Download May 2011 - American College of Radiology

MAY 2011
VOL. 66 ISSUE 5
ADVOCACY • ECONOMICS • EDUCATION • CLINICAL RESEARCH • QUALITY & SAFETY
in this issue
13 TipsforEarningAccreditation
18 ClinicalTrialsAcrosstheGlobe
20 HowCanACRRegistriesHelpYou?
CHARTING
THE COURSE
AIRP DEBUTS ITS RADIOLOGIC PATHOLOGY PROGRAM
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The ACR advantage
• Unmatched imaging
review by radiologists
• Peer-reviewed,
educationally focused
• Designed by radiologists and
medical physicists
• Guided by expert technologists
• Multi-site, multi-modality pricing
The CMS countdown clock continues to tick. On Jan. 1, 2012, only
fully accredited providers of advanced diagnostic imaging services will
receive Medicare reimbursements. Start your application today to ensure
your facility meets the CMS deadline and continues to be competitive.
ACR accreditation is recognized as the gold standard in medical
imaging. To apply, visit acr.org.
Choose the Gold Standard. Choose ACR.
7647 5.11
ACR Board of Chancellors
John A. Patti, M.D., FACR (Chairman)
Bulletin
Paul H. Ellenbogen, M.D., FACR (Vice Chair)
James H. Thrall, M.D., FACR (President)
Contents Bulletin
MAY 2011 • VOL. 66 • ISSUE 5
Lawrence P. Davis, M.D., FACR
(Vice President)
Alan D. Kaye, M.D., FACR (Speaker)
Howard B. Fleishon, M.D., FACR
(Vice Speaker)
Executive Editor
Anne C. Roberts,
M.D., FACR
Lynn King,
M.P.S.
(Secretary-Treasurer)
features
Managing Editor, Editorial
Bibb Allen Jr., M.D., FACR
Cary Boshamer
Albert L. Blumberg, M.D., FACR (ASTRO)
Managing Editor, Production
James A. Brink,
M.D.,Colgan
FACR
Betsy
Manuel L. Brown, M.D., FACR
Senior Writer
Cheri L. Canon,
M.D. Keefer
Raina
Gerald D.
Dodd III,
FACR
Design
& M.D.,
Production
www.touch3.com
Burton P. Drayer,
M.D., FACR (RSNA)
Cassandra S. Foens,
M.D.,Us
FACR
Contact
ON COURSE
Nearly every radiologist has taken
the Radiologic Pathology Correlation
Course. This year, the course has been
organized through the American Institute
for Radiologic Pathology, a program
sponsored by the American
College of Radiology.
10 >> alsoinside
ToP.contact
a member
Donald
Frush, M.D.,
FACR of the
ACR Bulletin staff, e-mail
James H. Hevezi,
Ph.D., FACR
[email protected].
Bruce J. Hillman, M.D., FACR (JACR)
Richard T. Hoppe, M.D., FACR (ARS)
David C. Kushner, M.D., FACR
Paul A. Larson, M.D., FACR
Carol H. Lee, M.D., FACR
Deborah Levine, M.D., FACR
Jonathan S. Lewin, M.D., FACR (ARRS)
13
STEP BY STEP
What does it take for outpatient
service providers that bill under Medicare
Part B to get accredited? It may not be as
difficult as you think. But don’t delay, as
the deadline for accreditation is only seven
months away.
9
16
18
20
Lawrence A. Liebscher, M.D., FACR
Carolyn C. Meltzer, M.D., FACR
Cynthia S. Sherry, M.D., FACR
MCLC:RESEARCH
A
FROMRADIOLOGY’SNEXT
GENERATION
TATECHAPTERS:ADVOCATING
S
ATTHESTATELEVEL
CLINICALRESEARCH:
GLOBALEXPLORATION
EGISTRIES:GAUGINGPRACTICE
R
PERFORMANCE
Geoffrey G. Smith, M.D., FACR
departments
4
Executive Editor
Lynn King, M.P.S.
Senior Managing Editor
Betsy Colgan
Plug into the ACR. Be sure to visit us on:
Senior Writer
5
17
Brett Hansen, M.A.
Copywriter
Alyssa Martino
Design & Production
www.touch3.com
Contact Us
To contact a member of the
ACR Bulletin staff, e-mail
[email protected].
Check out the ACR Bulletin on your iPhone at
www.nxtbook.com/nxtbooks/acr/
acrbulletin_201105/ or download
the Nxtbook Newsstand iPad app.
For instructions, visit http://bit.ly/evbVj6.
www.acr.org
21
22
ROM THE CHAIR: MEDPAC’S
F
FANCY FOOTWORK
DISPATCHES
CONOMIC CHAIRMAN’S
E
REPORT: TRANSITIONING TO
ACCOUNTABLE CARE
TRANSITIONS
FINAL READ
FROM THE CHAIR
By John A. Patti, M.D., FACR
Chair, Board of Chancellors
MedPAC’s
Fancy
Footwork
Author’s Note: The
Medicare Payment
Advisory Commission
(MedPAC) held its
regular meeting on
February 23, 2011,
ostensibly to follow up
on recommendations
it had previously made to address the
in-office ancillary services exception that
permits self-referral of advanced imaging
in physician offices. It’s important that all
our members be aware of the ACR response
to this MedPAC meeting. Therefore, what
follows are direct excerpts of a letter written,
over my signature, to MedPAC Chair Glenn
Hackbarth, on March 15, 2011.
W
e are extremely concerned
with the tone of this
session because it focused
on payment cuts as a
way to solve the problem of self-referral.
You suggested that you are wary of
recommending sweeping solutions to the
problem of self-referral (such as bans)
“because the problem consists of a toxic
combination of self-referral, fee-for-service
(FFS) payment, and the mispricing of
services.” As we have said to MedPAC in past
correspondence, the ACR strongly disagrees
with the assertion that “mispricing” of
imaging services has driven the increase
in utilization and that these services “may
still be overpriced.” Further, we provided
MedPAC with extensive comments and
analysis to show how previously rapid
growth in utilization of diagnostic imaging
has been significantly tempered. In fact,
since 2007, the only segment of growth in
4 |
Bulletin | May 2011
imaging services involves imaging by nonradiologist physicians who self-refer.
The ACR applauded the June 2010
MedPAC report which noted that any
recommendations to control growth in
imaging should include critical review
of the current services exempted under
the in-office ancillary exception (IOASE)
with recommendations to severely
limit and/or regulate the practice of
self-referral. In the months leading up
to the February 2011 MedPAC meeting,
the ACR had been encouraged by the
amount of time and analysis devoted
to this issue by MedPAC staff and the
Commission, and fully anticipated a
workable solution would be offered.
Instead, we are now discouraged by the
unwillingness of MedPAC to definitively
and directly address the self-referral
problem. Rather, MedPAC has offered
draft recommendations that are nothing
more than a continued commentary on
the misperception that imaging services
are overpriced and that self-referral of
advanced imaging will cease if prices are
lowered. We view this as ignoring the role
that physician ownership plays in skewing
clinical decision making and increasing
utilization of imaging services.
Draft Recommendation 2: Congress
should direct the Secretary to apply
Multiple Procedure Payment Reductions
(MPPR) to the physician work component (of the Physician Fee Schedule) in
addition to the technical component.
The ACR does not believe that Congress
should be directed to apply the MPPR
to the physician work component. In
fact, there is no justification to apply
MPPR to the physician work component
and in 2010, CMS decided not to
extend its expansion of the MPPR on
the technical component to physician
work. We maintain that there are few, if
any, efficiencies in the physician work
component (PC) when two or more
interpretive studies are furnished to the
same patient by the same physician,
whether they involve contiguous or
non-contiguous body areas, the same or
different modalities, or single or multiple
sessions on the same date of service. Each
imaging study produces its own unique
and extensive set of images that must be
interpreted in their entirety, separately
dictated and communicated in separate
reports to the referring physician.
The 2009 GAO report referenced by
MedPAC mischaracterizes potential
savings based on duplication of pre-service
and post-service work. The GAO equates
less intense pre-service and post-service
work with more intense intra-service work,
which dramatically overstates the potential
efficiencies. This flaw in the understanding
of the valuation of physician work in the
MPFS casts doubt on the validity of the
entire GAO report.
In the Medicare Physician Fee Schedule,
physician payments for advanced imaging
modalities have been the focus of payment
reductions both legislatively and through
the regulatory process for several years.
These payment reductions are making it
increasingly difficult, even impossible, for
many radiologists to keep their offices and
freestanding imaging centers open in an
environment of steadily increasing practice
costs. We have noted that many freestanding imaging centers have been bought by
hospitals and, as transitioned physician
payment reductions are fully implemented,
we expect this trend to continue or escalate.
When non–self-referral outpatient offices
are owned by hospitals, examinations
performed at these facilities will be paid
under the HOPPS, which is currently, and
will continue to be, at a higher level than
the MPFS. Further cuts to MPFS advanced
imaging payments, in a misguided attempt
to mitigate self-referral, will only accelerate
the migration of radiologist office practice
to the higher cost hospital environment
and further encourage the self-referred
advanced imaging volume to increase. This
is a classic “lose-lose” strategy.
In closing we ask that you give our
comments careful consideration. We too
are concerned about inappropriate utilization and conflict of interest in ownership,
and we therefore urge the Commission
to choose the only effective, immediate
and rational solution: recommend that
Congress modify the current language of
the in-office ancillary exception (IOASE)
to exclude CT, MR, PET, and radiation
therapy from the definition of “ancillary”
in the Stark laws and regulations. //
dispatches
NEWS BRIEFS FROM THE ACR
AND AROUND THE STATES.
CALL FOR NOMINATIONS:
2012 ACR FELLOWSHIP
As a way to formally recognize members for
exceptional achievement in the radiology profession,
only 10 percent of ACR members have been
awarded Fellowship in the College. The deadline for
nominations for 2012 Fellowship from state chapters
to the College is June 30, 2011. Check with your
state chapter (a contact list is available at http://bit.
ly/fJJKtb) to determine their individual nomination
deadline. You can read more about
nomination guidelines and the review
process in the ACR Fellowship Guide,
available at http://bit.ly/hjVFQ6.
Nominees for Fellowship must
fall under one or more of the
criteria established in the bylaws for
nomination for ACR Fellowship. It is the
responsibility of the chapter to ensure
the accuracy of the information under
these criteria:
1. Service to the ACR at the national or
chapter level
2. The accomplishment of significant
scientific or clinical research in the
field of radiology or significant
contributions to its literature
3. The performance of outstanding
service as a teacher of radiology
4. Service to organized medicine in
local, state, or national medical
organizations
As chapters make their decisions, you should be
aware that there will be a new category of fellowship
this year. After the ACR Council acts to approve a
bylaws change agreed to last year, there will be a
category of fellowship for associate members with
more than 20 years of membership in the College.
These applications cannot be accepted prior to
Council action at the 2011 AMCLC; however, once
the bylaws change is adopted, these candidates
may also be considered for fellowship. To learn more
about ACR Fellowship, visit http://bit.ly/fD0J8k.
In 2010, Carol M. Rumack, M.D., FACR, ACR’s past president,
(left) presented Ruth C. Carlos, M.D., FACR, with ACR fellowship.
ACR Bulletin (ISSN 0098-6070) is published monthly, with combined issues for
July/August and November/December, by the American College of Radiology,
1891 Preston White Drive, Reston, VA 20191-4326.
From annual membership dues of $795, $12 is allocated to the ACR Bulletin
annual subscription price. The subscription price for nonmembers is $90. Application for periodical mailing privileges is pending at Reston, Va., and additional
mailing offices. POSTMASTER: Send address changes to ACR Bulletin, 1891
Preston White Drive, Reston, VA 20191-4326 or e-mail to [email protected].
Copyright ©2011 by the American College of Radiology. Printed in the U.S.A.
Opinions expressed in the ACR Bulletin are those of the author(s); they do
not necessarily reflect the viewpoint or position of the editors, reviewers, or
publisher. No information contained in this issue should be construed as medical or legal advice or as an endorsement of a particular product or service.
The ACR logo is a registered service mark of the American College of Radiology.
For information on how to join the College, visit www.acr.org, or contact staff
in membership services at [email protected] or 800-347-7748.
For comments, information on advertising, or to order reprints of the ACR
Bulletin, contact [email protected].
ACR Bulletin is published 10 times a year to keep radiologists informed on
current research, advocacy efforts, the latest technology,
relevant •education
Advocacy
Economics • Education • Clinical Research • Quality & Safety
courses and programs, and ACR products and services.
| 5
dispatches
In January, the African Society of Radiology (ASR)
held its first congress in Tripoli, Libya. Program
content included presentations on clinical radiology
applications for disease processes throughout the
continent, as well as socioeconomic, regulatory, and
radiation protection issues.
More than 100 participants from 19 countries in
Africa attended. Representatives from the ACR, the
International Society of Radiology (ISR), the Pan African
Congress on Radiology and Imaging Conference
(PACORI), the European Society of Radiology (ESR), the
European Congress of Radiology, and the Society of
French Radiology were also at the meeting.
The ACR was represented by Brad Short, senior
director of ACR Member Services and staff liaison for
the ACR Foundation International Outreach Committee
and the ACR Commission on International Relations.
Short gave an overview of the ACR Foundation
International Service program. Eric J. Stern, M.D., also
attended, providing clinical presentations on ultrasound
and an overview of the ISR’s Global Outreach Radiology
(GO-RAD) project. Stern is a professor of radiology at
the University of Washington in Seattle and editor-inchief of GO-RAD (www.isradiology.org/gorad).
“The attendees
were thirsty for
knowledge,
WEB EXCLUSIVE
often arriving
well in advance
You can view a video about the ASR’s
of sessions and
first congress at http://bit.ly/gNKadx.
staying late to
engage faculty,”
says Short. “This
FOURTH-YEAR RESIDENTS: DON’T LOSE
YOUR MEMBERSHIP
Residents making the transition from residency to
the radiology workforce will find that the ACR offers
valuable tools for transitioning into practice. Throughout their training, residents can take advantage of
the College’s resources, educational opportunities,
and networking prospects specifically designed for
members-in-training.
6 ||
Bulletin
Bulletin||May
May2011
2011
Courtesy Eric J. Stern
AFRICAN SOCIETY OF RADIOLOGY HOLDS
FIRST CONGRESS IN LIBYA
Attendees and presenters met at the First Congress of the
African Society of Radiology, held in Tripoli, Libya.
was an outstanding first congress, offering instructive
clinical courses, practical tips for improving radiological care in multiple settings, and opportunities for
networking.”
The meeting was hosted by Mohammad El-Fortia,
M.D., president of the Mediterranean and African
Society of Ultrasound, from Misurata Teaching Hospital in Misurata, Libya. Notable presenters included
ACR Honorary Fellows Hans Ringertz, M.D., Ph.D.,
and Prof. Guy Frija, M.D., as well as Michael Kawooya,
MbChB, M.Med, Ph.D., (PACORI founder), Nicholas
C. Gourtosyannis, M.D., Ph.D. (ISR president), Jan
Labusagne, M.D. (ISR president-elect), Claude
Manelfe, M.D., Ph.D. (former ISR president), and
Andras Palko, M.D., Ph.D. (ESR president). In addition,
Charles A. Gooding, M.D., FACR, received an honorary award from the ASR.
“The Libyan hosts were both gracious and generous in their hospitality,” says Short. The next meeting
of the African congress is scheduled to be held in
Alexandria, Egypt, in the spring of 2012.
As you develop your career and face new professional challenges, ensure that you continue to receive
your valuable ACR member benefits following residency. Simply click “My Profile” in the top righthand
corner of the ACR website (www.acr.org) and verify
that your contact information is up to date.
You will be able to access your mailing address,
phone, and e-mail address to customize the delivery
of your member benefits. For more information about
ACR member benefits, visit http://bit.ly/hUsXyI.
IMPROVING THE REVIEW PATH FOR
MEDICAL DEVICES
MEMBER RECEIVES CHICAGO RADIOLOGICAL
SOCIETY’S GOLD MEDAL
The FDA announced in January that it plans to review
its approval process for medical devices. The evaluation
includes making the 510(k) process, which requires
that manufacturers submit a premarket notification to
the FDA, more efficient by clarifying when review data
must be submitted, reported DiagnosticImaging.com.
The plan (outlined in an FDA press release available at
http://bit.ly/ga8tgd) seeks to achieve two goals: fostering device innovation and protecting patient safety. In
the release, Jeffrey E. Shuren, M.D., J.D., director of
the FDA’s Center for Devices and Radiological Health
(CDRH) expressed hope that the actions will result in “a
smarter medical device program that supports innovation, keeps jobs here at home, and brings important,
safe, and effective technologies to patients quickly.”
The review comes from the recommendations
of two working groups formed by the CDRH in
September 2009. The groups received public
input from industry, consumers, and health-care
professionals. Based on this input, the groups made
55 recommendations in August 2010. CDRH also
asked the Institute of Medicine, an independent
nonprofit organization, to review the current process.
Now, the CDRH has suggested 25 actions to improve
the 510(k) process in 2011, including new guidance
and more staff training. To read more about the CDRH
510(k) recommendations, visit http://bit.ly/dWdrd4.
Kate A. Feinstein, M.D.,
FACR, professor of radiology
and surgery at the University
of Chicago, received the
highest honor of the Chicago
Radiological Society (CRS).
The CRS Distinguished
Service Award (gold medal)
was awarded to Feinstein on
Feb. 17, 2011, in recognition
of outstanding leadership
in organized medicine
and dedicated service to
pediatric radiology.
As past president of both the CRS and the Illinois
Radiological Society, Feinstein is an active member
of her ACR state chapter and her local radiological
society. Feinstein has also served as an ACR alternate
councilor or councilor since 1998. She is a member of
the ACR’s Continuing Professional Improvement Expert
Panel on Pediatric Radiology (see www.acr.org/CPIExperts), the ACR Commission on Pediatric Radiology,
the Committee on Human Resources — Ultrasound,
and the Guidelines and Standards Committee of the
Commission on Pediatric Imaging. A past member of
countless other ACR committees and commissions,
Feinstein received fellowship in the ACR in 2002.
LEARNING FILE® ONLINE
PROVIDES CUSTOMIZED,
CASE-BASED EDUCATION
The ACR’s Learning File® Online
(LFOL) can assist radiology
resident groups or multimember
practices looking to sharpen their
clinical skills, prepare for the ABR
exam, or study for the Certificate
of Added Qualification exams.
The LFOL has a custom interface
and cases organized by curriculum. There are 12 subspecialty
areas and more than 3,600 cases
available.
You can choose specific
areas of focus or purchase
a subscription to all 12
subspecialties: body MRI, chest,
gastrointestinal, genitourinary,
head and neck, neuroradiology,
nuclear medicine, obstetric,
pediatric, skeletal, ultrasound,
and vascular interventional.
Subscription prices for one
specialty are $75 for ACR
members, $225 for nonmembers,
and $50 for residents. To view a
demo of the LFOL or packaged
pricing based on practice size, visit
www.acr.org/lfol.
An image from the ACR’s Learning File® Online, which can help hone your interpretation skills.
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 7
dispatches
MEETING MEANINGFUL USE CHALLENGES
Since the American Recovery and Reinvestment
Act was enacted in February 2009, the ACR IT and
Informatics Committee (ITIC), chaired by Khan M.
Siddiqui, M.D., and the ITIC Government Relations
Subcommittee, chaired by Keith J. Dreyer, D.O.,
Ph.D., have been active in the implementation
of the Medicare/Medicaid program providing
incentive for the
“meaningful use
(MU) of certified
electronic health
record (EHR)
technology.”
Under their
leadership, ACR
has participated
in more than 60
federal advisory
committee and
workgroup
meetings on MU
topics in two
years; met with
staff and advisors
from the Office
of the National
Coordinator for
Health IT (HIT)
(ONC); submitted
numerous comments, letters, and testimony to
relevant agencies; presented concerns to Congress;
provided information to media, industry, associations,
and individuals; and published regular online
articles about meaningful use. ACR also developed
regulatory analyses that continue to be used by
various organizations, including vendors, bloggers,
and third-party consultants.
The extensive efforts of the ACR and other
specialty societies throughout 2009 and 2010 have
resulted in significantly improved final rules in July
2010, which were far more flexible for specialists than
the proposed versions published in January 2010.
Despite these efforts, many challenges remain. For
example, the program is one-size-fits-all, which does
not translate well into specialized medicine. The ONC
regulations that define the technology requirements
are not always in step with the CMS regulations
that define MU requirements, requiring physicians
to implement technology they do not really need.
Hospital-based professionals, who are not technically
“hospital-based” per the regulatory definition,
are having difficulty working with their hospitals to
solve compliance issues. Additionally, radiology HIT
vendors are not yet seeking certification for their
products en masse, even though the opportunity is
there. Perhaps the most important concern, however,
is that MU does not currently ensure access to
diagnostic images and reports via EHR technology.
For comprehensive documentation, articles, and other
resources related to MU, visit http://bit.ly/gc8QWk.
//Calendar/
June
15–17FloridaRadiologicalSociety’s“Radiology:AreWetheNewEnemy?”Key Biscayne, Fla.
2–5SocietyforImagingInformaticsinMedicine
22–23MusculoskeletalUltrasoundforSonog11thAnnualMeeting,Washington, D.C.
raphers,Philadelphia
4–8SocietyofNuclearMedicineAnnual
25AmericanInstituteforRadiologicPathology
Meeting,San Antonio
(four-weekcourse),Silver Spring, Md.
9–115thAnnualBodyMRIUpdate,Atlanta
August
23–26ClinicalMagneticResonanceSociety
15thAnnualMeeting,Orlando, Fla.
5–7MusculoskeletalMR,Reston, Va.
11–12 BreastMRWithGuidedBiopsy,
July
Reston, Va.
9–10SocietyofBreastImagingPracticalBreast
MRI–Case-BasedReview,Baltimore
8 |
Bulletin | May 2011
//
AMCLC
Research From Radiology’s Next Generation
THE RFS LEFT ITS MARK AT THE 2010 AMCLC AND CONTINUES THE TRADITION IN 2011.
By Alyssa Martino
T
he AMCLC is quickly becoming
a rite of passage for residents,
given that the ACR’s RFS reached
a record attendance of 225 last
year. The growth in turnout, an increase
of approximately 25 percent, can be
largely attributed to Vanessa Van Duyn
Wear, M.D., chair of the 2009–2010 RFS
Executive Committee. In coordination with
the committee, and with support of ACR
leadership, Wear developed the inaugural
ACR-RFS poster session at AMCLC, which
returns — with several enhancements
— to this year’s conference. Allowing
residents to submit and present research has
singlehandedly provided a new way for them
to attend the AMCLC if they are not selected
to attend as a resident representative from
their state chapter.
As a result, more in-training members
receive direct exposure to the ACR. The
College also benefits by engaging members
earlier in their careers in volunteer work for
the community of radiology.
Wear recognized the impact attending
AMCLC could have on residents. “Once
residents attend the annual meeting and
learn about the College, they tend to
continue their involvement in the ACR,”
she says. “Residents are able to present their
posters, which will add to their resume
and give them a boost when applying for
a fellowship or job. More importantly,
attendees are able to see what the ACR and
the RFS do. Then they can take the lessons
learned home to their programs and spread
the word even further.”
The 2010 poster session was a success,
with 47 abstracts accepted on various
topics relating to the College’s five pillars:
advocacy, economics, education, clinical
research, and quality and safety. Notably,
nearly 65 percent of presenters were firsttime attendees. Modifications made to
this year’s session include a new location
for viewing posters and the addition of
electronic posters. Electronic posters
can be viewed throughout the meeting
via the AMCLC web portal (http://
amclc.acr.org), and print posters will
be displayed from Saturday, May 14, to
Tuesday, May 17, on the terrace level of
the Washington Hilton.
Wear believes that all ACR members
can benefit from viewing the research
displayed on the posters. “It’s great for the
attending radiologists and ACR leadership to see that residents are interested in
being involved in the College,” she says.
“Everyone knows that the residents of
today are the future of the College, and the
earlier we can get them involved and aware
of what the ACR does for radiologists, the
better,” she adds. Posters are judged and
selected for awards; some are even solicited
for submission to the JACR.
Scott Kennedy, M.D., M.B.A.,
submitted research to the
inaugural RFS poster session at
AMCLC about the benefits of
teaching residents in the emergency radiology department.
Vanessa Van Duyn Wear, M.D.,
former chair of the RFS Executive Committee, instituted a
poster session at the 2010
AMCLC to allow more residents
an opportunity to attend.
“Current residents will be our future
leaders in 15 to 20 years,” Wear says. “It’s
important for them to be exposed to
different facets of the College and figure
out their niche.” //
VALUED EXPERIENCE
In this Q&A with the ACR Bulletin, Scott Kennedy, M.D., M.B.A., a radiology resident at
NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York, N.Y., discusses
his experience at the 2010 AMCLC.
Q: What research did you submit to the 2010 AMCLC RFS poster session?
Kennedy: I presented a poster titled “A Novel Method for Teaching Medical Students Radiology at a Major Academic Medical Center.” It focused on how using medical students in
the emergency radiology section during weeknights and weekends was not only successful from an operational standpoint, as students triaged requests for imaging studies and
answered simple clinician questions while the on-call diagnostic radiology staff focused
on imaging study interpretation, but also from an educational perspective. In response to
a survey about their experience, 42.3 percent of current and former students stated that
this participation encouraged them to pursue diagnostic radiology as a specialty; 34.6
percent said the program had major or moderate importance in their specialty choice; and
76.9 percent described it as at least of moderate help to their medical career.
Q: What was your experience in attending the 2010 AMCLC as a resident?
Kennedy: The opportunity to attend the AMCLC as a resident was great. I was able to
meet a new group of residents who were also presenting their posters and learn about
each of their research projects. I attended many different lectures, including some on
physics, which I would soon be studying.
The best thing about the AMCLC, however, was sitting in on the different committee
meetings, chapter and society voting sessions, and other legislative programs. I had the
opportunity to see how the ACR functioned, what the important issues were, and how
they were being resolved.
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 9
ON
COURSE
10 |
Bulletin | May 2011
Residents from across the country
gather for AIRP’s inaugural Radiologic
Pathology Correlation Course.
By Brett Hansen
S
Photos courtesy Sylvia Johnson Photography
epia collages featuring Marilyn
Monroe, Alfred Hitchcock, and
James Cagney line the walls in
the lobby of the American Film
Institute’s Silver Theatre and Cultural
Center in Silver Spring, Md. They pose a
sharp contrast to stacks of reddish-brown
books, “Neuroradiology II: Test and
Syllabus (Professional Self-Evaluation
Program, 42),” piled on tables next to
the doorways leading into the theatre’s
auditorium. In a venue usually reserved
for entertainment, residents from
across the globe underwent an intensive
four-week educational experience from
Jan. 24 to Feb. 18, 2011 — the American
The new venue for the Radiologic
Pathology Correlation Course is the AFI
Silver Theatre and Cultural Center.
Institute for Radiologic Pathology’s
(AIRP’s) inaugural Radiologic Pathology
Correlation Course.
About nine months prior to the course,
the ACR’s leadership met with leaders and
faculty members from the Armed Forces
Institute of Pathology (AFIP), which had
sponsored a radiologic pathology correlation course, or “rad-path” course, for
residents for many years. The AFIP leaders
were concerned that the 2005 Base Realignment and Closure provisions that marked
the eventual end of the AFIP would also
signal the end of the rad-path course.
ACR leaders present at the meeting
included CEO Harvey L. Neiman, M.D.,
FACR; John E. Madewell, M.D., professor in the Department of Diagnostic
Radiology at the University of Texas M.D.
Anderson Cancer Center; Bill Shields,
J.D., LL.M., CAE, ACR’s general counsel;
and Ronald E. Freedman, M.B.A., ACR’s
assistant executive director for Education;
Marketing, Communications, and Public
Relations; and Publications. AFIP leaders
included Florabel G. Mullick, director
of the AFIP; Mark D. Murphey, M.D.,
current physician-in-chief of the AIRP
and former course director at the AFIP;
and William A. Gardner, M.D., executive
director of the American Registry of
Pathology.
Following the meeting, the ACR agreed
to sponsor the program and formed the
AIRP, which employs many of the former
AFIP staff. Additionally, the course itself
includes the same expert faculty who have
been developing new ways to help residents
get the most from their experience.
Changes and Improvements
Residents attending the AIRP wait for the
next lecturer in the AFI Silver Theatre’s
auditorium.
Donald E. Hatley Jr., administrator of
the AIRP, notes some of the changes that
occurred with the course, including the
Don E. Hatley Jr., administrator of AIRP, says that
now rad-path attendees
can submit their cases
electronically.
way case studies are submitted for review
by course section heads. Throughout the
course, staff and faculty use the cases to
help augment the presentations and syllabus. Residents can now submit their cases
electronically using the ACR TRIADTM
system, which enables the section heads
to review the cases and then provide the
residents with feedback more rapidly.
“In the past, they didn’t get feedback
until the third or the fourth week or maybe
even after they returned to their programs,”
Hatley says. In the future, he notes, the
section heads will be able to make more
detailed suggestions or solicit more information about the cases from the residents,
“which will make for better cases.”
The course also experienced a change
of location, moving from the Walter Reed
Army Medical Center campus to Silver
Spring. During the February course,
Hatley observed that attendees enjoyed
the new venue. “It’s more comfortable,
bigger, and has more access to things to
do when they get breaks for lunch and
things like that,” he says.
Waves of Content
Undoubtedly, there is much more to
the new course than comfortable seats
and nearby restaurants. Renee W. Bonetti,
M.D., and Tara B. Otto, M.D., both
third-year residents from the University
of South Alabama in Mobile, Alabama,
discussed the course’s content after having
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 11
COURSE
DATES
2011
July25–August19
September19–October14
2012
January23–February17
March5–30
April23–May18
July23–August17
September17–October12
attended for two weeks. Bonetti, who
plans to enter a fellowship in pediatric
radiology at Vanderbilt University, was
wowed by the lectures of Ellen M. Chung,
M.D., assistant professor of radiology
and nuclear medicine at the Uniformed
Services University of the Health Sciences
in Bethesda, Md. From the knowledge
she gained in Chung’s lectures, Bonetti
says that she would “show our techs how
to use ultrasound spectral Doppler for
diagnosing testicular torsion.”
Otto, who will be entering a fellowship in musculoskeletal radiology at the
University of Florida in Gainesville, Fla.,
enjoyed Murphey’s lectures on the topic.
She has also relished being able to “just sit
and learn” without having to worry about
being on call. “Plus, you’ll come back
smarter,” she says.
Other fans of Murphey’s lectures
were Ariel D. Prager, M.D., and Ronald
Winokur, M.D., third-year residents
from Thomas Jefferson University
in Philadelphia. “He broke the
information down for us and
helped clarify differences and
similarities,” notes Prager, who
hopes to become a dual fellow in
both neuroradiology and musculoskeletal radiology. “It’s good
to see [the information] all in a
condensed atmosphere rather than
spread out over several years,”
adds Winokur.
Engaging the Audience
Understanding how to help the
residents both enjoy and learn from
the lectures is no easy task, explains
Aletta Ann Frazier, M.D., an associate professor of radiology at the
University of Maryland School of Medicine
in Baltimore and an AIRP faculty member
specializing in chest radiology. Frazier,
who has lectured and created medical
illustrations for the rad-path course since
1998, also emphasizes the importance of
images in her presentations.
“I have learned over the years that the
fewer bulleted slides and the less wording
that I put up there and the more that I
include an excellent radiologic image and
a pathology image together, the more
receptive the audience is,” she says. “And,
you have to know the image well, know
the pathology, and make the connection as
best you can for your audience as to why
the image looks [a certain] way.”
Some concepts, Frazier notes, are
complicated and require an image that
“idealizes and distills as a unified graphic.”
For those concepts, or even perhaps to
WEB EXCLUSIVE
Watch residents from across the
country describe their experience at
AIRP’s inaugural rad-path course. Visit
www.airp.org. Also, take a sneak
peek at the MSK portion of the course
syllabus at http://bit.ly/hkMH1a.
12 |
Bulletin | May 2011
Renee W. Bonetti, M.D., (left) and
Tara B. Otto, M.D., residents from
the University of South Alabama in
Mobile, Ala., appreciate the insights
that they have gained from several of
the lectures.
Ariel D. Prager, M.D., (left) and
Ron Winokur, M.D., residents from
Thomas Jefferson University in
Philadelphia, enjoy the rigorous
atmosphere of the course.
summarize the most important parts of
the lecture during the remaining minutes,
Frazier will create an illustration that
brings everything together.
“I try to emphasize that there should be
an organic connection between what the
pathologists are seeing and what [radiologists] are appreciating because we are both
doctors,” she says. “We’re both trying to
come to the best conclusion in terms of what
is the best diagnosis. So I try to drive my
lectures a little more like that as opposed to
just the facts.”
Frazier believes that the ACR’s support
and resources will help improve the course
and better illustrate the connection between
radiology and pathology through the
enhanced use of mobile devices like the iPad,
tutorials, and active audience participation.
“In a way, this is a perfect learning lab for
postgraduate medical education,” she says.
While engaging lectures, increased
student interaction, and the electronic
submission of case studies all made for a
successful first course, the AIRP will only
continue to improve, notes Hatley. Some of
these enhancements will include a broader
use of such social media tools as Facebook
and Twitter, as well as the wide distribution
of the AIRP Luminary (www.airp.org/
newsletter.html), the program’s quarterly
newsletter, which features course-related
news and information for residents, alumni,
and faculty. These tools can even help
residents learn more about nearby restaurants or events in Maryland or Washington,
D.C., during their attendance. For more
information about the rad-path course, visit
www.airp.org. //
on-breast
ACR’s director of n
ion provides
imaging accreditat
w to get
some tips about ho
ly and quickly.
accredited smooth
By Matthew Robb
tion
accredita
A
cross the nation, hundreds of outpatient service
providers of CT, MRI, breast MRI, nuclear medicine,
and PET exams that bill under Medicare Part B are
scrambling to meet the Jan. 1, 2012, deadline for CMS
accreditation. With the stakes high and the deadline just seven
months away, delay is no longer an option. Facilities that fail
to receive accreditation will lose reimbursement, CMS officials
warn, and there will be no “under review” status grace period.
Nevertheless, many procrastinating providers have discovered
that becoming accredited is not as difficult as they originally
perceived, if they follow a few common-sense guidelines.
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 13
According to Krista M. Bush, M.B.A.,
RT(R)(CT)(M), ACR’s director of
non-breast imaging accreditation,
facilities typically find that getting the
process started is the hardest part. Step
one is to review the ACR requirements
online. Read, outline, and plan, Bush
encourages, but do not postpone.
“Even if funding hasn’t been secured,
providers can review ACR web pages on
accreditation right now,” she says. “Our
online application is quick and easy. All
we need is information on demographics
and modalities, payment of fee, and
signing of our legal agreement.”
There are no surprises with ACR
accreditation. “Right up front, we
outline what we are looking for and
give providers every resource needed to
succeed,” Bush notes.
Another immediate step providers
can take is to begin reviewing clinical
protocols with their supervising
14 |
Bulletin | May 2011
physician. Staff also can start reviewing
clinical images and can submit images
taken up to two months prior to their
application date. Similarly, providers can
schedule a medical physicist to perform
Facilities that fail to
receive accreditation will
lose reimbursement, CMS
officials warn, and there
will be no “under review”
status grace period.
phantom exams within the same twomonth window. “In some cases,” Bush
explains, “availability of medical physicists
or MR scientists may be temporarily
limited due to supply and demand.
Always plan ahead.”
Be Prepared
The ACR’s accreditation review period
takes approximately 90 days from the
date College staff receive a facility’s
testing materials until the final report is
issued, but facilities should not underestimate the preparation needed on their
end, Bush cautions. “This planning and
preparation process is critical, and it does
take time,” she says. “For some facilities,
the accreditation process — from start
to finish — may take four to six months.”
Additionally, if ACR reviewers find
deficiencies in the images, providers will
need additional time to correct errors
and reapply.
The accreditation timeline is further
complicated when facilities don’t turn their
requested materials in on time, Bush states.
For example, when the ACR accreditation
team sends out testing materials, facilities
are given 45 days to return them. “However,”
she says, “some facilities are putting it
“Radiologists wouldn’t believe how many
failing facilities have the supervising physician
call us and say, ‘You know, I didn’t even look at
the clinical images we sent you.’”
— Krista M. Bush, M.B.A., RT(R)(CT)(M)
off and taking 60 or even 90 days to
submit their testing materials. If we find
deficiencies, correcting those problems
could take another 30 to 60 days. That’s
why we tell facilities to get a completed
application to us no later than six months
before the deadline.”
Accreditation can also be stalled
because of slight errors. An eager service
provider may complete the online
application promptly but forget to sign the
legal agreement, fail to include payment,
or err in identifying the correct modalities.
In all cases, accreditation is delayed.
Bush encourages service providers to
read all documents with care and triple
check all submissions. “The ACR Clinical
Image Quality Guide makes it very clear,
for example, that under ‘Adult CT Head,’
we require contrast,” she notes. But,
“despite cautioning applicants, some
facilities are sending us head images
without contrast.” The requirements
are precise but ultimately help facilities
provide high-quality care.
When the ACR accreditation team
finds a deficiency, the service provider
must correct the identified problem, pay
another fee, receive new testing materials,
fill out and resubmit the new tests for ACR
reviewers to reassess the new images, and
wait for the final report. All of these issues
can cost a facility precious time.
Make It a Team Effort
Considering the time limits and
potential delays associated with
accreditation, “Physicians should be
proactive and involved in [the process],”
Bush explains. “This is a team effort that
requires strong oversight. Radiologists
wouldn’t believe how many failing
facilities have the supervising physician
call us and say, ‘You know, I didn’t even
look at the clinical images we sent you.’”
Before an imaging provider begins
the accreditation process, Bush advises
that the entire team sit down with
the supervising physician and/or
radiologist to ensure internal protocols
are consistent with ACR-approved
protocols and that every single image
submitted for review is approved. “If
providers’ protocols do not meet ACR
requirements, they should revise them,
scan several patients per these approved
protocols, and submit the new studies for
review,” she says.
As the team works together to
get accredited, Bush recommends
designating one point of contact to avoid
miscommunication. Additionally, “when
one person is responsible for the entire
process, there is real accountability,”
she says. “We advise against having one
person in charge of the clinical images, a
second person in charge of the phantom
images, a third person in charge of
submitting the package, and so on.
Accreditation is a team effort, but having
one point of contact is good practice.”
Dispelling Misconceptions
Some imaging providers may believe
they’re required to submit a random
sample of their work or a series of exams
from a specific day. Not so, says Bush.
“In ACR’s instructions, we make clear we
want only your best work,” she explains.
“Facilities select their own images — from
any day or time starting from two months
prior to submission of application up to
the 45-day window they have to submit
their testing. These images can be from
WEB EXCLUSIVE
Want to learn more about the process? View
ACR’s free webinars about accreditation for
breast MRI (http://bit.ly/ec0pli), nuclear
medicine/PET (http://bit.ly/f756zG), or CT
(http://bit.ly/dSJFrH). Presentation slides
are available for download at
www.acr.org/accreditation.
any part of that period, but the clinical
and phantom images must be within a
two-month time frame.”
Another misconception about
ACR accreditation involves all-body
imaging. Bush says, “If a facility has a
CT scanner that provides imaging of
all organ systems, the staff will select
exams reflecting those modalities. Still,
ACR does not ask for a large number
of exams.” If providers determine
their current work does not meet ACR
standards, Bush says they can start
by improving their image quality and
submit those [images] for review.
And the College does more than just
provide the paperwork for facilities. It
also serves as a resource with a dedicated
team to answer accreditation questions.
If providers get stuck somewhere in the
accreditation pipeline, the worst thing
they can do is put off asking ACR staff
and try to figure it out themselves, Bush
says. “[Providers] need to call us right
away,” she continues. “We provide topnotch, real-world technical expertise.
Contact us by phone [800-770-0145].
Our registered technologists can help
providers get back on track fast.”
By visiting www.acr.org/accreditation,
facilities can find how-to information,
fact sheets, and insider tips, all clearly
written and logically organized to walk
accreditation-seekers from first steps
to successful completion. “If anything
is late or missing, we send out three
reminders,” Bush notes. “When a facility
nears expiration, we alert them about that.
The College’s process is comprehensive,
proactive, and transparent. That’s the ACR
difference. And that’s why the ACR is the
gold standard in accreditation,” she says. //
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 15
//
STATE CHAPTERS
Advocating at the State Level
LOCAL ADVOCACY CAN HELP ADVANCE IMPORTANT ISSUES AND UNIFY
RADIOLOGY COMMUNITIES.
ByEugeniaBrandt
T
he recession may be over statistically, but it certainly does not feel
that way in state capitols, where
legislators struggle to balance
budgets and revenue shortfalls. Fall 2010
elections have tipped the balance of power
in many states. North Carolina is one
such state; after 104 years with a Democratic majority, it has turned Republican.
Christopher G. Ullrich, M.D., FACR, from
Charlotte Radiology in N.C., chair of the
ACR’s State Government Relations Committee, discusses how running a successful
state political action committee (PAC) has
helped his state chapter advance the issues
important to radiology.
Christopher G. Ullrich,
M.D., FACR, says that
even 10 minutes with
a legislator can help
advance issues critical
to radiologists.
Q
What have you learned from running a successful state PAC?
Ullrich: First, I want to emphasize that any
state chapter that wishes to establish a PAC
needs to have federal tax-exempt status as a
501(c)(4) or 501(c)(6) entity, which is how
the North Carolina Radiological Society
is organized. On the other hand, a state
chapter that has 501(c)(3) exempt status
as a scientific, educational, or charitable
organization cannot facilitate any political
activity — and thus cannot start a PAC.
Additionally, good state PACs are careful to
follow state election law.
The impetus for the North Carolina
chapter taking a serious look at running a
state PAC was the “Hillary Care” legislative
proposal in 1992. At that time, we started
focusing on the legislative processes and
our limited ability, as a profession, to gain
access to the decision makers within the
legislative machine. We found out that
16 |
Bulletin | May 2011
it mattered who had been elected,
whether or not they understood or
supported your perspective, or even if
you had an opportunity to engage in
dialogue with them about it.
At the same time, we recognized
that we could not always look to the
state medical society to represent us
effectively on all issues; we needed to
have an independent voice. We knew
that if we took the time to build an effective
network, other stakeholders would have to
take us more seriously and we could work
with the medical society, while working
independently when our priorities differed.
Q
What contributed to the success of
your efforts?
Ullrich: Early on, the state radiological
society recognized that running a single,
state-wide PAC was a less effective strategy,
so we focused on developing local PACs
controlled by radiologists who actually
contributed funds and had a say in how
they were applied. Over the years, we have
supported local candidates so that we have
a series of good decision makers within the
legislature. When you are considered a key
stakeholder, you are invited to the table at
the start of the discussion, so radiologists
have a chance to influence all big decisions
related to imaging.
Q
What would you recommend to
societies seeking to establish a
state PAC?
Ullrich: Keep your PACs local. I believe
our model functions well and can be
implemented elsewhere. The key is finding
a good, knowledgeable lobbyist or legislative representative. There may be firms
willing to take your money, but you have to
find somebody genuinely devoted to your
issues. Since 1992, we have been fortunate
enough to work with John T. Bode, an
attorney in Raleigh, N.C. In the political
process, one must be able to marshal
political funds, build relationships with
legislators, and have effective representation
throughout the entire legislative process.
Having good guidance as you navigate the
legislative process is absolutely crucial.
Q
Were there any surprises?
Ullrich: Something we didn’t envision that
has been constructive is the open dialogue
we have with hospitals, state hospital
associations, and other stakeholders. As we
all worked together to develop common
legislative interests and engaged other
groups, radiology raised its profile as a
hospital-based physician specialty.
Q
Many of your colleagues who are
American College of Radiology Association (ACRA™) members contribute
to a bipartisan political action committee
(RADPAC). Is there reluctance to also
contribute to a state PAC?
Ullrich: Federal PACs and state PACs are
very different arenas. It’s possible to have
a bigger impact on the local level with
a relatively small investment; in a state
campaign, a check for $10,000 is an impressive contribution as compared to at the
federal level, where candidates must raise
millions of dollars. Moreover, RADPAC
cannot be tapped for some issues that arise
in the states. //
Eugenia K. Brandt ([email protected])
is the assistant director of state affairs
in the ACR Government Relations and
Economic Policy Department.
Transitioning to
Accountable Care
FEE-FOR-SERVICE PAYMENTS MAY BECOME A THING OF
THE PAST. WILL YOU BE READY FOR THEIR REPLACEMENT?
I
magine our health-care system without
fee-for-service (FFS) payments. Unlikely
in the near term? Perhaps. But doing
away with FFS as we know it is currently
on the minds of many health-care policy
makers. The Medicare Payment Advisory
Commission (MedPAC)
began discussing FFS’s
fallacies in 2008, and the
Patient Protection and
Affordable Care Act mandates that the CMS begin
investigating as soon as
2012, using Medicare
shared-savings programs, also known as
accountable care organizations (ACOs), for
physician reimbursement.
While proponents of accountable care
suggest that an integrated service model is a
revolutionary concept, others counter that
ACOs are little more than the HMOs and
other forms of managed care that did not
catch on in the 1990s. But this time around,
there seems to be more determination than
ever to move away from the FFS-payment
system. Given the struggling economy,
aging baby boomers, and tighter budgets,
such government organizations as CMS,
MedPAC, and the Government Accountability Office are looking for savings and
ways to shift relative values to other areas of
the fee schedule.
Historically, the FFS payment system
has been a friend to radiology, yet over
the past few years, FFS payments for
radiology have been significantly cut.
Federal legislation has mandated specific
technical-component (TC) payment
reductions through the Deficit Reduction
Act of 2005, changes to the equipmentusage assumption, and multiple-procedure
payment reductions (MPPR). CMS has
unilaterally expanded the MPPR for the
TC. Additionally, professional-component
payments for radiology services have
been reduced by Current Procedural
Terminology® code bundling, adverse
coverage decisions for new radiological
services, and arbitrary payment reductions
counter to recommendations from the
Relative Value Scale Update Committee.
As always, the ACR economics team
continues to vigorously defend the values of
our FFS payments, but we are also developing recommendations about how radiology
will fit into the proposed integrated service
models. An ACR white paper in the May
issue of JACR reviews the ACO concept and
discusses ways radiologists can participate
and add value to these entities.1
In an ACO, a variety of payment models
based on sharing risk could be used for
payments to physicians. FFS payments
with incentives for pay for performance
could be one such model; however, this
offers payers and providers the least opportunity for sharing risk. The potential for
shared risk and gain increases if an ACO
receives payment for an episode of care in
which reimbursement for the hospital stay
and all physician services is bundled into
a single payment. The highest degree of
sharing risk with payers would occur when
the ACO enters a capitation arrangement
with the payers and agrees to provide all of
the care for a group of beneficiaries for a
set payment. Radiologists may be asked to
participate in an ACO under any of these
payment models.
While it’s likely that contracts for
radiologist participation in ACOs will be
made on a case-by-case basis, the ACR
is working to establish guidelines to help
members stay informed. We believe that
to be most effective in an accountable-care
environment, radiologists will need to bring
more than their interpretive skills to the
table. Providing an ACO with important
noninterpretive services, such as utilization
management, management of quality and
radiation-safety programs, management
of IT systems, and even total department
management, is a way for radiologists
not only to add considerable value to the
enterprise but also to enhance the stature of
radiology within the system.
ECONOMIC <<
CHAIRMAN’S
REPORT
By Bibb Allen Jr., M.D., FACR
Accurate, timely interpretations will be
requisite in any payment model, but image
interpretation can easily be outsourced, and
if our interpretive skills are all that radiologists bring to the ACO, we will be able to
compete only on price. If that scenario
becomes the dominant model, our specialty
risks commoditization. On the other hand,
if radiologists are willing to provide these
important noninterpretive services for the
ACO, the entire organization benefits, which
enhances both radiologists’ value to the
ACO and their ability to play a key role in
the ACO’s structure and governance.
Changing the focus from productivity
based on managing the PACS work list to
becoming effective managers and performing other essential noninterpretive work may
require a cultural shift for some because,
historically, many have perceived noninterpretive work as “no-pay” work that interferes
with interpreting examinations. However, in
an ACO environment, our incentives will be
different, and radiologists’ value will not be
based just on the volume of interpretations.
I recently heard someone remark, “Most
practices will change only when the pain
of changing is less than the pain of not
changing.” This perception may be based on
the notion that a change in focus away from
the volume of interpretations may not only
be counterintuitive but also counterproductive. In last month’s column, I discussed Dr.
Donald Berwick’s concept of an “escape fire”
for health care, emphasizing that effective
solutions will likely seem counterintuitive.
But noninterpretive work performed by
radiologists will bring significant value to
the health-care enterprise and could become
radiology’s escape fire in transitioning to
new payment systems. //
ENDNOTE
1. Allen, B. “ACR White Paper: Strategies for
Radiologists in the Era of Health Care Reform and
Accountable Care Organizations: A Report From the
ACR Future Trends Committee.” JACR 2011;5:309–317.
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 17
//
CLINICAL RESEARCH
Global Exploration
ACR’S CLINICAL RESEARCH STUDIES ARE BECOMING WELL ESTABLISHED
ALL OVER THE WORLD.
By Nancy Fredericks and Julie Catagnus
R
TOG® and ACRIN®
globalization initiatives
have resulted in the groups’
establishment of clinical trials
in countries on all but two of the world’s
continents. Two physicians, Susanna M.
Lee, M.D., Ph.D., a diagnostic radiologist
at Massachusetts General Hospital in
Boston, and Benjamin W. Corn, M.D.,
director of the Institute of Radiotherapy
at the Tel Aviv Sourasky Medical Center
in Israel, have played key roles in ACR’s
research abroad and understand the
benefits and challenges involved with its
globalization.
As chair of the ACRIN Gynecologic
Committee, Lee was instrumental in
opening five sites in Korea for a trial
evaluating FDG-PET/CT for staging
advanced cervical and endometrial
cancer (GOG-0233/ACRIN 6671). Corn,
a U.S.-trained radiation oncologist
and the RTOG’s Non-North American
Membership Committee Chair, has
initiated and championed several
Susanna M. Lee, M.D., Ph.D.,
emphasizes the efforts of ACRIN’s
leadership to lay important
groundwork in a country before
clinical trials began.
18 |
Bulletin | May 2011
“Language has posed the greatest challenge,
as English is often not the primary language of
overseas scientists or their support staff.”
—SusannaM.Lee,M.D.,Ph.D.
international institutions’ participation
in numerous RTOG trials.
“Outreach to foreign sites improves
our chances to accrue patients with
certain diseases, such as advanced
cervical cancer, which has dramatically
declined in the United States but remains
the most prevalent female pelvic cancer
overseas,” Lee says. Visits by ACRIN’s
leadership to Korean medical centers laid
the groundwork for their radiologists
to understand ACRIN as an imaging
clinical-trials organization. As Lee points
out, “this concept of a group — in which
radiologists, rather than oncologists, are
running the trials, and questions being
Benjamin W. Corn, M.D., says that
clinical trials have made drug therapy
more readily available in different
countries.
asked are relevant to imaging issues — is
unique to the United States.”
An additional focus is involving
foreign researchers on scientific
committees, which can help principal
investigators design trial concepts that
more effectively meet a location’s needs.
For example, England and Japan are now
represented on the ACRIN Gynecologic
Committee, and Lee hopes to add a
member from Brazil.
“The accelerated accrual derived from
international collaboration is vital,”
Corn states, “especially as increased
understanding of disease pathobiology
leads to the use of targeted therapies and
reduces the numbers of patients meeting
the narrower group definitions.” Corn
also emphasizes the country-specific
genetic patterns of disease presentation,
such as the different behavior of lung
cancer in Japan and the distinctive
distribution of breast cancer type 1
susceptibility protein gene mutations in
Ashkenazi Jewish women with breast
cancer, as reasons to test whether
therapies that work well in the United
States are as effective in other countries.
“A single-country trial with a positive
result is often met with skepticism about
whether the conclusions reached can be
successfully applied to other countries,”
adds Corn. “An international distribution of patients in a trial enhances the
feasibility and efficacy of the research,
and increases the likelihood of its
conclusions being accepted,” he says.
Considering Language
and Culture
“Language has posed the greatest
challenge [to international research], as
English is often not the primary language
of overseas scientists or their support
staff,” Lee says. Additional time is needed
to become familiar with each country’s
culture and attitude, both of which affect
conducting a specific trial.
An example of some of the language
and culture difficulties faced, according
to Corn, is translating quality-of-life
data collection tools from English into
Hebrew. It’s an expensive process because
of the need to validate that the intent of
the original text is maintained.
Additionally, sending human
tissue in connection with protocols
of biomarker research requires very
detailed justification. As Corn reflects,
“this heightened concern is a reaction to
the unethical medical studies conducted
on Jews during the Holocaust. The strict
guidelines, while deserving of respect,
can create difficulties in establishing
state-of-the-art research studies.”
Foreign Perspectives
Institutions that are both credentialed
by U.S. research organizations and meet
their standards are viewed with respect
internationally, which is a motivating
factor for institutions overseas to enroll
in U.S.-based trials, Corn points out.
“There was a ripple effect throughout our
institution when we began to implement
the rigorous RTOG imaging standards
and quality assurance procedures,” he
says. “Our staff took up the challenge
to apply these standards to the care of
all patients whether or not they were
enrolled in an RTOG trial.”
Participation in global trials can
also make expensive treatment more
accessible. Corn cites the example of
research showing a survival benefit for
patients with glioblastoma from adding
temozolomide to traditional surgery and
radiation. “Because governmental funding for this drug was not yet available,
Israeli families affected by this serious
brain tumor who could not afford the
drug faced some disturbing dilemmas,”
Corn says. His institution’s approval as
a site for RTOG 0525 provided access to
the drug for anyone meeting the trial’s
eligibility criteria.
Despite the benefits of making
expensive medications and treatments
available, the increasing use of modalities
combining drug therapy with radiotherapy creates a reliance on the manufacturer
and its willingness to supply the ancillary
drug. In fact, not all companies will
provide the drug at no cost to countries
outside the United States. “Not only
does this create financial hardships for
patients, but our [international review
board] won’t approve a trial unless all
citizens have equal access to the study
drug,” explains Corn.
“There was a ripple
effect throughout our
institution when we
began to implement the
rigorous RTOG imaging
standards and quality
assurance procedures.”
—BenjaminW.Corn,M.D.
Regulatory issues pose another burden
that is often beyond the researchers’
control. “[The National Cancer Institute]
has worked to break down barriers to
obtain approval of imaging agents from
FDA-counterpart foreign agencies,”
Lee explains. “Challenges remain for
exporting trials involving a new drug or
imaging agent.”
Exchanging Ideas
Although many challenges are
encountered in an international
environment, radiologists and nuclear
medicine physicians join an international
trial or organization for a variety of
reasons. According to Lee, “In addition
to academic prestige, there is excitement
about working on the research of the
future — a frontier to be explored. The
interactions researchers experience as part
of a worldwide effort give them a sense of
what’s going on in other regions without
having to be constantly globe trotting,”
Another contributor to worldwide
collaboration are international meetings. “International meetings have also
made it easier to put a face to a specific
procedure or country site,” Lee says. The
meetings foster collegiality within both
the radiology and gynecologic research
communities, which Lee believes helps
to establish research sites and disseminate ideas. Opportunities for imaging
research have steadily grown worldwide,
as evidenced by the fact that Japan now
has the highest density of CT scanners
per capita in the world.
Despite regulatory issues affecting the
questions that can be asked in foreign
research, there is more access to some imaging agents and a research environment
that encourages different ways of thinking.
“Imaging research has truly become an
international venture,” Lee says.
One point to consider when invited to
speak at other institutions considering
RTOG trial participation, Corn says,
is not to sign on to too many trials at
once. “It is important to choose wisely
based on whether you have the patient
population and the resources necessary
to be successful.”1
The dynamic cross-fertilization of
ideas that occurs across countries has
been enhanced by greater sophistication
in communications technologies. Corn
attributes this collaborative spirit to
the medical visionaries among RTOG’s
management. “RTOG has been able
to ride its leadership crest with grace,”
he notes. “There is a definite openness
about sharing ideas and learning from
each other. The focus is on working
together toward achieving a common
goal: eradicating cancer.” //
Nancy Fredericks, M.B.A. (nfredericks@
acr.org) is communications director, ACR
Clinical Research Center.
Julie Catagnus is a freelance writer.
ENDNOTE
1. Corn, B.W., et al. “Globalization of the Radiation Therapy Oncology Group: Implementation of
a Model for Service Expansion and Public Health
Improvement.” Journal of Clinical Oncology
2008;26:1160–1166.
Advocacy • Economics • Education • Clinical Research • Quality & Safety | 19
//
REGISTRIES
Gauging Practice Performance
HOW DOES YOUR PRACTICE MEASURE UP? FIND OUT WHEN YOU BENCHMARK
YOUR DATA THROUGH ACR REGISTRIES.
ByAlyssaMartino
D
espite hundreds of
medical standards and
guidelines, not every
practice is identical in its
delivery of services. How many patients
receive biopsies after a certain imaging
procedure? How much radiation is
emitted during a CT of the abdomen?
Knowing the answers to these questions
is essential, but even more important is
knowing how your practice data compare
with data from other facilities nationwide
and in your region. ACR registries —
databases that store details about various
practices related to radiology — provide
this invaluable information.
Gale A. Sisney,
M.D., whose facility
participates in the
National Mammography
Database, thinks
benchmarking is critical
to improve patient care.
Richard L. Morin, Ph.D.,
FACR, is chair of the ACR
Dose Index Registry.
Currently, the ACR National Radiology
Data Registry™ serves as a data warehouse
for several registries run by the College.
(Visit http://nrdr.acr.org to learn more.)
Though each of the databases collects
information that can help with improving
overall quality, two particular registries
revolve around topics that have received
intense media and public attention: the
Dose Index Registry (DIR) and the National Mammography Database (NMD).
Reviewing Dose Metrics
Patients and physicians alike are
talking about radiation safety. With
concerns over CT at the forefront of
20 |
Bulletin | May 2011
national news, the DIR can help provide
reassurance over the safety of ionizing
radiation emitted from CT machines.
“The DIR is a tool that will allow
individuals and institutions to understand
their dose index relative to other similar
institutions in their area and across the
country,” explains Richard L. Morin,
Ph.D., FACR, from the Mayo Clinic in
Florida, and chair of the ACR Dose Index
Registry. “If a facility’s dose index for a
head CT is six deviations above the mean,
[the DIR provides] an opportunity to
determine the variation and the practice
can make adjustments.”
Accuracy is a key benefit of ACR
registries, including the DIR, because
they primarily gather data electronically.
(Though other ACR registries involve
some manual entry of data, the DIR
is solely electronic.) “Humans will
make transposition errors so that
approximately 20 percent of the time the
resulting data aren’t really reflective of the
practice,” Morin explains. “The DIR captures all CT scans done off a scanner so
we can see a true snapshot of a particular
practice and a specific machine.”
Additionally, many practices
participating in the pilot DIR have formed
CT oversight committees to examine the
appropriate use of the modality. “[The
existence of these committees is] very
comforting to patients who are concerned
about dose,” says Morin.
To date, the DIR, which has been in a
pilot project phase since February 2010,
has been successful in practice and vendor
participation. “We’ve been in touch
with vendors since early development
of the DIR and have found them to be
cooperative and interested,” says Morin.
And when the DIR officially launches at
the 2011 AMCLC, Morin believes that
awareness will sharply increase.
“We’re heading toward one common
idea: you need to have metrics to deter-
mine if you’re practicing in a high-quality
manner,” says Morin. “But you have to
be able to compare [those metrics] to a
large, national database to say that you’re
practicing in concert with your colleagues.” According to Morin, if you find
out you’re not in line with national data,
then a new question arises: “What can I
do to bring that metric more in sync with
the rest of practitioners?”
Seeking Mammography Standards
Like radiation dose, mammography has
grown as a center of patient questioning
during the past few years. According to
Gale A. Sisney, M.D., from the University
of Wisconsin in Madison, whose facility
participates in the NMD, “We really need
to look at our practices and evaluate how
patients are affected. My practice decided
to participate because we believe it’s very
important for us to be able to compare
our practice with national and regional
standards.”
Sisney’s practice recently submitted five
years’ worth of data to the registry. “We’re
constantly doing quality-improvement
initiatives, but this is the first time we’ve
benchmarked against national standards,”
she says.
Currently, Breast Imaging Centers of
Excellence (that have earned accreditation
in all of the ACR’s voluntary breast-imaging accreditation programs and modules)
are offered a special discount to enroll in
the NMD. For more information, e-mail
[email protected].
Another reason to get involved is that
all NMD participants receive reports that
meet and exceed the FDA’s audit requirements under the Mammography Quality
Standards Act. “I urge all facilities to join,”
concludes Sisney. “We all need to show
how well our practices are performing
and stand together on these issues. We
can only do that if most practices decide
to participate.” //
TRANSITIONS
CALIFORNIA-INLANDEMPIRE Interventional Radiologist - 21-member
radiology group seeks BC interventional
radiologist for general radiology/light call.
Flexible work schedules with ability to
work from home part of the time. Short
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benefit package. Easy drive to mountains,
ocean, & lakes. Contact: Joseph Wheatley
at 909-570-3107 or by email at jwheatley@
ren-rad.com.
MARYLAND-WASHINGTOND.C.
- General & Interventional Radiology Looking for radiologist with interventional
skills to cover coastal hospital 1.5 hours
from main Washington, D.C. hospital.
Interested in living in the general region of
hospital; enjoy developing an interventional
practice to include local hospitals. The
smaller hospitals are supported by PACS.
Contact: Laurie Hunt at 301-652-5771 or by
e-mail at [email protected].
CONNECTICUT-NEWHAVEN - Radiology
Administrative Fellowship - Apply now for
Yale School of Medicine Dept. of Diagnostic
Radiology 2-year fellowship, in July 2012
or July 2013. Complete the Yale School of
Management MBA Leadership in Healthcare
program while remaining clinically active.
Salary plus tuition reimbursement. Contact:
Howard Forman, M.D., at howard.forman@
yale.edu or visit http://www.med.yale.edu/
diagrad/contactus/forman.html.
NEWJERSEY-CLINTON - BC/BE
Radiologist - Job opening in central New
Jersey for full-time BC/BE radiologist with
fellowship training in neuroradiology/MRI
to join group of 8 radiologists. Contact:
Send CV to Heidi Postma, PO Box 5388,
Clinton, NJ 08809 or by e-mail at heidi@
hunterdonradiology.com.
MARYLAND-WASHINGTOND.C. General & Breast Imaging - Looking for
radiologist with breast imaging skills to
cover coastal hospital 1.5 hours from main
Washington, D.C. hospital. Interested in
living in the general region of hospital;
enjoy developing full-service breast health
service, possibly including local hospitals.
Interest in nuclear medicine a plus. Contact:
Laurie Hunt at 301-652-5771 or by e-mail at
[email protected].
CLASSIFIED ADS These job listings are paid advertisements. The
ACR offers a bundled advertising package entitling advertisers who
purchase an online and ACR Bulletin classified ad to a 15 percent
discount on a classified ad in the Journal of the American College of
Radiology. To learn more about this bundled offer, e-mail [email protected].
RATES: ACR members: $50 per ACR Bulletin ad. Nonmembers:
$125 per ACR Bulletin ad. These fees are in addition to online posting fees. Ad length is a maximum of 50 words.
Advertising instructions, rate information, and complete policies
are available at http://jobs.acr.org. 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 Web site. Only jobs posted on the Web site are eligible to appear in the ACR Bulletin, on a space-available basis.
NEWJERSEY-SOUTHERNNEWJERSEY,
SUBURBSOFPHILADELPHIA - Diagnostic
Radiologist - Three-hospital system with
2 outpatient imaging centers. Fellowship
training a plus but must be flexible to cover
most modalities. Available immediately, but
will wait for the right candidate. Contact:
Locke Barber at 856-661-5473 or by e-mail
at [email protected].
NEWYORK-HOWARDBEACH - Part-time
Radiologist - Radiologist to read musculoskeletal & body images. Part-time, flexible
hours. No intervention. Knowledge of PACS.
Contact: Send resume to David Kasow,
M.D., at [email protected].
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VIRGINIA-VIRGINIABEACH- Medical
Director of Breast Imaging - Democratic,
equitable, 25-radiologist subspecialty group
seeks fellowship-trained breast imager
for partnership track opening & medical
director of breast imaging position that
includes mix of breast imaging & diagnostic
radiology. Will consider recent breast
fellowship-trained/experienced radiologists.
Contact: Jamie Walker at 757-889-5422 or
by e-mail at [email protected].
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Advocacy • Economics • Education • Clinical Research • Quality & Safety | 21
final read
>>
Spencer B. Gay, M.D., FACR
Department of Radiology
University of Virginia, Charlottesville, Va.
TELL US ABOUT A TIME YOU
SOLVED A CONFLICT WITH A
PARTNER OR ASSOCIATE.
C
onflict is not much fun at
the hospital, but the patients are
more important than how I feel
about someone. This particular incident occurred when we had a film
room and employees carried piles of heavy
—SpencerB.Gay,M.D.,FACR
plastic jackets around the department. An
employee there had not done his best to try
to find the plastic jacket for a case, and I was
a bit pointed in my remarks about his level
of effort. For several weeks, I could feel the tension every time I saw him in the film room,
and it was really getting to me.
I could not figure out what to say to get past this, as he was really in the wrong. But
eventually, I looked at his side of things, realized that we would need to continue to work
together and recognized that I should apologize for being emotional when criticizing his
behavior. When I did apologize, it changed the whole dynamic of our relationship, and
we became quite friendly after that.
The one thing that I have learned after administering a residency program for a while
is that, in any conflict, there are at least two sides to the story, each seen from a unique
point of view. Until both parties are willing to see the shared perspective, they may never
Spencer B. Gay, M.D., FACR
come together about a conflict. //
22 |
“I could feel the tension every time I saw him in
the film room, and it was really getting to me.”
Bulletin | May 2011
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Advocacy • Economics • Education • Clinical Research • Quality & Safety | 23
ACR BULLETIN
1891 Preston White Drive
Reston, VA 20191-4326
ACR BULLETIN
1891 Preston White Drive
Reston, VA 20191-4326
PERIODICALS
PERIODICALS
How Does Your CT Dose
Measure Up?
ARRS Annual Scholarship Program
now accepting nominations
Investing in the Future of Radiology
The American Roentgen Ray Society (ARRS) and The Roentgen Fund®
invite medical schools, affiliated hospitals and clinical research
institutions
to nominate
one candidate
the 2011valuable
ARRS Annual
The
new ACR
Dose Index
Registryfor
provides
benchmarks and comparisons of your facility’s CT dose indices to
Scholarship Program.
similar facilities in your geographical area and nationwide. Data are collected automatically, anonymized at your facility,
and
to the
registry
with minimal
intervention
on your part.
Eachuploaded
year, up to two
$140,000
scholarships
are awarded
to
young investigators,
educators
and/orIndex
administrators
to to improve quality of care and patient safety at your facility.
Register
with the
ACR Dose
Registry
support studies that will prepare them for leadership positions
in academic radiology.
ARRS Annual Scholarship Program
now accepting nominations
Scholarships are funded through a generous grant from
The Roentgen Fund®.
Investing
in the Future
of Radiology
The
general requirements
for candidates
are:
■ MD or DO from an accredited institution
American Roentgen
Ray Society
(ARRS)
and The
Roentgen
Fund®
■ TheCompletion
of all required
residency,
fellowship
training
or equivalent
medical schools,
affiliated Board
hospitals
and clinical
■ invite
Certification
by the American
of Radiology
or research
equivalent
institutions
to
nominate
one
candidate
for
the
2011
ARRS
Annual professor or equivalent for no more than five years beyond
■ Full-time faculty appointment as a lecturer, instructor, assistant
Scholarship
Program.
completion of training; Appointment must be in a department of radiology, nuclear medicine, or an associated department in
the radiological sciences of a medical school teaching hospital in the U.S. or Canada
Visit
the
ACR booth
at AMCLC,
May 14–17, and sign up to participate.
year, up
to two
awarded
to application
■ Each
Candidate
must
be$140,000
a memberscholarships
of the ARRSare
at the
time the
is submitted and for the duration of the award
young investigators,
educators https://nrdr.acr.org
and/or administrators to| Info: 703-715-4383 | AMCLC: http://amclc.acr.org
Website:
studies that will
prepare
for leadership
positions
Forsupport
more information
about
the them
scholarship
program
and application procedures,
in
academic
radiology.
visit www.arrs.org or call 1-800-227-5463 or 703-648-8900.
7647 5.11
Scholarships
funded
through a generous
grant from is November 19, 2010.
The
deadlinearefor
submission
of applications
®
The Roentgen Fund .
Kudos to Contributors
The College recognizes the following ACR members who contributed to the proposed
2011 Practice Guidelines and Technical Standards.
Principal reviewers and collaborative committee chairs for
revision of existing guidelines/standards:
Mark W. Anderson, M.D. — MRI of the Elbow
Kimberly E. Applegate, M.D., M.S., FACR — Pediatric Fluoro
Contrast Enema
Lincoln L. Berland, M.D., FACR — Performing and Interpreting CT
Lawrence R. Bigongiari, M.D., FACR — Hysterosalpingography
Marcela Bohm-Velez, M.D., FACR — Sonohysterography
John M. Boone, Ph.D., FACR — Radiographic Fluoroscopic Equipment
Lynn S. Broderick, M.D., FACR — Chest Radiography, Portable Chest
Radiography
Jeffrey J. Brown, M.D., M.B.A., FACR — Performing and Interpreting MRI
Barry D. Daly, M.D., M.B., B.Ch. — Abdominal Radiography
Eric N. Faerber, M.D., FACR — Skeletal Surveys in Children
Brian J. Goldsmith, M.D. — 3-D External Beam
Richard J. Gray, M.D. — Management of Dialysis Access
Nicholas J. Hangiandreou, Ph.D. — Ultrasound Equipment
Robert D. Harris, M.D., M.P.H., FACR — Performing and Interpreting
Ultrasound
Alan C. Hartford, M.D., Ph.D. — Intensity-Modulated Radiation
Therapy
Bruce E. Hasselquist, Ph.D. — PET Imaging Equipment
Robert E. Henkin, M.D., FACR — Radiopharmaceuticals
Marta Hernanz-Schulman, M.D., FACR — Neonatal Spine Ultrasound
Joshua A. Hirsch, M.D., FACR — Vertebral Augmentation
Jill E. Jacobs, M.D. — Cardiac CT
Paul E. Kinahan, Ph.D. — PET Imaging Equipment
J.H. Edmund Lee, M.D. — MRI of the Hip and Pelvis
Mahadevappa Mahesh, M.S., Ph.D., FACR — Radiographic Fluoroscopic Equipment
Serena L. McClam, M.D. — Modified Barium Swallow
Ellen B. Mendelson, M.D., FACR — Breast Ultrasound
Suresh K. Mukherji, M.D., FACR — CT Head and Neck
Laurence Needleman, M.D., FACR — Extracranial Cerebrovascular
Ultrasound
A. Orlando Ortiz, M.D., M.B.A., FACR — CT Spine
Matthew S. Pollack, M.D., FACR — Abdominal Radiography, CME
Parvati Ramchandani, M.D., FACR — Percutaneous Nephrostomy
James M. Rausch, M.D., FACR — Modified Barium Swallow
Michelle L. Robbin, M.D., FACR — Preoperative Dialysis Access
Ultrasound
David A. Rubin, M.D. — MRI of the Ankle and Hindfoot
Eric J. Russell, M.D., FACR — Cervicocerebral Catheter Angiography
Steven K. Seung, M.D., Ph.D. — Stereotactic Radiosurgery
Peter J. Strouse, M.D., FACR — Pediatric Fluoro Contrast Enema
Timothy L. Swan, M.D. — Informed Consent Image-Guided
Mihra S. Taljanovic, M.D. — MRI of Musculoskeletal Infections
Ruedi F. Thoeni, M.D. — CT Abdomen and Pelvis
Julie K. Timins, M.D., FACR — CME
Shreyas S. Vasanawala, M.D. — Pediatric MRI
Suzanne L. Wolden, M.D. — Total Body Irradiation
Pamela K. Woodard, M.D., FACR — Cardiac MRI
Collaborative and reviewing committees for revision of
existing guidelines/standards:
Debra L. Acord, M.D. — Sonohysterography
Sanford D. Altman, M.D. — Management of Dialysis Access
Teresita L. Angtuaco, M.D., FACR — Performing and Interpreting
Ultrasound
Mark R. Armstrong, M.D. — Performing and Interpreting CT
Mert O. Bahtiyar, M.D. — Sonohysterography
Stephen Balter, Ph.D., FACR — Informed Consent Image-Guided
John D. Barr, M.D. — Vertebral Augmentation
Lori L. Barr, M.D., FACR — Neonatal Spine Ultrasound
Robert M. Barr, M.D. — Cervicocerebral Catheter Angiography
Walter S. Bartynski, M.D. — CT Spine
James F. Benenati, M.D. — Cervicocerebral Catheter Angiography
Raymond E. Bertino, M.D., FACR — Preoperative Dialysis Access
Ultrasound
David C. Beyer, M.D., FACR — Intensity-Modulated Radiation
Therapy
Sadaf T. Bhutta, M.B.B.S. — Cardiac MRI
Nathan H. J. Bittner, M.D. — Total Body Irradiation
David A. Bloom, M.D. — Neonatal Spine Ultrasound
David A. Bluemke, M.D., Ph.D., FACR — Cardiac MRI
Edward I. Bluth, M.D., FACR — Extracranial Cerebrovascular
Ultrasound
Kiery A. Braithwaite, M.D. — MRI of the Elbow, MRI of Musculoskeletal Infections
Robert L. Bree, M.D., FACR — Sonohysterography
Daniel Breitkopf, M.D. — Sonohysterography
Alan S. Brody, M.D. — Chest Radiography, Portable Chest Radiography
Allan L. Brook, M.D. — Vertebral Augmentation
Dorothy I. Bulas, M.D., FACR — Neonatal Spine Ultrasound
Anne M. Cahill, M.B., B.Ch. — Percutaneous Nephrostomy
Michael J. Callahan, M.D. — Body CTA
Caroline T. Carrico, M.D. — Neonatal Spine Ultrasound, Performing
and Interpreting Ultrasound
Philip N. Cascade, M.D., FACR — Performing and Interpreting MRI
Ian L.S. Cassell, M.D. — MRI of Musculoskeletal Infections, Pediatric
MRI
Danny Chan, M.D. — Management of Dialysis Access
Frandics P. Chan, M.D., Ph.D. — Body CTA, Cardiac CT
Dianna D. Cody, Ph.D. — Performing and Interpreting CT
Harris L. Cohen, M.D., FACR — Neonatal Spine Ultrasound
Brian D. Coley, M.D. — Neonatal Spine Ultrasound, Percutaneous
Nephrostomy
Kristin L. Crisci, M.D. — Chest Radiography, Pediatric Fluoro Contrast
Enema, Portable Chest Radiography
Kassa Darge, M.D., Ph.D. — Pediatric MRI
Jesse A. Davila, M.D. — MRI of the Ankle and Hindfoot, MRI of the
Elbow, MRI of the Hip and Pelvis, MRI of Musculoskeletal Infections
John E. DePersio, M.D., FACR — Informed Consent Image-Guided
Colin P. Derdeyn, M.D. — Cervicocerebral Catheter Angiography
Benoit Desjardins, M.D., Ph.D. — Cardiac CT
Arthur A. De Smet, M.D., FACR — MRI of the Ankle and Hindfoot,
Kudos to Contributors
MRI of the Elbow, MRI of the Hip and Pelvis, MRI of Musculoskeletal
Infections
Kevin J. Doody, M.D. — Sonohysterography
Stephen C. Dragotakes, R.Ph., B.C.N.P., FAPhA — Radiopharmaceuticals
Julia Drose, R.D.M.S., R.D.C.S., R.V.T. — Extracranial Cerebrovascular Ultrasound, Preoperative Dialysis Access Ultrasound
Theodore Dubinsky, M.D. — Sonohysterography
Thomas J. Eichler, M.D. — Intensity-Modulated Radiation Therapy
Judy A. Estroff, M.D. — Neonatal Spine Ultrasound
Eric N. Faerber, M.D., FACR — CT Abdomen and Pelvis, CT Head
and Neck, CT Spine
Lorraine M. Fig, M.D., M.B., Ch.B., M.P.H. — Radiopharmaceuticals
John D. Fish, M.D. — CT Spine
Elliot K. Fishman, M.D., FACR — Body CTA
Lynn A. Fordham, M.D. — Abdominal Radiography, Neonatal Spine
Ultrasound, Performing and Interpreting Ultrasound, Skeletal Surveys
in Children
Allan J. Fox, M.D. — Cervicocerebral Catheter Angiography, Performing and Interpreting MRI
Helena Gabriel, M.D. — Performing and Interpreting Ultrasound,
Sonohysterography
James M. Galvin, D.Sc. — Intensity-Modulated Radiation Therapy,
Total Body Irradiation
Pradeep Garg, Ph.D. — Radiopharmaceuticals
Huan B. Giap, M.D., Ph.D. — Total Body Irradiation
Ruth B. Goldstein, M.D. — Sonohysterography
Steven R. Goldstein, M.D. — Sonohysterography
Edward G. Grant, M.D., FACR — Extracranial Cerebrovascular
Ultrasound
S. Bruce Greenberg, M.D. — Cardiac CT, Cardiac MRI, Pediatric MRI
Bennett S. Greenspan, M.D., FACR — Radiopharmaceuticals
Sachin K. Gujar, M.B., B.S. — CT Head and Neck, CT Spine
Beverly E. Hashimoto, M.D., FACR — Extracranial Cerebrovascular US
Jeffrey C. Hellinger, M.D. — Cardiac CT
Charlotte Henningsen, M.S., R.D.M.S., R.V.T., FSDMS — Neonatal
Spine Ultrasound
Barbara S. Hertzberg, M.D., FACR — Performing and Interpreting
Ultrasound
Joshua A. Hirsch, M.D., FACR — Cervicocerebral Catheter Angiography
John W. Ho, M.D. — Percutaneous Nephrostomy
Vincent B. Ho, M.D., M.B.A. — Cardiac CT, Cardiac MRI
Ronald V. Hublall, M.D. — Chest Radiography, Portable Chest
Radiography
Geoffrey S. Ibbott, Ph.D., FACR — Intensity-Modulated Radiation
Therapy
Jerry G. Jarvik, M.D. — Vertebral Augmentation
Mary Lee Jensen, M.D. — Vertebral Augmentation
Valerie L. Jewells, D.O. — CT Head and Neck
Blaise V. Jones, M.D. — CT Head and Neck, CT Spine
John E. Jordan, M.D. — Performing and Interpreting CT, Vertebral
Augmentation
Nadja Kadom, M.D. — CT Spine
David F. Kallmes, M.D. — Vertebral Augmentation
Sanjeeva P. Kalva, M.D. — Informed Consent Image-Guided
J. Herman Kan, M.D. — MRI of the Ankle and Hindfoot, MRI of the
Elbow, MRI of the Hip and Pelvis, MRI of Musculoskeletal Infections,
Pediatric MRI
Brian D. Kavanagh, M.D., M.P.H. — Intensity-Modulated Radiation
Therapy
Marcus M. Kessler, M.D. — Chest Radiography, Portable Chest
Radiography
Stephen A. Kieffer, M.D., FACR — CT Spine
Paul K. Kleinman, M.D. — Skeletal Surveys in Children
Bernadette L. Koch, M.D. — CT Head and Neck
Andre A. Konski, M.D., M.B.A., M.A., FACR — 3-D External Beam
Steven J. Kraus, M.D., M.S. — Pediatric Fluoro Contrast Enema
Rajesh Krishnamurthy, M.D. — Cardiac MRI
Sanjoy Kundu, M.D. — Body CTA, Management of Dialysis Access
Faye C. Laing, M.D. — Sonohysterography
Jill E. Langer, M.D. — Performing and Interpreting Ultrasound,
Preoperative Dialysis Access Ultrasound
David A. Larson, M.D., Ph.D., FACR — Stereotactic Radiosurgery
Edward Y. Lee, M.D., M.P.H. — Body CTA
J.H. Edmund Lee, M.D. — MRI of the Ankle and Hindfoot, MRI of the
Elbow, MRI of Musculoskeletal Infections
Walter S. Lesley, M.D. — Cervicocerebral Catheter Angiography
Curtis A. Lewis, M.D., M.B.A., J.D., FACR — Cervicocerebral
Catheter Angiography
Leann E. Linam, M.D. — Abdominal Radiography, Neonatal Spine
Ultrasound
Harold I. Litt, M.D., Ph.D. — Body CTA, Cardiac CT
Mark E. Lockhart, M.D., M.P.H. — Preoperative Dialysis Access Ultrasound
Mahadevappa Mahesh, M.S., Ph.D., FACR — Performing and
Interpreting CT
Mary C. Mahoney, M.D., FACR — Informed Consent Image-Guided
Francis E. Marshalleck, M.B., B.S. — Percutaneous Nephrostomy
William W. Mayo-Smith, M.D. — Performing and Interpreting CT
J. Kevin McGraw, M.D. — Vertebral Augmentation
Minesh P. Mehta, M.D. — Stereotactic Radiosurgery
Philip M. Meyers, M.D. — Cervicocerebral Catheter Angiography,
Vertebral Augmentation
Michelle A. Michel, M.D. — CT Head and Neck
Najeeb N. Mohideen, M.D. — 3-D External Beam
Charlotte A. Moore, M.D. — Pediatric Fluoro Contrast Enema
Kevin R. Moore, M.D., M.S. — CT Head and Neck
Srinivasan Mukundan Jr., M.D., Ph.D. — CT Head and Neck, CT
Spine
Martha M. Munden, M.D. — Neonatal Spine Ultrasound, Performing
and Interpreting Ultrasound
Laurence Needleman, M.D., FACR — Preoperative Dialysis Access
Ultrasound
Dan L. Nguyen, M.D. — Vertebral Augmentation
Dmitry Niman, M.D. — Vertebral Augmentation
Edward J. O’Brien Jr., M.D., FACR — Cervicocerebral Catheter
Angiography
Paul G. Pagnini, M.D. — 3-D External Beam
R. Sean Pakbaz, M.D. — Vertebral Augmentation
The College recognizes the following ACR members who contributed to the proposed
2011 Practice Guidelines and Technical Standards.
Christopher J. Palestro, M.D. — Radiopharmaceuticals
Harriet J. Paltiel, M.D. — Neonatal Spine Ultrasound
Shawn E. Parnell, M.D. — MRI of the Ankle and Hindfoot, MRI of the
Hip and Pelvis
David M. Paushter, M.D., FACR — Extracranial Cerebrovascular
Ultrasound
John S. Pellerito, M.D., FACR — Preoperative Dialysis Access Ultrasound
Jeannette M. Perez-Rossello, M.D. — Skeletal Surveys in Children
Myria Petrou, M.D. — CT Spine
Neil A. Petry, M.S., R.Ph., B.C.N.P., FAPhA — Radiopharmaceuticals
C. Douglas Phillips, M.D., FACR — CT Head and Neck
Daniel J. Podberesky, M.D. — Abdominal Radiography
James A. Ponto, M.S., R.Ph., B.C.N.P. — Radiopharmaceuticals
Louis Potters, M.D., FACR — Stereotactic Radiosurgery
James A. Purdy, Ph.D., FACR — 3-D External Beam
Carl C. Reading, M.D., FACR — Preoperative Dialysis Access Ultrasound
Gautham P. Reddy, M.D., M.P.H. — Cardiac MRI
Kent B. Remley, M.D. — Vertebral Augmentation
Cynthia K. Rigsby, M.D. — Cardiac MRI
Michelle L. Robbin, M.D., FACR — Extracranial Cerebrovascular
Ultrasound
Michael I. Rothman, M.D. — CT Spine, Vertebral Augmentation
Deborah J. Rubens, M.D. — Extracranial Cerebrovascular Ultrasound
David A. Rubin, M.D. — MRI of the Elbow, MRI of the Hip and Pelvis
Eva I. Rubio, M.D. — Pediatric Fluoro Contrast Enema
U. Joseph Schoepf, M.D. — Cardiac CT
Paula J. Schomberg, M.D. — Total Body Irradiation
Christopher J. Schultz, M.D. — Intensity-Modulated Radiation
Therapy, Stereotactic Radiosurgery
Leslie M. Scoutt, M.D. — Extracranial Cerebrovascular Ultrasound
David J. Seidenwurm, M.D. — Cervicocerebral Catheter Angiography
Laureen M. Sena, M.D. — Cardiac CT
Sabah-e-Noor Servaes, M.D. — CT Abdomen and Pelvis
Rajiv R. Shah, D.O. — CT Spine
Susan E. Sharp, M.D. — Chest Radiography
Manrita K. Sidhu, M.D. — Percutaneous Nephrostomy
Sudha P. Singh, M.B., B.S. — Skeletal Surveys in Children
Robert M. Sinow, M.D. — Performing and Interpreting Ultrasound
Daniel Skupski, M.D. — Sonohysterography
Eric M. Spickler, M.D., FACR — CT Head and Neck, CT Spine
G. Scott Stacy, M.D. — MRI of the Ankle and Hindfoot, MRI of the
Elbow, MRI of the Hip and Pelvis, MRI of Musculoskeletal Infections
John D. Statler, M.D. — Vertebral Augmentation
Arthur E. Stillman, M.D., Ph.D., FACR — Cardiac CT
LeAnn S. Stokes, M.D. — Body CTA, Percutaneous Nephrostomy
Robert W. Tarr, M.D. — Cervicocerebral Catheter Angiography
Alexander J. Towbin, M.D. — Abdominal Radiography, CT Abdomen
and Pelvis
Patrick A. Turski, M.D., FACR — Cervicocerebral Catheter Angiography
Hilary R. Umans, M.D. — MRI of the Ankle and Hindfoot, MRI of the
Elbow, MRI of the Hip and Pelvis, MRI of Musculoskeletal Infections
Thomas M. Vesely, M.D. — Management of Dialysis Access
Brad Van Voorhis, M.D. — Sonohysterography
Ronald C. Walker, M.D. — Radiopharmaceuticals
Anoop S. Wattamwar, M.D. — CT Spine
Sjirk J. Westra, M.D. — Body CTA, CT Abdomen and Pelvis
Joseph P. Williams, M.D. — MRI of the Ankle and Hindfoot, MRI of
the Hip and Pelvis
Joan C. Wojak, M.D. — Cervicocerebral Catheter Angiography,
Informed Consent Image-Guided
Pamela K. Woodard, M.D., FACR — Body CTA
Santosh V. Yajnik, M.D. — Stereotactic Radiosurgery
Wayne Yakes, M.D. — Cervicocerebral Catheter Angiography
Albert J. Yoo, M.D. — Vertebral Augmentation
E. Kent Yucel, M.D., FACR — Cardiac MRI
Darryl A. Zuckerman, M.D. — Percutaneous Nephrostomy
Principal drafters and committee chairs for new
guidelines/standards:
Elizabeth A. Morris, M.D., FACR — MRI-Guided Breast Interventional
David A. Rubin, M.D. — MRI of Musculoskeletal Infections
Geoffrey D. Rubin, M.D. — Body CTA
Leadership for guidelines process:
Alan D. Kaye, M.D., FACR — speaker
Howard B. Fleishon, M.D., M.M.M., FACR — vice speaker
Paul A. Larson, M.D., FACR — chair, Commission on Quality and
Safety
Kimberly E. Applegate, M.D., M.S., FACR — vice chair, Commission
on Quality and Safety
Sponsoring committee chairs and co-chairs:
Jacqueline A. Bello, M.D., FACR — Neuroradiology
Mary C. Frates, M.D., FACR — Ultrasound
Richard A. Geise, Ph.D., FACR — Medical Physics
Jay A. Harolds, M.D., FACR — Nuclear Medicine
Marta Hernanz-Schulman, M.D., FACR — Pediatric
Ella A. Kazerooni, M.D., FACR — Thoracic Radiology, Body Imaging
Mark J. Kransdorf, M.D., FACR — Musculoskeletal Imaging, Body
Imaging
Mary C. Mahoney, M.D. — Breast Imaging
Darlene F. Metter, M.D., FACR — Nuclear Medicine
Donald L. Miller, M.D., FACR — Interventional and Cardiovascular
Joel F. Platt, M.D. — Abdominal Imaging, Body Imaging
Seth A. Rosenthal, M.D., FACR — Radiation Oncology
Geoffrey D. Rubin, M.D. — Cardiac Imaging, Body Imaging
Julie K. Timins, M.D., FACR — General, Small, and Rural Practice
Sponsoring commission chairs:
Albert L. Blumberg, M.D., FACR — Radiation Oncology
James A. Brink, M.D., FACR — Body Imaging
Manuel L. Brown, M.D., FACR — Nuclear Medicine
Donald P. Frush, M.D., FACR — Pediatric
James M. Hevezi, Ph.D., FACR — Medical Physics
Kudos to Contributors
The College recognizes the following ACR members who contributed to the proposed
2011 Practice Guidelines and Technical Standards.
Carol H. Lee, M.D., FACR — Breast Imaging
Deborah Levine, M.D., FACR — Ultrasound
Carolyn C. Meltzer, M.D., FACR — Neuroradiology
Anne C. Roberts, M.D., FACR — Interventional and Cardiovascular
Geoffrey G. Smith, M.D., FACR — General, Small, and Rural
Practice
Council Steering Committee (CSC) subcommittee chairs and
co-chairs:
Mark J. Adams, M.D., M.B.A., FACR — MRI of the Elbow
Edward I. Bluth, M.D., FACR — Extracranial Cerebrovascular US,
Preoperative Dialysis Access Ultrasound
Jonathan Breslau, M.D., FACR — CT Head and Neck, CT Spine,
Vertebral Augmentation
Paul J. Chang, M.D. — MRI of Musculoskeletal Infections, Pediatric
MRI
Beverly G. Coleman, M.D., FACR — Breast Ultrasound, Performing
and Interpreting Ultrasound, Sonohysterography
Philip S. Cook, M.D., FACR — Percutaneous Nephrostomy, Vertebral
Augmentation
Richard Duszak Jr., M.D., FACR — Body CTA, Cervicocerebral
Catheter Angiography, Informed Consent Image-Guided, Management of Dialysis Access
Jay A. Harolds, M.D., FACR — PET Imaging Equipment, Radiographic Fluoroscopic Equipment, Radiopharmaceuticals, Ultrasound
Equipment
William T. Herrington, M.D., FACR — Abdominal Radiography,
Chest Radiography, CME, CT Abdomen and Pelvis, Performing and
Interpreting CT, Portable Chest Radiography
Kay D. Lozano, M.D. — MRI of the Ankle and Hindfoot, MRI of the
Hip and Pelvis
Mahadevappa Mahesh, M.S., Ph.D., FACR — PET Imaging Equipment, Radiographic Fluoroscopic Equipment, Ultrasound Equipment
Alan H. Matsumoto, M.D., FACR — Body CTA, Cervicocerebral
Catheter Angiography, CME
Rodney S. Owen, M.D., FACR — Cardiac CT, Cardiac MRI, MRI
of the Ankle and Hindfoot, MRI of the Hip and Pelvis, Performing and
Interpreting MRI
Seth A. Rosenthal, M.D., FACR — 3-D External Beam, Intensity-Modulated Radiation Therapy, Stereotactic Radiosurgery, Total Body Irradiation
Richard Strax, M.D., FACR — Hysterosalpingography, Modified
Barium Swallow
Richard N. Taxin, M.D., FACR — MRI-Guided Breast Interventional,
Neonatal Spine Ultrasound, Pediatric Fluoro Contrast Enema, Skeletal
Surveys in Children
Member/CSC subcommittee:
The College wishes to thank the following ACR members who participated
in a CSC subcommittee to review and reconcile drafts with comments
submitted during the field-review cycle. Documents that resulted from that
activity have been submitted as resolutions for consideration during the
2011 AMCLC.
Mark J. Adams, M.D., M.B.A., FACR — Abdominal Radiography,
MRI of the Ankle and Hindfoot, MRI of the Hip and Pelvis
Dianna M. E. Bardo, M.D. — CT Spine
Wendie A. Berg, M.D., Ph.D., FACR — Breast Ultrasound
Bruce J. Bortnick, M.D., FACR — Pediatric Fluoro Contrast Enema
Douglas L. Brown, M.D. — Performing and Interpreting Ultrasound
Steven M. Cohen, M.D., FACR — Breast Ultrasound
Gregg A. Dickerson, M.D., FACR — Stereotactic Radiosurgery
Carl J. D’Orsi, M.D., FACR — Breast Ultrasound
Richard K. Downs, M.D. — CT Head and Neck
Kate A. Feinstein, M.D., FACR — Pediatric Fluoro Contrast Enema
Allan J. Fox, M.D. — CT Head and Neck
Paul J. Friedman, M.D., FACR — Cardiac CT, Cardiac MRI
James M. Galvin, D.Sc. — Stereotactic Radiosurgery
Linda A. Harrison, M.D. — CT Abdomen and Pelvis
Alan C. Hartford, M.D., Ph.D. — Stereotactic Radiosurgery
James M. Hevezi, Ph.D., FACR — Stereotactic Radiosurgery
Phan T. Huynh, M.D., FACR — Breast Ultrasound
Geoffrey S. Ibbott, Ph.D., FACR — Stereotactic Radiosurgery
Jeffrey B. Judd, M.D. — CT Spine
Stuart S. Kaplan, M.D. — Breast Ultrasound
Mary M. Karst, M.D. — Abdominal Radiography
Sue C. Kaste, D.O. — Pediatric Fluoro Contrast Enema
Steven T. Krueckeberg, M.D. — CT Head and Neck
Constance D. Lehman, M.D., Ph.D., FACR — Breast Ultrasound
James W. Lockard, M.D. — Breast Ultrasound
Debra L. Monticciolo, M.D., FACR — Breast Ultrasound
Govind Mukundan, M.D. — CT Head and Neck
Ingrid E. Naugle, M.D., FACR — Breast Ultrasound
Laurence Needleman, M.D., FACR — Performing and Interpreting
Ultrasound
John H. Niemeyer, M.D., FACR — CT Abdomen and Pelvis
Henry D. Royal, M.D. — PET Imaging Equipment
Edward A. Sickles, M.D., FACR — Breast Ultrasound
Richard A. Szucs, M.D., FACR — CT Abdomen and Pelvis
Suzanne M. Thigpen, M.D. — Cardiac CT
James H. Timmons, M.D. — Pediatric Fluoro Contrast Enema
Mitchell E. F. Travis, M.D. — Breast Ultrasound.
Morlie L. Wang, M.D. — Performing and Interpreting Ultrasound
Hadyn T. Williams, M.D. — PET Imaging Equipment
Additional Commentors during 2011 field review:
Mark J. Adams, M.D., M.B.A., FACR — MRI of Musculoskeletal
Infections
Matthew J. Bassignani, M.D. — Informed Consent Image-Guided
Carl J. D’Orsi, M.D., FACR — MRI-Guided Breast Interventional
Sue C. Kaste, D.O. — Pediatric MRI
Lawrence A. Liebscher, M.D., FACR — Chest Radiography, PET
Imaging Equipment, Radiographic Fluoroscopic Equipment
Samir B. Patel, M.D. — MRI-Guided Breast Interventional
Charles S. Sutton, M.D. — Vertebral Augmentation
Hadyn T. Williams, M.D. — Radiopharmaceuticals