Quality Improvement in Radiology: Catching Cancer Early with Dr. Ben Wandtke

Most radiologists measure their impact one read at a time. Ben Wandtke decided to measure his by what happens after the report goes out. Ben is a professor and vice chair of quality and safety in the Department of Imaging Sciences at the University of Rochester Medical Center, chief of diagnostic imaging at Thompson Hospital, and director of the University of Rochester's CT lung screening program. He chairs the American College of Radiology's Commission on Quality and Safety, rebuilt the ACR's Diagnostic Center of Excellence program, and serves as a physician lead for the ACR's Learning Network. In this episode of The Operating System, Ben tells Andy how it started: four missed lung cancer diagnoses at a 110 bed community hospital, and a decision to stop letting incidental findings fall through the cracks. He built a Microsoft Access database in an afternoon with one person from IT and a quality nurse, and started tracking patients manually. That program now manages 18,000 patients a year, and the organizations Ben has worked with through the ACR Learning Network have pushed their follow up completion rates past 80 percent, a jump of 30 points or more from where they started, in a space where studies have shown as many as 30 to 70 percent of patients with a follow up recommendation never complete it. We get into how he applied the same approach to lung cancer screening, growing one health system's volume from 200 patients a month to more than 1,000 while pushing screening rates into the 60 to 70 percent range, how he took a six week CT scheduling backlog down to four days in about two months without hiring a single new technologist, and the 6 and 12 program he built to keep his department improving on a fixed cycle instead of waiting for a crisis. We also talk about where he thinks radiology is headed next: using AI and EMR data to flag cardiovascular risk the same way mammography already flags breast cancer risk, and why he thinks earlier detection, not more treatment, is what actually bends the cost curve in healthcare.