ARRS 2022 Abstracts

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E1622. Staying Abreast of the MQSA and Accreditation Process: ACR and MQSA Accreditation for the New Supervising Radiologist
Authors
  1. Abhishek Haritha; Medstar Georgetown University Hospital
  2. Erin Crane; Medstar Georgetown University Hospital
  3. Judy Song; Medstar Georgetown University Hospital
Background
The Mammography Quality Standards Act (MQSA), established in 1992 and amended in 1998 and 2004, standardizes mammography quality to ensure safe and reliable care and detect breast cancer at its earliest treatable stage. The American College of Radiology (ACR) monitors an accreditation system to ensure quality and safety among all imaging modalities throughout the United States. Maintaining these standards ensures a high quality of care for patients. MQSA also supplies quantifiable measures of a radiologist's ability to discover early cancers and comparisons to national goals and trends. However, the consequences of not meeting these standards are severe for a breast imaging practice. The MQSA and ACR accreditation process is a source of stress and anxiety for many practices. The complexity of maintaining accreditation can be daunting for a new supervising radiologist.

Educational Goals / Teaching Points
The goals of this exhibit are to provide a new supervising radiologist with a brief background of MQSA and accreditation; an easy to navigate and understand guide to MQSA and ACR accreditation; a step by step process to maintain accreditation in mammography, ultrasound, breast MRI, US-guided biopsies, and stereotactic biopsies; and a compilation of FAQS and tips to make the process easier and less stressful for a new supervising radiologist.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The key to a smooth accreditation and MQSA process is starting early. We provided a timeline to success based on starting early, filling your application, forming your team/kick off meeting, collecting your images, reviewing your images, and reviewing the accreditation report. The accreditation process can be divided into three main parts: the application, the package, and the approval/revision process. The MQSA process can be divided into six processes: equipment tests; quality assurance records; quality control records; personnel qualifications; medical records; and mammography medical audit and outcome analysis records. Accreditation must be done for each modality. Specifically for a breast imaging center, includes mammography, ultrasound, MRI, ultrasound biopsy, and stereotactic biopsy. The new Enhancing Quality Using the Inspection Program (EQUIP) guidelines have been implemented as an extension for MQSA. The three fundamental EQUIP requirements that the supervising radiologist is responsible for includes ensuring the facility has a corrective action plan for inferior quality clinical images; ensuring each facility has procedures to ensure clinical images comply with accreditation body standards; and ensuring a procedure is in place for the lead physician to oversee quality assurance and quality control records and corrective actions.

Conclusion
The MQSA and ACR accreditation process has helped standardize care of breast centers throughout the country, ensuring quality and safety for patients. However, the process can be stressful for a new supervising radiologist and the consequences severe if those standards are not met.With this guide, new supervisors will have quick and easy access to ensure success during the process.