Join Us for the 2017 AUA QI Summit on Stewardship of Imaging

Advanced imaging techniques top lists of the most important medical innovations in the past 30 years, and play a major role in the diagnosis and management of urological disease.  While these technologies have transformed care, they are under increased scrutiny, with estimates that up to half of the advanced imaging studies obtained in the US are potentially avoidable at an estimated annual cost of over $30 billion.  In addition to contributing to unsustainable growth in the costs of care, there is increasing recognition of substantial harms from radiation exposure, in particular from CT scans, the use of which has soared in recent years.  Opportunities to reduce these harms include reducing potentially avoidable CT imaging, but also improving how safely CT scans are delivered.  Against this backdrop, there are increasing calls for physician-led stewardship of advanced imaging services.

The 2017 American Urological Association (AUA) Quality Improvement Summit on Challenges and Opportunities for Stewardship of Urological Imaging responds to these demands.  Building on the successes of prior AUA QI Summits, this unique meeting will bring together leaders from urology, radiology, and emergency medicine for a high-yield, interactive discussion of practical opportunities to improve quality and patient safety on October 21, 2017 at AUA Headquarters.  These are important ends in themselves but also means to preserve access to clinically necessary imaging services.   

The urology community has been actively engaged in imaging stewardship, particularly related to potentially avoidable staging imaging in prostate cancer.  Dr. Jim Montie will share the experience of the Michigan Urologic Surgery Improvement Collaborative (MUSIC) at the Summit, and related activities are scaling up nationwide through the AUA’s Quality Registry, AQUA.  In parallel, the rapid adoption of prostate MRI demands quality assurance; relevant resources from the American College of Radiology (ACR) will be reviewed at the Summit.

A number of exciting potential opportunities for collaborative QI targeting the large population of patients with urinary stone disease will be a major focus of the Summit.  In contrast to low risk prostate cancer, where staging imaging may be eliminated in most cases, imaging is central to diagnosis and management in most episodes of care for urinary stone disease.  Recognizing this, the need for stewardship of these services is crucial, given the millions of patients presenting each year.

Our keynote speaker, Rebecca Smith-Bindman, will provide an overview of radiation harms from imaging and practical strategies to mitigate them.  While Dr. Smith-Bindman’s trial of renal colic imaging in the ED may be familiar to many urologists, she is also an internationally recognized expert on the harms of radiation from CT, particularly related to avoidable variation in dose.  These themes dovetail with national activities led by our radiology and emergency medicine colleagues also on the Summit agenda.   Dr. Chris Moore, co-Chair of the Summit, discovered massive underuse of reduced-dose protocols for renal colic CT in real world practice.  To address this, he is leading a national effort disseminating practical tools to support the implementation of reduced-dose CT.  These will be among a suite of practical resources made available through the Summit for urologists to engage in local QI activities.  In parallel, the American College for Emergency Physicians (ACEP) is supporting efforts to implement ultrasound for low-risk patients presenting to the ED with suspected recurrent renal colic.  We will review these activities, as well as an ongoing multispecialty collaboration between the AUA, ACEP, and the American College of Radiology (ACR) to develop best-practice recommendations for imaging patients with renal stone disease. 

Finally, while intrinsically valuable, the call for QI in general and stewardship of imaging in particular is also reinforced by emerging regulatory and reimbursement requirements.  Improvement Activities comprise a portion of the Merit-based Incentive Payment System (MIPS) in the new CMS Quality Payment Program, and residency training programs are required to include patient safety and quality improvement activities under the ACGME Common Program Requirements.  In addition, the Protecting Access to Medicare Act of 2014 requires activities related to CT dose optimization and consultation of appropriate use criteria and clinical decision support.  The Summit will provide attendees with a comprehensive toolkit of practical resources to address these emerging requirements, drawing on resources mentioned above as well as additional activities of our partners and imaging equipment manufacturers.   

The Summit marks a new era of collaboration and coordination between urology, radiology, and emergency medicine.  Residents and fellows interested in patient safety and quality improvement are encouraged to apply for a travel scholarship.  We hope you can join us for this unique, interdisciplinary meeting reviewing important challenges and opportunities for stewardship of urological imaging—register today

Matthew E. Nielsen, MD, MS, FACS

QI Summit Chair

Quality initiatives: How to participate—and benefit