Improving the Completeness of CMR Reporting in rTOF Patients

Friday, February 6, 2026

4:06 PM - 4:13 PM

Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

Presenting Author(s)

Sara Mohamed, DO, MSc

Resident Physician
Cleveland Clinic Children's
Cleveland, Ohio, United States

Primary Author(s)

Sara Mohamed, DO, MSc

Resident Physician
Cleveland Clinic Children's
Cleveland, Ohio, United States

Co-Author(s)

AT

Animesh Tandon, MD, MSc

Assistant professor
The University of Texas Southwestern Medical Center, United States

Co-Author(s)

IA

Izzet T. Akbasli, MD

Research Fellow
Cleveland Clinic Children's, United States
WL

Wilson Liou, BA

Medical Student
Case Western Reserve University, United States
MA

Mark Abboud, BA

Medical Student
Case Western Reserve University, United States
RK

Rukmini Komarlu, MD

Pediatric Cardiologist
Cleveland Clinic Children's
Cleveland, Ohio, United States
Nadine Choueiter, MD

Director of pediatric cardiac non invasive imaging
Montefiore Medical Center
Bronx, New York, United States

Background: Cardiac MRI (CMR) is commonly used in patients with repaired tetralogy of Fallot (rTOF) to characterize anatomic, volumetric/functional, flow, and tissue characterization data. The Society for Cardiovascular Magnetic Resonance and American College of Cardiology QNet (quality network) have both generated quality metrics for comprehensive rTOF CMR data elements that cover these domains. We aimed to analyze our baseline compliance with these quality metrics as part of an ongoing quality improvement project.

Methods: In this quality improvement project, we aimed to explore the completeness of the CMR reports at our institution. During the first PDSA cycle, we created our own comprehensive guidelines from a combination of the ACC QNet metrics and guidelines from SCMR, yielding a total of 65 data elements (Table 1). We then collected baseline data from rTOF patient CMRs performed during 2023 and 2024 at Cleveland Clinic through manual chart review of CMR report text.

Results: We noted several deficiencies in the completeness of our rTOF CMR reports. Only 18% included a qualitative assessment of right ventricular hypertrophy. 68% of reports included information about RVOT morphology and 36% included details about RVOT regional function (Figure 1). Only 6% of reports included patients' heart rate. Overall the average report contained 44/65 data elements (IQR 42-47).

Conclusion: Our data thus far demonstrates a clear need for improved compliance with rTOF CMR quality metrics. As the second step of our PDSA cycle, we distributed our guidelines among the pediatric cardiologists on the CMR team and encouraged adherence to this structured reporting. We will examine CMRs over the next 3 months to measure improvement in reporting. Finally, our long-term goal is to implement a structured reporting system that will enhance report completeness, with the added benefit of making reporting faster and more seamless for the physicians authoring the reports.

Comprehensive Data Elements

Contrast
Use of IV contrast agent	Name of IV contrast agent	Dose of IV contrast agent
Patient Cooperation
Requirement for sedation or anesthesia	Use of suspended ventilation if anesthesia was used	Do we say if the patient had trouble with breath holds?	Did we describe the study quality somewhere?
If the study was low quality, did we say why?	Did we say what structures were poorly shown?
Demographics
Age	Sex	Height	Weight
Body Surface Area (BSA)	Heart Rate
Venous Anatomy
Systemic venous anatomy	Pulmonary venous anatomy
Septum Assessment
Evaluation to exclude residual ventricular septal defect (VSD)	Evaluation to exclude atrial septal defect (ASD)
Cardiac Chambers
RV EDV (absolute)	RV EDVi (indexed)	RV ESV	RV ESVi
RV EF	RV hypertrophy qualitative assessment	RV hypertrophy quantitative assessment	LV EDV (absolute)
LV EDVi (indexed)	LV ESV	LV ESVi	LV EF
Evaluation to exclude wall motion abnormalities	Qp:Qs
Aorta and Coronary Arteries
Aortic valve regurgitation fraction	Aortic root dimensions	Ascending aorta dimensions	Aortic arch sidedness
Aortic arch branching order	Prescence of aortopulmonary collaterals in TET pulmonary atresia with MAPCAs	Left main coronary origin and proximal course	Left main bifurcation to LAD and LCx
Right main coronary origin and proximal course
RVOT and Pulmonary Arteries
RV outflow tract morphology	RV outflow tract regional function	Pulmonary regurgitation fraction	Main pulmonary artery dimension
LPA dimension	RPA dimension	Differential pulmonary blood flow attempted if branch pulmonary stenosis is present	LPA stenosis
RPA stenosis
AV Valves
Degree of tricuspid regurgitation – qualitative assessment	Degree of tricuspid regurgitation – quantitative assessment	Degree of mitral regurgitation – qualitative assessment	Degree of mitral regurgitation – quantitative assessment
Vascular Dimensions
Does the report mention the sequence on which vessel dimensions are measured on?
Comparison with previous relevant studies
Dates of previous relevant studies	Types (e.g. CT, echocardiography, catheterization, nuclear medicine) of previous relevant studies	How key results of current exam compare with prior studies	“It should be stated if parameters from the prior study were manually measured.”
Late gadolinium enhancement
Presence of LGE in the LV	Segmental descriptive distribution of LGE in the LV	Presence of LGE in the RV	Segmental descriptive distribution of LGE in the RV

Comprehensive Data Elements

Contrast
Use of IV contrast agent	Type of IV contrast	Name of IV contrast agent	Dose of IV contrast agent
Patient Cooperation
Requirement for sedation or anesthesia	Use of suspended ventilation if anesthesia was used	Do we say if the patient had trouble with breath holds?	Did we describe the study quality somewhere?
If the study was low quality, did we say why?	Did we say what structures were poorly shown?
Demographics
Age	Sex	Height	Weight
Body Surface Area (BSA)	Heart Rate
Venous Anatomy
Systemic venous anatomy	Pulmonary venous anatomy
Septum Assessment
Evaluation to exclude residual ventricular septal defect (VSD)	Evaluation to exclude atrial septal defect (ASD)
Cardiac Chambers
RV EDV (absolute)	RV EDVi (indexed)	RV ESV	RV ESVi
RV EF	RV hypertrophy qualitative assessment	RV hypertrophy quantitative assessment	LV EDV (absolute)
LV EDVi (indexed)	LV ESV	LV ESVi	LV EF
Evaluation to exclude wall motion abnormalities	Qp:Qs
Aorta and Coronary Arteries
Aortic valve regurgitation fraction	Aortic root dimensions	Ascending aorta dimensions	Aortic arch sidedness
Aortic arch branching order	Prescence of aortopulmonary collaterals in TET pulmonary atresia with MAPCAs	Left main coronary origin and proximal course	Left main bifurcation to LAD and LCx
Right main coronary origin and proximal course
RVOT and Pulmonary Arteries
RV outflow tract morphology	RV outflow tract regional function	Pulmonary regurgitation fraction	Main pulmonary artery dimension
LPA dimension	RPA dimension	Differential pulmonary blood flow attempted if branch pulmonary stenosis is present	LPA stenosis
RPA stenosis
AV Valves
Degree of tricuspid regurgitation – qualitative assessment	Degree of tricuspid regurgitation – quantitative assessment	Degree of mitral regurgitation – qualitative assessment	Degree of mitral regurgitation – quantitative assessment
Vascular Dimensions
Does the report mention the sequence on which vessel dimensions are measured on?
Comparison with previous relevant studies
Dates of previous relevant studies	Types (e.g. CT, echocardiography, catheterization, nuclear medicine) of previous relevant studies	How key results of current exam compare with prior studies	“It should be stated if parameters from the prior study were manually measured.”
Late gadolinium enhancement
Presence of LGE in the LV	Segmental descriptive distribution of LGE in the LV	Presence of LGE in the RV	Segmental descriptive distribution of LGE in the RV

Most and Least Reported Data Elements