While vital for high-quality care, accreditation can be challenging and sometimes tedious for imaging departments. To help, this new article series will offer some tips for how to comply with the latest Intersocietal Accreditation Commission (IAC) Quality Improvement (QI) requirements with quality and ease.
Effective earlier this year, the IAC standardized its QI programs across all imaging modalities with the goal of addressing variations between the different modality divisions at IAC and to ease the burden of maintaining accreditation. Although some modalities such as echocardiography weren't changed much, others such as vascular testing experienced substantial modifications. The changes were adopted for all modalities except for nuclear medicine/PET.
In April, however, the IAC announced its proposed changes to the standards, including the addition of the standardized QI measures for nuclear medicine/PET and some minor changes to both adult and pediatric echocardiography. All proposed changes are open for comment until June 15.
4 key measures
Judith Buckland, president of CardioServ.As a result of the standardization initiative, the IAC QI program now has four key measures for all modalities to follow:
- Test appropriateness
- Technical quality
- Interpretive quality
- Report completeness
As was the case before, modality divisions still retain the option to add a division-specific measure. In this article, we'll delve into the first two measures: test appropriateness and technical quality. Our next article will cover the remaining two measures.
Test appropriateness
Known to most under its previous name of Appropriate Use Criteria (AUC), this measure requires all modalities to assess the appropriateness of testing indications. The exception is pediatric echocardiography, as there are currently no published industry standards for assessing test appropriateness. In addition to renaming this measure from AUC to test appropriateness, the terminology of the appropriateness categories changed from appropriate, uncertain, and inappropriate to the following:
- Appropriate/usually appropriate
- May be appropriate
- Rarely appropriate/usually not appropriate
Notably, this was a brand new measure for the vascular testing division as vascular QI had never required any kind of test appropriateness tracking until now. Although test appropriateness is now mandated across all imaging modalities, the specific number of cases to evaluate is modality-specific.
Since the new QI program became effective earlier this year, the IAC has also announced proposed changes to significantly reduce the number of required cases to be evaluated within the adult echo division. These proposed changes are still under review with no effective date yet announced, however.
Summary of test appropriateness measure.
Technical quality
The second required across-the-board QI measure is technical quality. Most divisions already had some sort of required technical measure, but that was sometimes under a different name. This was also a brand new measure for the vascular division.
There are now three standardized features of the new technical quality measure, as well as an additional safety measure as applicable:
- The clinical images for clarity of images and/or evaluation for suboptimal images or artifact
- Completeness of the study
- Adherence to the facility imaging acquisition protocols
- Safety of imaging (MRI, CT, and proposed for nuclear)
All modality divisions now allow some kind of peer-review process to meet this standard and ensure image quality, completeness, and adherence to protocols. Over the course of this article series, we'll share lots of recommendations and tips on how to complete all of these measures with quality and ease.
Summary of technical quality measure.
Stay tuned for our next article, which will review the other two new IAC key quality measures: interpretive quality and report completeness.
Judith Buckland is president of CardioServ, a consulting firm focused on inspiring excellence in diagnostic imaging. Judith can be reached by email at [email protected] or via CardioServ's website.
The comments and observations expressed do not necessarily reflect the opinions of AuntMinnie.com.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
