Impact of a quality assessment program on radiologist performance in ultrasound-guided renal transplant biopsy

Purpose: The purpose of this study was to analyze the impact of a quality assessment (QA) program on radiologist performance in ultrasound-guided renal transplant biopsy. Methods: The numbers of glomeruli and small arteries obtained during ultrasound-guided renal transplant biopsy of all consecutive patients performed by any of 8 radiologists in an ultrasound section between September 1, 2007, and May 31, 2010, were recorded. Procedural success was assessed using Banff 97 criteria. Two subgroups were defined on the basis of each radiologist's approximate fractional full-time equivalent effort in the section, with 2 radiologists who were engaged 100% of their clinical noncall time in the ultrasound section constituting the primary ultrasound subgroup and 6 radiologists who were engaged <25% of their clinical noncall time in the ultrasound section constituting the secondary ultrasound subgroup. The biopsy success rate for individuals, subgroups, and the entire section for 9 months before (pre-QA) and 24 months after (post-QA) the onset of quarterly dissemination of the QA data was analyzed. Results: Of 339 biopsies in the pre-QA period, 90.5% were successful. Of 1,063 biopsies in the post-QA period, 96.0% were successful (P < .001). The pre-QA individual radiologist success rates ranged between 71.4% and 96.7% (mean, 86.2 ± 10.3%). The post-QA individual radiologist success rates ranged between 80.0% and 97.9% (mean, 92.5 ± 6.6%). The primary ultrasound subgroup success rate increased from 93.4% to 97.5% (P = .005). The secondary ultrasound subgroup success rate increased from 85.7% to 93.8% (P = .004). Conclusions: A renal transplant biopsy QA program improves operator performance.