Purpose: In pursuit of enhanced mammography image quality for breast cancer detection, our study, guided by the American College of Radiology (ACR) standards, employed lean management principles within our breast center. Under ACR's guidance, we initiated a quality improvement project to identify barriers to obtaining high-quality mammograms and enhance processes within our breast center to ensure dependable adherence to these standards.
Materials and Methods: We educated clinical team members about ACR's major and minor criteria for mammography positioning. Over an eight-week period, we assessed 60 mammograms weekly. This set a compliance baseline and enabled ongoing monitoring of improvements according to ACR criteria.
Lean tools, such as fishbone diagrams and Gemba walks, unveiled the root causes behind performance gaps. We addressed these shortcomings through educational initiatives, which encompassed daily quality improvement huddles, reinforcement of positioning techniques, and personalized feedback. An educational online seminar with a national mammography positioning expert and the involvement of a positioning coach further supported our efforts.
Results: Initially, 20 % of mammograms met all ACR criteria for breast positioning. Technologist experience did not directly impact compliance to image quality, but we identified specific, repeated criteria lapses unique to each technologist.
We uncovered inefficiencies in workflow and technique, such as inconsistent image acquisition order and a lack of a diagnostic checklist to ensure all positioning criteria were met. Scheduling challenges, like uniform imaging slots for all patients regardless of special needs, led to time pressures and technologist performance issues.
Through the iterative application of improvement strategies and tools, we witnessed consistent progress in image quality. An impressive 89% of mammograms met all ACR major and minor criteria for breast positioning at the conclusion of the study.
Conclusion: Our journey demonstrates the power of the Gemba walk and lean tools in achieving a significant improvement in mammography positioning quality, increasing compliance from a 20% baseline to an impressive 89% by the study's end. A key factor in our success was maintaining a non-punitive and respectful atmosphere, fostering a safe environment for recognizing individual mistakes and sharing best practices for continuous positioning improvement.
Clinical Relevance Statement: Lean techniques can be successfully used to improve mammography positioning in clinical practice. High quality mammograms are essential for the early detection and prevention of breast cancer, saving lives and improving patient care.
