AUG.2016 | VOL.71 | NO.8
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The Crossroads
of Radiology
ACR 2016 Special Report
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Contents
AUGUST 2016 | VOL.71 | NO.8
ALSO INSIDE
9
P.
ACR 2016TM SPECIAL REPORT
9 The Crossroads of Radiology®
19The Power of Navigation
The Harvey L. Neiman Molecular Imaging
Fund honors the legacy of a medical visionary
who dedicated his professional life to improving
patient care.
DEPARTMENTS
4From the Chair of the Board of Chancellors
This year’s annual meeting highlighted
upcoming technologies and emerging shifts
in the patient experience.
MORETON LECTURE
5Dispatches
News from the College and beyond
CONVOCATION
8From the Chair of the Commission on Economics
Looking into the future, the College focuses
on ensuring radiology’s place in future
payment systems.
13 Stepping
14 Medal
Out of the Dark Into the Light
of Honor
ECONOMICS FORUM AND ELECTION RESULTS
16 The
Story of Radiology
CAPITOL REPORT
17 A
Day on the Hill
SOCIAL MEDIA
18 The
Crossroads in 140 Characters
Archives of past issues are available at www.acr.org.
QUESTIONS? COMMENTS? Contact us at [email protected].
21 Job Listings
22 Final Read
How do you include patients in their health care
decision-making?
MISSION STATEMENT
The ACR Bulletin supports the American College of
Radiology’s Core Purpose by covering topics relevant to
the practice of radiology and by connecting the College
with members, the wider specialty, and others. By
empowering members to advance the practice, science,
and professions of radiological care, the ACR Bulletin
aims to support high-quality patient-centered health care.
NEWS FROM THE CHAIR OF THE
Board of Chancellors
By James A. Brink, MD, FACR, Chair
Looking Into the Future at ACR 2016
Much of the discussion at this year’s annual meeting revolved around upcoming technologies
and emerging shifts in the patient experience.
T
HE ACR 2016 MEETING provided a wonderful
venue for radiologist from all types of practice to gather and exchange ideas regarding
the topics most important to our specialty.
Session tracks were focused on advocacy, economics and health policy, clinical education,
clinical research, governance, informatics and innovation, leadership, and quality and safety. Radiologists
chose sessions in their particular area of excellence or
sampled topics of interest from many tracks.
An important feature of a professional society is the
ability to foster expressions of ideas and exchange of
knowledge. While some may shy away from controversial
subjects or speakers who are likely to express divergent
opinions, I for one celebrate the opportunity to hear
what policymakers and others outside our specialty are
thinking about our profession and its future.
One of these controversial voices was Ezekiel
Emanuel, PhD, MD, MSc, our keynote speaker.
Emanuel gave a dire prognosis in which radiologists
are replaced by machines in the not-too-distant future.
While the technical evolution toward artificial intelligence is inevitable, it is likely that many disciplines
in medicine and beyond will be affected. Lawyer-less
lawsuits, author-less journalism, and oncologist-less
chemotherapy may be the future. (Read more about
Emanuel’s address on page 10.)
As Emanuel stated, our future success lies in our
ability to collectively preserve the human element of
our profession. As David C. Kushner, MD, FACR, said
in his presidential address, it is critical that radiologists
Radiologists will be able to harness
the power of machine learning without
becoming obsolete in the process.
make themselves invaluable members of the care team.
So long as we keep the patients at the center of our
focus, I’m confident that we can leverage the technical evolution toward machine learning and artificial
4
Bulletin | AUGUST 2016
intelligence for improved diagnosis, reduced error, and
greater efficiency.
Certainly, the overflow attendance at the educational session focused on machine learning speaks to
the thirst for knowledge about this important area.
Moreover, I was very pleased to see the rich attendance
Communicating openly and
constructively will help avoid
the fear that this technology
will replace our jobs.
at the Clinical Data Science Industry Council Meeting,
which took place during the ACR 2016 meeting. Here,
ACR leaders convened a group of industry representatives focused on machine learning and artificial
intelligence. The group discussed important trends in
this emerging industry.
A key action item that emerged from this council
meeting also surfaced during the Economics Forum.
Rosemarie Ryan, co-CEO and a founder of customer
service strategy company Co:Collective, highlighted
the need for good storytelling for our profession.
According to Ryan, effective storytelling can lead to
organizational change that engenders customer loyalty.
Ryan’s message to radiologists was a simple one: you
must figure out what radiology’s story is. By conveying your value to patients, referring physicians, and
the broader health system, radiologists will be able to
harness the power of machine learning without becoming obsolete in the process.
In this same vein, the Clinical Data Science Industry
Council identified the need for uniform messaging
around the potential benefits of machine learning for
our specialty. Communicating openly and constructively
will help avoid the fear that this technology will replace
our jobs. Instead, we can change the conversation and
take control of this important technical evolution for the
benefit of our patients and our profession.
DISPATCHES
NEWS FROM THE ACR AND BEYOND
CALENDAR
september
8–10 Coronary CT Angiography,
ACR Education Center,
Reston, Va.
8–11 2016 RLI Leadership
Summit, Babson Executive
Conference Center,
Wellesley, Mass.
19–20 Breast MR with Guided
Biopsy, ACR Education
Center, Reston, Va.
october
3–4 CT Colonography, ACR
Education Center,
Reston, Va.
14–16 Cardiac MR, ACR Education
Center, Reston, Va.
28–29 Prostate MR, ACR Education
Center, Reston, Va.
november
8 I nternational Day of
Radiology (learn more at internationaldayof
radiology.com)
8–9 Breast MR with Guided
Biopsy, ACR Education
Center, Reston, Va.
©iStock/ Er Ten Hong
12–14 ACR-Dartmouth PET/CT
Course, ACR Education
Center, Reston, Va.
1 in 3 Radiologic Recommendations Not Followed
ONE-THIRD OF RADIOLOGIST RECOMMENDATIONS — including calls for additional imaging,
clinical correlation, laboratory studies, and consultation with a specialist — are not followed,
according to a large retrospective study done at Boston Medical Center. Patient management
review also showed that almost one-half of these missed recommendations were not acknowledged in the referring physician’s notes; disturbingly, serious health issues such as cancer were
among this group.
Possible causes of these communication breakdowns include electronic or fax messages
that fail to deliver, information going to a physician who is not the patient’s primary care
doctor, and patients who do not return for care. Solutions for improved follow-through may
be staff dedicated to communicating results, improved IT systems, and information delivered
through a portal. Read more at bit.ly/Diagnostic_Missed.
Here’s What You Missed
#SoMe
Beyond its function as a social sharing and communication tool, social media can have far-reaching
impacts on global radiology education, particularly in traditionally underserved areas. Read
more at bit.ly/Social_Educ.
GETTING THE WORD OUT
Community outreach, patient education, and collaboration are all ways you can market your practice
while building community. Learn from your colleagues at bit.ly/Word_Out.
THE PERFECT RADIOLOGY REPORT
Clear, concise communication has not lost its value in the digital age. Tips for writing reports that serve
patient care can be found at bit.ly/Report_Tips.
WWW.ACR.ORG
5
DISPATCHES
Connect With the ACR 2016 Virtual Meeting
©iStock/ chokkicx
DIDN’T MAKE IT TO the Crossroads of Radiology®, or want to catch up on sessions
you missed? Connect with the ACR 2016 Virtual Meeting for convenient access to
over 100 hours of programming — at an unbeatable value.
Celebrating Excellence
• Enjoy 24/7, on-demand access from your desktop or mobile device
• Claim CME, SA-CME, and RLI credits for up to 12 months
• Access full-motion video of slides with audio
Order today and learn more at acrvirtualmeeting.org.
MAINTAINING A SUCCESSFUL STATE CHAPTER
is a more intense undertaking than most realize.
State chapters provide educational opportunities,
coordinate important local advocacy efforts, and
dedicate themselves to making a positive impact
in their communities and in the specialty. Each
year, the College honors chapters that have gone
above and beyond in one of five areas: membership,
meetings and education, quality and safety,
government relations, and overall excellence. Below
are the winners. Divisions are based on chapter size.
EXCELLENCE IN MEETINGS & EDUCATION
Division A: Puerto Rico
Division B: Arkansas
Division C: Alabama
Division D: Florida
EXCELLENCE IN MEMBERSHIP
Division A: Rhode Island
Division B: Iowa
Division C: South Carolina
Division D: North Carolina
EXCELLENCE IN QUALITY AND SAFETY
Division A: Hawaii
Division C: Indiana
Division D: Michigan
OVERALL EXCELLENCE
Division A: Hawaii
Division B: Arkansas
Division C: District of Columbia
Division D: Texas
6 Bulletin | AUGUST 2016
©iStock/ peshkov
EXCELLENCE IN GOVERNMENT RELATIONS
Division A: Rhode Island
Division B: Oklahoma
Division C: Colorado
Division D: New York
Personalize Your Online ACR Experience
VISIT ACR.ORG AND CLICK the green “My ACR” tab to personalize your online
experience and email communications with the College. From this tab you can
manage your profile, change your password, renew your membership, and more.
Get started now!
Check Out the ACR Career Center
LOOKING FOR A NEW JOB? Don’t overlook the
ACR Career Center, the premier electronic
recruitment resource for the radiology profession.
The Career Center had over 400 live jobs in
May — and numbers continue to climb. You can
access the Career Center at acr.org/career-center.
Check out several of the open listings on page 21.
Announcing the 2017 Bruce J. Hillman Fellowship
in Scholarly Publishing
Description of the Fellowship
ACR is seeking applications for the Bruce J. Hillman Fellowship in Scholarly
Publishing. The fellowship is designed to provide a concentrated, two-week
experience in medical editing, journalism, and publication for an interested and
qualified staff radiologist. The goal is to sufficiently engage talented junior and
mid-career radiologists and encourage them to pursue some aspect of medical
journalism as part of their subsequent careers.
During the summer/fall of 2017, the selected fellow will travel for two weeks to
Reston, VA, and receive hands-on experience editing and publishing the Journal of
the American College of Radiology (JACR ®) with the JACR Editor-in-Chief, Bruce J.
Hillman, MD, FACR, Deputy Editor Ruth Carlos, MD, MS, FACR, and JACR staff.
He or she will also travel to New York City to spend time with the JACR’s publisher,
Elsevier, and complete a project in scholarly publishing.
Eligibility
To qualify for the fellowship, the radiologist must meet the following criteria:
• A minimum of three years in a post-training staff position at an academic or private practice
• Membership in the ACR
• Evidence of interest in medical journalism, including publishing articles and serving as a reviewer for medical journals
or participating on an editorial board
Application and Deadline
No later than Aug. 31, 2016, please submit the following materials to Brett Hansen, JACR senior managing editor, at
[email protected], 1891 Preston White Drive, Reston, VA 20191-4326. Applicants will be notified about whether they have
been selected no later than Oct. 31.
• A single page with the applicant’s name, position, institution and contact information that lists in bullet format his/her
accomplishments in writing, editing, serving on editorial boards for medical journals and other related items
• A current curriculum vitae
• A written statement explaining how the fellowship might relate to the applicant’s career goals
• A letter from the applicant’s chair or group president expressing support for the applicant and agreeing to release
the fellow for the time necessary to complete the activities
Visit jacr.org for additional information concerning
timelines and responsibilities.
08.16
FROM THE CHAIR OF THE
Commission on Economics
By Ezequiel Silva III, MD, FACR, Chair
New Chairs, Same Mission
As the cast of volunteers evolves, the Commission on Economics continues to work
to maintain payments and ensure radiology’s place in future payment systems.
T
HE COMMISSION ON ECONOMICS THANKS
the outgoing chairs and welcomes the
new chairs who will lead the following
important committees: Managed Care, the
Radiology Integrated Care (RIC) Network,
Interventional Radiology (IR), Academic
Radiology, and Reimbursement (RUC). I discussed
our new MACRA Committee and its chair, Greg
Nicola, MD, in last month’s July column. The newly
appointed committee members are recognized experts
in their respective areas of payment policy. The chairs
and their committees will collaborate to maintain the
commission’s unwavering commitment to protecting
radiology’s place in legacy payment systems, such as
fee for service. In addition, they will work to ensure
radiology’s place in future payment models, such
as those defined by the Medicare Access & CHIP
Reauthorization Act (MACRA).
Mark O. Bernardy, MD, FACR, previously the
chair of the Managed Care Committee, is now the
vicechair of the Commission on Economics. He will
help oversee our broader economic actions. Robert G.
Berkenblit, MD, FACR, will continue our efforts to
ensure favorable coverage for such important services
as mammography/tomosynthesis, lung cancer
screening, and CT colonography.
Joaquim M. Farinhas, MD, and David A. Rosman,
MD, were the founding chairs of the RIC Network.
The RIC Network was developed to allow radiologists
with local experience working within new payment
models to share their experiences and is the ACR’s
vehicle for monitoring implementation strategies for
new and novel payment structures. The new chair
of the RIC Network is Seth M. Hardy, MD, who
brings to the job experience from his accountable
care organization in Maine. He will help facilitate the
broader exchange of ideas necessary for more farreaching success.
The Commission on Economics maintains a
number of specialty committees in order to provide
the clinical expertise necessary to inform payment
policy. Sean M. Tutton, MD, has served as chair of
the IR Committee since 2012, helping us navigate the
8
Bulletin | AUGUST 2016
rapid bundling and restructuring of the IR component
coding system. Our new chair, C. Matthew Hawkins,
MD, an expert on IR coding, authors the Coding
Q&A Column for the Society of Interventional
Radiology’s IR Quarterly.
James V. Rawson, MD, FACR, the founding chair
of the Commission on Patient- and Family-Centered
Care, leaves his role as chair of our Committee on
Economic Issues in Academic Radiology. The new
chair is Joshua A. Hirsch, MD, FACR, the perfect
choice to inform our actions. In fact, the ACR’s recent
strategic plan includes the following expectation
of economics: “Promote appropriate funding for
radiology graduate medical education and research
within health care reform.” This will require a high
level of experience and focus, which we are confident
that Dr. Hirsch can bring to the effort.
It has been a personal honor to serve as chair of
the Reimbursement Committee and as the advisor
to the Relative Value Scale Update Committee
(RUC) from 2012 to 2016. During that time, I led
a team committed to maintaining the valuation of
radiology services when confronted with a number
of challenges, including the far-reaching “potentially
misvalued” initiative, which brought forth dozens of
radiology codes for revaluation. The RUC processes
can be quite technical, and negotiations at the
RUC can be delicate. I am confident that under the
direction and leadership of the incoming chair, the
Reimbursement Committee will thrive. Our new
chair, Kurt A. Schoppe, MD, has a solid reputation
with the RUC, having served as the alternate advisor
to the RUC since 2012.
It is with deep gratitude that I thank our outgoing
chairs and welcome our new chairs. I am confident
that they are well prepared to lead their talented
committee members and staff. As health care policy
evolves from a volume- to a value-driven architecture,
having talented and motivated individuals to lead
that transition is critical. Success in this realm will
require collaboration within the ACR and external
collaboration with stakeholders and policymakers. I
thank our new chairs for providing that leadership.
SPECIAL REPORT
THE CROSSROADS
OF RADIOLOGY
The ACR annual meeting armed today’s radiologists with the tools
to thrive in the health care’s future climate. The shift to patient- and
family-centered care was front and center as ACR members mapped
out a strategy for engaging patients more fully in their care.
Presidential Address: Things Change
David C. Kushner, MD, FACR, opened his
presidential address by acknowledging one
of the constants in the universe: change.
Radiology, he pointed out, is facing changes in
payment models, practice models, and patient
expectations — to name a few. The shift to
patient- and family-centered care is changing
the way radiologists work. Kushner pointed
to this paradigm shift as an opportunity for
radiology to reinforce its value. “The radiologist, a member of the patient care team, has
personal investment in whether the patient
actually gets better or not,” said Kushner.
What’s driving this change? Kushner
noted several factors, including generational thinking, technical advances, growing
emphasis on diversity, and increased patient
education and medical literacy. In addition,
our nation’s health system faces serious
challenges in caring for patients efficiently
and affordably.
As health systems and government
regulators take on these challenges, radiologists will be called upon to demonstrate
their value to both patients and the health
system at large. “We will need to help define
what value means in concert with the rest
of medicine,” said Kushner. “A successful
practice will be the group that participates
in this change.” With R-SCAN, Imaging 3.0,
informatics tools (including clinical decision support), and registries, the College is
preparing members to do just that.
WWW.ACR.ORG
9
SPECIAL REPORT
Left: Attendees gather for the ACR 2016 opening sessions.
Center: Ezekiel Emanuel, PhD, MD, MSc, presents his
keynote address. Bottom left: William T. Herrington,
MD, FACR, ACR Council speaker, addresses the audience.
Bottom right: David C. Kushner, MD, FACR, delivers his
presidential address.
In this time of change, Kushner encouraged
radiologists to keep patients at the forefront of
everything they do and prioritize interaction.
“If we claim we are the experts,” said Kushner,
“we must be the ones who explain the procedures, the reports, and the implications to the
patient as a part of the health care team.”
Keynote Address: Predictions for the Future
Ezekiel Emanuel, PhD, MD, MSc, began
his keynote with some sobering statistics.
In 2015, U.S. health care spending was
estimated to top $3 trillion.1 This figure is
larger than the entire economy of the United
Kingdom, emphasized Emanuel, a faculty
member at the Wharton School and School
of Medicine and University of Pennsylvania,
founding chair of the Clinical Center of the
National Institutes of Health, and former
special advisor on health policy for the
Office of Management and Budget.
5 TRENDS TO WATCH
During his keynote, Ezekiel
Emanuel, PhD, MD, MSc, outlined
five trends that will influence the
future of health care:
• Decline in the use of hospitals
• More outpatient care
• More care in patients’ homes
• Fewer medical tests
• Machine learning
10
Bulletin | AUGUST 2016
Despite all this, Emanuel said, “I am
an optimist!” He pointed to the 2010
Affordable Care Act, which led to a drop in
the number of uninsured patients.2 Recent
years have also seen a 17 percent reduction
in hospital-acquired conditions3 and a slowing in the growth of insurance premiums.4
And radiology has not been left out of
these advances. The specialty has been
instrumental in flattening the use of imaging
and kicking off efforts to decrease radiation
risk to patients. Emanuel also pointed out,
“Radiologists are more visible and more
engaged in advising on patient care.”
While there’s much to be hopeful about,
Emanuel encouraged radiologists to prepare for
changes to the way they practice. He pointed to
machine learning as one of the most pressing
issues in the coming years. Emanuel called the
technology “the real threat to radiology.”
At its most basic, machine learning is a statistical algorithm that automatically improves
with experience. “Unsupervised machine
learning occurs when the machine is left on its
own — with no human input or labels — to
find structure and relationships in the data,”
said Emanuel. (Read more about the future
of machine learning on page 16.) Emanuel
encouraged radiologists to recognize the
benefits of machine learning, which include
the following:
• The technology combines predictors in
non-linear and interactive ways.
• Algorithms can handle significantly more
complex datasets with hundreds of billions
of data points.
• There are already billions of digitized scans
to train machines to improve their predictive accuracy.
• Machine learning enables shorter time for
reading and interpretation.
• Machine learning is not affected by fatigue,
emotion, or other human variables.
“Machine learning will only get better over
time, with larger datasets, greater computing
power, and more computer ‘experience,’”
said Emanuel. “The biggest barrier will not
be technical but human willingness to accept
machine-based diagnoses.”
ENDNOTES
1. K eehan SP, et al. National health expenditure projections,
2014–24: spending growth faster than recent trends. Health
Affairs. July 2015. Available at bit.ly/HealthAffairsSpending. Accessed May 20, 2016.
2. U.S. Census Bureau. Health Insurance Coverage in the United
States: 2014. bit.ly/HealthInsuranceCensus. Published Sept.
2015. Accessed May 20, 2016.
3. A gency for Healthcare Research and Quality. Efforts
to improve patient safety result in 1.3 million fewer
patient harms. Available at bit.ly/AHRQstats. Accessed
May 20, 2016.
4. Henry J. Kaiser Family Foundation. 2015 Employer Health
Benefits Survey. Published Sept. 22, 2015. Available at bit.ly/
KaiserBenefits. Accessed May 20, 2016.
BOC Chair Report: Part of the Care Team
“If you’re in medicine, you’re in politics.”
With these memorable words, Bibb Allen Jr.,
MD, FACR, began his final report as chair
of the ACR Board of Chancellors during
Tuesday’s Council Session. Allen’s opening
remarks centered on the ACR’s accomplishments during his two-year tenure as BOC
chair, from helping to roll back the multiple
procedure payment reduction to the implementation of the College’s strategic plan.
Allen went on to praise ACR’s work in
aligning radiologists to the coming era of
value-based health care. College initiatives
like R-SCAN that incorporate clinical
decision support, explained Allen, have been
prescient since participation in the CMS
Transforming Clinical Practice Initiative is
one activity that counts toward satisfying
the Merit-Based Incentive Payment System
(MIPS) Clinical Practice Improvement
Activity (CPIA) performance category.
Using CMS’ value-based mandates as a
pivot point, Allen also touted the College’s
efforts at advancing patient-centered care.
From its registries like the Dose Index Registry
to the Lung Cancer Screening Registry —
both of which satisfy the CPIA requirement
for participation in a Qualified Clinical Data
Registry within several MIPS performance
categories — to its Imaging 3.0TM effort, ACR
has worked tirelessly to refocus radiologists
on doing what is best for patients. In addition,
Allen noted that the Commission on Patientand Family-Centered Care has already made
strides toward embedding the patient perspective into the practice of radiology.
Allen concluded by pointedly asking the
audience, “Do we want to be report generators, or do we want to be part of the clinical
care team?” Given that CMS predicts radiologists will come in near the bottom of physician compliance with respect to value-based
payment measures, ACR members have an
uphill battle. However, Allen concluded by
issuing an impassioned plea to prove the
skeptics wrong before conveying his heartfelt
thanks for his time as BOC Chair.
CEO Report: Accountability Wave
William T. Thorwarth Jr., MD, FACR, began
his CEO report by highlighting a number of
Left: Bibb Allen Jr., MD, FACR, delivers his final report as chair of the ACR Board of Chancellors.
Right: William T. Thorwarth Jr., MD, FACR, gives the CEO report.
successes ACR has enjoyed since last year’s
annual meeting. Notable achievements
include deepening relationships with other
radiological associations and increasing recognition at major medical organizations like the
AMA and the Council of Medical Specialty
Societies, all of which support ACR’s strategic
plan. Thorwarth also emphasized the importance of every ACR member’s participation in
the R-SCAN program to position themselves
for the evolving value-based landscape.
In addition to R-SCAN, another recently
developed tool that will help radiologists navigate the hills and valleys of value-based care
is the Inpatient Cost Evaluation Tool (ICE-T)
app. Created by the Harvey L. Neiman Health
Policy InstituteTM, the ICE-T app evaluates
imaging costs for each diagnosis-related group
to assist members with negotiations for their
share of bundled payments. The app features
an easy-to-navigate interface that will help
radiologists make a credible case for joining
alternative payment models in the near future.
Turning to the future, Thorwarth underscored the need for radiology to make itself
more appealing to medical students. Following
this year’s AUR meeting, ACR joined with
organizations like the Alliance of Medical
Student Educators in Radiology, the Alliance
of Clinician-Educators in Radiology, the
Association of University Radiologists, and the
Association of Program Directors in Radiology
to host a job fair that accentuated the positive
ACR 2016 ELECTION RESULTS
The following individuals were elected
at ACR 2016 to represent the College.
ACR President
Bibb Allen Jr., MD, FACR
ACR Vice President
Cheri L. Canon, MD, FACR
Board of Chancellors
Seth A. Rosenthal, MD, FACR
Robert S. Pyatt Jr., MD, FACR
Council Steering Committee
Catherine J. Everett, MD, MBA, FACR
Richard B. Gunderman, MD, FACR
Johnson B. Lightfoote, MD, FACR
Richard Strax, MD, FACR
College Nominating Committee
Kathryn G. Gardner, MD, FACR
Andrew V. Kayes, MD
Suzanne L. Palmer, MD
Member-in-Training Representative
to Intersociety Commission
David C. Gimarc, MD
Alexander S. Misono, MD, MBA
WWW.ACR.ORG
11
SPECIAL REPORT
aspects of radiology. Data suggest that the
nation’s aging population will provide today’s
residents and fellows with a lot of work for years
to come. The younger generation of radiologists
will be on the front line as what Thorwarth
called the “accountability wave” breaks in
performance year 2017. But the good news, he
concluded, is that ACR has been preparing for
this moment for decades and is well positioned
to help radiologists thrive into the future.
RFS Report: The Future of Imaging
Neil U. Lall, MD, outgoing chair of ACR’s
Resident and Fellow Section Executive
Committee, reported on several of the RFS’
recent noteworthy achievements. The RFS has
extended its reach to the radiology community
over the past year by increasing its blogging
activity. Spearheaded by Colin M. Segovis,
MD, PhD, outgoing RFS secretary, this effort
has resulted in dozens of articles. Blog posts
run the gamut, including a series spotlighting
one resident’s determination to bring PACS
technology to a hospital in Kathmandu. Check
out these blogposts at acrbulletin.org.
Lall also expounded on how RFS participants are leading members of several College
commissions, committees, and work groups.
Members of particular note include Amy K.
Patel, MD, who is working within the ACR
Commission for Women and General Diversity
to recruit more women and minorities into
radiology. In addition, Ashley E. Prosper, MD,
heads the RFS Medical Student Task Force.
The task force’s mandate is to enact a plan to fill
radiology residency positions.
A cornerstone of the RFS has become its
Journal Club, and Lall thanked recent special
guests, including Geraldine B. McGinty, MD,
MBA, FACR, and Frank J. Lexa, MD, MBA.
Together with ongoing efforts like strengthening ties with resident and fellow sections in
other associations, the RFS has a bright future.
YPS Report: Active Engagement
Jennifer E. Nathan, MD, outgoing ACR Young
and Early Career Physician Section (YPS)
chair, said the primary goals of the YPS are to
attract and retain members and foster future
ACR leaders. The section is meeting these goals
with activities that focus on professional development, networking, and certification.
For starters, the YPS had a dedicated Sunday
morning program at ACR 2016. The program
included two parts: how to succeed in your
practice and how to be a successful radiologist.
Outside of the annual meeting, the YPS
has created content for its members, including an electronic newsletter plus a column
and podcasts in the JACR®, Nathan said. The
section also helped pilot Engage, an ACR
tool that promotes networking and facilitates
information sharing.
Nathan also mentioned that an amendment under consideration to add a YPS
member to the ACR Board of Chancellors.
The YPS already has representation on over
90 percent of ACR committees and commissions, she noted.
However, a recent survey showed that
many YPS members don’t understand their
roles on the committees and commissions
on which they serve. The section plans to
respond with welcome packets for new
committee and commission members and
mentorship programs, Nathan said.
WHY TAKE THE R-SCAN PLEDGE?
ACR 2016 attendees got a chance to learn more about the Radiology Support,
Communication, and Alignment Network (R-SCAN), a collaborative project that brings
radiologists and referring clinicians together to improve imaging utilization. Take the
pledge today to get started on the following:
•Optimize imaging care, reduce unnecessary exams, and lower the cost of care
•Access a free customized version of the ACR Select clinical decision support tool
•Work with ordering physicians to prepare for use of clinical decision support
•Receive free educational resources
•Prepare for the future of value-based care
•Meet MOC Part 4 requirements and earn free CME for participation
To learn more and take the pledge, visit the new R-SCAN website at rscan.org.
12
Bulletin | AUGUST 2016
ABR UPDATE: EVOLVING MOC
Milton J. Guiberteau, MD, FACR, president
of the American Board of Radiology (ABR),
delivered updates to Maintenance of
Certification (MOC) Part 3: Assessment of
Knowledge, Judgement, and Skills and Part
4: Improvement in Medical Practice. The
ABR’s goal is to make MOC a more coherent, continuous, and convenient process.
To that end, the ABR Board of Governors
has adopted a new MOC Part 3 online
assessment model to replace the existing
MOC exam. Guiberteau said the Online
Longitudinal/Continuous Assessment will
do the following:
• Minimize travel, expense, and time away
from work and families by bringing the
process to the participants online
•Result in a more continuous assessment
• Promote professional development
through assessments with learning
opportunities
• Incorporate modern learning models
The new model transforms the current traditional examination from an assessment
of learning into an assessment for learning,
Guiberteau said. “Although we will never
have perfect physician assessment tools,
ABR is committed to offering one that is
consistent with our goals of demonstrating
competence while promoting professional
development,” he said.
With regard to Part 4, the ABR has added a
second category that radiologists can use to
satisfy the improvement requirements. Now
the requirements can be met through either
Practice Quality Improvement Projects or
Participatory Quality Improvement Activities.
Participatory Quality Improvement
Activities include serving in a local or
national leadership role in a national quality improvement program, participating in
a clinical quality or safety review committee, working on a peer review project,
engaging in a root-cause -analysis team, or
reporting to a national registry.
Guiberteau noted that these activities
encourage radiologists to engage with
their imaging colleagues, referring clinicians, and other care partners. While it
may seem radiologists are more isolated
than ever before, these activities can help
change that while improving quality in
imaging practices, he said.
Moreton lecturer
and patient advocate
Andy DeLaO advises
radiologists to take
charge of their health
care stories.
STEPPING OUT OF THE
DARK INTO THE LIGHT
Radiologists must not let others tell their stories.
M
oreton lecturer and patient advocate
Andy DeLaO began his Moreton
Lecture by reminding radiologists
why they are in the imaging profession. “Revenue and payment are the results
of what you do, but the purpose, cause, and
belief you find in your work — that’s why
you do it,” said DeLaO. For radiologists,
the purpose, cause, and belief in their work
is making a profound difference in the lives
and health of their patients.
But there’s a problem. Medicine has
become industrialized, and the story of why
physicians are in their profession becomes
buried under the push to do more things
faster. Medicine is increasingly focused on
efficiency, metrics, and compliance. “The
words doctors use day to day have nothing
to do with patients,” said DeLaO. Essentially,
physicians are telling a story vastly different
than the one they set out to tell.
Right now, medicine belongs to the experience economy. In these climates, businesses evolve products from simple goods
to the point where people are willing to buy
products based on the experience they are
having. This is how most hospitals look at
the patient experience — they assume what
patients want and determine factors like
sharing a room vs. having a private room
or the color of the paint on the walls. Few
facilities include the patient in the process,
said DeLaO.
Radiologists must go beyond providing
what they assume is the ideal experience
and meet with their patients. Creating connections allows patients to recognize that
radiologists have a profound impact on the
patient’s health care story.
“Those words you use in your interpretive reports? That story is being told by
other people,” said DeLaO. Radiologists are
writing the stories but they’re allowing other
specialties to take those stories and make
them their own — to the patient, it’s that
specialist working with them and shaping
the patient’s world and experiences, not the
radiologist, despite the fact the radiologist
has laid the plan for their health care journey.
And there is a real danger in that.
If patients don’t understand your value,
it’s likely other entities don’t either — neither the politicians that govern legislation
nor the insurance companies you may rely
on nor your own administration. “You
either choose to connect, or you will be
eliminated,” warned DeLaO.
Making connections with individuals
is easy. “It’s as simple as picking up your
phone and deciding to connect with
someone,” said DeLaO. He offered real
world examples of radiologists who are
already making connections, such as James
V. Rawson, MD, FACR, who participates
in a wide variety of social media activities
like the #HCLDR chat, a multidisciplinary
tweet chat designed to bring health care
leaders together and empower future
leaders. DeLaO also mentioned Ruth
C. Carlos, MD, FACR, who created the
JACR hackathon, which brought different
health care stakeholders together to solve a
common patient problem (read more about
the hackathon on page 15). You can also
do things like create a summary report and
give the patient your contact information,
said DeLaO. That way, you are telling your
story directly.
WWW.ACR.ORG
13
SPECIAL REPORT
MEDAL OF HONOR
Members gather to bestow the College’s highest honors.
E
ach year, the College recognizes individuals who stand above
the rest — their work supports quality patient care and
advances the specialty. In 2016, over 100 recipients donned
their caps, gowns, and colors representing their medical schools
and marched down the aisles in recognition of receiving their ACR
Fellowship. In addition to the fellows, the celebration honored the
2016 ACR Distinguished Achievement Award Recipient, Honorary
Fellows, and ACR Gold Medalists.
3
4
1
2
14
5
Bulletin | AUGUST 2016
8
6
9
7
1. The new ACR fellows vow to place
patients first.
2. The 2016 ACR fellows wait for Convocation.
3. L awrence P. Davis, MD, FACR, receives the
ACR Gold Medal.
4. Professor Peter J. Hoskin, MD, accepts his
honorary fellowship.
5. Charles D. Williams, MD, FACR, becomes one
of 2016’s ACR Gold Medalists.
6. Anne C. Roberts, MD, FACR, outgoing ACR
vice president, carries the ceremonial mace.
7.Christoph L. Zollikofer, MD, becomes one of
this year’s Honorary Fellows.
8. Mary Jane Donahue proudly accepts the
Distinguished Achievement Award.
9. W
alter J. Curran Jr., MD, FACR, accepts the
ACR Gold Medal.
JACR HACKATHON
Reinventing medical journal
access may have been the theme
of the JACR Hackathon, but the
collaboration and mutual respect
among individuals from different backgrounds stretched
the outcomes of the event far beyond the confines of the
scholarly publishing space. Radiologists, health IT experts,
developers, patients, and patient advocates all met for
the event, which began Saturday morning and extended
through Sunday during ACR 2016.
Gary L. Kreps, PhD, a university distinguished
professor and the director of the Center for Health
and Risk Communication at George Mason University,
admonished participants to come up with designs that
responded to key communication characteristics of
their audiences and took into consideration key demographic and cultural variables.
Kreps’ presentation was one of several from experts
in patient advocacy, human-centered design, and
scholarly publishing. Six teams were then formed, and
each came up with a unique technological solution that
would provide patients with easier access to scholarly
publishing as well as access to those who could help
them interpret and digest peer-reviewed content. The
hackathon winner, Team PitchN, was among those that
worked through the night to develop a beta version of
their concept.
WWW.ACR.ORG 15
SPECIAL REPORT
ECONOMICS FORUM:
THE STORY OF RADIOLOGY
1
2
This year’s forum explored the intersection between patient
care and the economics of radiology.
T
he importance of storytelling and
placing patients at the center of care
took center stage at the two-part 2016
Economics Forum. Moderated by
Geraldine B. McGinty, MD, MBA, FACR,
outgoing chair of the Commission on
Economics, the presentations marked ACR’s
progress in patient-centered care while highlighting opportunities for improvement.
Radiology: The Untold Story
McGinty kicked off the proceedings by
introducing Rosemarie Ryan, former CEO
of the marketing communications company J. Walter Thompson. Ryan spoke
to the audience about the importance of
radiology communicating its story to the
public. Her concept of “StoryDoing” (learn
more at bit.ly/ACRStoryDoing) involves
storytelling that leads to organizational
change that, in turn, engenders
customer loyalty.
Grounding the theme of storytelling firmly in the realm of radiology, Ezequiel Silva III, MD, FACR,
incoming chair of the Commission on
Economics, spoke about the value of taking
ownership of radiology’s message for the
purpose of fair reimbursement. Instruments
like the Harvey L. Neiman Health Policy
InstituteTM Inpatient Cost Evaluation Tool
(available at bit.ly/HPI-ICE-T), explained
Silva, are powerful storytelling mechanisms.
Silva went on to underscore the need for a
powerful narrative in radiology, especially in
light of the reimbursement uncertainty facing
imaging experts. A compelling narrative,
concluded Silva, will enable radiologists at the
local level to be successful no matter what the
final reimbursement rules look like.
MACHINE LEARNING AND RADIOLOGY
Machine learning is no radiology apocalypse. In fact, the technology presents many opportunities for the specialty, according to ACR 2016 presenters on the topic.
“I, for one, am not worried about computers taking over,” said Ross W. Filice, MD, assistant professor and chief of imaging informatics in the department of radiology at Medstar
Georgetown University Hospital and chief of imaging informatics at MedStar Medical
Group Radiology.
Simply put, machine learning is a statistical algorithm that improves with training.
Keith Dreyer, DO, PhD, FACR, associate professor of radiology at Harvard Medical School,
noted the ACR has two machine-learning solutions: ACR Select® (a clinical decision support
tool) and ACR AssistTM (a structured reporting framework).
Such tools will “make us have to do less of the tedious kind of stuff,” said Tarik K.
Alkasab, MD, PhD, radiologist in the division of emergency imaging in the department
of radiology and service chief of informatics/IT and operations at Massachusetts
General Hospital.
To prepare, radiologists should start collecting the data to train the algorithms, said
J. Raymond Geis, MD, FACR, radiologist with Advanced Medical Imaging Consultants PC
and vice chair of the ACR IT Informatics Commission. “The limiting factor is not the
algorithms, it’s the data,” said Geis.
16
Bulletin | AUGUST 2016
3
4
1.Geraldine B. McGinty, MD, MBA, FACR,
outgoing chair of the Commission on
Economics and incoming vice chair of the ACR
Board of Chancellors, moderates this year’s
Economics Forum.
2.Ezequiel Silva III, MD, FACR, incoming chair of the
Commission on Economics, compels radiologists
to take ownership of radiology’s narrative.
3.R
osemarie Ryan, former CEO of J. Walter
Thompson, emphasizes the importance of
communication radiology’s story.
4. R
aymond K. Tu, MD, FACR, discusses the
economics of imaging.
The Patient-Centered Path
Part two of the Economics Forum featured a
snapshot of where radiology is now in terms
of its evolution toward providing value-based
care. James V. Rawson, MD, FACR, P.L., J.
Luther and Ada Warren Professor and chair of
radiology and imaging at the Medical College
of Georgia, implored radiologists to engage
patients. “If you don’t talk to the patient, you
won’t know what they’re looking for,” said
Rawson, who chairs the ACR Commission on
Patient- and Family-Centered Care.
Raymond K. Tu, MD, FACR, chief of staff
at the Not-for-Profit Hospital Corporation
and chair of the ACR Medicaid Network,
noted that Medicaid beneficiaries include
millions of children and disabled people. Tu
quoted Hubert Humphrey: “The moral test of
government is how it treats those at the dawn
of life, the children; at the twilight of life, the
elderly; and in the shadows of life — the sick,
the needy, and the handicapped.”
continued on page 21
MAKING SENSE OF ALPHABET SOUP
During the session “How to Be a
Successful Radiologist,” Chris Sherin,
director of congressional affairs at the
College, and Richard Duszak Jr., MD,
FACR, briefed attendees on some of the
most talked about health care acronyms
of 2016 — MACRA, MIPS, and APMs.
ACR members meet with Rep. Pete
Sessions (R-TX), chair of the House
Rules Committee.
A DAY ON THE HILL
Radiologists from around the country flocked to Capitol Hill to take
radiology’s message to Congress.
O
ver 500 radiologists, fellows, and
residents attended the annual Capitol
Hill Day during ACR 2016. This
year, we thanked our Senators and
Representatives for including provisions
within H.R. 2029, the Consolidated
Appropriations Act of 2016. This legislation lowered the professional component of the multiple procedure payment
reduction (MPPR) from 25 percent to
5 percent for advanced imaging studies
(such as CT, MRI, and US) performed on
the same patient, in the same session, on
the same day.
We also thanked our elected officials for
including additional provisions within H.R.
2029 that place a two-year moratorium on the
flawed United States Preventive Services Task
Force’s (USPSTF) mammography screening recommendations. Thanks to Congress,
private insurance companies must continue to
provide women ages 40 and above with access
to annual mammograms without any form of
patient cost sharing through Jan. 1, 2018.
After thanking our Members of Congress
for these recent victories, our focus shifted
to gaining cosponsors for H.R. 1151/S.
1151, the USPSTF Transparency and
Attendees prepare to visit their state
representatives in Congress.
Accountability Act. This bipartisan legislation
seeks to reform the task force in a variety
of ways. First and foremost, the bill seeks
to increase the overall level of transparency
within the USPSTF’s recommendation
process, including the data and research
methodologies the task force uses to justify
its recommendations. H.R 1151/S. 1151
also mandates the inclusion of specialized
physicians on the USPSTF when it comes to
issues in a certain field of expertise and creates
a more standardized 60-day public comment
period for pending recommendations.
continued on page 21
The Medicare Access and CHIP
Reauthorization Act implements a new
system of incentive payments based on
quality metrics and risk sharing. MACRA,
implemented by CMS as the Quality
Payment Program, asks physicians to participate in two kinds of payment systems:
MIPS, or the Merit-Based Incentive
Payment System, is essentially a
modified fee-for-service program, said
Sherin. MIPS streamlines programs
such as PQRS, Meaningful Use, and
others into one program. This is the
area most radiologists will fall under,
according to Duszak.
Each physician under MIPS will earn a
composite score from 0 to 100 based on
the performance in these programs. The
score determines whether the physician
receives a bonus or penalty. Sherin
updated attendees on some of the new
facets of MIPS, including that those considered non-patient-facing physicians
(those having 25 or fewer patient-facing
encounters during one year) will receive
consideration under MIPS due to their
unique situation compared to physicians
who see multiple patients a day.
APMs, or alternative payment models,
are the other track physicians can participate in. APMs are a form of population-based care. An entire group of physicians assumes an amount of financial
risk for the continued care of a patient,
based on factors such as whether the
patient must be readmitted or not.
For more information on MACRA,
MIPS, and APMS, watch a webinar
at bit.ly/MACRAWeb or read “Catch
Your Wave?”from the July Bulletin
at bit.ly/CatchWave.
WWW.ACR.ORG
17
SPECIAL REPORT
THE CROSSROADS
IN 140 CHARACTERS
Members from throughout the College, along with patients and patient
advocates participated in tweet chats, voiced their opinions, and shared
their insights and memorable moments on Twitter. We’ve gathered some of
our favorite tweets from the meeting here. What are you tweeting about?
BY THE NUMBERS
Here are the stats on social
media at #ACR2016.
18
Bulletin | AUGUST 2016
40,099,920 10,582 1,136
impressions (the amount of people who
potentially see or interact with tweets)
TWEETS
PARTICIPANTS
iStock © rasslava
ACR Foundation
The Power of Navigation
The Harvey L. Neiman Molecular Imaging Fund honors the legacy of a medical visionary
who dedicated his professional life to improving patient care.
D
URING HIS TENURE AT THE HELM of the
ACR, Harvey L. Neiman, MD, FACR,
guided the College to become one of the
world’s largest and most influential medical
specialty societies. Prior to his death in 2014,
Neiman expressed his belief that molecular
imaging would be the next advance in radiology. Today,
the Harvey L. Neiman Molecular Imaging Fund is
helping to transform that vision into reality.
“It was Dr. Neiman’s inspiration to establish an ACR
commission on molecular imaging,” says James H.
Thrall, MD, FACR, former chair of the ACR Board
of Chancellors, chair emeritus of the department of
radiology at Massachusetts General Hospital, and
professor of radiology at Harvard Medical School.
“Dr. Neiman understood the potential significance of
molecular imaging before it became a catchphrase in
the medical community.” Neiman tapped Thrall to head
up the first ACR commission on molecular imaging,
which later became part of the ACR Commission on
Nuclear Medicine and Molecular Imaging.
To continue Neiman’s focus on the future, the
ACR Foundation established the Harvey L. Neiman
Molecular Imaging Fund to support researchers
advancing the diagnosis and treatment of cancer,
neurological and cardiovascular diseases, and other
serious illnesses.
COMING OF AGE
Today molecular imaging is playing an increasingly
important role in patient care, medical research, and
pharmaceutical development. “We live in the era of
molecular medicine,” says Thrall. “Medicine of antiquity
had to do with the gross observation of the outside of
the human body. Today molecular imaging is a way to
understand the human organism at a molecular level.”
Ultimately, he says, the nano-scale is where radiology
researchers should be focused, because this is where the
earliest changes that lead to the development of a disease
or condition occur. “If you have to wait until changes
are manifest on gross anatomy imaging, in many cases
you are already too late to initiate effective therapy,” says
Thrall. “The closer we can get to the origins of disease in
our diagnostic imaging methods, the more value we’ll
bring to the care of our patients.”
"Anyone can steer the ship, but it takes
a leader to chart the course."— John C. Maxwell
Carolyn C. Meltzer, MD, FACR, the William P.
Timmie Professor and Chair of Radiology and Imaging
Sciences at Emory University School of Medicine and
former member of the ACR Board of Chancellors,
agrees. “Diagnostic radiology is a highly descriptive,
structurally driven field that looks at a cross section
of the appearance of organs and describes disease
processes,” she says. “Molecular imaging allows us to
look beneath the anatomic structures to see the function
of tissues, normal and not normal. It is the molecular
makeup that is the strongest opportunity for specifically
targeted and anatomically effective treatment.”
GETTING PERSONAL
In the ACR 2015 Moreton Lecture about imaging in
the age of precision medicine, Thrall indicated that
WWW.ACR.ORG 19
iStock © PeopleImages
precision medicine or personalized medicine is broadly
defined as the tailoring of medical treatment to the
individual characteristics of each patient.1 This process
entails classifying patients into subpopulations that
differ in their susceptibility to a particular disease, in
the biology or prognosis of those diseases they may
develop, or in their response to a specific treatment.
“Imaging is poised to play major roles in the age of
precision medicine,” he says. “The imaging community
needs to think in terms of how imaging surveillance of
patients with known genetic mutations can contribute
to the concept.”
According to Meltzer, “Precision medicine is the
future of radiology. The way we practice now is often
about treating people as if they will all react similarly
to treatment. The overarching vision for how we’ll
practice medicine going forward is by understanding
each individual’s genetic and chemical makeup, as well
as other unique factors that might lead to better disease
identification and targeting with specific therapeutics.
For radiology, this is an exciting, promising field. Every
day, there are new technologies, imaging agents, and
specific molecular biomarkers and nano-particles that
DONATE TODAY
A contribution to the ACR Foundation directed to
the Harvey L. Neiman Molecular Imaging Fund
represents an opportunity to honor the legacy of
Harvey L. Neiman, MD, FACR, and contribute to the
future of the radiology specialty in molecular imaging.
Learn more at bit.ly/NeimanFund. Support the ACR
Foundation at donate.acrfoundation.org.
20
Bulletin | AUGUST 2016
we can leverage to diagnose and treat each patient at
the cellular level.”
SEEDING THE FUTURE
Where will the next advances in molecular imaging take
root and begin to grow? Bruce J. Hillman, MD, FACR,
founder and past chair of the ACR Imaging Network
(ACRIN), believes that the future of the specialty
lies with young radiology researchers. “A primary
goal of the fund is to provide seed money for young
investigators who have an idea and are looking for proof
of concept. It’s important to offer small grants to new
investigators who want to build a scientific case, which
helps them attain comprehensive funding for broader
research,” he says.
“The Neiman Fund helps young investigators get
started with a place to begin bench research that can
be translated into clinical trials and, ultimately, clinical
practice,” says Meltzer. “The focus of this fund is to
inspire and fund young investigators in the field of
molecular imaging. To do this promising work, it’s
important to have clinical radiologists involved along
with molecular scientists and chemists.”
Thrall emphasizes that the ACR Foundation plays
a key role in the competitiveness of the specialty and
supporting younger investigators. “There are so many
opportunities to keep the radiology specialty strong,”
he said. “We need to capitalize on these areas to remain
on the cutting edge, and one of the ways to do that is to
support the Neiman Fund.”
By Linda Sowers, freelance writer for ACR Press
ENDNOTE
1. Th rall JH. Moreton Lecture: imaging in the age of precision medicine.
JACR 2015;12(10):1106–1111.
JOB LISTINGS
CLASSIFIED ADS These job listings are paid advertisements. Publication
of a job listing does not constitute a recommendation by the ACR. The ACR
and the ACR Career Center assume no responsibility for accuracy of
information or liability for any personnel decisions and selections made
by the employer. These job listings previously appeared on the ACR Career
Center website. Only jobs posted on the website are eligible to appear in
the ACR Bulletin. Advertising instructions, rates, and complete policies are
available at http://jobs.acr.org or e-mail [email protected].
New York – Buffalo. Twenty-person radiology practice in greater western
New York seeks two full-time radiologists, fellowship preferred, ABR-certified
or eligible. General diagnostic responsibilities include evenings, nights, and
weekend rotations. Market competitive compensation, vacation, and benefits
offered. Interested candidates are encouraged to call or send their professional
CV for immediate consideration. Contact: John Bellomo by phone at 716-8636392 or by email at [email protected].
Pennsylvania – State College. Diagnostic radiologist for a six-person hospital-based private practice group. Job available due to recent retirement.
260-bed hospital in a university town. One imaging center operated by
hospital. Contact: Gregory Weimer, MD, by phone at 814-234-6137 or by
email at [email protected].
Georgia – Atlanta. We are seeking a fellowship-trained neuroradiologist to
join our practice in Atlanta with experience in functional MR, tractography, and
MR perfusion imaging. Please submit your CV to [email protected].
Contact: by email at [email protected].
Utah – Salt Lake City. Due to program expansion, the abdominal imaging
fellowship at the University of Utah has an additional one-year position
available for the July 2016‒June 2017 academic year. Applicants must meet
requirements for Utah medical license, which requires two years of training in
an ACGME program. For more information, visit bit.ly/28PaXTm. Contact: Terri
Clayson by phone at 801-581-2868 or by email at [email protected].
Utah – Salt Lake City. The abdominal imaging fellowship at the University
of Utah is accepting applications for the 2017‒2018 academic year. The fellowship is comprised of multimodality abdominal pelvic imaging with an MR
emphasis. Applicants must meet requirements for Utah licensure, requiring
two years of training in an ACGME program. For more information, visit bit.
ly/28PaXTm. Contact: Terri Clayson by phone at 801-581-2868 or by email at
[email protected].
Illinois – Champaign. Seeking full-time private-practice general radiologist
in central Illinois. Practice services two hospitals and a small private clinic.
As a smaller group, each radiologist interprets nearly all aspects of imaging,
from mammography to MRI. Attractive 1st and 2nd year salary with benefits
and full partnership after two years. Flexible start date. Contact: Ramaprasad
Chilakapati by phone at 217-477-2930 or by email at [email protected].
CONTINUED
Economics Forum: The Story of Radiology
continued from page 16
Richard Duszak, MD, FACR, affiliate senior research fellow at the
Harvey L. Neiman Health Policy InstituteTM, addressed health care
policy, saying radiologists need evidence to secure funding. “Without
good data, you’re just another constituent asking for money,” he said.
Duszak referenced several studies that have increased cash flow into
the specialty, calling them an investment in the future.
McGinty then took the stage to discuss commercial payers, saying
they like the radiology benefit managers, making the implementation of
clinical decision support a heavy lift. “But we’ve absolutely got to try,” she
said. Finally, McGinty gave a forecast for 2020, when the Medicare Access
and Chip Authorization Act will be live. She is confident the specialty
will remain strong: “It is in our DNA to learn from the best of the past to
inform our future.”
CONTINUED
A Day on the Hill
continued from page 17
The final bill we lobbied for was H.R. 4632/S. 2262, the CT
Colonography Screening for Colorectal Cancer Act. This bipartisan piece of
legislation mandates that Medicare cover the cost of CT colonography, or
virtual colonoscopy, as a colorectal cancer screening procedure. Radiologists
recognize the benefit of providing patients with a minimally invasive way to
be screened for colorectal cancer as screening rates for this deadly disease are
currently less than 60 percent in many parts of the country.
I always look forward to the annual Capitol Hill Day, and this year
was no exception. What makes the day so special for me is the stalwart
relationships we have built with our Kansas representatives. In 2014,
I was fortunate to help with Senator Pat Roberts’ (R-KS) re-election
campaign. Earlier this year, I spent extended time with the majority of
my Senators and Representatives through my participation in ACR’s
Rutherford-Lavanty Government Relations Fellowship. It is a truly gratifying feeling when you know each of your federal representatives on a
first-name basis and understand that they support ACR’s many advocacy
goals. Fostering these types of relationships can play an integral role in
passing legislation favorable to the specialty of radiology.
I was also particularly elated this year that nearly 40 percent of all
Capitol Hill Day attendees were residents and fellows, proving that
the leaders of tomorrow truly care about the future of radiology and
want to play an active role in our specialty’s continued success.
Although ACR has one of the strongest government relations
teams advocating for us year round, it is imperative that individual
radiologists also make ourselves visible in Washington. Moreover,
a story that personally resonates with Senators and Representatives
and includes compelling facts and data to show how an issue affects
their constituents can be all it takes to gain support. Our efforts in
Washington really do translate to results.
To put it in perspective, 8,000 bills were introduced in Congress in 2015.
Of those, 90 percent did not get a vote. However, we were able to push
through the MPPR reduction, the mammography screening moratorium,
and the repeal of the sustainable growth rate, in a single calendar year.
We most definitely need radiologists tirelessly reading at the workstation; they are invaluable assets to patient care. However, it is equally imperative for radiologists to solidify their position in Washington by lobbying
Congress for fair reimbursement and affordable, accessible care for our
patients. This active involvement in federal advocacy efforts will collectively ensure our specialty survives and thrives in the years to come.
By Amy K. Patel, MD, breast radiology fellow at Mallinckrodt Institute of Radiology
Washington University in St. Louis
WWW.ACR.ORG
21
Final Read
ACR BOARD OF CHANCELLORS
Courtesy Join Y. Luh
Join Y. Luh, MD, radiation oncologist at Dr. Russel Pardoe
Radiation Oncology Center at St. Joseph Hospital in Eureka, Calif.
Join Y. Luh, MD, poses with his team at the Doctor Russel Pardoe Radiation Oncology Center.
Q:
How do you include
patients in their health
care decision-making?
AS A RADIATION ONCOLOGIST, I have direct face-to-face interaction with patients
throughout the care process, from the initial consultation to long-term follow up.
These interactions ensure I cultivate lasting relationships with cancer survivors.
When my patients proceed with radiation therapy, their informed consent is
the result of a shared decision-making process between the patient and physician.
My initial consult may involve a healthy 75-year-old who is referred to me to
discuss the role of post-lumpectomy radiation therapy for her early-stage breast
cancer. I review the mature clinical trial evidence showing the local control
and potential overall survival benefit of adjuvant radiation, but I also help her
appreciate the smaller absolute benefit in healthy women over 70 who go on
endocrine therapy. I discuss the option of a shorter course of radiation using
hypofractionation over three to four weeks as opposed to the classic six and a
half weeks. After discussing the acute and potential long-term side effects of
radiation, she feels comfortable making an informed decision.
When I see patients for palliative radiation to relieve symptoms such as pain,
obstruction, or compression, I help them prioritize what matters most to them,
whether that is pain relief, survival, or functionality level. Some patients choose
to enroll in hospice with no further cancer directed treatment, while others may
choose to receive a short course of palliative radiation.”
Classically known as the therapeutic arm of radiology, radiation oncology
is a field where we can celebrate the successes of those that we can cure and be
thankful for palliative radiation’s ability to relieve suffering.
22
Bulletin | AUGUST 2016
Bibb Allen Jr., MD, FACR (President)
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