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Focusing on Practice Excellence

Operational improvement, lung cancer detection, population health, point-of-care ultrasound and patient follow-up were among the discussion topics at the 2022 ACR Quality and Safety Conference.
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We really can make a difference in lung cancer survivors, and thanks to the ACR for its tremendous activity in this realm. The depth of knowledge the ACR has is unparalleled.

—Ella A. Kazerooni, MD, MS, FACR
January 01, 2023

Inspired by a jam-packed agenda and an in-person audience for the first time since 2019, the 2022 ACR Quality and Safety Conference explored some of the hottest trends and topics in radiology and quality improvement. The Oct. 20–22 event in Washington, D.C., drew about 180 in-person attendees and 70 people virtually, and it featured a keynote, educational sessions, an award ceremony and preconference workshops. Here are some of the highlights:

Operational Improvement

During a welcome session on “High-Value Operational Improvement Strategies,” keynote speaker Pamela T. Johnson, MD, FACR, vice chair of quality and safety at Johns Hopkins Medicine’s department of radiology, provided context on why provider-led strategy around the value of care is so important to improving clinical effectiveness and reducing healthcare costs. Her keynote was titled “Harmonizing the Drivers of Value-Based Care Transformation: Professionalism, Provider-Led Performance Improvement, Payers and Policy Makers.”

Johnson, who also serves as vice president of care transformation and a professor of radiology and radiological science at Johns Hopkins, said the quality of radiology interpretations needs to be monitored to find opportunities to reduce misdiagnoses — in turn, improving patient outcomes while reducing costs, she said. For example, she shared evidence that radiology interpretations can contribute to overdiagnosis of pulmonary and genitourinary infection, which in turn drives overuse of antibiotics. Twenty percent of hospitalized patients who receive antibiotics have an adverse reaction, which may prolong hospitalization or result in a post-discharge emergency department visit or readmission.1

Communication with clinicians results in better radiology quality, and she cited a service she created at Johns Hopkins Medicine to help clinicians easily contact radiology specialists. In closing, Johnson spoke about the radiologist’s role in patient outcomes and experience: “It’s a tremendous opportunity for us, as diagnostic radiology is the beginning of the patient journey, and we can drive better care longitudinally by measuring the quality, demonstrating the quality and improving the quality of what we’re doing.”

LCS and Population Health

The ACR’s efforts in early lung cancer detection and population health took the spotlight during a session led by Ella A. Kazerooni, MD, MS, FACR, chair of the College’s Lung-RADS® Committee
and Lung Cancer Screening Registry (LCSR). “It is reassuring to have a session on LCS and population health — considering lung cancer is the number one cause of cancer deaths in the country,” Kazerooni said. “A few things we’ve learned through the 1.2 million screens in the Registry compared to the national population include who is being screened more than we thought and who is not being screened enough.”2

For instance, she said, more women, individuals over age 65 and current smokers are coming forward for screening. Individuals eligible for LCS are disproportionately low-income, uninsured and on Medicaid.3

Kazerooni talked about early lung cancer detection programs, citing the National Lung Cancer Roundtable’s LungPLAN™ model, which is free. It is evidence-based, using ACR LCSR data, and customer-focused for clinicians, navigators and administrators. She mentioned the revenue that can be gained by participating in the program. LungPLAN resources and more information are available on the National Lung Cancer Roundtable website.

“We really can make a difference in lung cancer survivors,” she told the audience. “And thanks to the ACR for its tremendous activity in this realm. The depth of knowledge the ACR has is unparalleled.” She also encouraged attendees to visit the Screen Your Lungs website to watch an important public awareness video on LCS.

Kazerooni introduced Liora Sahar, PhD, GISP, senior director of data science with the American Cancer Society, to talk about population health and how geospatial mapping can be used to identify diverse populations at risk for lung cancer, allowing the medical community to help close the gaps in screening. For example, there’s a difference in access to LCS among eligible adults living in rural versus urban communities. Some patients have to drive 40 miles or more for screening, she said.

The session also included a presentation by Shawn D. Teague, MD, FACR, chair of the ACR’s LCSR Education/Quality Improvement (QI) Subcommittee and associate professor with National
Jewish Health/University of Colorado, who spoke about using ACR LCSR data for performance improvement. The LCSR, Teague explained, is one of six QI registries that comprise the National
Radiology Data Registry (NRDR®), with the goal of helping clinicians monitor and demonstrate the quality of LCS CT in their practices through regular reports, including peer benchmarks.

It's a tremendous opportunity for us, as diagnostic radiology is the beginning of the patient journey, and we can drive better care longitudinally by measuring the quality, demonstrating the quality and improving the quality of what we are doing.

—Pamela T. Johnson, MD, FACR

Teague pointed out that while CMS no longer requires participation in the LCSR for reimbursement, participation in the Registry continues to grow. “We are adding new measures to the Registry, including new reports that help participants understand their performance and how it compares to that of their peers,” he said. Benefits of participation include guidance to gain the most from your LCSR reports, 20 CME credits for completing a plan/do/study/act (PDSA) project, and a QI project that can count toward ABR Maintenance of Certification.

Point-of-Care Ultrasound

A preconference session on point-of-care ultrasound (POCUS) focused on how certain organizations develop POCUS programs. Moderated by Alexander J. Towbin, MD, associate chief of clinical operations and radiology informatics and a pediatric radiologist at Cincinnati Children’s Medical Center, the session included presentations from numerous organizations on how they built their POCUS programs. Sonya Echols, PhD, RT, and David Evans, MD, represented Virginia Commonwealth University Health Systems. David L. Waldman, MD, PhD, FACR, represented the University of Rochester Medical Center, and Jeannie K. Kwon, MD, represented the University of Texas Southwestern Children's Medical Center. The doctors weighed in on factors that helped them build their POCUS programs, such as developing a business plan or framework, forming a POCUS committee and workforce, enlisting an effective vendor and working together to form a workflow with other practices within the organization.

Patient Follow-Up

In a session on “Follow-Up Recommendations,” moderator Ben C. Wandtke, MD, MS, MMM, vice chair of quality and safety at University of Rochester Medical Center, set the stage for organizations to share their best practices in not only identifying incidental findings and making sure patients get proper care, but also implementing a follow-up tracking system.

Woojin Kim, MD, a radiologist at the Palo Alto Veterans Affairs Hospital and the chief medical officer at Equium Intelligence, stressed the importance of making a proper plan for follow-up recommendations. Kim highlighted the need for analyzing multiple methods to find the most effective way to track and implement follow-up exams. Regan City, PA-C, CPHQ, a healthcare quality and performance improvement specialist with Radiology Partners, discussed a pilot study she was involved in to help her organization develop a long-term tracking plan. Key factors, she said, are to consider the workload involved to ensure everyone is properly prepared and to interview radiologists to be sure everyone is on the same page.

Neville Irani, MD, an associate professor in the radiology department at the University of Kansas Health System and founder of the Healthcare Quality Improvement Platform, focused on developing relationships with patients to make sure they come back for follow-up exams. Christopher Moore, MD, an emergency physician and professor at Yale School of Medicine, capped off the presentations by focusing on how to analyze data found through follow-up tracking. Moore talked about looking at disparity factors and how everything was communicated to determine opportunities for improvement.

Quality Improvement

A breakout session titled “Participating in a National Quality Improvement Learning Collaborative” featured seven panelists who gave the audience ideas on improving their practices. Moderators
David B. Larson, MD, MBA, FACR, chair of the ACR Commission on Quality and Safety and vice chair for education and clinical operations at Stanford University, and Kandice Garcia Tomkins, MS, RN, quality improvement manager in the radiology department at Stanford Health Care, explained that a learning network is an organizational structure to facilitate meaningful improvement. The session moved to presentations by practices and organizations that have participated in the ACR Learning Network, which has created four cohorts comprised of four to six healthcare sites each that work together to solve the same problem. Representatives from Hudson Valley Radiologists, P.C., talked about how they learned through the program to slow down and work more methodically so they can break down the image/data part by part, and to value all opinions in working to find the best way to improve patient care. Solis Mammography used the program to learn the differences between its definition of quality and the ACR’s definition, using that information to continue its success plan.

2023 Event

Planning is already in the works for the 2023 ACR Annual Conference on Quality and Safety. As the ACR marks its 100th anniversary, the next meeting of the minds will help radiologists continue to keep up with the most pressing issues in quality and safety.


1. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA Intern Med. 2017;177(9):1308–1315.

2. American Cancer Society, Key Statistics for Lung Cancer, Accessed 11-21-2022.

3. Silvestri GA, Goldman L, Burleson J, Gould M, Kazerooni EA, Mazzone PJ, Rivera MP, Doria-Rose VP, Rosenthal LS, Simanowith M, Smith RA, Tanner NT, Fedewa S. Characteristics of persons screened for lung cancer in the United States: A cohort study. Ann Intern Med. 2022; 175(11):1501–1505.

Author Alexander Utano, editorial assistant, and Chad E. Hudnall, senior writer, ACR Press