The project was conducted in a radiology department in an academic medical center in a large metropolitan area that functions as the region's main hospital within the urologic specialty. The radiology department experiences the highest volume of uroradiology examinations and procedures with a diverse and competent team of seven experienced specialized uroradiologists, 26 MR-radiographers, 1 MR-radiographer specialized in abdominal protocols, one chief radiographer, and two medical secretaries.

A3 reporting tool: 

The A3 reporting tool was used to create a visual presentation of the stages of the entire improvement process project and to evaluate and solve problems continuously. It is divided into three project phases correlating with Kaizen process improvement [3,4]. The three project phases are preparation, event, and sustain (Figure 1) [3]. The A3 report provides an overview and breaks down the macro-level process into manageable subprocesses. 

Value stream map: 

A value stream map (VSM) was used to show all activities related to our urologic MRI protocols from the beginning of the service to the end. It was used to identify opportunities, waste, and non-value-added activities and prepare for a future-state VSM [3]. The VSM times were calculated from a cohort of patients scanned between December 1, 2020, and November 30, 2022, before introducing the new protocols on December 1, 2022.

Based on VSM (Figure 2), we identified two opportunities to apply the Kaizen process to our workflow. 

• Opportunity 1:  Referral and protocoling

The idea was to optimize and produce a focused referral and protocoling workflow. Instead of the formerly used broad-spectrum standard “one-size-fits-all" MRI urography, we developed four urologic MRI protocols for key indications for more tailored and more careful sequence selection based on the clinician's needs for the most common Uro-MR indications based on the institution's experience. 

We identified the four most common indications and developed an appropriate protocol for each one, although each protocol can also answer less common indications (Table 1). 

• Opportunity 2: Total study/scanning time 

By optimizing the protocol workflow and image selection tailored to the clinical question, as mentioned previously, we could effectively reduce acquisition times while retaining diagnostic performance (Figure 3). In this way, the most appropriate sequences were selected according to the clinical question we need to answer. 

The following data was registered from December 1, 2022 to August 31, 2023: Time and date for referral, protocolling, scanning information, and time and date for starting and finishing the radiology report. Scanning information included prepping time and scanning time, where the summation of both was determined as the total study time. Prepping time was defined as the time/moment the radiographer started the patient in the system, meaning taking them in and preparing them for the scan, giving IV contrast, etc. Scanning time is the exact time when the patient is in the scanner from the beginning to the end of the scan. 

Finally, run charts of the median data scanning information/times were graphed for both the retrospective and prospective study groups.