Statement of the German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists on Requirements for the Performance and Reporting of MR Imaging Examinations Outside of Radiology

Abstract

Background Magnetic Resonance Imaging (MRI) is a very innovative, but at the same time complex and technically demanding diagnostic method in radiology. It plays an increasing role in high-quality and efficient patient management. Quality assurance in MRI is of utmost importance to avoid patient risks due to errors before and during the examination and when reporting the results. Therefore, MRI requires higher physician qualification and expertise than any other diagnostic imaging technique in medicine. This holds true for indication, performance of the examination itself, and in particular for image evaluation and writing of the report. In Germany, the radiologist is the only specialist who is systematically educated in all aspects of MRI during medical specialty training and who must document a specified, high number of examinations during this training. However, also non-radiologist physicians are increasingly endeavoring to conduct and bill MRI examinations on their own. Method In this position statement, the following aspects of quality assurance for MRI examinations and billing by radiologists and non-radiologist physician specialists are examined scientifically: Requirements for specialist physician training, MRI risks and contraindications, radiation protection in the case of non-ionizing radiation, application of MR contrast agents, requirements regarding image quality, significance of image artifacts and incidental findings, image evaluation and reporting, interdisciplinary communication and multiple-eyes principle, and impact on healthcare system costs. Conclusion The German Roentgen Society, German Society of Neuroradiology, and Society of German-speaking Pediatric Radiologists are critical with regard to MRI performance by non-radiologists in the interest of quality standards, patient welfare, and healthcare payers. The 24-month additional qualification in MRI as defined by the physician specialization regulations (Weiterbildungsordnung) through the German state medical associations (Landesärztekammern) is the only competence-based and quality-assured training program for board-certified specialist physicians outside radiology. This has to be required as the minimum standard for performance and reporting of MRI exams. Exclusively unstructured MRI training outside the physician specialization regulations has to be strictly rejected for reasons of patient safety. The performance and reporting of MRI examinations must be reserved for adequately trained and continuously educated specialist physicians. Key Points: Citation Format

Kompetenz und Innovation in der kardiovaskulären MRT: Stellungnahme der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung

“…Die Deutsche Röntgengesellschaft (DRG) weist in einem aktuellen Positionspapier auf den richtigen Umgang mit aktiven und passiven Implantaten hin [12]. Gerade das ist eine Kernkompetenz des Facharztes für Innere Medizin und Kardiologie, der nicht nur die Notwendigkeit einer speziellen Programmierung von Schrittmacher-und Defibrillatoraggregaten erkennt, sondern diese auch selbst durchführen kann.…”

“…Ein Kardiologe ist daher mit möglichen pharmakologischen Nebenwirkungen der applizierten Gadoliniumchelate oder Vasodilatatoren im Rahmen der CMR-Untersuchung vertraut und kann betroffene Patienten umgehend versorgen. [12]. Die Etablierung der Qualifizierungsstufen der DRG (Q1-Q3) macht nur deutlich, dass sehr wohl auch aufseiten der radiologischen Kollegen erkannt wurde, dass die Facharztausbildung allein nicht in der Lage ist, das notwendige Wissen für Indikationsstellung/Durchführung und Auswertung von CMR-Untersuchungen ausreichend abzubilden.…”