is true that a breast MR scan is very likely not the luckiest 20 minutes during the patient’s lifetime, said Umutlu. However, explaining the procedure properly relieves anxiety.

Medical consultation needs to include hormonal status and patient and family history of breast cancer. “The more we know, the better our diagnosis will be”, said Umutlu.

Contrast media application has also become an issue during recent years. Umutlu shared the experience at her institution: Her department at Essen does around 120 MRI scans per day. 5 patients per months ask about Gadolinium deposition in the brain. “Macrocyclics have shown to be safe and we know that, but our patients don’t, so we have to explain it to them”, she said. Explaining that contrast is crucial to get the correct diagnosis is also necessary, she added.

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#3 During the Exam – Think About Patient Comfort

Technicians and staff need to keep patient comfort in mind. Vendors have picked up on this, noted Umutlu, showing contour coils for abdominal MRI that have ended the feeling of being strapped into a coil. However, the truth is somewhat different for breast MRI. “We have excellent coils, but they are uncomfortable”, said Umutlu with respect to the vendors, who could change this. In the MRI machine it is cold, loud, and patients are lying on their belly, face down, with their hands over their head. “This means their whole weight is on their sternum, usually without cushioning”, explained Umutlu. Slight cushioning without destroying signal could alleviate the pain. “The more uncomfortable patients are, the more likely they will move, thus causing motion artifacts.

#4 During the Exam – Keep Examination Times Short

Protocols should be as long as needed, but as short as possible. Umutlu recommended focussing on fast high-resolution dynamic imaging. “The dynamic phase is your workhorse”, underlined Umutlu.

#5 After the Exam – Fast High-Quality Report and Personal Communication

ACR BI-RADS structured reporting is the gold standard for breast MRI reports and should be performed after every exam. Radiologists should also be very aware that the way they communicate has a strong impact on their patients. Every word may count.

Umutlu ended with a quote for radiologists to remember: “In a world where you can be anything, be empathetic”.

References

Brook OR et al. Measuring and improving the patient experience in radiology. Abdom Radiol 2017,42:1259-67.

Doshi AM. Factors Influencing Patients’ Perspectives of Radiology Imaging Centers: Evaluation Using an Online Social Media Ratings Website. J Am Coll Radiol 2016, 13(2):210-6.

Kapoor N. Improving Patient Experience in Radiology: Impact of a Multifaceted Intervention on National Ranking. Radiology 2019 Jan 22:182307.

Rosenkratz AB, Pysarenko K. The Patient Experience in Radiology: Observations from over 3,500 Patient Feedback Reports in a Single Institution. J Am Coll Radiol. 2016;13(11):1371-7.

Presentation Title: Improving patient experience
Speaker: Lale Umutlu, Essen University, Germany
Date: Wednesday, 27th February 2019
Session Code:
SY 1