AMCLC Daily Wrap Up: Monday, May 17, 2010

Securing Radiology’s Place in Health Care
Speakers report on residents, research, and the specialty’s relationships.

Resident and fellow participation in AMCLC grew 28 percent over last year’s conference. Members of the Resident and Fellow Section (RFS) are in a unique position as stakeholders of the College, and according to RFS President Vanessa Van Duyn Wear, MD, are excited to be the future of the ACR. During her report, Wear discussed the highlights of the last year for the RFS.

A major accomplishment was the redesign of the RFS website (http://rfs.acr.org), which includes the handbook, “Getting Started,” a tool for first-year radiology residents. Wear also spoke about such projects as the mobile updates, designed to keep RFS members current on AMCLC activities and the ACR Appropriateness Criteria® Learning Modules, which are still in development by RFS members. Check the RFS site for information on these and other ventures.

Additionally, the RFS held its first-ever annual poster session this year. Sixty-seven abstracts were submitted and 49 posters accepted. Residents have also been actively contributing to the JACR, having published eight articles within the last year.

Who Should Perform Imaging?
Residents and fellows also tuned in to a conversation about the ABR, given by N. Reed Dunnick, MD, FACR, who discussed the ABR’s role in health care. Dunnick is concerned about physicians’ credentials, such as certificates of proficiency, granted by rogue boards and used by nonradiologists to gain imaging privileges, which should be based on radiologic training, knowledge, clinical skills, and board certification. Unfortunately, he said, rogue boards can and do offer credentials for imaging and are not regulated by the American Board of Medical Specialties, to which ABR belongs.

For example, Dunnick noted, “I could create the American Board of Adrenal Imaging, incorporate it, offer a certification for it, and charge a hefty fee that you could use as a credential to establish imaging privileges in your organization.” So the question is, Dunnick asked, “Who should be allowed to perform imaging?”

The answer: Those who are trained and committed to continued radiologic education. The specialty, Dunnick asserted, needs the ABR’s help to move from a “binge-and-purge mentality,” in which residents “cram a lot of facts prior to taking oral boards and then forget them,” to a lifetime of learning.

“I think the new [oral board] exam structure is a step toward this,” he said. “But it must be documented through continuing self-assessment modules. We need to make sure there are standards for training that ensure imagers have the knowledge and clinical skills to practice radiology appropriately.”

ACRIN® Branches Out
While Dunnick spoke about the ABR’s future in health care, ACRIN Chair Mitchell D. Schnall, MD, PhD, FACR, highlighted events over the past year for ACRIN®, which recently celebrated its 10th anniversary. At such an important milestone, ACRIN leadership converged for a spring retreat earlier this year. One outcome of that meeting was a new scientific objective, which Schnall presented at AMCLC: to concentrate more on how imaging impacts patient management and care.

This new objective opens up ACRIN’s research for other diseases. ACRIN is branching out from cancer research with trials on novel imaging agents for Alzheimer’s as well as research into cardiovascular diseases.

A number of cancer studies are also underway. In fact, Schnall hopes to complete the data collection this year for the National Lung Cancer Screening Trial. He also revealed that ACRIN opened 10 new protocols in 2009, an impressive feat. It’s the highest number opened in the last three years.

About to open for enrollment is “ACRIN 6690: MRI and CT in Hepatoma.” “If you’re at a transplant center, we’d love to hear from you about participating,” said Schnall. For more information, including contact details for all ACRIN trials, visit www.acrin.org.

RTOG®’s Unique Place in Research
With 14 trials activated in 2009, RTOG® has had a triumphant year. It successfully renewed several NCI grants and received funding for new initiatives from the American Recovery and Reinvestment Act. Moreover, with 52 open trials in 2009, RTOG broke a record for the most open trials in the organization’s history.

“It’s quite an accomplishment, considering the regulatory review process currently going on,” said RTOG Group Chair Walter J. Curran Jr., MD. Plus, with significant advances in imaging-planning software and hardware, “we are now at the point where, after those applications are properly applied and tested, we can make substantial differences in cancer control,” he said.

When discussing the status of the NCI Clinical Trials Cooperative Group Program, Curran said, “RTOG has a unique niche among these cooperative groups. A lot of the decisions [for the groups’ modifications] will be made on Capitol Hill. This system has had tremendously positive results but it’s imperfect, so constructive changes are needed.”

Predict Patient Outcomes
Delivering a humorous, educated take on radiology’s future in his presentation, “Future of Radiology in the New Health-Care Paradigm,” Moreton Lecturer Jeff Goldsmith, PhD, president of Health Futures Inc., noted that radiology is a remarkable success story on many levels. Radiology, he said, was the “first medical discipline to go global, the first to grasp the importance of digital standards, and the first to recognize you could move images. Radiologists arrived at the digital revolution before anyone else in the medical field. They were far-sighted enough to select TCP/IP and were Internet-ready before Internet use exploded.

“Radiology was the first discipline to grasp the importance of an evidence-based payment methodology and the first diagnostic discipline to leap the fence into curative intervention — you invented interventional radiology.”

However, he noted, “This is not necessarily a good thing. Are we becoming more like some European societies? A history of sustained success is viewed not as something to emulate but something to tear down. We saw this in the ramp up to the DRA.”

Goldsmith then pointed out that “even though we can take remarkable pictures of patients, far clearer than what you can see if you open the patient up, we’re raising prolonged anxiety in patients in the present diagnostic process.” He proposed that the next “value-add” that radiology could provide to patients is in being proactive, helping predict patient outcomes, supplying them with information more quickly, and answering the questions they really want answers to, such as, “Is this tumor really going to shorten my life?”

Other challenges lie ahead for the specialty, including turf issues, which are unnerving from the patient’s point of view. “Patients want all the disciplines involved in their care to be on the same team,” he elaborated. “The market will reward people who have figured out how to work together,” he said. “Creating these new disciplines will require engaging specialties with which you presently compete and incorporating their activities into radiology practices or departments.”

Relating to the Hospital
The first open-microphone session on radiologists and hospitals sparked lively debate. Several participants stepped up to voice their opinions on these sometimes tenuous relationships. Alan D. Kaye, MD, FACR, hosted the session and asked attendees for their ideas on how the ACR can help guide future policies or resources on this subject.

The consensus seemed to be that making radiologists visible would help improve the relationship between hospitals and radiologists. Speakers suggested that radiologists try to connect with their fellow physicians and clinicians, participate in multidisciplinary conferences, and make hospital boards aware of what radiologists do and the value added to patient care.

However, the message from speakers at the microphones seemed to be that if you’re not regularly interacting with doctors at your practice or institution, there’s a problem. In that case, “You are merely a teleradiologist who happens to be in the same building,” said one commenter. Make yourself a part of the medical team with your hospital, he suggested. “Keep the lights on, keep the door open, and make it a welcome environment, or the hospital won’t care if it’s you or someone in Australia doing the work,” added another contributor.

Another controversial topic, teleradiology, brought many to the microphones during a reference committee session on Resolution No. 53: Teleradiology Entities, a late submission. Participants provided their diverse thoughts on teleradiology as they debated whether and how much teleradiology is a threat to the specialty.

One speaker represented the opposing view, offering,“We are not the College of American On-site Radiology,” and adding that radiologists use teleradiology in a variety of ways, including to spend time with families and attend meetings. Many stated that the resolution needed further clarification, as the issue of the technology of teleradiology should be distinct from the issue of business practice. The complete list of passed resolutions is available online at the AMCLC portal site http://amclc.acr.org.