Abstract
Background
Breast cancer is one of the most commonly diagnosed cancers worldwide and is the most
common cancer affecting women in Saudi Arabia. This research aims to highlight the
strategy and measures needed to improve breast imaging services focusing on imaging
justification, optimization, acquisition, and interpretation.
Patients and Methods
The Find, Organize, Clarify, Understand, Select – Plan, Do, Check, Act (FOCUS-PDCA)
methodology of quality improvement was adopted. In phase one, identification of deficiencies
or problems was made by evaluating imaging requests, time management, workforce, and
resource utilization between 2015 and 2017 (3 years). These were presented on a fishbone
diagram. Optimization of services was made by appointing or training reliable breast
imaging staff. The action plan and changes were subsequently implemented and their
effects, in terms of improvement in justified imaging requests, increase in the number
of screening studies, imaging acquisition, reporting by specialists, and adherence
to a standard Breast Imaging-Reporting and Data System mammography reporting format,
were evaluated from 2018 till the end of 2021.
Results
Total mammographic studies almost doubled in a year (from an average of 225 per annum
in preintervention years to 443 exams postintervention), in which mammography screening
studies increased three times in the postintervention period. Breast imaging referrals
were streamlined primarily under primary care physicians and breast surgeons, with
more than double referrals for the screening studies. Standard reporting was achieved
in more than 90% of studies compared to 60% initially.
Conclusion
Breast imaging services can be improved by promoting awareness and education to patients
and primary physicians, streamlining imaging requests, properly utilizing time and
resources, ensuring imaging acquisition, and interpretation by specialists.
Keywords
breast cancer - screening - imaging - quality assessment - fishbone diagram - FOCUS-PDCA
