Evaluating Quality of Magnetic Resonance Imaging of the Shoulder and Optimization of Imaging Planes

Purpose or Learning Objective: To evaluate the adequacy of magnetic resonance imaging (MRI) of the shoulder regarding image acquisition in the correct planes at a UK district general hospital.

Methods or Background: MRI is the preferred method to evaluate internal derangement of the shoulder. Routine shoulder MRI scans typically include images acquired in the axial, oblique coronal, and oblique sagittal planes. The imaging planes must be angled so the rotator cuff tendons can be visualized in continuity, to avoid discrepancy when interpreting tears and other rotator cuff pathology. This goal is best achieved by aligning the localizers parallel and perpendicular to the supraspinatus central tendon. The American College of Radiology and European Society of Musculoskeletal Radiology have published specific guidelines.

We performed a retrospective audit of 150 shoulder MRI scans between February and May 2022 to assess their quality. The Royal College of Radiology stipulates a target of 100% regarding quality of image acquisition in shoulder MRI imaging. We deemed a local target > 95% would be acceptable.

Results or Findings: Our audit revealed that only 59% of shoulder MRIs were optimally scanned in both imaging planes. A greater number of errors were evident in the sagittal plane, with 38% of scans not meeting the standard. Differences in age, sex, and shoulder side did not show any significant correlation with poor scanning technique. A demonstratable link was identified between the scanning machine used and the quality of the scan, with poorest outcomes in mobile scanning units.

We subsequently provided radiographers with educational material and standardized the scanning protocol across all scanners including the mobile units. Significant improvements in quality of image acquisition were observed on a repeat audit a month later. The percentage of scans optimized in both imaging planes increased from 59% to 84%. Of note, the percentage of scans optimized in the sagittal plane increased 25%. Furthermore, the percentage of optimal quality scans produced by the mobile scanners more than doubled.

Conclusion: High-quality MRI imaging is essential for correct radiologic interpretation. Radiologists and radiographers both have a role in ensuring that imaging meets the desired standards. Our audit allowed us to identify areas for development and enabled us to significantly improve the MRI service at our Trust. We encourage other radiology departments to closely monitor the quality of their MRI scans and for radiologists and radiographers to work together when implementing plans for improvement.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
26 May 2023