Showing papers in "Journal of The American College of Radiology in 2004"
TL;DR: As an example of how the current "war on terrorism" could generate a durable civic renewal, Putnam points to the burst in civic practices that occurred during and after World War II, which he says "permanently marked" the generation that lived through it and had a "terrific effect on American public life over the last half-century."
Abstract: The present historical moment may seem a particularly inopportune time to review Bowling Alone, Robert Putnam's latest exploration of civic decline in America. After all, the outpouring of volunteerism, solidarity, patriotism, and self-sacrifice displayed by Americans in the wake of the September 11 terrorist attacks appears to fly in the face of Putnam's central argument: that \"social capital\" -defined as \"social networks and the norms of reciprocity and trustworthiness that arise from them\" (p. 19)'has declined to dangerously low levels in America over the last three decades. However, Putnam is not fazed in the least by the recent effusion of solidarity. Quite the contrary, he sees in it the potential to \"reverse what has been a 30to 40-year steady decline in most measures of connectedness or community.\"' As an example of how the current \"war on terrorism\" could generate a durable civic renewal, Putnam points to the burst in civic practices that occurred during and after World War II, which he says \"permanently marked\" the generation that lived through it and had a \"terrific effect on American public life over the last half-century.\" 3 If Americans can follow this example and channel their current civic
5,309 citations
TL;DR: RADPEER is now operational and is a good solution to the need for a peer review system with the desirable characteristics listed above.
Abstract: Purpose To develop and test a radiology peer review system that adds minimally to workload, is confidential, uniform across practices, and provides useful information to meet the mandate for "evaluation of performance in practice" that is forthcoming from the American Board of Medical Specialties as one of the four elements of maintenance of certification. Method RADPEER has radiologists who review previous images as part of a new interpretation record their ratings of the previous interpretations on a 4-point scale. Reviewing radiologists' ratings of 3 and 4 (disagreements in nondifficult cases) are reviewed by a peer review committee in each practice to judge whether they are misinterpretations by the original radiologists. Final ratings are sent for central data entry and analysis. A pilot test of RADPEER was conducted in 2002. Results Fourteen facilities participated in the pilot test, submitting a total of 20,286 cases. Disagreements in difficult cases (ratings of 2) averaged 2.9% of all cases. Committee-validated misinterpretations in nondifficult cases averaged 0.8% of all cases. There were considerable differences by modality. There were substantial differences across facilities; few of these differences were explicable by mix of modalities, facility size or type, or being early or late in the pilot test. Of 31 radiologists who interpreted over 200 cases, 2 had misinterpretation rates significantly ( P Conclusions A substantial number of facilities participated in the pilot test, and all maintained their participation throughout the year. Data generated are useful for the peer review of individual radiologists and for showing differences by modality. RADPEER is now operational and is a good solution to the need for a peer review system with the desirable characteristics listed above.
188 citations
TL;DR: The authors estimate that the cost to the American health care system of unnecessary imaging resulting from self-referral by nonradiologists is $16 billion per year.
Abstract: A recent report by the Medicare Payment Advisory Commission to Congress indicated that the utilization of diagnostic imaging is growing more rapidly than that of any other type of physician service. This has engendered concern among those who pay for health care. In this article, the authors review the role of self-referral in driving up imaging utilization. A number of studies of the self-referral factor in imaging have been conducted over the past three decades. These have consistently shown that when nonradiologist physicians operate their own imaging equipment and have the opportunity to self-refer, their utilization is substantially higher than among other physicians who refer their patients to radiologists. It has also been shown that the vast bulk of the recent increases in imaging utilization are attributable to nonradiologists who self-refer. The authors estimate that the cost to the American health care system of unnecessary imaging resulting from self-referral by nonradiologists is $16 billion per year.
118 citations
TL;DR: It is with an understanding of these issues that radiologists and other radiology personnel can participate in an informed discussion with referring physicians and patients and continue to optimize the practice of CT.
Abstract: We are currently seeing increasing opportunities to improve patient care with computed tomography (CT). At the same time, we are challenged to use this technology wisely. In particular, we are being asked to balance the benefits against the risks, chiefly those of ionizing radiation. To do this, we must have a foundation from which to determine the relative risks. This foundation necessarily must be composed of several components. First, it is important to understand the patterns of use and increasing application of CT, particularly multidetector CT. In addition, it is helpful to be familiar with measures of radiation pertinent to CT and the doses provided by this modality. This foundation then provides a context in which to discuss the issue of low-dose radiation and cancer risk as well as potential changes in CT practice guidelines and regulation. It is with an understanding of these issues that radiologists and other radiology personnel can participate in an informed discussion with referring physicians and patients and continue to optimize the practice of CT.
106 citations
TL;DR: Disagreement rates varied by modality and by radiologist, and it was found that controlling for other factors, both differences among radiologists and across modalities, statistically significantly contributed to differences in disagreement rates.
Abstract: Purpose To calculate disagreement rates by radiologist and modality to develop a benchmark for use in the quality assessment of imaging interpretation. Methods Data were obtained from double readings of 2% of daily cases performed for quality assurance (QA) between 1997 and 2001 by radiologists at a group practice in Dallas, Texas. Differences across radiologists in disagreement rates, with adjustments for case mix, were examined for statistical significance using simple comparisons of means and multivariate logistic regression. Results In 6703 cases read by 26 radiologists, the authors found an overall disagreement rate of 3.48%, with a disagreement rate of 3.03% for general radiology, 3.61% for diagnostic mammography, 5.79% for screening mammography, and 4.07% for ultrasound. Disagreement rates by radiologist for the 10 radiologists with at least 20 cases ranged from 2.04% to 6.90%. Multivariate analysis found that controlling for other factors, both differences among radiologists and across modalities, statistically significantly contributed to differences in disagreement rates. Conclusion Disagreement rates varied by modality and by radiologist. Double reading studies such as these are a useful tool to rate quality of imaging interpretation and to establish benchmarks for QA.
81 citations
TL;DR: For high-quality radiology reporting, accuracy is most important and Clarity, completeness and timeliness are also very important.
Abstract: Purpose Our long-term goal is to improve the quality of reports in radiology imaging interpretation. The rationale for this project focused on identifying the characteristics of a high-quality report from the perspective of referring physicians and radiologists. Methods We undertook a survey of physician faculty at a large Midwestern academic medical center (including university, children's, veteran's, county and private practice hospitals) regarding radiology report quality concepts. Results Using a 5-point Likert scale, >95% of respondents indicated the highest importance rating (score=5) for radiology report characteristic "Accurate," with mean score of 4.94. Seventy-eight to 83% of respondents considered "Clear," "Complete" and "Timely" to have the highest importance rating, with means of these scores between 4.73 and 4.79. Somewhat less desirable characteristics included "Well-organized" and "Mentions pertinent negatives"—though radiologists tended to think the latter was less important than did all other categories of physician respondents. The single greatest problem area in reporting is lack of timeliness. Using a 10-point Likert scale, respondents gave a median score of seven for overall satisfaction with current reporting. Conclusions For high-quality radiology reporting, accuracy is most important. Clarity, completeness and timeliness are also very important. Radiologists tend to consider mentioning pertinent negatives as less important than do referring physicians; otherwise, respondents from different specialties largely agreed on which characteristics are most important for high-quality reports. There is room for improvement in physician satisfaction with radiology reporting.
72 citations
TL;DR: It is suggested that further research is needed to elucidate why women do not seem to be choosing diagnostic radiology as frequently as one might predict based on the lifestyle of diagnostic radiologists and the numbers of women currently entering medical school.
Abstract: While the number of women entering medical schools is approaching 50% nationally, women continue to be underrepresented in a number of specialties including diagnostic radiology While diagnostic radiology has many characteristics that might be desirable to women, such as reasonable call hours, flexible scheduling, and high salaries, women still do not choose diagnostic radiology as a career This article examines the literature to discern possible reasons for why women are entering diagnostic radiology at a lower rate We address trends among women in academic medicine, which resemble trends among women in diagnostic radiology, and examine the effects of gender and socialization in medical school on specialty choices among women The current literature suggests a constellation of factors may be responsible for the gender differences in diagnostic radiology We suggest that further research is needed to elucidate why women do not seem to be choosing diagnostic radiology as frequently as one might predict based on the lifestyle of diagnostic radiologists and the numbers of women currently entering medical school Once these reasons are made clear, it will be possible for residency program directors and medical schools to ensure that women are making informed specialty choices, whatever those choices may be
68 citations
TL;DR: The value of molecular imaging is illustrated by some examples for diseases such as cancer, neurological and psychiatric disorders, cardiovascular disease, infection and inflammation, and the monitoring of gene therapy and stem cell therapy.
Abstract: This review summarizes the rapidly growing field of molecular imaging, the spatially localized and/or temporally resolved sensing of molecular and cellular processes in vivo. Molecular imaging is used to map the anatomic locations of specific molecules of interest within living tissue and has enormous potential as a powerful means to diagnose and monitor disease. Molecular imaging agents comprise a targeting component that confers localization and a component that enables external detectability with an imaging modality, such as PET, SPECT, MRI, optical, and ultrasound. The advantages and disadvantages of each of these modalities are discussed in regard to spatial resolution, temporal resolution, sensitivity, and cost. Molecular imaging agents can be divided into three categories, Type A, which bind directly to a target molecule, Type B, which are accumulated by molecular or cellular activity by the target, and Type C, which are undetectable when injected but can be imaged after they are activated by the target. The current status of clinical molecular imaging agents is presented as well as examples of some preclinical applications. The value of molecular imaging is illustrated by some examples for diseases such as cancer, neurological and psychiatric disorders, cardiovascular disease, infection and inflammation, and the monitoring of gene therapy and stem cell therapy.
62 citations
TL;DR: The importance of empirical data pertaining to quality and variability in radiology, the underlying causes of error, and the sources of variability are discussed and key measures and approaches used in improvement efforts are reviewed.
Abstract: Achieving and delivering optimal quality of care in radiology requires continual self-examination by the profession, particularly with regard to technical, interpretive, and communication skills. The importance of empirical data pertaining to quality and variability in radiology, the underlying causes of error, and the sources of variability are discussed. Key measures (e.g., receiver operating characteristics, kappa) and approaches (professional audits and peer reviews, surveys, inspections, and risk management programs) used in improvement efforts are reviewed, and data from key studies are highlighted. Diagnostic errors are important because of their connection to outcomes and the wide variability observed with modalities such as chest radiography and mammography.
51 citations
TL;DR: The overutilization of noninvasive diagnostic imaging (NDI) is a complex problem with many other aspects aside from self-referral, and the extent of self- referral by radiologists (called "autoreferral" by some) is discussed.
Abstract: The overutilization of noninvasive diagnostic imaging (NDI) is a complex problem with many other aspects aside from self-referral. This article discusses (1) other causes of overutilization, (2) the rationales used by nonradiologist physicians to justify self-referring their patients for NDI, (3) the extent of self-referral by radiologists (called "autoreferral" by some), and (4) steps that could be taken to curb the overutilization of NDI in the United States. It is important for radiologists to be familiar with these issues and to support efforts to control overutilization.
48 citations
TL;DR: The ACR annually engages in a long-range planning activity called the FORUM on a specific issue deemed important to the specialty of radiology over a horizon of 5 to 10 years.
Abstract: The ACR annually engages in a long-range planning activity called the FORUM on a specific issue deemed important to the specialty of radiology over a horizon of 5 to 10 years. The FORUM brings together experts from multiple disciplines to discuss the topic, develop scenarios, and make recommendations to the ACR and the specialty on what courses to take to improve the development of radiology. The Third Annual FORUM, held May 21 to 23, 2003, was on the subject of improving quality and safety. The sessions ended with numerous recommendations as to how the specialty of radiology could promote safer, higher quality imaging that would also engage the interest and participation of the public, employers, insurers, and government. These fell into the following categories: (1) how to measure the performance of radiologists, (2) how to use measurements of performance to improve quality and safety, (3) means of working with employers and insurers to improve care and reduce waste, (4) the development of new ACR programs intended to foster change, and (5) disseminating information about ACR efforts on behalf of improving quality and safety.
TL;DR: When interventionalists code their own procedures, CPT errors are common, but the associated RVU impact is small, and given the consequences of incorrect coding, physician-assigned CPT codes warrant review by experienced coders before claims submission.
Abstract: Purpose To evaluate the accuracy of Current Procedural Terminology (CPT) coding for interventional radiology procedures and the associated professional economic impact when coding is performed by operating physicians. Methods Procedure reports and physician charge sheets were obtained for 549 interventional radiology encounters performed by 62 physicians at 23 hospitals and analyzed for appropriate CPT code use. Physician-selected CPT codes were reviewed by experts, who determined correct coding by consensus. Physician coding errors and professional relative value unit (RVU) impact were analyzed. Expert discordance and associated RVU impact were similarly evaluated. Results Physicians correctly coded only 242 of 549 IR cases (44%). The overall professional RVU impact of their errors was +4.2% (overcoding). Physician coding was correct least frequently for complex arterial interventions (15 of 53, 28%) and dialysis access interventions (16 of 54, 30%) and correct most frequently for less code-intensive drainage (19 of 31, 61%) and biopsy procedures (35 of 47, 74%). Experts were initially concordant in 497 of 549 cases (91%), with only a minimal tendency (+0.3% RVU) toward overcoding. Expert coding differences were explained by simple code oversights (28 of 52, 54%), coding guideline ambiguity (15 of 52, 29%), and physician documentation ambiguity (9 of 52, 17%). Conclusion When interventionalists code their own procedures, CPT errors are common, but the associated RVU impact is small. Given the consequences of incorrect coding, physician-assigned CPT codes warrant review by experienced coders before claims submission. Although radiology practices should strive for perfect coding, expert discordance suggests that this goal is unattainable but less elusive than for nonradiology services.
TL;DR: The present paper reflects the current approach to performance measurement in health care services based on the available literature, which may be applied to the field of radiology.
Abstract: The objective of this paper is to provide an overview of how to develop and implement a performance measurement system in radiology departments. Although an extensive literature review (PubMed, MEDLINE, etc) was carried out to search for relevant published scientific papers, the number of publications regarding performance indicators in radiology departments was very limited. The present paper reflects the current approach to performance measurement in health care services based on the available literature, which may be applied to the field of radiology. Performance indicators are tools that evaluate an organizations progress toward its goals [1]. In radiology, in addition to finance, other aspects that affect the functioning of the organization, such as clinical productivity and patient satisfaction, also need to be assessed. The main categories of indicators adopted in radiology departments include: (1) productivity, (2) finance, (3) patient safety, (4) access, and (5) customer satisfaction. Once specific indicators in each of these categories are selected, the data collection methods should be incorporated into the routine departmental processes. Information obtained should be made available to all stakeholders via various media. In conclusion, performance indicators establish a common denominator in order to make comaparisons of the organization's performance over time. To improve the quality of services, these indicators should be benchmarked, i.e., the processes should be compared to the best in the field.
TL;DR: It is critical to participate actively in organizations and processes to continue development of the MOC initiative, because it is beneficial to patients, applicable to practicing physicians, and credible to public interests.
Abstract: Lifelong learning is critical to radiology and the method by which, as professionals, we have kept up to date on new knowledge and developments. The American Board of Medical Specialists and the American Board of Radiology, along with other professional societies such as the Council of Medical Specialty Societies and the ACR, identified a need and an opportunity to serve the public and our profession through the Maintenance of Certification (MOC) initiative. These issues of lifelong learning, public concern, and MOC-and their interrelationship-are discussed. Lifelong learning is defined as a continuation of medical education with an ongoing process of professional development along with self-assessment, which enables physicians to maintain the requisite knowledge, skills, and professional standards. Continuing professional development can be grouped into three categories: formal, nonformal, and informal learning. Examples from the author's career illustrate key points. Future technologies and scientific discoveries affect radiology and make the commitment to lifelong learning even more critical. The challenge will be the maintenance of specialty certification and its components and competencies, along with the attainment of knowledge and the skills necessary in our unique practices for quality patient care in the evolving health care environment. These are important challenges to our boards, professional societies, specialty societies, institutions, and practicing community. It is critical to participate actively in these organizations and processes to continue development of the MOC initiative, because it is beneficial to patients, applicable to practicing physicians, and credible to public interests.
TL;DR: Nonradiologist physicians utilize ultrasound at much higher rates than radiologists, primarily reflecting the influence of echocardiography, which raises the concern that self-referral may be leading to higher utilization and costs.
Abstract: Purpose To ascertain changes in the utilization rates of diagnostic ultrasound among radiologists, cardiologists, and other physicians in recent years. Methods and materials The nationwide Medicare Part B databases for 1993 and 2001 were searched in all ultrasound Current Procedural Terminology 4 codes, except for ophthalmic ultrasound and supervision and interpretation codes. Ultrasound examinations were categorized as general, vascular, breast, obstetric (very low in the Medicare population), and echocardiography. Using the Medicare physician specialty codes, utilization rates per thousand Medicare beneficiaries per year were calculated for radiologists, cardiologists, and other physicians for all codes in the five aforementioned categories. Results Radiologists performed 24% of all ultrasound examinations in 2001. The overall utilization rate of ultrasound examinations among radiologists increased from 132.9 per thousand Medicare beneficiaries in 1993 to 166.3 in 2001, a 25% increase. Among cardiologists, the rate increased from 190.3 in 1993 to 356.1 in 2001, an 87% increase. The vast bulk of these examinations were echocardiograms, but cardiologists also had some involvement in vascular ultrasound. Among other physicians, the rate increased from 116.9 in 1993 to 167.0 in 2001, a 43% increase. The areas of greatest involvement by these other physicians were echocardiography, vascular ultrasound, and general ultrasound. Of the five ultrasound categories, echocardiography had by far the highest volume. Conclusion Nonradiologist physicians utilize ultrasound at much higher rates than radiologists, primarily reflecting the influence of echocardiography. Between 1993 and 2001, the ultrasound utilization rate grew over 3 times as rapidly among cardiologists as among radiologists; the rate among other physicians grew almost twice as rapidly as it did among radiologists. This raises the concern that self-referral may be leading to higher utilization and costs.
TL;DR: The mechanisms that facilitate planning for and implementing an efficient practice organization and governance structure are detailed and the tasks of group leaders are defined, as are the committees necessary for appropriate action.
Abstract: Radiology practices that are well organized and effectively governed have a competitive advantage. Decisions are made rapidly, actions are taken decisively and in accordance with established policy, and each group member has a responsibility for practice building. Such groups are perceived by their peers, hospital administration, and community business leaders to be both formidable and effective. This paper details the mechanisms that facilitate planning for and implementing an efficient practice organization and governance structure. The tasks of group leaders are defined, as are the committees necessary for appropriate action. The integral roles of a mission statement and a business plan are discussed. Practices adopting the suggested organizational structure will be best positioned to survive in both good times and bad.
TL;DR: Women adherent to mammography and cervical cancer screening guidelines were significantly more likely to undergo colorectal cancer screening than those who were not adherent, although coloreCTal cancer acceptance in the adherent group was still suboptimal.
Abstract: Purpose Despite high acceptance levels of mammography and cervical cancer screening by U.S. women, adherence with colorectal cancer screening remains suboptimal. A better understanding of the relationship among cancer screening behaviors by women may provide insight into interventions to enhance colorectal cancer screening. Methods Women 50 years and older who participated in the 2000 Behavioral Risk Factors Surveillance Survey and lived in one of the five states that administered the colorectal cancer module (Colorado, Illinois, Massachusetts, Ohio, and Utah) were queried regarding cancer screening patterns. Predictors of colorectal cancer screening were determined using multivariate analysis from sociodemographic data and non-colorectal cancer screening adherence rates (based on American Cancer Society guidelines). Results Among the 1300 colorectal cancer module respondents, cancer screening adherence was significantly less for colorectal cancer (24.9%) compared with cervical cancer (57.2%) or breast cancer (78.6%). In multivariate analysis, increasing age, health insurance, adherence with cervical cancer screening (adjusted odds ratio [OR] 2.09, p p p Conclusions Women adherent to mammography and cervical cancer screening guidelines were significantly more likely to undergo colorectal cancer screening than those who were not adherent, although colorectal cancer acceptance in the adherent group was still suboptimal. Because psychological barriers to colorectal cancer screening exist, non-colorectal cancer screening visits that women already readily accept potentially represent a setting (or “teachable moment”) for the delivery of education and behavior-related interventions aimed at reducing the burden of colorectal cancer.
TL;DR: The benefits of an OM process in a radiology setting is considered, and available techniques and concepts of OM are addressed, along with gains and benefits that can be derived from these processes.
Abstract: Providing radiology services is a complex and technically demanding enterprise in which the application of operations management (OM) tools can play a substantial role in process management and improvement. This paper considers the benefits of an OM process in a radiology setting. Available techniques and concepts of OM are addressed, along with gains and benefits that can be derived from these processes. A reference framework for the radiology processes is described, distinguishing two phases in the initial assessment of a unit: the diagnostic phase and the redesign phase.
TL;DR: The fundamental structure of reimbursement for radiology and radiation oncology services is described and the multiple steps required as a new procedure advances from a research concept to the assignment of a code in the American Medical Association's Current Procedural Terminology are described.
Abstract: All radiologists and radiation oncologists provide medical services to patients every day with the full anticipation that these services will be appropriately reimbursed. Yet most take this process for granted. Few have even a rudimentary idea how the system works by which a coding mechanism and reimbursement schedule are developed and maintained for the vast array of services they provide. Clearly, this is not good business. You need not stay in the dark any longer! This article describes (1) the fundamental structure of reimbursement for radiology and radiation oncology services; (2) the multiple steps required as a new procedure advances from a research concept to the assignment of a code in the American Medical Association's Current Procedural Terminology; (3) the process by which the new procedure and code are assigned a reimbursement value in the Medicare Fee Schedule, which acts as the base for over 75% of current medical reimbursement; and (4) the maintenance of this system for existing procedures.
TL;DR: The fact that managed care is associated with the slower adoption of MRI and less availability of some of the most advanced MRI equipment suggests the need for attention to the potential for managed care to have important effects on the quality of care and health care spending by influencing technology growth.
Abstract: Background Financial incentives associated with managed care may shift incentives associated with the adoption of new medical technologies. This study examined whether managed-care activity was associated with the adoption rate of magnetic resonance imaging (MRI) equipment during the 1990s. Data and methods Data from three nationwide "censuses" of MRI sites conducted in 1993, 1997, and 1999 were used. The number of MRI sites and magnets; magnet field strength; MRI procedures; the use of contrast media; and the presence of power injectors, echoplanar imaging, cardiac MRI, and interventional MRI were measured in each of 322 metropolitan statistical areas each year. Regression analysis was used to assess the relationship between area MRI availability and overall area health maintenance organization (HMO) market share, controlling for potential confounders. Results Areas with higher HMO activity had markedly lower adoption and use of MRI. By 1999, high-HMO areas had about 40% fewer MRI scanners per 100,000 people than low-HMO areas (1.02 vs. 1.73, P P Conclusions The fact that managed care is associated with the slower adoption of MRI and less availability of some of the most advanced MRI equipment suggests the need for attention to the potential for managed care to have important effects on the quality of care and health care spending by influencing technology growth.
TL;DR: Radiologists need to be aware of the evidence that exists in the medical literature on errors made by nonradiologists in image interpretation and to bring it to the attention of hospital authorities or medical policy-making groups that are charged with improving patient safety.
Abstract: Previous publications have demonstrated that in side-by-side testing, radiologists clearly outperform nonradiologist physicians at interpreting plain radiographs. Other articles, mostly in the nonradiologic literature, have shown that in actual practice settings, nonradiologist physicians make frequent errors in image interpretation. On the other hand, several other studies have concluded that such errors are infrequent and generally do not affect patient outcomes. However, most of the latter studies have had methodologic flaws. Radiologists need to be aware of the evidence that exists in the medical literature on errors made by nonradiologists in image interpretation and to bring it to the attention of hospital authorities or medical policy-making groups that are charged with improving patient safety.
TL;DR: A clear understanding of the differences between teaching and educational scholarship is necessary for the purpose of defining the role of the clinician educator.
Abstract: As a result of dramatic changes in the health care environment, the importance of the teaching mission to the future of radiology is gaining greater recognition. A new breed of “clinician educators” has a presence in most academic radiology departments. A clear understanding of the differences between teaching and educational scholarship is necessary for the purpose of defining the role of the clinician educator. For teaching to be considered scholarship, it must be public, susceptible to critical review, and accessible for exchange and use by other scholars; unless teaching has all three of these characteristics, it cannot be considered scholarship. Medical schools can improve the retention of their best teachers by defining tracks and criteria for rewarding teaching efforts. Universities, medical schools, academic medical centers, and professional organizations are vital components of the infrastructure needed to promote educational scholarship. They provide a community of education scholars who share, collaborate, and exchange work and promote the science of education.
TL;DR: Although fiscal rewards are most common, managers should consider other incentives, such as research time, resources for research, vacation time, and recognition awards, because academic radiologists may be motivated by factors other than financial gains.
Abstract: As radiologists are increasingly faced with the challenges of rising demand for imaging services and staff shortages, the implementation of incentive plans in radiology is gaining importance. A key factor to be considered while developing an incentive plan is the strategic goal of the department. In academic radiology, management should decide whether it will reward research and teaching productivity in addition to clinical productivity. Various models have been suggested for incentive plans based on (1) clinical productivity, (2) multifactor productivity, (3) individual productivity, (4) section productivity, and (5) chair’s discretion. Although fiscal rewards are most common, managers should consider other incentives, such as research time, resources for research, vacation time, and recognition awards, because academic radiologists may be motivated by factors other than financial gains.
TL;DR: The rationale for the evolution and development of the radiologist assistant as designed by ACR and ASRT is discussed and the roles and responsibilities of the RA as approved by the ACR Council are presented.
Abstract: ACR and ASRT joined forces to address the workforce shortages of radiologists and radiological technologists with the development of a radiologist assistant. This paper discusses the rationale for the evolution and development of the radiologist assistant as designed by ACR and ASRT. With the profession of radiology experiencing workforce shortages among radiologists and radiological technologists many radiological groups were beginning to hire ancillary personnel to fill efficiency gaps in practices. Many academic institutions were in the process of considering programs to initiate advanced practice status for radiologic technologists. Several state legislatures were considering laws that would provide extended scope of practice technology with additional training. The ACR and ASRT entered into discussions to address these concerns in order to: (1) assure patient safety by allowing only properly trained personnel to provide radiological service to patients; (2) assure that these ancillary personnel are not allowed to practice without appropriate physician supervision; (3) assure that there are not 50 different state scope of practice laws based more on political expediency than quality patient care; (4) alleviate workforce shortages for radiological technologists by creating a professionally satisfying career path; (5) alleviate some of the time pressures placed on radiologists as a result of their workforce shortages. The ACR had a choice to lead on the development of the roles and responsibilities of the radiologist assistant or continue to allow the process to evolve as market and political pressures warranted. As a leader in the profession, the ACR believed that it was in the best interest of its members and the profession to be at the table with the development of the roles and responsibilities of the radiologist assistant to assure the best for our patients. The roles and responsibilities of the RA as approved by the ACR Council are presented.
TL;DR: A decade's experience in the nation's first filmless radiology department is reviewed and 10 cautionary and informative lessons on making the process more successful, more efficient, and less stressful are summarized.
Abstract: The authors review a decade's experience in the nation's first filmless radiology department and outline the challenges and rewards of the transition. They summarize their experience with 10 cautionary and informative lessons on making the process more successful, more efficient, and less stressful. A number of possible avenues of new research and assessment on the effects of filmless operation on radiologists, imaging staff, referring clinicians, and patients are highlighted.
TL;DR: A rising gap in the demand for and capacity to deliver radiology services has created a need for radiologist extenders, and a variety of roles have been developed, depending on the skills of the individuals and the subspecialty areas in which they work.
Abstract: Improvements in imaging technologies are contributing to increases in the demand for radiology services. Efforts to match this rising demand are limited by the Centers for Medicare & Medicaid Services cap on resident positions and the challenges in obtaining appropriate visas and medical licenses for international medical graduates. This rising gap in the demand for and capacity to deliver radiology services has created a need for radiologist extenders. A variety of roles have been developed for these radiologist extenders, depending on the skills of the individuals and the subspecialty areas in which they work. Prominent among these are radiologist assistants, physician assistants, nurse practitioners, dosimetrists, and advanced-practice nuclear medicine technologists. Quality patient care is best accomplished when radiologist extenders function under the guidance of qualified radiologists, nuclear physicians, or radiation oncologists.
TL;DR: The data suggest that radiologists are more efficient when physician assistants are assigned to service, both in terms of numbers of studies interpreted, and timeliness of reporting and billing.
Abstract: We describe a model of how physician assistants can be used in an academic medical center to expand radiologist productivity, and to enhance the departmental academic and educational missions. At Harborview Medical Center, following a training program and graduated responsibility under supervision, physician assistants provide initial interpretation of radiology studies, consultation to referring physicians, and perform less complicated interventional procedures. Acceptance of physician assistants by the radiologists, radiology residents, and referring physicians has been high. Although the impact of physician assistants on departmental clinical productivity is difficult to measure, our data suggest that radiologists are more efficient when physician assistants are assigned to service, both in terms of numbers of studies interpreted, and timeliness of reporting and billing. As a result of the success of our program, we believe that physician assistants can have an important role in radiology practice.