Last Updated on July 8, 2026 by Don Gerig, RDCS
A strong QI process does more than satisfy accreditation requirements. It helps your lab identify variability, improve consistency, and strengthen the quality of patient care.
For IAC Echo accreditation, facilities must complete ongoing quality review in several key areas, including Technical Quality Review, Interpretive Quality Review, Final Report Completeness and Timeliness, and Test Appropriateness. The good news is that these reviews do not have to be complicated or completely separate processes.
In this article, we’ll share three practical strategies to help your lab complete Technical Quality Review and Interpretive Quality Review with quality, efficiency, and less stress.
Current IAC Adult Echocardiography Standards require a written QI program that includes evaluation and review of:
- Test appropriateness
- Technical quality and, if applicable, safety of the imaging
- Interpretive quality review
- Final report completeness and timeliness
Technical and Interpretive Measures: The Perfect Pair
Technical Quality Review evaluates the technical quality of the images and, if applicable, procedural safety. This includes image clarity, suboptimal images or artifact, completeness of the study, and adherence to the facility’s imaging acquisition protocols. Interpretive Quality Review evaluates the quality and accuracy of the physician interpretation based on the acquired images.
Simply put… both the performer of the test and the interpreter of the test should have their work checked for accuracy. None of the modalities, except Echocardiography, specify a required number of studies to review. Since Echo requires the review of 2 cases per testing area per quarter for both the Technical and Interpretive Measure we will follow that format. The same cases may be used for all QI measures, which makes combining Technical Quality Review and Interpretive Quality Review a practical and compliant strategy.
For echocardiography, clinical correlation remains an important quality concept and is still addressed in the IAC guidelines. However, this article focuses specifically on combining Technical Quality Review and Interpretive Quality Review using the same selected cases.
HACK #1: Assign The Same 2 Cases To Each Physician
By assigning the same two cases to all physicians for review, you will be able to better assess variability within your lab. Did I mention this makes it easier too! We always recommend selecting abnormal studies if possible. Sure, you can review a normal study for proper interpretation but there is just so much more to learn about how a study with pathology was interpreted. Abnormal studies allow for greater learning opportunities. Looking for just 2 abnormal studies per testing area is a lot more doable!
But why not just have each physician over-read another physician? We have had clients tell us “at our facility we just have a physician select any study and then over-read it”. That’s ok but I would ask you to consider this scenario.
A group of 5 physicians participate in peer review. You have to select 2 different studies for each doctor to over-read – that’s 10 studies to select! Now imagine there is a discrepancy between the doctors. All you have at your fingertips is the original findings and the peer review findings. Who is right and who is wrong?? Hey Dr. Smith, Dr. Jones thinks the EF is 45% not 30%!
Now imagine this same group of 5 physicians participating in peer review with your new secret weapon of efficiency! You select only 2 cases and have each physician complete an over-read and alas, there is a discrepancy! Now you have actual variability data to present! You can present the 5 over-reads to the physician. Image how much more valuable this data is. Hey Dr. Smith, we reviewed a case and 4 out of 5 physicians interpreted the EF as 45% not 30%, would you like to review this study again? It’s easier for a physician to acknowledge a discrepancy when tracked against a group of his peers. You can even start to track if the same physicians consistently over call or under call pathology. All this is great information to help improve the quality of your lab.
HACK #2: Review the Same 2 Cases For Both Technical And Interpretive Quality
You’ve already selected your 2 abnormal cases for the physician peer review to complete your interpretive measure. You now need to review the technical quality of 2 studies per testing area per quarter. Why not review the same two studies for both your Technical and Interpretive Measures! Your physician peer review form can include fields for commenting on both interpretive accuracy and technical quality.
For example: Were the required views obtained? Was image quality adequate? Were Doppler and measurements appropriate? Was the study complete enough to answer the clinical question? What a great opportunity to get feedback from a physician regarding the technical quality of a study! In addition, your Technical Director (or designated staff member) can also review the study to ensure the protocol was followed, etc.
We have found this to be a wonderful opportunity for sonographers/technologists to receive feedback from the interpreting physicians on the technical quality of their studies.
HACK #3: Decide On Best Way To Complete: Individually or As a Group
There are many ways to complete this combined peer review to meet the technical and interpretive measures. You can assign these cases to the physicians to review on their own time or you can review them as a group at your QI Meetings.
4 Tips for Individual Peer Review
If you assigned the peer review to be completed individually by the physicians we strongly recommend some kind of regular reminder to ensure the forms are completed before the end of the quarter.
- Provide each physician with a peer review form that allows them to comment on both their interpretive findings and the technical quality. In addition, if the Technical Director (or designated staff member) is involved in the review of technical quality they too, would receive a review form.
- Collect all review forms
- Review findings for discrepancies and variability
- Report findings to all staff and discuss at QI meetings
4 Tips for Group Peer Review
This is a great option for larger labs as the peer review will be completed live at meetings and prevents the need for the physicians to complete the peer review on their own time.
- Make sure you have access to view images at your meeting. Pull up the 2 peer review cases at the meeting so all physicians can review the study
- All in attendance will review the study and complete their review form
- When the attendees complete the forms, open up the review for discussion. What pathology did they identify, severity, technical quality, etc.
- Discuss findings and resolve discrepancies. If correlation or confirmation data are available, such as comparison with another echocardiographic modality, cardiac CT or MRI, catheterization, nuclear perfusion imaging, or surgical findings, these results can help guide the discussion.
We have discrepancies, now what?
You can handle discrepancies in the technical and interpretive measure in any way you see fit. Remember the goal is continual quality improvement not perfection. Anything that is looked at gets better! The one word answer that we think is the most appropriate in all situations, whether a technical issue or an interpretive issue is EDUCATE!
- Review discrepancies and issues with the relevant staff members.
- Use correlation or confirmation data when available to help evaluate accuracy.
- Document the findings, discussion, and any corrective actions.
- Provide additional education or training when needed.
Not Too Shabby!
You now have a practical, time-saving strategy to complete both your Technical Quality Review and Interpretive Quality Review with quality and ease! By using the same selected cases across multiple QI measures, your lab can streamline the review process while gaining a clearer picture of where variability may exist.
Remember, the goal of QI is not perfection. The goal is to identify opportunities for improvement, document the process, reconcile discrepancies, and use the findings to support better, more consistent patient care.
Take the steps to implement these ideas into your lab and make your QI process both meaningful and manageable!
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