ACR AMCLC Meeting Roundup for May 16th 2010

Taking Radiology Off the Menu
AMCLC empowers radiologists to safeguard the specialty from external forces.

Health-care reform legislation, the MIPPA mandate for accreditation, ever-increasing costs and decreasing reimbursement, reducing radiation dose, and the USPSTF’s recommendations on screening mammography, among others, topped the list of major issues that will be discussed at the 87th AMCLC in Washington, DC. Members of the ACR leadership directly addressed all of these concerns and offered suggestions for how to confront them in the future.

Radiologists can tackle tough issues through communication and empowerment said ACR Council Speaker Alan D. Kaye, MD, FACR, in his opening remarks on the efforts of the ACR Council and the Council Steering Committee (CSC) to enhance the 2010 meeting. Some of the improvements to the 2010 AMCLC came from the efforts of three work groups that examined the annual meeting.

The work groups recommended continuing to explore technological enhancements to the AMCLC, including separate radiation oncology programming and developing Microsoft SharePoint sites for the CSC, work groups, chapters, and more. In fact, with the new AMCLC Web portal (http://amclc.acr.org), ACR members have access to valuable AMCLC content all year long, before and after the meeting. Kaye sees radiology as an information technology service and believes that the College should take an active role in this area.

Christoph Wald, MD, chair for one work group, provided a 30,000-foot perspective on some of the less obvious upgrades to the portal. “This is your toolbox for the meeting but also in between meetings,” Wald said. “Make it your companion.”

In an unsurprising development, given how many radiologists are early adopters of new technologies, the iPad stood out as the new mobile device of choice for attendees. Many found appealing the availability of a new application with the AMCLC portal’s content for their mobile devices (including iPads).

Focus on Quality and Safety
Acknowledging that the past year has been a challenging one with health-care reform taking considerable time, money, and focus, ACR CEO Harvey L. Neiman, MD, FACR, said he was “truly proud of the activities undertaken this year. They show we’re one of the premier organizations inside the beltway.

“This year, I’d like to recognize the outstanding efforts of the Quality and Safety Department,” said Neiman. “They are working on our behalf to ensure that radiologists, radiation oncologists, interventional radiologists, nuclear medicine physicians, and medical physicists have the tools necessary to demonstrate the outstanding quality of practice that we deliver to our patients.” Neiman discussed the streamlining of the accreditation process, which includes the development of electronic application forms and will likely, later this year, feature a web-based method for image submission.

He also highlighted the quality and safety implications that the ACR’s National Radiology Data Registry™ could have for the future of radiology. The ABR accepts several of the ACR’s six registries as part of a PQI project for Part IV of the MOC. Now in pilot testing, the new Dose Index Registry should be available by the end of the year, Neiman indicated. It is “imperative that every practice participate in this or a similar dose index to document radiologists’ expertise in minimizing dose for CT,” Neiman said.

Echoing Neiman’s call for participation in ACR’s registries, 2008 to 2010 Chair James H. Thrall, MD, FACR, discussed CT colonography (CTC) specifically. Pointing out that President Obama had a virtual colonoscopy earlier this year, Thrall stated, “Our question for Medicare is, ‘When will a service deemed suitable for the president be made available to the public?’” After the resounding applause died down, he added, “The good news is, the College never gives up.”

According to Thrall, the bar set by CMS for both quality of data and approach to regulatory process has gone up, but “we will meet the challenge. We have additional data pertaining to the specific age group under statistical review [for CTC].”

He also considered another subject of immense importance: health-care reform. “The best thing [about health-care reform] from my point of view is that 32 million more Americans will be covered,” he said. “But I wonder if the people in Washington, D.C., realize that we’ve already been taking care of these people in our practices?”

Answering the Dues Question
While Thrall questioned the future of radiology, Secretary-Treasurer Paul H. Ellenbogen, MD, FACR, provided his take on the ACR’s current financial position and said that he sees it as “quite good.” Some of the most important revenue for the ACR comes from quality and safety initiatives and revenues in this area are projected to increase. However, Ellenbogen cautioned, the boost from accreditation revenues can’t be counted on, given the cyclical nature of accreditation renewals (three-year cycle) and the one-time rush to beat the mandatory 2012 accreditation deadline.

Ellenbogen also discussed the reasons for a proposed dues increase from $750 per year to $795, the first increase in a decade. Pointing out that a bad economy is “the right time to raise dues,” Ellenbogen revealed that if dues had increased each year at the inflation rate, they would currently be $900, which is more than the proposed increase. For more information detailing the background of the dues increase, including ways the College has already worked to reduce expenses, check out the April ACR Bulletin article, page 8.

ACR President Rumack Speaks Up on Radiation Dose
In the always popular presidential address, ACR President Carol M. Rumack, MD, spoke about radiation dose, a topic attracting growing media coverage on an almost daily basis. “Such events [overexposure] have captivated media, lawyers, patients, and even the U.S. FDA,” Rumack said.

Calling on members to do more, Rumack said, “we need to focus on patient safety.” She proposed another “pillar” for the ACR: patient-focused radiology. “We’re well known for our quality and safety, but this new pillar is terribly important,” she said. “We’ve reached new heights in imaging quality, but in doing so, we’ve increased the dose. Performing and interpreting a patient exam is just one part of our service to patients. It’s critical that we focus on radiation dose and patient care as a first priority.”

Adding that the ACR’s logo has been “Quality Is Our Image,” Rumack proposed that “we change it to emphasize patient safety because it’s the most important part of patient care. Our logo should be ‘Patient-Focused Imaging!’”

Unfortunately, no central agency exists to report events of radiation overexposure, and Rumack thinks one should be created. One proactive way to address the issue of overexposure is through education, she maintained. Rumack hopes that the ACR, in part with other organizations, can develop a proactive system to train radiologists and radiologic technologists so overexposure can be avoided. She pointed out that the College has been working on a number of tools to help radiologists reduce dose or explain dose to their patients, including ACR accreditation, Practice Guidelines and Technical Standards, ACR Appropriateness Criteria®, data registries, RadiologyInfo.org, and Image Wisely, a campaign similar to Image GentlySM but designed specifically for adult patients.

Rumack quoted a March JACR article, “Flying in the Plane You Service: Patient-Centered Radiology”. “Just as a mechanic is required to fly in the plane he just serviced, radiology professionals should make each decision as if they were going to fly on the next flight [as that patient].”

Radiology has changed, and correspondingly, Rumack thinks that being a good radiologist with superior medical knowledge in an isolated reading room is not enough. “We need to take charge of radiation dose to make it clear that we’re essential for safe imaging,” she said. “It’s an opportunity for the ACR and all radiologists. We are the experts.

“Patient protection requires oversight by radiologists, not just the equipment companies. It’s time to be the face of radiology. If we distance ourselves from taking responsibility for dose, there’s a risk to our reputation as the experts. “Missed Rumack’s address? No problem. You’ll see it later this year in the JACR.

Transitions
With a string quartet introducing this year’s three ACR Gold Medalists and 114 honorary and new ACR Fellows, the convocation was especially memorable, serving to acknowledge those individuals’ significant contributions to radiology and to the ACR. Unsurprisingly, several of the Gold Medalists and Honorary Fellows had difficulty getting through their speeches when it came to thanking loved ones.

William T. Thorwarth Jr., MD, FACR, who received a gold medal, said he was “under strict instructions not to thank my wife,” but, of course, he did. Meanwhile, another gold medalist William R. Hendee, PhD, FACR, talked about the perception of radiology in his acceptance speech. “I’m grateful that the public no longer thinks we deal with radios,” he said. All were honored and appreciative of the efforts of the College and their fellow radiologists who nominated and supported them. For a complete description of the backgrounds of the Gold Medalists and Honorary Fellows, check out page 26 of the March ACR Bulletin, “Refusing to Settle.”

Radiation Oncology Programming: Appropriateness Criteria
The Radiation Oncology Appropriateness Criteria® course, which debuted at AMCLC, was a huge hit for the radiologic community. Peter A. S. Johnstone, MD, FACR, chaired this new CME activity — for which 47 radiologists and seven faculty signed up — run jointly by the ACR, the ARRS, and the American Radium Society (ARS). Albert L. Blumberg, MD, FACR, of the department of radiation oncology at Greater Baltimore Medical Center, explains that the course’s development was an amalgam of several factors. After conversations with colleagues at the ARS, Blumberg noticed the opportunity to collaborate on an educational program of sorts.

“The ARS is mostly radiation oncologists, so we thought we could provide something of substantial interest to them,” adds Johnstone. Blumberg explains, “People are really starting to refer to guidelines more frequently in oncologic circles, and I think our product developed with that in mind — rather than adding onto currently existing guides.”

The meeting included speakers on a variety of topics, such as using the ACR Appropriateness Criteria to meet MOC-PQI requirements and techniques to treat patients with prostate cancer, anorectal cancer, and bone metastases. “I hope [participants] learned specifically what the Radiation Oncology Appropriateness Criteria are and how they might be helpful in their day-in, day-out practices,” Blumberg explains.

However, he notes that a broader significance was gained from the workshop. “The bigger message I wanted radiation oncologists to know is that they are an integral part of what makes the College so special for the field of radiology,” he says. Blumberg adds that within this specialty, the criteria remain relatively invisible as opposed to the diagnostic side. “I think this program helps to start changing that paradigm,” he concludes.

In addition to this special course for radiation oncologists, the ACR has recently begun offering a weekly e-newsletter specifically for radiation oncology practices.