A Systematic Review of Quality Improvement Initiatives Led by Radiology Nurses in Diagnostic Imaging Services
Abstract
Background: The diagnostic imaging department is a high-risk, complex setting with patient safety, operational efficiency, and patient experience as the priorities. Within this setting, the radiology nurse's role has transformed significantly from procedural to core coordination and leadership of quality improvement (QI).
Aim: This synopsis synthesizes literature between the years 2015 and 2025 to examine the extent, impact, and characteristics of QI activities driven or sponsored by radiology nurses.
Methods: A Systematic review of peer-reviewed articles was conducted. Top scholarly databases were used to conduct literature searches, and studies were included if they described nursing-led QI projects within diagnostic imaging and quantified outcomes.
Results: The findings demonstrate how evidence-based care by radiology nurses is important in closing four areas of high value: patient safety (i.e., reducing contrast reactions and falls), patient experience, operational effectiveness, and safety culture. These evidence-based approaches yield significant reductions in adverse events, higher levels of patient satisfaction, increased throughput, and cost savings. Standardized checklists, anticipatory risk analysis, and robust patient education are among common success factors, but pitfalls like role ambiguity and limited resources remain.
Conclusion: Radiology nurses are strong leaders of QI in imaging and not just implementers. Providing them with formal leadership training and clear role delineation is necessary for the establishment of service quality and safety. Further research should also quantify the return on investment of nursing-led QI and its role in emerging technologies like artificial intelligence.
Full text article
References
Aakre, K. T., Valley, T. B., & O'Connor, M. K. (2010). Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative. Radiographics, 30(2), 309-315. https://doi.org/10.1148/rg.302095735
Abraham, P., Hsieh, L. J., Buckner, E., Flores, E. J., Davis, M. A., Tamayo-Murillo, D., & Newton, I. G. (2023). Change management strategies toward dismantling race-based structural barriers in radiology. Academic Radiology, 30(4), 658-665. https://doi.org/10.1016/j.acra.2023.01.035
Acauan, L. V., Seda, J. M., Paes, G. O., & Stipp, M. A. C. (2021). Quality management in imaging diagnosis and the nursing team: a case study. Revista brasileira de enfermagem, 74(suppl 5), e20200912. https://doi.org/10.1590/0034-7167-2020-0912
Alexander, C., Tschannen, D., Argetsinger, D., Hakim, H., & Milner, K. A. (2022). A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders. Journal of Nursing Management, 30(3), 694-701. https://doi.org/10.1111/jonm.13537
Alhajeri, M., Aldosari, H., & Aldosari, B. (2017). Evaluating latest developments in PACS and their impact on radiology practices: A systematic literature review. Informatics in Medicine Unlocked, 9, 181-190. https://doi.org/10.1016/j.imu.2017.08.005
Alharbi, Majed Mohmmad, Almohammadi, E. A., Alharbi, Maher Sliman, Mobaraki, A. I., & Mojammi, S. M. A. (2024). Technological advancements in X-Ray: From digital to AI-based interpretation. Saudi Journal of Medicine and Public Health, *1*(1), 106–113. https://doi.org/10.64483/jmph-51
Almutairi, N. A. M. (2025). Dark Blood MRI Sequences in Myocardial Tissue Characterization: A Comprehensive Review. Saudi Journal of Medicine and Public Health, *2*(2), 62–68. https://doi.org/10.64483/jmph-33
Alruqi, A. F. F. (2025). Nursing Management and Clinical Outcomes of Aspiration Pneumonia in Intensive Care Units: A Critical Review of Evidence-Based Interventions and Risk Reduction Strategies. Saudi Journal of Medicine and Public Health, *2*(2), 114–123. https://doi.org/10.64483/jmph-63
Burford, B., Grieg, P., Kelleher, M., Merriman, C., Platt, A., Richards, E., ... & Vance, G. (2023). Interprofessional simulation as an enhancement of psychological fidelity: A focus group study of medical and nursing students. Health Science Reports, 6(5), e1237. https://doi.org/10.1002/hsr2.1237
Chau, M. (2024). Enhancing safety culture in radiology: Key practices and recommendations for sustainable excellence. Radiography, 30, 9-16. https://doi.org/10.1016/j.radi.2024.04.025
Dahiya, A., Joshi, P., Tiwari, S. K., Garg, R., Rastogi, S., & Sharma, K. K. (2025). Effectiveness of Nurse‐Led Psychoeducation on Knowledge and Psychological Distress in Cancer Patients Undergoing Radiological Imaging: A Randomized Controlled Trial. Psycho‐Oncology, 34(5), e70164. https://doi.org/10.1002/pon.70164
Ding, S., Meystre, N. R., Campeanu, C., & Gullo, G. (2018). Contrast media extravasations in patients undergoing computerized tomography scanning: a systematic review and meta-analysis of risk factors and interventions. JBI Evidence Synthesis, 16(1), 87-116. DOI: 10.11124/JBISRIR-2017-003348
Evans, J. (2025). Empowering Future Leaders in Radiology Nursing: Strategies for Success. Journal of Radiology Nursing. 44(1), 48-51. https://doi.org/10.1016/j.jradnu.2024.12.002
Flug, J. A., Ponce, L. M., Osborn, H. H., & Jokerst, C. E. (2018). Never events in radiology and strategies to reduce preventable serious adverse events. Radiographics, 38(6), 1823-1832. https://doi.org/10.1148/rg.2018180036
Ghamdi, A. L., & Saleh, S. (2022). A Comprehensive Analysis of Nursing Care Management in Radiology Departments: Challenges and Innovations. International Journal, 10(6). https://doi.org/10.30534/ijbmieh/2022/251062022
Gill, A. M., & Shanta, L. L. (2020). Application of transition theory for orientation of experienced nurses to radiology and imaging nursing. Journal of Radiology Nursing, 39(2), 106-113. https://doi.org/10.1016/j.jradnu.2019.10.005
Haigh, L. (2024). The Use of Nurse-Patient Pre-Procedure Phone Calls to Reduce Delays and Cancellation Rates in Ultrasound Biopsy Patients: A Quality Improvement Project (Doctoral dissertation, Jacksonville University).
Han, N., Jeong, S. H., Lee, M. H., & Kim, H. S. (2024). Impacts of Just Culture on Perioperative Nurses' Attitudes and Behaviors With Regard to Patient Safety Incident Reporting: Cross-Sectional Nationwide Survey. Asian Nursing Research, 18(4), 323-330. https://doi.org/10.1016/j.anr.2024.09.001
Johnson, P. T., & Anzai, Y. (2021). Radiology at the helm of value-based care transformation: from stewardship to leadership. Journal of the American College of Radiology, 18(9), 1226-1228. https://doi.org/10.1016/j.jacr.2021.07.018
Kelly, A. M., & Cronin, P. (2015). Practical approaches to quality improvement for radiologists. Radiographics, 35(6), 1630-1642. https://doi.org/10.1148/rg.2015150057
Khalid, M. A., Amjad, M. M., Fahad, M. S., Tariq, K. A., Aldughmani, F. A., Alshammry, R. A. A., & Razan, A. S. (2024). The Integration of Technology in Emergency Radiology: Challenges for Nursing. Journal of International Crisis and Risk Communication Research, 7(S6), 1750. DOI:10.63278/jicrcr.vi.2338
Lambert, P., Chaisson, K., Horton, S., Petrin, C., Marshall, E., Bowden, S., ... & Brown, J. (2017). Reducing acute kidney injury due to contrast material: how nurses can improve patient safety. Critical care nurse, 37(1), 13-26. https://doi.org/10.4037/ccn2017178
LaValley, C. B. (2022). Reducing central line-associated bloodstream infections at a rural midwestern hospital through an evidence-based nurse-led practice change intervention. Doctor of Nursing Practice Scholarly Projects. 29. https://commons.nmu.edu/dnp/29
Long, Z., Li, J., Liao, H., Deng, L., Du, Y., Fan, J., ... & Jing, B. (2022). A multi-modal and multi-atlas integrated framework for identification of mild cognitive impairment. Brain Sciences, 12(6), 751. https://doi.org/10.3390/brainsci12060751
Mastro, K. A. (2017). The Effects of a Patient-and Family-Centered Nonsedation/General Anesthesia Preparation Intervention for Pediatric Magnetic Resonance Imaging on Magnetic Resonance Image Quality, Healthcare Costs, and Operational Efficiency. University of Colorado Denver, Anschutz Medical Campus.
Morse, V., & Warshawsky, N. E. (2021). Nurse leader competencies: Today and tomorrow. Nursing administration quarterly, 45(1), 65-70. DOI: 10.1097/NAQ.0000000000000453
Nasr, I. M., Al Ruweili, H. M. F., & alotaibi, H. moutlq M. (2025). The Significance of Routine Abdominal Ultrasound Before Bariatric Surgery. Saudi Journal of Medicine and Public Health, *2*(2), 147–158. https://doi.org/10.64483/jmph-68
Nunnally, J., Ko, S. M., Ugale, K., Lowe, T., Bond, J., Kenny, J. E. S., ... & Haycock, K. (2024). A nursing-led sepsis response team guiding resuscitation with point-of-care ultrasound: A review and model for improving bundle compliance while individualizing sepsis care. SAGE Open Medicine, 12, 20503121241290378. https://doi.org/10.1177/20503121241290378
Pavone, K. (2019). Evaluating The Effects Of A Nurse-Led Intervention For Delirium And Pain Management Among Older Adults In The Surgical Intensive Care Unit (Doctoral dissertation, University of Pennsylvania).
Polonsky, M. S. (2019). High-reliability organizations: the next frontier in healthcare quality and safety. Journal of Healthcare Management, 64(4), 213-221. DOI: 10.1097/JHM-D-19-00098
Rachh, P., Pendley, A. M., Duong, P. A. T., Hanna, T. N., & Heilbrun, M. E. (2021). Decreasing CT acquisition time in the emergency department through lean management principles. Radiographics, 41(3), E81-E89. https://doi.org/10.1148/rg.2021200107
Sadigh, G., Applegate, K. E., & Saindane, A. M. (2017). Prevalence of unanticipated events associated with MRI examinations: a benchmark for MRI quality, safety, and patient experience. Journal of the American College of Radiology, 14(6), 765-772. https://doi.org/10.1016/j.jacr.2017.01.043
Saga, E., Skovdahl, K., Lindholm, E., Sørum Falk, R., & Bing-Jonsson, P. C. (2023). Development of a Workplace‐Based Training Program for Nurse‐Led Ultrasound‐Guided Femoral Nerve Blocks: A Feasibility Study with the Patients’ Perspective in Focus. In Nursing Forum (Vol. 2023, No. 1, p. 8810083). Hindawi. https://doi.org/10.1155/2023/8810083
Shah, R. M., Dehadrai, A., Keshwani, A., Schmitz, B., & Carr, J. C. (2025). Closing the loop: nine-year outcomes of an electronic medical record-based protocol for reporting incidental imaging findings. Journal of the American College of Radiology. https://doi.org/10.1016/j.jacr.2025.08.047
Singer, C., Boldor, N., Vaknin, S., Olmer, L., Wilf-Miron, R., & Myers, V. (2025). Scheduling an appointment for MRI: patient perception of wait time and difficulty. Israel Journal of Health Policy Research, 14(1), 14. https://doi.org/10.1186/s13584-025-00677-5
Sison, M., & Rodelas, M. D. (2024). Management skills, emotional competence and leadership skills of chief radiologic technologists. Journal of Medical Imaging and Radiation Sciences, 55(3), 101601. https://doi.org/10.1016/j.jmir.2024.101601
Wallace, S., & Wallace, C. (2022). Nurses as leaders and managers for safe, high-quality patient care. PK Vana, BA Vottero, & G. Altmiller (3rd Eds.), Quality and Safety Education for Nurses, 41-78.
Werthman, J. A., Maxwell, C. A., Dietrich, M. S., Jordan, L. M., & Minnick, A. F. (2021). Moderate sedation education for nurses in interventional radiology to promote patient safety: results of a national survey. Journal of Radiology Nursing, 40(1), 49-55. https://doi.org/10.1016/j.jradnu.2020.10.007
Whitebird, R. R., Solberg, L. I., Bergdall, A. R., Lopez-Solano, N., & Smith-Bindman, R. (2021). Barriers to CT dose optimization: the challenge of organizational change. Academic radiology, 28(3), 387-392. https://doi.org/10.1016/j.acra.2020.02.016
Yusop, N., Mat, S., Mustafar, R., & Ismail, M. I. (2025). Fuzzy logic nursing tool for early acute kidney injury detection in surgical patients. Frontiers in Nephrology, 5, 1624880. https://doi.org/10.3389/fneph.2025.1624880
Authors
Copyright (c) 2025 Muthiba Khalifa Almutairi, Abdullatif Yousef Ahmed Almuqahwi, Amaal Issa Dahlan, Rabab Gida Alamri, Hind Yousef Ahmad Albutyan, Latifah Aiyedh Almutairi, Duaa Saleh Saad Alhamood, Khaled Mohammed Alsahli, Aisha Alsheta, Hamzah Mohammed Ahmed Buayti
This work is licensed under a Creative Commons Attribution 4.0 International License.