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IAC Newsletter

In reviewing trends from 2008, fifty percent of the ICAMRL applicant laboratories received a delay status when applying for accreditation. Although the problems that result in a delay can often be easily corrected, the disappointment and additional demands placed upon laboratory staff might be avoided by identifying the potential issues prior to application submission.

WHAT IS DELAYED ACCREDITATION?

After the review of a laboratory’s accreditation application, the Board of Directors renders an accreditation decision. One of three decisions is made: Accreditation Granted (full or provisional), Accreditation Delayed, or Site Visit Required. A delayed decision means that there are significant issues, deficiencies or lack of adherence to The ICAMRL Standards that must be addressed by the laboratory before ICAMRL accreditation can be granted. Delay of the laboratory’s application requires that additional material be sent to further demonstrate adherence to The ICAMRL Standards and/or to provide the adequate documentation necessary for a complete application review.

MOST COMMON REASONS FOR DELAY

The chart to the right illustrates the most frequent reasons an accreditation decision is delayed, with the following sections providing specifics, as well as several ways to help prevent a delay in your laboratory’s accreditation.

INCOMPLETE FINAL REPORTS

55% of the applications received in 2008 were delayed for issues related to final reports.

The ICAMRL Standards state that the final report must be in the form of a document that is retrievable and/or reproducible for review by health care personnel. In general, the report must contain sufficient information so that any health care professional has access to adequate information regarding the indications for the examination, the type of examination performed and the results of the diagnostic study.

The following components are required by The ICAMRL Standards (Section 4 of the Organization Standards) and are listed below in order of most frequent deficiencies noted:

• Date of interpreting physician signature/verification
• Clinical indication for the performance of the MR exam
• Amount and type of contrast administered, if applicable
• Adequate description of test (inclusive of examination and pulse sequences used)
• Manual or electronic interpreting physician’s signature
• Interpreted and reported by a member of the medical staff listed in the application
• Standardized format
• Date of examination
• Overview and summary of findings
• Comparison with previous related studies, where available
• Reasons for limited examinations, if applicable

POLICY AND PROCEDURE DELAYS

53% of the applications received in 2008 were delayed for issues related to miscellaneous policies.

Developing, implementing and maintaining clearly written policies and procedures is one of the key elements in ensuring the successful outcome of a process and improved patient care. The ICAMRL requires that applicant laboratories have a comprehensive quality assurance program in place that assures quality patient care, as well as written policies and procedures to facilitate the program. As evident by the data, many applicant laboratories applying for ICAMRL accreditation find that writing policies and procedures proves to be a challenging part of the process.

Guidance on writing policies and procedures was featured in the Summer 2008 issue of the IAC Newsletter. The article, “The Who, What, Why & How of Writing Policies and Procedures” can be viewed from the ICAMRL website.

CASE STUDY DELAYS

44% of the applications received in 2008 were delayed for issues related to case studies.

A primary factor resulting in the delay of ICAMRL accreditation is incomplete documentation and overall poor quality of submitted case studies. As a random selection is not required, it is crucial that the submitted cases represent the laboratory’s “best work”. The cases must include all of the hardcopy documentation required by The ICAMRL Standards, while demonstrating good testing techniques. The technical expertise of the operator becomes evident to the application reviewers when they are evaluating the submitted case studies. The manipulation of the scan parameter factors to balance the resolution and signal-to-noise ratio is crucial to produce diagnostic images. Of equal importance is the proper positioning of the anatomy in the coil to evaluate true anatomical slice planes, and to avoid wrap and coil artifacts. The technologist’s knowledge of the tools used to reduce pulsatile flow and breathing motion is clear to the reviewers as well. Applicant laboratories that have been delayed for image quality issues are encouraged to engage the manufacturer’s applications specialist to get specific guidance on the particular MRI scanner and software. A thorough and regular review of The ICAMRL Standards, including Section 2, Techniques, will assist in assuring that testing procedures are being performed in a standardized method, in compliance with the requirements of the ICAMRL process. The article, “The Art of Imaging,” featured in the Spring 2008 issue of the IAC Newsletter, may also prove beneficial to help improve image quality.

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