2018 ACR Commission on Human Resources Workforce Survey

Practical Strategies to Retain Radiologists

Since the great resignation associated with the coronavirus disease 2019 pandemic, radiology practices are now challenged with maintaining adequate radiology staffing requirements to cope with increasing clinical workload requirements. The authors describe practical strategies for radiology practice leaders to retain radiologists in the current challenging job market, while mitigating their burnout.

Pre- and post-COVID-19 gender trends in authorship for paediatric radiology articles worldwide: a systematic review

BACKGROUND

Gender inequalities in academic medicine persist despite progress over the past decade. Evidence-based targeted interventions are needed to reduce gender inequalities.

OBJECTIVE

This systematic review aimed to investigate the impact of COVID-19 on gender trends in authorship of paediatric radiology research worldwide.

MATERIALS AND METHODS

This prospectively registered, PRISMA-compliant systematic review searched the following databases: PubMed, MEDLINE, Web of Science, and Scopus from January 1, 2018, to May 29, 2023, with no restrictions on country of origin. Screening and data extraction occurred independently and in duplicate. Gender of first, last, and corresponding authors were determined using an artificial intelligence-powered, validated, multinational database ( www.genderize.io ). Two time periods were categorised according to the Johns Hopkins Center for Systems Science and Engineering: pre-COVID (prior to March 2020) and peak and post-COVID (March 2020 onwards). One-sample binomial testing was used to analyse proportion of authorship based on gender. Categorical variables were described as frequencies and percentages, and compared using testing chi-square or Fisher exact testing, with a threshold of P<0.05 representing statistical significance.

RESULTS

In total, 922 articles were included with 39 countries represented. A statistically significant difference in authorship based on gender persisted during the peak and post-COVID time period (March 2020 onwards) where women represented a statistically significant lower proportion of last (35.5%) and corresponding (42.7%) authors (P<0.001, P=0.001, respectively). Statistically significant differences for first authors were not found in either period (P=0.08 and P=0.48).

CONCLUSION

This study identifies differences in gender trends for authorship in paediatric radiology research worldwide. Future efforts to increase authorship by women are needed.

The Second Mountain: Climbing the Challenges of Midcareer Radiology

A radiologist's career can be divided into the early, middle, and late phases. The midcareer phase is a particularly difficult period and has the highest rate of burnout among radiologists. Often throughout the early phase of a radiologist's career, during residency, fellowship, and while a junior faculty member, there is an abundance of support to help in personal and professional growth, but this support often wanes as radiologists gain seniority. Unfortunately, this often leaves midcareer radiologists feeling forgotten, or "invisible." This lack of support can lead to burnout, decreased job satisfaction, and premature departure from the workforce. The purpose of this review is to bring to light the challenges, such as higher rates of burnout and career stagnation, in addition to the lack of emphasis placed on midcareer mentorship, sponsorship, and career development programs, facing radiologists while climbing the "second mountain" of their career, as well as to provide potential individual and institutional interventions to combat these challenges. In addition, emphasis will be placed on the difficulties experienced by midcareer female radiologists, whose challenges are particularly problematic and to our knowledge have received little attention in the imaging literature to date.

Prevalence of Burnout of Radiologists in Private Practice

PURPOSE

The aim of this study was to evaluate the prevalence and demographic factors associated with both burnout and fulfillment of private practice radiologists within the largest coalition of independent wholly physician-owned diagnostic radiology practices within the United States.

METHODS

The study cohort included practicing radiologists within the largest coalition of wholly radiologist-owned, independently practicing diagnostic radiology groups within the United States. Practicing radiologists within all 31 radiology private practices within the organization were electronically mailed a web link to a confidential institutional review board-approved survey in August and September 2021. The survey included validated questions from the Stanford Professional Fulfillment Index, individual and practice demographics, and self-care. Radiologists were classified as being burned out and professionally fulfilled on the basis of established cutoffs from the Professional Fulfillment Index.

RESULTS

The overall response rate was 20.6% (254 of 1,235). The overall rate of radiologist burnout was 46% (Cronbach's α = 0.92), and professional fulfillment was 26.7% (Cronbach's α = 0.91). The inverse association between professional fulfillment and burnout was highly significant (r = -0.66, P < .0001) on the basis of average scores. Radiologists who took call (evenings, overnight, and weekends) were statistically most likely to be burned out. Older radiologists were less likely to experience burnout. Factors statistically significantly associated with professional fulfillment were eating nutritious meals and exercising at least four times per week. No statistically significant association was seen between either burnout or fulfillment with gender, ethnicity, practice geography, or practice size.

CONCLUSIONS

In the largest coalition of independent wholly physician-owned diagnostic radiology practices across the United States, about one-half of radiologists were burned out, and just over one-quarter were professionally fulfilled. Taking call was significantly associated with radiologist burnout. Self-care habits were associated with professional fulfillment.

The Pre-Radiology Internship: Room for Improvement?

BACKGROUND

A clinical internship is currently required by the American Board of Radiology prior to Radiology residency. The purpose of this investigation is to evaluate practicing radiologists' perspectives on the value of the internship and their recommendations for optimization.

METHODS

A five-minute online survey was distributed via email to practicing radiologist members of the American College of Radiology.

RESULTS

A total of 566 completed responses (11.3% response rate) were received. Most respondents agreed that their internship was essential for improving non-radiology clinical knowledge (84%) and affirming their decision to become a radiologist (74%). Most respondents (59%) disagree that the one-year internship before residency should be eliminated. Most (53%) of the radiologists in an academic practice agreed that internship should be integrated into Radiology residency. If radiologists were to redesign the internship ("PreRad Internship"), a majority of the respondents would include training in other medical specialties (71%), working along technologists (55%) and informatics/AI/computer science (54%). While the greatest proportion (50%) of interventional radiologists reported a Surgery internship would be the most beneficial for their primary subspecialty (50%), diagnostic radiologists most commonly (27%) reported the PreRad Internship would be the most beneficial. The greatest proportions of Abdominal-, Breast-, and Neuroradiology-trained respondents reported a PreRad Internship would be the most beneficial internship for their primary field of subspecialty Radiology practice (32%, 36%, and 33%, respectively).

CONCLUSION

The internship before Radiology residency offers some benefits but could be further optimized. There is support from practicing radiologists for a redesigned, more Radiology-specific PreRad Internship.

Prevalence of burnout in private practice radiology leaders

RATIONALE AND OBJECTIVES

To evaluate prevalence and demographic factors associated with both burnout and fulfillment of private practice radiologist leaders within the United States.

MATERIALS AND METHODS

The study cohort was the largest coalition of wholly radiologist owned, independently practicing radiology groups within the United States. Two designated leaders within each of the 30 radiology private practices within the organization Strategic Radiology were electronically mailed a weblink to a confidential IRB-approved survey in July 2021. Surveys included questions from the Stanford Professional Fulfillment Index, individual and practice demographics, and self-care.

RESULTS

The overall response rate was 67% (40/60). Fulfillment and burnout scores were calculated from the individual questions, and radiologists were classified as being fulfilled or not and burned out or not based upon score cutoffs previously validated from the Stanford Professional Fulfillment Index (PFI). The overall professional fulfillment rate of staff was 43% and the overall burnout rate was 33%. (Cronbach's α = 0.90 for fulfillment and 0.91 for burnout). The inverse correlation between professional fulfillment and burnout was highly significant (r = -0.42, p = 0.007). No statistically significant association was seen between either burnout or fulfillment and age, gender, ethnicity, practice geography or practice size.

CONCLUSION

Utilizing the validated Stanford PFI for assessment, the prevalence of burnout in private practice radiologist leaders was 33%. The prevalence of professional fulfillment was 43%, with a mild inverse association between professional fulfillment and burnout.

SUMMARY

In private practice leaders, the prevalence of burnout was 33% and the prevalence of professional fulfillment was 43%.

Medical workforce in the United States

This section focuses on the professional workforce comprised of the primary medical specialties that utilize ionizing radiation in their practices. Those discussed include the specialties of radiology and radiation oncology, as well as the subspecialties of radiology, namely diagnostic radiology, interventional radiology, nuclear radiology, and nuclear medicine. These professionals provide essential health care services, for example, the interpretation of imaging studies, the provision of interventional procedures, radionuclide therapeutic treatments, and radiation therapy. In addition, they may be called on to function as part of a radiologic emergency response team to care for potentially exposed persons following radiation events, for example, detonation of a nuclear weapon, nuclear power plant accidents, and transportation incidents. For these reasons, maintenance of an adequate workforce in each of these professions is essential to meeting the nation's future needs. Currently, there is a shortage for all physicians in the medical radiology workforce.

Artificial Intelligence in Fracture Detection: A Systematic Review and Meta-Analysis

Background Patients with fractures are a common emergency presentation and may be misdiagnosed at radiologic imaging. An increasing number of studies apply artificial intelligence (AI) techniques to fracture detection as an adjunct to clinician diagnosis. Purpose To perform a systematic review and meta-analysis comparing the diagnostic performance in fracture detection between AI and clinicians in peer-reviewed publications and the gray literature (ie, articles published on preprint repositories). Materials and Methods A search of multiple electronic databases between January 2018 and July 2020 (updated June 2021) was performed that included any primary research studies that developed and/or validated AI for the purposes of fracture detection at any imaging modality and excluded studies that evaluated image segmentation algorithms. Meta-analysis with a hierarchical model to calculate pooled sensitivity and specificity was used. Risk of bias was assessed by using a modified Prediction Model Study Risk of Bias Assessment Tool, or PROBAST, checklist. Results Included for analysis were 42 studies, with 115 contingency tables extracted from 32 studies (55 061 images). Thirty-seven studies identified fractures on radiographs and five studies identified fractures on CT images. For internal validation test sets, the pooled sensitivity was 92% (95% CI: 88, 93) for AI and 91% (95% CI: 85, 95) for clinicians, and the pooled specificity was 91% (95% CI: 88, 93) for AI and 92% (95% CI: 89, 92) for clinicians. For external validation test sets, the pooled sensitivity was 91% (95% CI: 84, 95) for AI and 94% (95% CI: 90, 96) for clinicians, and the pooled specificity was 91% (95% CI: 81, 95) for AI and 94% (95% CI: 91, 95) for clinicians. There were no statistically significant differences between clinician and AI performance. There were 22 of 42 (52%) studies that were judged to have high risk of bias. Meta-regression identified multiple sources of heterogeneity in the data, including risk of bias and fracture type. Conclusion Artificial intelligence (AI) and clinicians had comparable reported diagnostic performance in fracture detection, suggesting that AI technology holds promise as a diagnostic adjunct in future clinical practice. Clinical trial registration no. CRD42020186641 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Cohen and McInnes in this issue.

Gender trends in authorship of Pediatric Radiology publications and impact of the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has heightened existing gender differences in academic productivity in medicine. There have been discrepant repercussions for women in academics due to the pandemic, including fewer publications, potentially impacting academic advancement.

OBJECTIVE

To evaluate trends over time in the gender of authors of manuscripts submitted to Pediatric Radiology.

MATERIALS AND METHODS

This retrospective review of unsolicited manuscripts submitted to Pediatric Radiology from January 2017 to December 2020 included only submissions from North America. For each submission, genders of the first, last (senior) and corresponding authors were inferred by inspection or confirmed by internet search. Chi-square and Fisher exact tests were used to compare authorship gender proportions. Quarterly comparisons between 2019 and 2020 were performed to assess for differences during the COVID-19 pandemic.

RESULTS

Between 2017 and 2020, 1,018 manuscripts were submitted. There was no significant difference in female authorship over time (P > 0.05 for first, last and corresponding authors), but there was an increase in female first authorship (38.6% in 2017, 43.2% in 2020). The frequencies of female first (P = 0.03) and last (P = 0.01) authors were significantly higher for educational manuscripts (reviews and pictorial essays) versus other manuscript types. Manuscript submissions increased in the second quarter of 2020; however, there was a statistically significant decrease in last authorship by women during this period (P = 0.02).

CONCLUSION

Female authorship of manuscripts submitted to Pediatric Radiology has remained relatively stable between 2017 and 2020. During the early phase (March-May 2020) of the COVID-19 pandemic, female last authorship was significantly lower versus the previous year.

Artificial intelligence-supported lung cancer detection by multi-institutional readers with multi-vendor chest radiographs: a retrospective clinical validation study

Background

We investigated the performance improvement of physicians with varying levels of chest radiology experience when using a commercially available artificial intelligence (AI)-based computer-assisted detection (CAD) software to detect lung cancer nodules on chest radiographs from multiple vendors.

Methods

Chest radiographs and their corresponding chest CT were retrospectively collected from one institution between July 2017 and June 2018. Two author radiologists annotated pathologically proven lung cancer nodules on the chest radiographs while referencing CT. Eighteen readers (nine general physicians and nine radiologists) from nine institutions interpreted the chest radiographs. The readers interpreted the radiographs alone and then reinterpreted them referencing the CAD output. Suspected nodules were enclosed with a bounding box. These bounding boxes were judged correct if there was significant overlap with the ground truth, specifically, if the intersection over union was 0.3 or higher. The sensitivity, specificity, accuracy, PPV, and NPV of the readers’ assessments were calculated.

Results

In total, 312 chest radiographs were collected as a test dataset, including 59 malignant images (59 nodules of lung cancer) and 253 normal images. The model provided a modest boost to the reader’s sensitivity, particularly helping general physicians. The performance of general physicians was improved from 0.47 to 0.60 for sensitivity, from 0.96 to 0.97 for specificity, from 0.87 to 0.90 for accuracy, from 0.75 to 0.82 for PPV, and from 0.89 to 0.91 for NPV while the performance of radiologists was improved from 0.51 to 0.60 for sensitivity, from 0.96 to 0.96 for specificity, from 0.87 to 0.90 for accuracy, from 0.76 to 0.80 for PPV, and from 0.89 to 0.91 for NPV. The overall increase in the ratios of sensitivity, specificity, accuracy, PPV, and NPV were 1.22 (1.14–1.30), 1.00 (1.00–1.01), 1.03 (1.02–1.04), 1.07 (1.03–1.11), and 1.02 (1.01–1.03) by using the CAD, respectively.

Conclusion

The AI-based CAD was able to improve the ability of physicians to detect nodules of lung cancer in chest radiographs. The use of a CAD model can indicate regions physicians may have overlooked during their initial assessment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08847-9.

Current Perspectives of Artificial Intelligence in Pediatric Neuroradiology: An Overview

Artificial Intelligence, Machine Learning, and myriad related techniques are becoming ever more commonplace throughout industry and society, and radiology is by no means an exception. It is essential for every radiologists of every subspecialty to gain familiarity and confidence with these techniques as they become increasingly incorporated into the routine practice in both academic and private practice settings. In this article, we provide a brief review of several definitions and techniques that are commonly used in AI, and in particular machine vision, and examples of how they are currently being applied to the setting of clinical neuroradiology. We then review the unique challenges that the adoption and application of faces within the subspecialty of pediatric neuroradiology, and how these obstacles may be overcome. We conclude by presenting specific examples of how AI is currently being applied within the field of pediatric neuroradiology and the potential opportunities that are available for future applications.

Factors Influencing the Commitment of Students to Radiology as a Career Choice During Medical School Education

RATIONALE AND OBJECTIVES

The purpose of this study is to analyze the significance of specific factors in choosing radiology as a specialty compared to switching to/from a different specialty as reported in the Graduation Questionnaire (GQ) and Matriculating Student Questionnaire (MSQ) data provided by Association of American Medical Colleges.

METHOD AND MATERIALS

The study cohort included students who completed both the MSQ and GQ questionnaires in the span of 3-5 years. The cohort was divided into three groups-"Committed" (students who chose radiology in both the first and final year of medical school), "Switched Away" (students who chose radiology on the MSQ but later switched to a different specialty, and "Switched-To" (students who chose radiology on GQ after initially selecting an alternate specialty on the MSQ).

RESULTS

Of 1965 students who chose radiology between the years 2013 and 2016, 281 were Committed, 625 Switched-Away, and 1059 Switched-To. There were significant differences among the groups for salary, length of residency, and work-life balance factors. In the Switched-Away group, more students were influenced by length of residency (18% vs. 5%, p < 0.001) and fewer were influenced by salary (21% vs. 30%, p=0.004) or work-life balance (54% vs. 66%, p = 0.001) when compared to the Committed group. The Switched-To group did not significantly differ from the Committed group (all p > 0.05) for length of residency (6% vs. 5%), salary (30% vs. 30%) and work-life balance (69% vs. 66%).

CONCLUSION

The data provide insight into factors that influence medical students to initially commit to, switch away from, and switch to radiology during medical school. Understanding these dynamics can inform mentors to guide medical students who are interested in a radiology career.

How Radiology Leaders Can Address Burnout

The 2018 Annual Workforce Survey conducted by the ACR Commission on Human Resources demonstrated that, although the majority of radiology practice leaders acknowledge radiologist burnout as a significant problem, only about one in five leaders responded that their practices were either extremely or very effective at addressing physician burnout. Moving forward, leaders will be increasingly held accountable and expected to describe to their teams their reasons for not addressing burnout. In this article, common misperceptions that may contribute to radiology practice leaders not addressing burnout are described, followed by outlining practical skills that leaders should develop to effectively address burnout.

What Causes the Most Stress in Breast Radiology Practice? A Survey of Members of the Society of Breast Imaging

OBJECTIVE

The objective of this study is to determine the major stressors affecting practicing breast radiologists.

METHODS

All members of the Society of Breast Imaging within the United States received an email invitation to complete an anonymous survey evaluating stressors that may contribute to physician burnout. Stressors evaluated included pace at work, work-life balance, care of dependents, job security, financial strain, decreasing reimbursement, new regulations, delivering bad news, fear of getting sued, and dealing with difficult patients, radiologists, and administrators.

RESULTS

The overall response rate was 13.5% (312/2308). For those who opened the email, response rate was 24.6% (312/1269). The most prevalent stressors reported were working too fast (222/312, 71.2%), balancing demands of work with personal life (209/312, 70.0%), fear of getting sued (164/312, 52.6%), and dealing with difficult administrators (156/312, 50%). Prevalence of stress related to new regulation requirements, job security, financial strain, decreased reimbursement, dependent care, call, delivering bad news, and dealing with difficult patients, difficult referrers, and difficult radiologists were present in fewer than 50% of respondents.

CONCLUSION

The most prevalent sources of stress in breast imaging radiologists relate to working too fast and balancing demands of work with time needed for personal life.

Radiologist-Practice Separation: Recent Trends and Characteristics

PURPOSE

To assess recent trends and characteristics in radiologist-practice separation across the United States.

METHODS

Using the Medicare Physician Compare and Medicare Physician and Other Supplier Public Use File data sets, we linked all radiologists to associated group practices annually between 2014 and 2018 and assessed radiologist-practice separation over a variety of physician and group characteristics. Multivariate logistic regression modeling was used to estimate the likelihood of radiologist-practice separation.

RESULTS

Of 25,228 unique radiologists associated with 4,381 unique group practices, 41.1% separated from at least one group practice between 2014 and 2018, and annual separation rates increased 38.4% over time (13.8% from 2014 to 2015 to 19.2% from 2017 to 2018). Radiologist-practice separation rates ranged from 57.4% in Utah to 26.3% in Virginia. Separation rates were 42.8% for general radiologists versus 38.2% for subspecialty radiologists. Among subspecialists, separation rates ranged from 43.0% for breast imagers to 33.5% for cardiothoracic radiologists. Early career status (odds ratio [OR] = 1.286) and late (OR = 1.554) career status were both independent positive predictors of radiologist-practice separation (both P < .001). Larger practice size (OR = 0.795), radiology-only (versus multispecialty) group (OR = 0.468), academic (versus nonacademic) practice (OR = 0.709), and abdominal (OR = 0.820), musculoskeletal (OR = 0.659), and neuroradiology (OR = 0.895) subspecialization were independent negative predictors (all P < .05).

CONCLUSIONS

With over 40% of radiologists separating from at least one practice in recent years, the US radiologist workforce is highly and increasingly mobile. Because reasons for separation (eg, resignation, practice acquisition) cannot be assessed using administrative data, further attention is warranted given the manifold financial, operational, and patient care implications.

Providing second-opinion interpretations of pediatric imaging: embracing the call for value-added medicine

The value of obtaining second-opinion interpretations by specialty radiologists has been established. In pediatric radiology, this has primarily been explored in general terms, comparing tertiary pediatric radiologists' interpretations to referral reads. In adults, second reads by subspecialty radiologists have been shown to yield changes in patient management, including in neuroradiology, musculoskeletal radiology and oncological radiology. Here, we examine second-opinion reads by pediatric radiologists by reviewing the pediatric and adult subspecialty literature. We also present our experience in providing subspecialty outside reads, summarizing lessons learned in implementing a system for outside interpretations into a pediatric radiology practice.

Resident Physicians' Perceptions of Diagnostic Radiology and the Declining Interest in the Specialty

RATIONALE AND OBJECTIVES

The relative competitiveness of radiology and the number of first-choice applicants to diagnostic radiology have steadily declined over the past decade. The purpose of this study was to identify factors contributing to the declining interest in diagnostic radiology as a career and to explore factors affecting specialty choice.

MATERIALS AND METHODS

A retrospective survey was distributed to resident physicians at a single academic center between July and August 2017. Participants identified factors affecting career choice and evaluated level of agreement with statements regarding radiology using 5-point Likert scales. Higher scores indicated stronger agreement.

RESULTS

One hundred and fifty-two resident physicians from Canada participated (21.5% response rate): 20 radiology and 132 nonradiology. Of the total, 27% were registered in postgraduate year (PGY) 1, 23% in PGY 2, 15% in PGY 3, 19% in PGY 4, and 16% in PGY 5, or above. Sixty-one percent of the respondents self-reported as female, 34% as male, and 5% as other/unknown. Of those in radiology, 40% self-reported as female, 55% as male, and 5% as other/unknown, compared to 64% female, 31% male, and 5% other/unknown in other specialties. Regardless of specialty, positive clinical/mentoring experiences strongly affected career choice. Radiology residents were attracted to diverse pathology (M = 4.5) and positive staff/resident interactions (M = 4.4). Nonradiology residents were deterred by lack of patient contact (M = 3.9) and dark work environment (M = 3.6). Resident physicians who had applied to radiology were more likely to report positive mentorship during medical school, disagree that technology will replace radiologists, and desire a higher income specialty (Wald = 56.6, p < 0.001). More recent graduates showed a higher level of concern regarding the potential negative impact of technology and outsourcing on the profession (F (3, 189) = 2.6, p = 0.05). Several trainees (21%) considered radiology, but lacked mentorship (52%) and identified job market concerns (29%).

CONCLUSION

More recent graduates are relatively more concerned about technology replacing radiologists, and radiology applicants have less concern about artificial intelligence replacing radiologists. As positive interactions with radiologists and mentorship are key influencers, our results advocate for early training exposure and reinforcement regarding the positive outlook of the profession.

Perceptions of Adequacy of Breast Imaging Training in the United States among Breast Radiologists

OBJECTIVE

To evaluate the perceptions of breast imaging training in the United States among practicing breast radiologists.

METHODS

An anonymous electronic survey was sent to physician members of the Society of Breast Imaging. Study participants were queried about why they practice breast imaging, what percentage of their clinical practice consists of breast imaging, details about their breast imaging training, and how well their training prepared them for their breast imaging practice. Results were stratified by whether respondents completed a breast imaging fellowship and length of time practicing breast imaging. Results were compared using the Chi-squared test or Fisher's exact test.

RESULTS

We received 271 completed survey responses. Of the survey respondents, 52.4% (141/269) were employed in private practice, 24.2% (65/269) in academic practice, and 23.4% (63/269) in a mixed/hybrid practice. Overall, 46.6% (125/268) of respondents reported practicing a greater proportion of breast imaging than anticipated during training and 18.7% (50/268) had not anticipated that their future practice would include breast imaging at all. The 62.3% (167/268) of survey respondents who had completed a breast or women's imaging fellowship were significantly more likely to report sufficient training in screening mammography, diagnostic mammography, breast procedures, and MRI interpretation.

CONCLUSION

Our study highlights perceived areas of insufficiency in breast imaging training. These were most notable among those who did not complete a breast imaging fellowship. These insufficiencies may be considered when updating the next version of the residency training curriculum.

Perceived Impact of COVID-19 on Pediatric Radiology Departments Around the World: WFPI COVID-19 Task Force Survey Results from 6 Continents

PURPOSE

To investigate how COVID-19 has impacted pediatric radiology practice around the world at the present time.

MATERIALS AND METHODS

This study was based on a survey conducted by the World Federation of Pediatric Imaging (WFPI) COVID-19 task force. Pediatric radiology representatives from countries around the world were identified and asked to complete an electronic survey consisting of 17 questions related to the impact of, concerns surrounding, and education related to COVID-19 on pediatric radiology. For each outcome variable, a pair of 2-way frequency tables was constructed: one against COVID-19 prevalence, and another against region. Tests of independence of the tables' row and column factors were performed based on Fisher's exact test and odds ratios (OR) were estimated via logistic regression models corresponding to these 2-way tables.

RESULTS

The survey (response rate 87%, 72/83) comprised representatives from 71 countries and Hong Kong across 6 continents. 66/72 respondents (92%) indicated that COVID-19 has resulted in moderate (21/72, 29%), significant (36/72, 50%), or complete (9/72, 13%) change in radiology departments/practices in their countries. The two most frequent concerns over the next four months were personal/family health (54/72, 75%) and exposure (48/72, 67%). 79% (57/72) of respondents indicated some level of discomfort in identifying pediatric COVID-19 imaging manifestations. Changes in resident education were reported by 68/72 (94%) respondents, and 22/72 (31%) were concerned that the likelihood of current trainees pursuing a career in pediatric radiology will be impacted.

CONCLUSION

COVID-19 has had a substantial negative impact on pediatric radiology practice around the world.

Providing Effective Feedback in Breast Imaging to Improve Trainee Performance

While feedback is an essential component of medical education, feedback to trainees is frequently nonspecific and not focused on performance improvement. Providing specific feedback to trainees helps them to reflect, develop self-assessment skills, and recalibrate. In light of increasing clinical volumes, stresses related to modern healthcare delivery, and high physician burnout, instructors need efficient methods to provide actionable feedback to trainees. For breast imaging radiologists involved in education, improving feedback skills can help their learners develop expertise in breast imaging while also attracting and inspiring the next generation of radiologists.

Gender Variation in Invited Presenters at Two National Radiology Specialty Meetings

RATIONALE AND OBJECTIVES

To assess gender balance amongst invited speakers at 2 national radiology conferences over the past decade.

MATERIALS AND METHODS

The 2009, 2014, and 2019 Association of University Radiologists (AUR) and American Roentgen Ray Society (ARRS) conference programs were evaluated for the number and gender of invited speakers, as well as various presentation characteristics. Gender balance was stratified across conferences and years.

RESULTS

The final analysis included 1657 invited speakers and 45, 602 minutes of presentation. AUR showed a nonsignificant increase in the percent of presentations by women from 42.2% to 46.5% and in the percent of distinct female presenters from 41.6% to 46.0%. For ARRS, percentage of female presenters varied minimally from 36.1% to 38.2%. In AUR 2009, female presenters spoke on average 5.7min less than men (P= 0.042) and 6.5% of women gave lectures over 30 minutes vs 22.2% of men (P = 0.032). Subsequent AUR and ARRS conferences did not demonstrate presentation length disparities. For AUR, no keynote female speaker was identified. For ARRS, there was no significant difference in percentage of keynote speakers based on gender (P ≥0.516). A disproportionately high percentage of presentations before 8am (44.4%-66.7%) were by women.

CONCLUSION

Female representation was greater than among the overall radiology workforce, highlighting a role of national societies in promoting female radiologists. Nonetheless, such representation is confounded by disproportionate underrepresentation in visibility of invited talks. While improvement in some presentation measures were observed, continued efforts are warranted to promote equal opportunities for female radiologists at national conferences.

Second-Opinion Reads in Interstitial Lung Disease Imaging: Added Value of Subspecialty Interpretation

PURPOSE

The purpose of this study was to determine how often a second-opinion interpretation of interstitial lung disease (ILD) by an academic cardiothoracic radiologist is discordant with the initial interpretation by a nonacademic radiologists and how often the clinical diagnosis determined by multidisciplinary consensus agrees with the initial and second-opinion interpretations.

METHODS

This retrospective study included 364 consecutive second-opinion CT examination reports of imaging from nonacademic radiology practices from July 2014 to May 2016. The second-opinion interpretations, provided by seven fellowship-trained cardiothoracic radiologists, were compared with the initial interpretations and the clinical diagnoses determined by multidisciplinary consensus.

RESULTS

Two hundred ninety-six consecutive reports met the inclusion criteria, and two hundred had findings of ILD. The initial interpretations lacked specific diagnoses in 41% of reports, but the second-opinion reports lacked specific diagnoses in only 7%. When a diagnosis was provided, the second-opinion diagnosis disagreed with the initial interpretation in 25% of cases. The clinical-consensus diagnosis was concordant with that of the academic radiologists 85% of the time but concordant with the initial interpretation only 44% of the time. The academic radiologists' diagnostic sensitivity was higher than that of the initial radiologists for the four most common diagnoses: usual interstitial pneumonitis (0.91 versus 0.4), sarcoidosis (0.94 versus 0.60), hypersensitivity pneumonitis (0.79 versus 0.17), and nonspecific interstitial pneumonitis (0.72 versus 0.14).

CONCLUSIONS

Academic cardiothoracic radiologists were more likely to provide specific diagnoses for ILD, and these diagnoses were more likely to be concordant with the multidisciplinary consensus.

J, Gyawali B, McCormack V, de Anderson MM, Mehrotra R, Mohar A, Murillo R, Pace LE, Paskett ED, Romanoff A, Rositch AF, Scheel J, Schneidman M, Unger-Saldana K, Vanderpuye V, Wu TY, Yuma S, Dvaladze A, Duggan C, Anderson BO. Breast cancer early detection: A phased approach to implementation

When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.

Subspecialty Employment Needs in Academic Radiology Settings Across Canada

PURPOSE

The purpose of this survey was to identify current and projected subspecialty employment needs across Canadian academic radiology practices.

METHODS

An electronic survey was distributed to academic radiology department heads within the faculties of medicine at Canadian universities between September and October 2019. Respondents identified the number of partnership track radiologists hired in the last academic year, the number of fellowship-trained new hires, and the top 3 subspecialties for new and prospective hires. Descriptive statistics were used to summarize the data.

RESULTS

Nine academic radiology department heads responded to the survey (75% response rate) with good regional representation across Canada. Ninety-five percent of new hires within the last academic year were subspecialty fellowship trained. The top subspecialties for new hires in the last year were abdominal imaging and interventional neuroradiology, with 77.8% and 44.4% of academic leaders reporting them as one of the top 3 subspecialties, respectively. The top 3 subspecialties for prospective hires in the next academic year included musculoskeletal imaging (n = 6, 66.7%), followed by abdominal imaging (n = 5, 55.6%), with pediatric radiology (n = 3, 33.3%) and cardiothoracic imaging (n = 3, 33.3%) tying for third place. There was some variability in the subspecialty needs for hires between regions.

CONCLUSIONS

The survey results provide valuable information about the current and future subspecialty needs of academic radiology practices. The data obtained can provide guidance to trainees regarding fellowship training options that will optimize their future employability.

Prevalence of Burnout in Breast Imaging Radiologists

OBJECTIVE

Burnout is defined as a psychological syndrome arising as a response to chronic prolonged interpersonal job-related stress. Physician burnout has been increasingly recognized over the past decade as an epidemic within the United States. The goal of this study was to ascertain the prevalence of burnout amongst practicing breast imaging radiologists.

METHODS

A survey contained demographic questions based on workforce surveys carried out by the American College of Radiology and a validated condensed version of the Maslach Burnout Inventory (MBI) evaluating the three aspects of burnout. The radiologist members of the Society of Breast Imaging (SBI) received the survey internally from the SBI as a weekly e-mail with a web link to the survey from February 19, 2019, to March 13, 2019. The link allowed respondents to complete the survey anonymously. The authors were blinded to the SBI mailing list and the SBI was blinded to the responses.

RESULTS

A total of 370 breast imaging radiologists from the SBI responded to the survey. Overall, 290 out of 370 (78.4%) were highly burned out in at least 1 measured dimension of burnout; 197 out of 362 (54.4%) were highly burned out in at least 2 dimensions of burnout; and 27 out of 362 (7.5%) were highly burned out in all 3 dimensions of burnout. However, rates of personal accomplishment were high, with only 8.8% experiencing high burnout in the dimension of personal accomplishment.

CONCLUSION

Our study demonstrates a high prevalence of burnout amongst breast imaging radiologists. Burnout rates were highest in the youngest breast imaging radiologists.

Comparing Breast and Abdominal Subspecialists' Follow-Up Recommendations for Incidental Liver Lesions on Breast MRI

Purpose:

The aim of this study was to compare breast imaging subspecialists’ follow-up recommendations for incidental liver lesions (ILLs) on breast MRI with abdominal subspecialty radiologists’ opinions informed by best-practice recommendations.

Methods:

In this retrospective study at an academic medical center, natural language processing identified reports with ILLs among 2,181 breast MRI studies completed in 2015. Electronic health record and radiology report reviews abstracted malignancy presence or absence, prior imaging, and breast subspecialists’ recommendations regarding ILLs for random sets of 30 patients: ILLs with follow-up recommendations, ILLs without recommendations, and without ILLs. Two abdominal radiologists evaluated MRI liver findings and offered follow-up recommendations in consensus. The primary outcome was agreement between breast and abdominal subspecialists in patients with ILL follow-up recommendations compared with those without (χ² analysis). Secondary outcomes were agreement between subspecialists when ILLs were reported and referring clinicians’ adherence to follow-up recommendations.

Results:

ILLs were identified in 11.3% of breast MRI reports (247 of 2,181); breast subspecialists made follow-up recommendations in 12% of them (30 of 247). Abdominal subspecialists agreed with breast subspecialists when ILLs required no follow-up (29 of 30 cases) but disagreed with 28 of 30 breast subspecialists’ follow-up recommendations (agreement proportion 29 of 30 versus 2 of 30, P < .0001). Subspecialists agreed in 93% of cases (28 of 30) when breast imagers reported no ILLs. Overall, 16 of 30 breast subspecialists’ follow-up recommendations were performed; ILLs were benign in 15.

Conclusions:

Abdominal subspecialists disagreed frequently with breast subspecialists regarding follow-up recommendations for ILLs on breast MRI. Abdominal subspecialty consultation or embedding liver imaging decision support in breast imaging reporting workflow may reduce unnecessary imaging and improve care. Improvement opportunities may exist in other cross-subspecialty interpretation workflows.

Taking the professional leap from trainee to attending

The transition from trainee to attending can be one of the most difficult transitions in a radiologist's career. Even if a recent graduate is clinically competent, their future successful integration as part of a practice relies on more than just performing correct image interpretation. This article addresses several strategies to help new hires successfully transition to their new practice and become permanent, contributing members of their team.

Current Status and Future Wish List of Peer Review: A National Questionnaire of U.S. Radiologists

OBJECTIVE. Most peer review programs focus on error detection, numeric scoring, and radiologist-specific error rates. The effectiveness of this method on learning and systematic improvement is uncertain at best. Radiologists have been pushing for a transition from an individually punitive peer review system to a peer-learning model. This national questionnaire of U.S. radiologists aims to assess the current status of peer review and opportunities for improvement. MATERIALS AND METHODS. A 21-question multiple-choice questionnaire was developed and face validity assessed by the ARRS Performance Quality Improvement subcommittee. The questionnaire was e-mailed to 17,695 ARRS members and open for 4 weeks; two e-mail reminders were sent. Response collection was anonymous. Only responses from board-certified, practicing radiologists participating in peer review were analyzed. RESULTS. The response rate was 4.2% (742/17,695), and 73.7% (547/742) met inclusion criteria. Most responders were in private practice (51.7%, 283/547) with a group size of 11-50 radiologists (50.5%) and in an urban setting (61.6%). Significant diversity was noted in peer review systems, with RADPEER used by less than half (45.0%) and cases selected most commonly by commercial software (36.2%) or manually (31.2%). There was no consensus on the number of required peer reviews per month (10-20 cases, 32.1%; > 20 cases, 29.1%; < 10 cases, 21.7%). Less than half (43.7%) did not use peer review for group education. Whereas most (67.7%) were notified of their peer review results individually, 21.5% were not notified at all. Around half were dissatisfied (44.5%) because of insufficient learning (94.0%) and inaccurate representation of their performance improvement (75.5%). Overall, the group discrepancy rates were unknown to most radiologists who participate in peer review (54.3%). Submission bias was the main reason for underreporting of serious discrepancies (49.0%). Most found four peer-learning methods feasible in daily practice: incidental observation, 65.1%; focused practice review, 52.9%; professional auditing, 45.8%; and blinded double reading, 35.4%. CONCLUSION. More than half of participants reported that peer review data are used for educational purposes. However, significant diversity remains in current peer review practice with no agreement on number of required reviews, method of case selection, and oversight of results. Nearly half of the radiologists reported insufficient learning, although most feel a better system would be feasible in daily practice.

White Paper: Corporatization in Radiology

Consolidation in health care has been widely recognized as having significant impact in the United States. A related trend is the corporatization of medical professional practices by companies in capital markets. Several medical subspecialties have been identified as attractive corporatization candidates, including radiology. The purpose of the white paper is to present information about the trend of corporatization in radiology. The real, recognized, and potential influences of capital investors in radiology need to be acknowledged as evolving and important considerations. Many radiologists and practices have already realized significant change as a result of corporatization. Corporatization presents significant practical, financial, ethical, and moral implications for those in and related to radiology.