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Christensen EW, Chung Y, Rula EY, Parikh JR. Changes in the Radiology Practice Landscape and Indicators of Practice Consolidation From 2014 to 2023. AJR Am J Roentgenol 2024:1-9. [PMID: 38838234 DOI: 10.2214/ajr.24.31357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND. A range of economic and health policy incentives are leading to ongoing consolidation among payers, hospitals, and physician practices. OBJECTIVE. The purpose of the present study was to evaluate consolidation among radiologists' affiliated practices through 2023, analyze the impact of consolidation on such practices' specialty mix and size, and assess radiologists' new affiliations after prior practices cease. METHODS. CMS data from 2014 to 2023 were used to identify all radiologists nationally along with their affiliated practices. Based on the specialty mix of all affiliated physicians, practices were categorized as radiology only or multispecialty; multispecialty practices were further categorized as radiology majority, other specialty majority, or no majority specialty. Practices that ceased (i.e., became absent within CMS data) were identified. Temporal shifts were assessed to infer consolidation patterns. RESULTS. From 2014 to 2023, the number of radiologists enrolled in Medicare increased 17.3% (from 30,723 to 36,024), whereas the number of affiliated practices decreased 14.7% (from 5059 to 4313). The number of radiology-only, radiology-majority, other-specialty-majority, and no-majority-specialty practices changed by -31.8% (from 3104 to 2118), 10.9% (from 402 to 446), -5.7% (from 615 to 580), and 24.6% (from 938 to 1169), respectively. The number of practices with one to two, three to nine, 10-24, 25-49, 50-99, and 100 or more radiologists changed by -18.7% (from 2233 to 1815), -34.4% (from 1406 to 923), -25.2% (from 910 to 681), 33.2% (from 352 to 469), 121.6% (from 125 to 277), and 348.5% (from 33 to 148). A total of 3494 practices ceased, including 2281 radiology-only practices. Among 3854 radiologists whose only affiliation was a ceased radiology-only practice, their subsequent-year affiliation was a radiology-only practice in 54.3% and a multispecialty practice type in the remaining instances. CONCLUSION. An overall decrease in the number of radiology practices and concurrent growth in the number of radiologists was mirrored by shifts from small toward large practices and from radiology-only toward multispecialty practices, consistent with ongoing practice consolidation. Although determining the causes of consolidation was beyond this scope of this study, the shifts may relate to economic incentives and legislative changes favoring large multispecialty practices. CLINICAL IMPACT. The continued consolidation of radiologists into large multispecialty practices may facilitate subspecialization and greater negotiating power in payer contracting. However, radiologists may prefer smaller and/or radiology-only practices for reasons of autonomy and influence on practice structure.
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Affiliation(s)
- Eric W Christensen
- Harvey L. Neiman Health Policy Institute, 1892 Preston White Dr, Reston, VA 20191
- Health Services Management, University of Minnesota, St. Paul, MN
| | - YoonKyung Chung
- Harvey L. Neiman Health Policy Institute, 1892 Preston White Dr, Reston, VA 20191
| | - Elizabeth Y Rula
- Harvey L. Neiman Health Policy Institute, 1892 Preston White Dr, Reston, VA 20191
| | - Jay R Parikh
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Firouzabadi FD, Hesami M, Sheikhy A, Radmard M, Dabiri M, Ramezanpour S, Yousem DM. Representation of International Medical Graduates Among Diagnostic Radiology Chairs, Neuroradiology Chiefs, and Program Directors. Acad Radiol 2024:S1076-6332(24)00291-5. [PMID: 38871553 DOI: 10.1016/j.acra.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
RATIONALE AND OBJECTIVES The number of international medical graduates (IMGs) entering radiology residencies and neuroradiology fellowships averaged 9.7% and 20.9% from 2021 to 2023, respectively. We aimed to determine whether IMG graduates are populating leadership roles at a proportionate rate in diagnostic radiology (DR) and neuroradiology. MATERIALS AND METHODS We surveyed 191 DR program directors, 94 neuroradiology program directors (PDs), 192 chairs of radiology, and 91 directors of neuroradiology inquiring about their original citizenship and medical school (American Medical Graduates [AMG] vs IMG). We reviewed institutional websites to obtain missing data and recorded H indices for each person using Scopus. RESULTS We confirmed the original citizenship and medical school location in 61-75% and 93-98% of each leadership group. We found that 16.2% of DR program directors, 43.7% of neuroradiology PDs, 28.5% of Chairs, and 40.6% of neuroradiology directors were not originally US citizens. The IMG rate was 18/188 (9.6%), 20/90 (22.2%), 26/186 (14.0%), and 19/85 (22.4%) for the same groups respectively. The most common country of origin and medical school cited was India for all leadership groups. IMGs had a median H index of 14 while AMG 10, significantly different (p = 0.021) CONCLUSION: Compared to the rate of diagnostic and neuroradiology trainees entering from 2021 to 2023, IMGs are proportionately represented at the leadership positions studied. The H index of the IMGs was higher than AMG. We conclude that IMGs have made substantial and proportionate inroads in radiology and neuroradiology leadership.
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Affiliation(s)
| | - Mina Hesami
- Section of Emergency Ultrasound, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ali Sheikhy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahla Radmard
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Mona Dabiri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | | | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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Cayón Somacarrera S, Alonso Rodríguez C, Del Campo Del Val L, Oleaga Zufiría L, Rodríguez Carnero P. Women in Radiology: A perspective from Spain. RADIOLOGIA 2024; 66:121-131. [PMID: 38614529 DOI: 10.1016/j.rxeng.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/17/2023] [Indexed: 04/15/2024]
Abstract
INTRODUCTION There are gender inequalities in all fields, including radiology. Although the situation is improving, the presence of radiologists in leadership positions continues to be a minority. The objective of this article is to analyse the situation of women in the spanish radiology, comparing it with Europe and the United States. MATERIALS AND METHODS We selected the years 2000-2022 as reference period to make a comparison with feminization data throughout history. In addition, relevant specific data from the just begun 2023 were also included. The variables in which we investigated feminization were the following: medical students, medical graduates, radiology residents and specialists, section chiefs, department chairs, radiology residency programme directors, radiology university professors, presidents of the main radiological entities and societies in Spain, Europe and the United States, recipients of the main awards given by these radiological societies and chief editors of their journals. In order to perform this analysis we conducted an in-depth bibliographic research, we contacted the radiological societies of Spain, Europe and the USA and we carried out a survey in the main Spanish radiology departments. RESULTS The female presence in radiology decreases as we rise to leadership positions, a situation that is patent in Spain, Europe and the US, comparison that will be analysed in depth throughout the article. In Spanish hospitals in 2021 there were 58.1% female radiology residents, 55% female radiologists, 42.9% female section chiefs and 24.4% female department chairs. In SERAM's history there have been 10% female presidents, 22% female gold medallists and 5% female editors-in-chief. If we analyse data from 2000 to 2023, female presidents reach 32% and female gold medallists 31%. CONCLUSIONS Although gender inequality is declining, in radiology women continue to be underrepresented in leadership positions. Work must be done in order to build a diverse and inclusive profession that reflects demographic reality.
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Affiliation(s)
- S Cayón Somacarrera
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.
| | - C Alonso Rodríguez
- Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain
| | - L Del Campo Del Val
- Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, Madrid, Spain
| | - L Oleaga Zufiría
- Servicio de Radiodiagnóstico, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - P Rodríguez Carnero
- Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, Madrid, Spain
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Kyarunts M, Michaelcheck CE, Kobeissi H, Kallmes DF, Agid R, Brinjikji W. Gender disparities in industry compensation and research payments among neurointerventional surgeons in the USA. J Neurointerv Surg 2023; 15:1247-1250. [PMID: 36693726 DOI: 10.1136/jnis-2022-019921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND The purpose of this study is to examine the presence of gender disparity represented by industry payments and research funding within the field of interventional neuroradiology. METHODS Payment information was collected using the Centers for Medicare and Medicaid Services Open Payment database for the year 2019. Kruskal-Wallis tests were used to analyze differences in annual compensation based on sex in $US, while controlling for geographic factors, academic rank, and h-index. A sample t-test was performed to look at gender differences in h-indexes. RESULTS The study cohort was comprised of 893 interventional neuroradiologists, 73 (8.2%) of which were female. Of the $48889.20 in mean annual payments reported in the database, $5847.13 (11.2%) went to female interventional neuroradiologists (P<0.05). The significant difference in compensation between male and female neuroradiologists was evident after controlling for state-level variance and academic position. There was a statistically significant difference in total reimbursement (P<0.001), research (P<0.001), consulting (P<0.04), food and beverage (P<0.02), and compensation for services other than consulting between males and females (P<0.02). A statistically significant difference was found for h-index based on gender (males=16.7, females=10.1; P<0.001). CONCLUSIONS Our findings indicate that in the field of interventional neuroradiology, females receive less research funding and private industry compensation, have lower h-indexes, and are less likely to occupy the highest academic positions. The difference in funding did not differ when accounting for geographic state of practice and academic rank. Future studies should work to identify potential contributory factors of these trends.
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Affiliation(s)
- Mariam Kyarunts
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ronit Agid
- Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
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Parwani P, Chen T, Allen B, Kallianos K, Ng MY, Kozor R, Aremu OO, Farooqi KM, Secinaro A, Ricci F, Moharem-Elgamal S, Liberato G, Narang A, Ojha V, Ducci CB, Plein S, Ordovas KG. Challenges and opportunities for early career medical professionals in cardiovascular magnetic resonance (CMR) imaging: a white paper from the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Magn Reson 2023; 25:65. [PMID: 37968709 PMCID: PMC10652595 DOI: 10.1186/s12968-023-00968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023] Open
Abstract
The early career professionals in the field of Cardiovascular Magnetic Resonance (CMR) face unique challenges and hurdles while establishing their careers in the field. The Society for Cardiovascular Magnetic Resonance (SCMR) has expanded the role of the early career section within the society to foster the careers of future CMR leaders. This paper aims to describe the obstacles and available opportunities for the early career CMR professionals worldwide. Societal opportunities and actions targeted at the professional advancement of the early career CMR imagers are needed to ensure continuous growth of CMR as an imaging modality globally.
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Affiliation(s)
- Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA.
| | - Tiffany Chen
- Department of Clinical Medicine, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Bradley Allen
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Kimberly Kallianos
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Rebecca Kozor
- Cardiology Department, Royal North Shore Hospital and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Olukayode O Aremu
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kanwal M Farooqi
- Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabrizio Ricci
- Institute of Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
- Clinical Research Center, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sarah Moharem-Elgamal
- Cardiology Department, Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiology Department, National Heart Institute, Giza, Egypt
| | - Gabriela Liberato
- Diagnostic Imaging Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
- Department of Radiology, Sirio Libanês Hospital, São Paulo, Brazil
| | - Akhil Narang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vineeta Ojha
- Department of Radiology, Mahajan Imaging, Pushpawati Singhania Research Institute (PSRI), New Delhi, India
| | | | - Sven Plein
- Department of Biomedical Imaging Science, University of Leeds and Kings College London, London, UK
| | - Karen G Ordovas
- Department of Radiology, University of Washington, Seattle, WA, USA
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Sarangi PK, Narayan RK, Panda BB, Rao MK, Panda S, Mittal C. Subspecialization, Senior Residency, or Private Practice: The Dilemma of Final-Year Radiology Postgraduate Residents in India. Indian J Radiol Imaging 2023; 33:295-301. [PMID: 37362370 PMCID: PMC10289856 DOI: 10.1055/s-0043-1761255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background Radiology is among India's top five speciality choices pursued by meritorious medical graduates. With the advent of the subspecialization degree courses, fellowships, the requirement of senior residency as faculty eligibility criteria, and the lucrative option of private practice, the final-year postgraduates are given opportunities to choose from but with little guidance on what and how to choose. This study aims to analyze the views of the final-year radiology postgraduate residents in India regarding their understanding of how to proceed in their professional life with options available. Materials and Methods A cross-sectional, questionnaire-based study was conducted online via Google forms distributed via email and social media platforms. The questionnaire was prepared after going through previous literature, video blogs, and media available on the Internet and was further validated for content. Results About half (48%) of them wished to pursue higher studies in the form of Doctorate of Medicine (DM) degree courses or fellowships. Almost three-quarters of the participants preferred short-term subspecialization via fellowships over 3-year DM courses (28%). Regarding clinical practice, 61.9% preferred to take up senior residency, while slightly over one-third (35.7%) expressed their will to move on to private practice. Conclusion A relative conundrum was observed in the decision to take up senior residency or private practice or to go for DM but had to pursue a fellowship due to limited choice in topics and seats available in the country for subspecialization.
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Affiliation(s)
- Pradosh Kumar Sarangi
- Department of Radiology, Dr. B.C. Roy Multi-Speciality Medical Research Centre, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Ravi Kant Narayan
- Department of Anatomy, Dr. B.C. Roy Multi-Speciality Medical Research Centre, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Braja Behari Panda
- Department of Radiodiagnosis, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India
| | - M.V. Kameswar Rao
- Department of Radiodiagnosis, Maharaja Krushna Chandra Gajapati Medical College and Hospital, Berhampur, Odisha, India
| | - Swaha Panda
- Department of Otorhinolaryngology, Institute of Medical Sciences and Sum Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India
| | - Chaitanya Mittal
- Department of Forensic Medicine and Toxicology, Dr. B.C. Roy Multi-Speciality Medical Research Centre, Indian Institute of Technology Kharagpur, West Bengal, India
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The Pre-Radiology Internship: Room for Improvement? Clin Imaging 2023; 94:85-92. [PMID: 36495850 DOI: 10.1016/j.clinimag.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
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.
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Allen SC, Schroeder J, Budigi B, Bennett P. Workforce Pathway Development: Evaluation of an Educational Seminar to Increase Student Interest in Nuclear Medicine. Acad Radiol 2023; 30:370-378. [PMID: 35879209 DOI: 10.1016/j.acra.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES Attracting more students to nuclear medicine is imperative to improving diversity and meeting growing staffing needs. In this study, we implemented a short seminar about nuclear medicine and evaluated its impact on student perceptions of the field. MATERIALS AND METHODS We developed and presented 30-minute "Introduction to Nuclear Medicine" seminars to undergraduate college students and preclinical medical students. After the seminars, participants completed a post-pre survey to determine perceived changes to their perspective of nuclear medicine. Responses were coded on a Likert 1-5 scale with pre- and post- seminar results compared using T-test of means and analysis of variance. RESULTS Of the 83 students who attended the seminar, 79 (95.1%) students participated in the survey including 67 preclinical medical students and 12 undergraduate students. Of the 78 participants who provided demographic information, there were 38 (48.7%) women, 5 (6.4%) first-generation college students, and 39 (50.0%) people who identified as either multiracial or a race other than White/Caucasian. Among all participants (n = 79), there was a significant increase in perceived understanding of nuclear medicine (p < 0.001), confidence in ability to pursue nuclear medicine (p < 0.001), and interest in becoming a nuclear medicine professional (p < 0.001). Perceived increases in knowledge were highest among first-year medical students (p = 0.031), while interest (p = 0.40) and confidence (p = 0.85) in pursuing nuclear medicine did not vary by educational level. CONCLUSION Perceptions of student interest in nuclear medicine can be improved using an easily implemented, short seminar at the undergraduate college and preclinical medical school level.
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Affiliation(s)
- Samuel C Allen
- Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Jennifer Schroeder
- Department of Radiology, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston Salem, NC 27157
| | - Bhavana Budigi
- Department of Radiology, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston Salem, NC 27157
| | - Paige Bennett
- Department of Radiology, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston Salem, NC 27157.
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Detecting pediatric wrist fractures using deep-learning-based object detection. Pediatr Radiol 2023; 53:1125-1134. [PMID: 36650360 DOI: 10.1007/s00247-023-05588-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Missed fractures are the leading cause of diagnostic error in the emergency department, and fractures of pediatric bones, particularly subtle wrist fractures, can be misidentified because of their varying characteristics and responses to injury. OBJECTIVE This study evaluated the utility of an object detection deep learning framework for classifying pediatric wrist fractures as positive or negative for fracture, including subtle buckle fractures of the distal radius, and evaluated the performance of this algorithm as augmentation to trainee radiograph interpretation. MATERIALS AND METHODS We obtained 395 posteroanterior wrist radiographs from unique pediatric patients (65% positive for fracture, 30% positive for distal radial buckle fracture) and divided them into train (n = 229), tune (n = 41) and test (n = 125) sets. We trained a Faster R-CNN (region-based convolutional neural network) deep learning object-detection model. Two pediatric and two radiology residents evaluated radiographs initially without the artificial intelligence (AI) assistance, and then subsequently with access to the bounding box generated by the Faster R-CNN model. RESULTS The Faster R-CNN model demonstrated an area under the curve (AUC) of 0.92 (95% confidence interval [CI] 0.87-0.97), accuracy of 88% (n = 110/125; 95% CI 81-93%), sensitivity of 88% (n = 70/80; 95% CI 78-94%) and specificity of 89% (n = 40/45, 95% CI 76-96%) in identifying any fracture and identified 90% of buckle fractures (n = 35/39, 95% CI 76-97%). Access to Faster R-CNN model predictions significantly improved average resident accuracy from 80 to 93% in detecting any fracture (P < 0.001) and from 69 to 92% in detecting buckle fracture (P < 0.001). After accessing AI predictions, residents significantly outperformed AI in cases of disagreement (73% resident correct vs. 27% AI, P = 0.002). CONCLUSION An object-detection-based deep learning approach trained with only a few hundred examples identified radiographs containing pediatric wrist fractures with high accuracy. Access to model predictions significantly improved resident accuracy in diagnosing these fractures.
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Almansour H, O'Shea A, England RW, Afat S, Nikolaou K, Othman AE. Fellowship Training: Navigating the Decision to Be a Generalist or a Subspecialist- Radiology In Training. Radiology 2022; 305:E63-E65. [PMID: 35819323 DOI: 10.1148/radiol.220422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Haidara Almansour
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany (H.A., S.A., K.N., A.E.O.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.O.); Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Md (R.W.E.); and Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany (A.E.O.)
| | - Aileen O'Shea
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany (H.A., S.A., K.N., A.E.O.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.O.); Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Md (R.W.E.); and Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany (A.E.O.)
| | - Ryan W England
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany (H.A., S.A., K.N., A.E.O.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.O.); Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Md (R.W.E.); and Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany (A.E.O.)
| | - Saif Afat
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany (H.A., S.A., K.N., A.E.O.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.O.); Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Md (R.W.E.); and Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany (A.E.O.)
| | - Konstantin Nikolaou
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany (H.A., S.A., K.N., A.E.O.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.O.); Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Md (R.W.E.); and Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany (A.E.O.)
| | - Ahmed E Othman
- From the Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen University Hospital, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany (H.A., S.A., K.N., A.E.O.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.O.); Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Md (R.W.E.); and Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany (A.E.O.)
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Tharp K, Santavicca S, Hughes DR, Kishore D, Banja JD, Duszak R. Characteristics of Radiologists Serving as Medical Malpractice Expert Witnesses for Defense Versus Plaintiff. J Am Coll Radiol 2022; 19:807-813. [PMID: 35654146 DOI: 10.1016/j.jacr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Previous studies have reported higher qualification characteristics for anesthesiologists, neurosurgeons, orthopedic surgeons, and otolaryngologists serving as defense (versus plaintiff) medical malpractice expert witnesses. We assessed such characteristics for radiologist expert witnesses. METHODS Using the Westlaw legal research database, we identified radiologists serving as experts in all indexed medical malpractice cases between 2010 and 2019. Online databases were used to identify years of practice experience and scholarly bibliometrics. Using Medicare claims, individual radiologist practice types and mixes were ascertained. Radiologists testifying at least once each for defense and plaintiff were excluded from our defense-only versus plaintiff-only comparative analysis. RESULTS Initial Boolean searches yielded 1,042 potential cases; subsequent manual review identified 179 radiologists testifying in 231 lawsuits: 143 testified in one case (58 defense, 85 plaintiff) and 36 testified in multiple cases (10 defense-only, 14 plaintiff-only, 12 both). The 68 defense-only experts had fewer years of practice experience than the 99 plaintiff-only experts (28.3 versus 31.8 years, P = .02), but the two groups were otherwise similar in both practice type (44.6% versus 54.9% academic, P = .62) and mix (63.8% versus 65.8% practiced as subspecialists, P = .37) and as well as numbers of publications (60.5 versus 62.8, P = .86), citations (1,994.1 versus 2,309.2, P = .56), and h-indices (17.2 versus 16.8, P = .89). CONCLUSIONS In contrast to other specialists, radiologists serving as medical malpractice expert witnesses for defense and plaintiff display similar qualifications across various characteristics. Published practice parameter guidelines and experts' ability to blindly review archived original images might together explain this interspecialty discordance.
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Affiliation(s)
- Kenneth Tharp
- Department of Radiology and Imaging Sciences, Emory University School of Medicine.
| | - Stefan Santavicca
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Danny R Hughes
- Department of Radiology and Imaging Sciences, Emory University School of Medicine; Director of the Health Economics and Analytics Laboratory (HEAL), School of Economics, Georgia Institute of Technology
| | - Divya Kishore
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | | | - Richard Duszak
- Vice Chair of the Department of Radiology and Imaging Sciences, and Director of the Imaging Policy Analytics for Clinical Transformation (IMPACT) Research Center, Department of Radiology and Imaging Sciences, Emory University School of Medicine; ACR Board of Chancellors
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12
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Hetenyi S, Goelz L, Boehmcker A, Schorlemmer C. Quality Assurance of a Cross-Border and Sub-Specialized Teleradiology Service. Healthcare (Basel) 2022; 10:1001. [PMID: 35742052 PMCID: PMC9223114 DOI: 10.3390/healthcare10061001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The current literature discusses aspects of quality assurance (QA) and sub-specialization. However, the challenges of these topics in a teleradiology network have been less explored. In a project report, we aimed to review the development and enforcement of sub-specialized radiology at Telemedicine Clinic (TMC), one of the largest teleradiology providers in Europe, and to describe each step of its QA. EVALUATION The company-specific background was provided by the co-authors-current and former staff members of TMC. Detailed descriptions of the structures of sub-specialization and QA at TMC are provided. Exemplary quantitative evaluation of caseloads and disagreement rates of secondary reviews are illustrated. Description of Sub-specialization and Quality Assurance at TMC: Sub-specialization at TMC is divided into musculoskeletal radiology, neuroradiology, head and neck, a body, and an emergency section operating at local daytime in Europe and Australia. Quality assurance is based on a strict selection process of radiologists, specific reporting guidelines, feedback through the secondary reading of 100% of all radiology reports for new starters, and a minimum of 5% of radiology reports on a continuous basis for all other radiologists, knowledge sharing activities and ongoing training. The level of sub-specialization of each radiologist is monitored continuously on an individual basis in detail. After prospective secondary readings, the mean disagreement rate at TMC indicating at least possibly clinically relevant findings was 4% in 2021. CONCLUSION With continuing and current developments in radiology in mind, the essential features of sub-specialization and innovative QA are relevant for further expansion of teleradiology services and for most radiology departments worldwide to respond to the increasing demand for value-based radiology.
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Affiliation(s)
- Szabolcs Hetenyi
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
| | - Leonie Goelz
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Alexander Boehmcker
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
- AIDOC Medical, Aminadav St. 3, Tel Aviv-Yafo 6706703, Israel
| | - Carlos Schorlemmer
- European Telemedicine Clinic SL, Torre Mapfre, C/Marina 16-18, 08005 Barcelona, Spain; (S.H.); (A.B.); (C.S.)
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13
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Davenport MS, Higgins EJ, Weinstein S. Physician Extenders in Radiology Education. J Am Coll Radiol 2022; 19:754-756. [DOI: 10.1016/j.jacr.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
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The economic impact of circulating tumor-tissue modified HPV DNA for the post-treatment surveillance of HPV-driven oropharyngeal cancer: A simulation. Oral Oncol 2022; 126:105721. [PMID: 35077916 DOI: 10.1016/j.oraloncology.2022.105721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Following treatment of HPV-driven oropharynx cancer, surveillance nasopharyngoscopy and imaging are often performed but are expensive and frequently ineffective. A novel plasma circulating tumor-tissue modified viral HPV DNA (TTMV-HPV-DNA) assay accurately detects recurrences. We modeled the cost of the new assay. METHODS We designed and validated a partitioned survival model which replicated the results of the RTOG 1016 study and calculated cumulative surveillance costs from the payer's perspective. Two strategies were considered: a standard of routine endoscopy with imaging as needed and an alternative strategy which omitted scopes and imaging but obtained serial TTMV-HPV-DNA samples. No difference in effectiveness (QALY or LY) was assumed in the base case. A 5-year horizon was used, costs were reported in 2020 U.S. dollars discounted by 3%. Seven scenarios tested model assumptions and practice variation. Deterministic and probabilistic sensitivity analyses assessed parameter uncertainty. RESULTS In the base case, at the list TTMV-HPV-DNA price, the cumulative cost of surveillance was $11,674 for the standard strategy and $20,756 for the TTMV-HPV-DNA strategy (+$9082 over 5 years). Probabilistic sensitivity analysis demonstrated the cost difference ranged from $4917-$12,047. The TTMV-HPV-DNA strategy was most likely to be either cost saving or cost-effective if future data demonstrate small improvements in quality or quantity of life (approximately 33 quality-adjusted life-days), if the assay reduces utilization of imaging, and if the periodicity of TTMV-HPV-DNA draws could be reduced from that on clinical trials. CONCLUSIONS This data informs providers seeking to design more accurate, accessible, and economical post-treatment surveillance strategies.
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Thomas KL, Zafar H, Parikh P, Korngold E, Canon CL, Sadowski E. Representation of women among leadership and honorees within the Society of Abdominal Radiology, past and present. Abdom Radiol (NY) 2021; 46:5758-5762. [PMID: 33452899 DOI: 10.1007/s00261-020-02922-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate gender diversity over time within the leadership and honorees of the Society of Abdominal Radiology with comparison to other radiologic societies. METHODS This was a retrospective, observational study of the gender distribution of presidents and gold meal awardees within the Society of Abdominal Radiology (SAR) compared to three national radiology organizations: the American College of Radiology (ACR), the American Roentgen Ray Society (ARRS), and the Radiological Society of North America (RSNA). Data were collected from the inception of each society through 2020. Societies were directly contacted for president and Gold Medal awardee names when this information was not available on society websites. Differences in the proportion of female presidents and Gold Medal awardees before and after 2012, by society, were performed using χ2 test; 2012 was selected as a threshold year as this represented when SAR was created. RESULTS The proportion of female past presidents was 5%, 9%, and 33% for the SGR, SUR, and SAR, respectively, and 5%, 4%, and 7% for the ACR, ARRS, and RSNA, respectively. The proportion of female Gold Medal awardees was 5%, 4%, and 10% for the SGR, SUR, and SAR, respectively, and 5%, 7%, and 7%, respectively, for ACR, ARRS, and RSNA. There was a statistically significant increase in the proportion of women presidents and honorees in all societies after 2012 compared to before 2012, but no significant difference between societies in either time period. CONCLUSION A higher proportion of female presidents and honorees were demonstrated across all societies after 2012.
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Affiliation(s)
- Kerry L Thomas
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
| | - Hanna Zafar
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Puja Parikh
- Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Elena Korngold
- Department of Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Cheri L Canon
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Gender Differences in Diagnostic Radiology Practice: An Observational Study. J Am Coll Radiol 2021; 19:90-96. [PMID: 34767795 DOI: 10.1016/j.jacr.2021.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate gender differences in diagnostic radiology practice, specifically, the differences in scope of practice, the frequency of consultations to other colleagues, and the error rates. MATERIAL AND METHODS A retrospective observational study was performed including radiologists working for a European teleradiology provider between 2013 and 2019. Main outcome measures included the adjusted odds ratio of female gender for reporting cases in more than one subspecialty, the adjusted incidence rate ratio (IRR) of female gender for the count of second opinion requests to other colleagues, and the adjusted IRR of female gender for the count of radiologic errors. Multivariable adjustment was performed for covariates associated with experience, type of cases reported, part- or full-time employment, and reporting speed. RESULTS A total of 213 radiologists (36% female) were included in the analysis of gender differences in scope of practice. Female gender was associated with a lower odds of reporting cases in more than one subspecialty with an odds ratio of 0.46 (95% confidence interval, 0.22-0.96). A total of 204 radiologists (36% female) were included in the analysis of gender differences in the count of second opinion requests to colleagues. There was a trend toward an association between female gender and higher odds of requesting a second opinion with an adjusted IRR of 1.6 compared with male gender but it was not statistically significant (P = .08). A total of 199 radiologists were included (37% female) in the analysis of gender differences in the number of radiologic errors. Female gender was associated with a decrease in the odds of error with an IRR of 0.8 (95% confidence interval, 0.64-0.995). CONCLUSIONS Female radiologists tend to have a narrower scope of practice and make fewer mistakes than their male counterparts, even after detailed adjustment for factors that might explain gender differences in scope of practice and errors.
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Interpretations of Examinations Outside of Radiologists' Fellowship Training: Assessment of Discrepancy Rates Among 5.9 Million Examinations From a National Teleradiology Databank. AJR Am J Roentgenol 2021; 218:738-745. [PMID: 34730371 DOI: 10.2214/ajr.21.26656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: In community settings, radiologists commonly function as multispecialty radiologists, interpreting examinations outside of their fellowship training. Objective: To compare discrepancy rates for preliminary interpretations of acute community-setting examinations concordant versus discordant with interpreting radiologists' fellowship training. Methods: This retrospective study used the databank of a U.S. teleradiology company that provides preliminary interpretations for client community hospitals. The analysis included 5,883,980 acute examinations performed from 2012 to 2016 that were preliminarily interpreted by 269 teleradiologists with a fellowship of neuroradiology, abdominal radiology, or musculoskeletal radiology. When providing final interpretations, client on-site radiologists voluntarily submitted quality assurance (QA) requests if preliminary and final interpretations were discrepant; the teleradiology company's QA committee categorized discrepancies as major (n=8,444) or minor (n=17,208). Associations among examination type (common vs advanced), relationship between examination subspecialty and the teleradiologist's fellowship (concordant vs discordant), and major and minor discrepancies were assessed using three-way conditional analyses with generalized estimating equations. Results: For examinations with concordant subspecialty, major discrepancy rate was lower for common than advanced examinations [0.13% vs 0.26%; relative risk (RR) 0.50, 95% CI: 0.42, 0.60; p < .001]. For examinations with discordant subspecialty, major discrepancy rate was lower for common than advanced examinations (0.14% vs 0.18%; RR 0.81, 95% CI: 0.72, 0.90; p < .001). For common examinations, major discrepancy rate was not different between examinations with concordant versus discordant subspecialty (0.13% vs 0.14%; RR 0.90, 95% CI: 0.81, 1.01; p = .07). For advanced examinations, major discrepancy rate was higher for examinations with concordant versus discordant subspecialty (0.26% vs 0.18%; RR 1.45, 95% CI: 1.18, 1.79; p < .001). Minor discrepancy rate was higher among advanced examinations for those with concordant versus discordant subspecialty (0.34% vs 0.29%; RR 1.17, 95% CI: 1.001, 1.36; p = .04), but not different for other comparisons (p > .05). Conclusion: Major and minor discrepancy rates were not higher for acute community-setting examinations outside of interpreting radiologists' fellowship training. Discrepancy rates increased for advanced examinations. Clinical Impact: The findings support multispecialty radiologist practice in acute community settings. Efforts to match examination and interpreting radiologist subspecialty may not reduce diagnostic discrepancies.
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Evolution of the Interventional Radiology (IR) Pathway-Various Changes and Interrelation to Diagnostic Radiology (DR). Acad Radiol 2021; 28:1253-1263. [PMID: 33906805 DOI: 10.1016/j.acra.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
Interventional radiology continues to evolve into a more robust and clinically dynamic specialty underpinned by significant advancements in training, education, and practice. This article, prepared by members of the 2020-2021 Association of University Radiologists' task force of the Radiology Research Alliance, will review these developments, highlighting the evolution of interventional radiology pathways with attention to growing educational differences, interrelation to diagnostic radiology training, post-training practice patterns, distribution of procedures and future trends, amongst other key features important to those pursuing a career in interventional radiology as well as those in practice.
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Affiliation(s)
- Howard B Fleishon
- Department of Radiology and Medical Imaging, Emory University, School of Medicine, Johns Creek, Georgia.
| | - Robert S Pyatt
- Department of Radiology, Wellspan-Summit Health, Chambersburg, Pennsylvania
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20
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Lee CS, Moy L, Hughes D, Golden D, Bhargavan-Chatfield M, Hemingway J, Geras A, Duszak R, Rosenkrantz AB. Radiologist Characteristics Associated with Interpretive Performance of Screening Mammography: A National Mammography Database (NMD) Study. Radiology 2021; 300:518-528. [PMID: 34156300 DOI: 10.1148/radiol.2021204379] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Factors affecting radiologists' performance in screening mammography interpretation remain poorly understood. Purpose To identify radiologists characteristics that affect screening mammography interpretation performance. Materials and Methods This retrospective study included 1223 radiologists in the National Mammography Database (NMD) from 2008 to 2019 who could be linked to Centers for Medicare & Medicaid Services (CMS) datasets. NMD screening performance metrics were extracted. Acceptable ranges were defined as follows: recall rate (RR) between 5% and 12%; cancer detection rate (CDR) of at least 2.5 per 1000 screening examinations; positive predictive value of recall (PPV1) between 3% and 8%; positive predictive value of biopsies recommended (PPV2) between 20% and 40%; positive predictive value of biopsies performed (PPV3) between the 25th and 75th percentile of study sample; invasive CDR of at least the 25th percentile of the study sample; and percentage of ductal carcinoma in situ (DCIS) of at least the 25th percentile of the study sample. Radiologist characteristics extracted from CMS datasets included demographics, subspecialization, and clinical practice patterns. Multivariable stepwise logistic regression models were performed to identify characteristics independently associated with acceptable performance for the seven metrics. The most influential characteristics were defined as those independently associated with the majority of the metrics (at least four). Results Relative to radiologists practicing in the Northeast, those in the Midwest were more likely to achieve acceptable RR, PPV1, PPV2, and CDR (odds ratio [OR], 1.4-2.5); those practicing in the West were more likely to achieve acceptable RR, PPV2, and PPV3 (OR, 1.7-2.1) but less likely to achieve acceptable invasive CDR (OR, 0.6). Relative to general radiologists, breast imagers were more likely to achieve acceptable PPV1, invasive CDR, percentage DCIS, and CDR (OR, 1.4-4.4). Those performing diagnostic mammography were more likely to achieve acceptable PPV1, PPV2, PPV3, invasive CDR, and CDR (OR, 1.9-2.9). Those performing breast US were less likely to achieve acceptable PPV1, PPV2, percentage DCIS, and CDR (OR, 0.5-0.7). Conclusion The geographic location of the radiology practice, subspecialization in breast imaging, and performance of diagnostic mammography are associated with better screening mammography performance; performance of breast US is associated with lower performance. ©RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Cindy S Lee
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Linda Moy
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Danny Hughes
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Dan Golden
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Mythreyi Bhargavan-Chatfield
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Jennifer Hemingway
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Agnieszka Geras
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Richard Duszak
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
| | - Andrew B Rosenkrantz
- From the Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016 (C.S.L., L.M., A.B.R.); Harvey L. Neiman Health Policy Institute, Reston, Va (D.H., J.H., R.D., A.B.R.); American College of Radiology, Reston, Va (D.G., M.B.C.); Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland (A.G.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (R.D.)
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21
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Chai JL, Boland GW, Simmons W, Cochon L, Nardozza K, Curley PJ, Khorasani R. Integration of a Community Radiology Division into a Subspecialty-Focused Academic Radiology Department. Curr Probl Diagn Radiol 2021; 51:171-175. [PMID: 33840576 DOI: 10.1067/j.cpradiol.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Assimilate a general radiology division into a subspecialty-focused radiology department at an academic medical center. METHODS This Institutional Review Board-approved quality improvement initiative was performed at an academic medical centers' subspecialty-focused academic radiology department, aiming to assimilate a general radiology division providing interpretive services for a distributed set of community ambulatory practices. An Oversight Committee charged by the department chair created a charter with unambiguous goal, timelines, clear decision-making, and conflict resolution processes. The Committee assessed the resources and clinical capabilities of the general radiologists, and the anticipated shift in exam volume from the community into subspecialty divisions. Primary outcome, percentage of targeted organ systems-specific interpretations by general radiologists based on assigned subspecialty division, and secondary outcome of report turnaround time (TAT) for all ambulatory exams, were compared before and after sub-specialization. RESULTS Among 10 general radiologists, 4.5 were assigned to subspecialty divisions; 5.5 continued to cover an independent general radiology practice in a for-profit delivery network. In the 5 months' post-transition, a total 86.6% (11,668/13,477) of reports by the integrated general radiologists were within designated subspecialty divisions vs 23.9% (2,586/10,829) pre-transition (P < 0.01). There was no change in ambulatory radiology report TAT for non-urgent care center (UCC) or UCC exams pre- vs post-integration. DISCUSSION A quality improvement initiative with unambiguous decision-making and conflict resolution processes incorporated a general radiology practice (radiologists and exams) into a subspecialty-focused academic radiology practice without negatively impacting TAT metrics. Future studies would be needed to assess impact on quality of interpretations.
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Affiliation(s)
- Jessie L Chai
- Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Giles W Boland
- Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - William Simmons
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Laila Cochon
- Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kathryn Nardozza
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Patrick J Curley
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Ramin Khorasani
- Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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22
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Youmans DC, Duszak R, Rosenkrantz AB, Fleishon HB, Friedberg EB, Rodgers DA. Value of the New General Radiologist in Private Practice. J Am Coll Radiol 2021; 18:786-788. [PMID: 33676913 DOI: 10.1016/j.jacr.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Richard Duszak
- Vice Chair for Health Policy and Practice in the Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Andrew B Rosenkrantz
- Section Chief, Body Imaging, Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Howard B Fleishon
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Eric B Friedberg
- Division of Community Radiology Specialists, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Daniel A Rodgers
- Rodgers is President of Kanawha Valley Radiologists, Charleston, West Virginia
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Masur JH, Schmitt JE, Lalevic D, Cook TS, Bagley LJ, Mohan S, Nayate AP. Am I Ready to Be an Independent Neuroradiologist? Objective Trends in Neuroradiology Fellows' Performance during the Fellowship Year. AJNR Am J Neuroradiol 2021; 42:815-823. [PMID: 33664112 DOI: 10.3174/ajnr.a7030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Aside from basic Accreditation Council for Graduate Medical Education guidelines, few metrics are in place to monitor fellows' progress. The purpose of this study was to determine objective trends in neuroradiology fellowship training on-call performance during an academic year. MATERIALS AND METHODS We retrospectively reviewed the number of cross-sectional neuroimaging studies dictated with complete reports by neuroradiology fellows during independent call. Monthly trends in total call cases, report turnaround times, relationships between volume and report turnaround times, and words addended to preliminary reports by attending neuroradiologists were evaluated with regression models. Monthly variation in frequencies of call-discrepancy macros were assessed via χ2 tests. Changes in frequencies of specific macro use between fellowship semesters were assessed via serial 2-sample tests of proportions. RESULTS From 2012 to 2017, for 29 fellows, monthly median report turnaround times significantly decreased during the academic year: July (first month) = 79 minutes (95% CI, 71-86 minutes) and June (12th month) = 55 minutes (95% CI, 52-60 minutes; P value = .023). Monthly report turnaround times were inversely correlated with total volumes for CT (r = -0.70, F = 9.639, P value = .011) but not MR imaging. Words addended to preliminary reports, a surrogate measurement of report clarity, slightly improved and discrepancy rates decreased during the last 6 months of fellowship. A nadir for report turnaround times, discrepancy errors, and words addended to reports was seen in December and January. CONCLUSIONS Progress through fellowship correlates with a decline in report turnaround times and discrepancy rates for cross-sectional neuroimaging call studies and slight improvement in indirect quantitative measurement of report clarity. These metrics can be tracked throughout the academic year, and the midyear would be a logical time point for programs to assess objective progress of fellows and address any deficiencies.
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Affiliation(s)
- J H Masur
- From the Department of Radiology (J.H.M., J.E.S., D.L., T.S.C., L.J.B., S.M.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - J E Schmitt
- From the Department of Radiology (J.H.M., J.E.S., D.L., T.S.C., L.J.B., S.M.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - D Lalevic
- From the Department of Radiology (J.H.M., J.E.S., D.L., T.S.C., L.J.B., S.M.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - T S Cook
- From the Department of Radiology (J.H.M., J.E.S., D.L., T.S.C., L.J.B., S.M.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - L J Bagley
- From the Department of Radiology (J.H.M., J.E.S., D.L., T.S.C., L.J.B., S.M.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Mohan
- From the Department of Radiology (J.H.M., J.E.S., D.L., T.S.C., L.J.B., S.M.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - A P Nayate
- Department of Radiology (A.P.N.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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24
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Maralani PJ, Shewchuk JR, Joshi M, Ribeiro L, Carpio-O'Donovan RD, Landry D, Sharma M, Zakhari N, Symons S, Morrish W, Schmidt M. Diagnostic Neuroradiology Subspecialty Training: 1 Versus 2 Years; the Canadian Perspective. Can Assoc Radiol J 2021; 72:661-668. [PMID: 33461343 DOI: 10.1177/0846537120982984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Canada began a national reform of its post-graduate medical education training programs to a Competence By Design (CBD) model. Trends from accredited neuroradiology programs from the past 10 years were investigated to inform educators and stakeholders for this process. METHODS A 13-question electronic survey was sent to program directors of all 8 accredited neuroradiology training programs in Canada. Data was requested for each year on the 2008-2019 graduating classes. Questions pertained to program enrolment; program completion; post-training employment; and the sufficiency of 1-year training programs. RESULTS Response rate was 100%. Over the timeframe studied, the 2-year programs increased in size (P = 0.007), while the 1-year programs remained steady (P = 0.27). 12.2% of trainees enrolled in the 2-year program dropped out after 1 year, and were considered 1-year trainees thereafter. A higher proportion of 2-year trainees obtain positions within academic institutions (89.5 vs 67.2%, P = 0.0007), whereas a higher proportion of 1-year trainees obtain positions within non-academic institutions (29.3 vs 8.1%, P = 0.0007). A higher proportion of those with Canadian board certification in diagnostic radiology who completed a 2-year program obtained a position within a Canadian academic institution compared to non-certified 2-year trainees (P < 0.001). 71.4% of program directors agreed that a 1-year program was sufficient for non-academic staff positions. CONCLUSION The length of the training program has significant impact on employment in academic vs non-academic institutions. This information can be used to guide the upcoming CBD initiative for neuroradiology programs.
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Affiliation(s)
| | - Jason R Shewchuk
- Department of Radiology, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Joshi
- Department of Radiology, 2129University of Calgary, Calgary, Alberta, Canada
| | - Luciana Ribeiro
- Department of Radiology, 3710McMaster University, Hamilton, Ontario, Canada
| | | | - David Landry
- Department of Radiology, 5622Université de Montréal, Montreal, Québec, Canada
| | - Manas Sharma
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Nader Zakhari
- Department of Radiology, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Sean Symons
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - William Morrish
- Department of Radiology, 2129University of Calgary, Calgary, Alberta, Canada
| | - Matthias Schmidt
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
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25
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Dehkharghani S, Lansberg M, Venkatsubramanian C, Cereda C, Lima F, Coelho H, Rocha F, Qureshi A, Haerian H, Mont'Alverne F, Copeland K, Heit J. High-Performance Automated Anterior Circulation CT Angiographic Clot Detection in Acute Stroke: A Multireader Comparison. Radiology 2021; 298:665-670. [PMID: 33434110 DOI: 10.1148/radiol.2021202734] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Identification of large vessel occlusion (LVO) is critical to the management of acute ischemic stroke and prerequisite to endovascular therapy in recent trials. Increasing volumes and data complexity compel the development of fast, reliable, and automated tools for LVO detection to facilitate acute imaging triage. Purpose To investigate the performance of an anterior circulation LVO detection platform in a large mixed sample of individuals with and without LVO at cerebrovascular CT angiography (CTA). Materials and Methods In this retrospective analysis, CTA data from recent cerebrovascular trials (CRISP [ClinicalTrials.gov NCT01622517] and DASH) were enriched with local repositories from 11 worldwide sites to balance demographic and technical variables in LVO-positive and LVO-negative examinations. CTA findings were reviewed independently by two neuroradiologists from different institutions for intracranial internal carotid artery (ICA) or middle cerebral artery (MCA) M1 LVO; these observers were blinded to all clinical variables and outcomes. An automated analysis platform was developed and tested for prediction of LVO presence and location relative to reader consensus. Discordance between readers with respect to LVO presence or location was adjudicated by a blinded tertiary reader at a third institution. Sensitivity, specificity, and receiver operating characteristics were assessed by an independent statistician, and subgroup analyses were conducted. Prespecified performance thresholds were set at a lower bound of the 95% CI of sensitivity and specificity of 0.8 or greater at mean times to notification of less than 3.5 minutes. Results A total of 217 study participants (mean age, 64 years ± 16 [standard deviation]; 116 men; 109 with positive findings of LVO) were evaluated. Prespecified performance thresholds were exceeded (sensitivity, 105 of 109 [96%; 95% CI: 91, 99]; specificity, 106 of 108 [98%; 95% CI: 94, 100]). Sensitivity and specificity estimates across age, sex, location, and vendor subgroups exceeded 90%. The area under the receiver operating characteristic curve was 99% (95% CI: 97, 100). Mean processing and notification time was 3 minutes 18 seconds. Conclusion The results confirm the feasibility of fast automated high-performance detection of intracranial internal carotid artery and middle cerebral artery M1 occlusions. © RSNA, 2021 See also the editorial by Kloska in this issue.
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Affiliation(s)
- Seena Dehkharghani
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Maarten Lansberg
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Chitra Venkatsubramanian
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Carlo Cereda
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Fabricio Lima
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Henrique Coelho
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Felipe Rocha
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Abid Qureshi
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Hafez Haerian
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Francisco Mont'Alverne
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Karen Copeland
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
| | - Jeremy Heit
- From the Department of Radiology, New York University Langone Medical Center, 660 First Ave, 2nd Floor, New York, NY 10016 (S.D.); Department of Neurology, Stanford University Hospital, Stanford, Calif (M.L., C.V., J.H.); Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland (C.C.); Departments of Neurology (F.L., H.C., F.R.) and Radiology (F.M.), Hospital Geral de Fortaleza, Fortaleza, Brazil; Department of Neurology, Kansas University Medical Center, Kansas City, Kan (A.Q.); LifeBridge, Baltimore, Md (H.H.); and Boulder Statistics, Boulder, Colo (K.C.)
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26
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Kahr Rasmussen N, Nayahangan LJ, Carlsen J, Ekberg O, Brabrand K, Albrecht-Beste E, Nielsen MB, Konge L. Evaluation of competence in ultrasound-guided procedures-a generic assessment tool developed through the Delphi method. Eur Radiol 2020; 31:4203-4211. [PMID: 33201282 DOI: 10.1007/s00330-020-07280-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/09/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To develop a generic and objective tool for assessing competence in percutaneous ultrasound-guided procedures. METHODS Interventional ultrasound experts from the Nordic countries were invited to participate in a three-round Delphi process. A steering committee was formed to manage the process. In round 1, the experts were asked to suggest all aspects to consider when assessing competence in US-guided procedures. Suggestions were analyzed and condensed into assessment items. In round 2, the expert panel rated these items on a 1-5 scale and suggested new items. Items with a mean rating of ≤ 3.5 were excluded. In round 3, the expert panel rated the list items and suggested changes to the items. RESULTS Twenty-five experts were invited, and response rates in the three rounds were 68% (17 out of 25), 100% (17 out of 17), and 100% (17 out of 17). The three-round Delphi process resulted in a 12-item assessment tool, using a five-point rating scale. The final assessment tool evaluates pre-procedural planning, US technique, procedural technique, patient safety, communication, and teamwork. CONCLUSIONS Expert consensus was achieved on a generic tool for assessment of competence in percutaneous ultrasound-guided procedures-the Interventional Ultrasound Skills Evaluation (IUSE). This is the initial step in ensuring a valid and reliable method for assessment of interventional US skill. KEY POINTS • Through a Delphi process, expert consensus was achieved on the content of an assessment tool for percutaneous ultrasound-guided procedures-the Interventional Ultrasound Skills Evaluation (IUSE) tool. • The IUSE tool is comprehensive and covers pre-procedural planning, US technique, procedural technique, patient safety, communication, and teamwork. • This is an important step in ensuring valid and reliable assessment of interventional US skills.
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Affiliation(s)
- Niklas Kahr Rasmussen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, the Capital Region of Denmark, Copenhagen, Denmark
| | - Jonathan Carlsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olle Ekberg
- Department of Translational Medicine, Division of Medical Radiology, Lund University, Lund, Sweden
| | - Knut Brabrand
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Elisabeth Albrecht-Beste
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education, the Capital Region of Denmark, Copenhagen, Denmark
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27
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Zabel AOJ, Leschka S, Wildermuth S, Hodler J, Dietrich TJ. Subspecialized radiological reporting reduces radiology report turnaround time. Insights Imaging 2020; 11:114. [PMID: 33123830 PMCID: PMC7596149 DOI: 10.1186/s13244-020-00917-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives The objective of this study was to compare the radiology report turnaround time (RTAT) between decentralized/modality-based and centralized/subspecialized radiological reporting at a multi-center radiology enterprise. Methods RTAT values for MRI, CT, and conventional radiography were compared between decentralized/modality-based (04 September 2017–22 December 2017) and centralized/subspecialized radiology (03 September 2018–21 December 2018) reporting grouped into three subspecializations (body radiology, musculoskeletal radiology, and neuroradiology) at eleven sites of a multi-center radiology enterprise. For the objective of this investigation, hospitals were defined as major and minor hospitals. The Mann-Whitney U test served for statistical analyses. Results Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology resulted overall in a significant decrease of the RTAT: from 82 to 77 min for the first signature (p < 0.001), and 119 to 107 min and 295 to 238 min for the second signature (p < 0.001). Subgroup analyses demonstrate a significant decrease of the RTAT for MRI reports (e.g., second signature RTAT, 1051 to 401 min; p < 0.001) and conventional radiographs (e. g., second signature RTAT, 278 to 171 min; p < 0.001). The RTAT at major hospitals decreased from 288 to 245 min (second signature; p < 0.001) while the corresponding RTAT of minor hospitals decreased more remarkably, from 300 to 198 min (p < 0.001). However, the results were heterogenous; in some analyses, the RTAT even increased. The effect size analyses represent small effects. Conclusions Change of reporting system from decentralized/modality-based to centralized/subspecialized radiology was associated with a significant decreased RTAT. Specifically, the RTAT for MRI reports and conventional radiographs was significantly reduced. A pronounced RTAT decrease was observed at minor hospitals.
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Affiliation(s)
- Andreas Otto Josef Zabel
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland. .,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland.
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
| | - Juerg Hodler
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland.,Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Rämistrasse 100, 8091, Zürich, CH, Switzerland
| | - Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, CH, Switzerland.,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, CH-8091, Zürich, Switzerland
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Abstract
OBJECTIVE. In recent decades, teleradiology has expanded considerably, and many radiology practices now engage in intraorganizational or extraorganizational teleradiology. In this era of patient primacy, optimizing patient care and care delivery is paramount. This article provides an update on recent changes, current challenges, and future opportunities centered around the ability of teleradiology to improve temporal and geographic imaging access. We review licensing and regulations and discuss teleradiology in providing services to rural areas and assisting with disaster response, including the response to the coronavirus disease (COVID-19) pandemic. CONCLUSION. Teleradiology can help increase imaging efficiency and mitigate both geographic and temporal discrepancies in imaging care. Technologic limitations and regulatory hurdles hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.
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29
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Pacheco EO, Torres US, Alves AMA, Bekhor D, D'Ippolito G. Bosniak classification of cystic renal masses version 2019 does not increase the interobserver agreement or the proportion of masses categorized into lower Bosniak classes for non-subspecialized readers on CT or MR. Eur J Radiol 2020; 131:109270. [PMID: 32947091 DOI: 10.1016/j.ejrad.2020.109270] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE In a condition so prevalent as renal cysts, classifications should display satisfactory reproducibility not only among subspecialized readers. We aimed to compare the interobserver agreement of the Bosniak classification version 2019 (BC19) and current Bosniak classification (CBC) for non-subspecialized readers on CT and MRI and to verify whether BC19 leads to a downgrade of renal cystic masses when compared to CBC. METHODS We evaluated 50 renal cystic masses in 47 patients on MR and CT (25 per method). Eighteen readers (nine third-year radiology residents and nine abdominal imaging fellows) assessed the images using BC19 and CBC with an eight-week interval. Kappa statistic was used to assess agreement. An average score of Bosniak categories across all raters evaluated if there was downgrading of lesions on BC19. RESULTS The highest values of Kappa were found for fellows on CBC-MR (κ = 0.51), and the lowest values were found for residents on CBC-MR and fellows on BC19-MR (both κ = 0.36). On CBC, interobserver agreement was moderate for MR and CT (κ = 0.42 and 0.43, respectively), whereas on BC19, it was fair (κ = 0.38 and 0.40, respectively). The best agreements were in categories I (κ = 0.49-0.69) and IV (κ = 0.45-0.51). The poorest agreements occurred at IIF (κ = 0.18 on BC19-CT). There was a moderate median increase from CBC to BC19 in terms of Bosniak categories for both methods (MR [Z=-2.058, p = 0.040] and CT [Z=-2.509, p = 0.012]). CONCLUSION BC19, when compared to CBC, did not improve interobserver agreement nor diminished the proportion of masses categorized into lower Bosniak classes among non-subspecialized readers.
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Affiliation(s)
- Eduardo Oliveira Pacheco
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil.
| | - Ulysses S Torres
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil; Grupo Fleury - R. Cincinato Braga, 282 - Bela Vista, São Paulo, SP, 01333-910 Brazil
| | - Aldo Maurici Araújo Alves
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Daniel Bekhor
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil
| | - Giuseppe D'Ippolito
- Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP) - R. Botucatu, 740 - Vila Clementino, São Paulo, SP, 04023-062, Brazil; Grupo Fleury - R. Cincinato Braga, 282 - Bela Vista, São Paulo, SP, 01333-910 Brazil
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30
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Verma N, Pacini GS, Torrada JP, de Oliveira DM, Zanon M, Marchiori E, Mohammed TL, Hochhegger B. Subspecialized radiology reporting: productivity and impact on the turnaround times for radiology reports in a middle-income country. Radiol Bras 2020; 53:236-240. [PMID: 32904829 PMCID: PMC7458564 DOI: 10.1590/0100-3984.2019.0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the effect that transitioning from a model of general radiology reporting to one of subspecialized radiology reporting has on report turnaround times (TATs) and on productivity in the radiology department of a hospital in a middle-income country. Materials and Methods The reporting workflow in our radiology department was changed from general reporting (any radiologist reporting imaging studies for any specialty) to subspecialized reporting (radiologists exclusively reporting imaging studies that fall within their subspecialty-abdominal, musculoskeletal, cardiothoracic, emergency, or neurological imaging). This was a retrospective study in which we compared general reporting with subspecialized reporting in terms of the following variables: the TAT; the proportions of reports completed within 2 h and within 24 h (TAT-2h and TAT- 24 h, respectively); and productivity. Data were collected over two 24-month periods (2015-2016 for general reporting and 2017-2018 for subspecialized reporting). Results A total of 208,516 reports were generated. The median report TAT decreased from 49.1 h and 52.9 h in 2015 and 2016, respectively, to 16.1 h and 15.2 h in 2017 and 2018, respectively (p < 0.001). The TAT-2h also improved, increasing from 8.7% and 7.9% in 2015 and 2016, respectively, to 52.0% and 61.3% in 2017 and 2018, respectively (p < 0.001), as did the TAT- 24 h, which increased from 12.1% and 14.1% in 2015 and 2016, respectively, to 74.3% and 78.7% in 2017 and 2018, respectively (p < 0.001). Between the two periods, the total number of scans performed increased by 33% (p = 0.001). Conclusion The implementation of a subspecialized reporting system significantly improved the median TAT for radiology reports, as well as increasing the TAT-2h and TAT- 24 h, during a time of increased productivity.
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Affiliation(s)
- Nupur Verma
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Gabriel Sartori Pacini
- Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Diogo Martins de Oliveira
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Matheus Zanon
- Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Tan-Lucien Mohammed
- Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bruno Hochhegger
- Medical Imaging Research Lab (Labimed), Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.,School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Liu S, Rosenkrantz AB. Gender Variation in Invited Presenters at Two National Radiology Specialty Meetings. Curr Probl Diagn Radiol 2020; 50:472-476. [PMID: 32553673 DOI: 10.1067/j.cpradiol.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Shu Liu
- Department of Radiology, NYU Langone Health, New York, NY..
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Rosenkrantz AB, Hughes DR, Duszak R. Increasing Subspecialization of the National Radiologist Workforce. J Am Coll Radiol 2020; 17:812-818. [DOI: 10.1016/j.jacr.2019.11.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
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Rosenkrantz AB, Fleishon HB, Friedberg EB, Duszak R. Practice Characteristics of the United States General Radiologist Workforce: Most Generalists Work as Multispecialists. Acad Radiol 2020; 27:715-719. [PMID: 32234273 DOI: 10.1016/j.acra.2020.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES While subspecialty radiologists' practice patterns have received recent attention, little is known about the practice patterns of general radiologists. We aim to characterize this group (which represents most US radiologists). MATERIALS AND METHODS US radiologists' individual work efforts were assessed using the 2017 Medicare Provider and Other Supplier Public Use File and a previously validated wRVU-weighted claims-based classification system. Using prior criteria, radiologists without >50% work efforts in a single subspecialty were deemed generalists. For this study, a >25% subspecialty work effort threshold was deemed a subspecialty "focus area," and generalists with ≥2 subspecialty focus areas were deemed "multispecialists." Practice characteristics were summarized using various parameters. RESULTS Among 12,438 radiologists meeting existing claims-based criteria to be deemed generalists, 85.0% had ≥2 subspecialty focus areas of >25% work effort (i.e., multispecialists), 14.6% had one focus area, and 0.4% had no focus area. The fraction of generalists meeting multispecialist criteria was similar across radiologists' years in practice (range 84.7% to 85.4%), academic vs. nonacademic status (84.9% to 86.6%), and practice size (83.3% to 87.0%). Although general radiologist multispecialization varied geographically, a majority were multispecialists in all states (range 57.6% in VT to 93.9% in WY) and percentages were not associated with state-level population density (r = 0.013; p = 0.926). CONCLUSION The large majority of US general radiologists practice as multispecialists, and nearly all have at least one subspecialty focus area. The predominance of general radiologists' multispecialty focus across various practice types and locations supports their role in facilitating patient access to a range of radiologist subspecialties.
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Nellamattathil M, Flug J, Hoffmann JC, Weiss S, Amber I. Characteristics of musculoskeletal radiology job postings to guide radiology trainees. Clin Imaging 2020; 61:54-57. [PMID: 31962278 DOI: 10.1016/j.clinimag.2020.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/03/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To review current musculoskeletal (MSK) job market postings to define the listed requirements for practice in order to provide insight to guide residents pursuing fellowship training in MSK radiology to best meet the needs of potential future employers. METHODS Utilizing the ACR (American College of Radiology) Career Center, a review of the ACR job postings began 6/1/2018 focusing on jobs labeled as musculoskeletal (MSK) subspecialty. E-mail notifications from the career center were reviewed, and jobs were tracked prospectively for 1 year. Data was collected regarding the number of positions, the location, the practice type, and required skills both within musculoskeletal radiology and within the remainder of the radiology subspecialties. RESULTS 456 postings met the inclusion criteria. Approximately 19% were for a dedicated MSK radiologist, 25% sought a combination of MSK and a general skill set, and 56% were specifically for a general radiologist position. Approximately 29% of jobs require some combination of mammography and/or light interventional radiology (IR). DISCUSSION Our results indicate that majority of job postings for musculoskeletal radiology require a practice that is not specifically limited to MSK, mirroring trends in other radiology subspecialties. Radiology trainees and program directors should be aware of the needs being demanded by the job market to help guide trainees to individualize their training to best meet the needs of their future employment.
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Affiliation(s)
- Michael Nellamattathil
- Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, USA
| | - Jonathan Flug
- Department of Radiology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Jason C Hoffmann
- Department of Radiology, NYU Winthrop Hospital, 259 First Street, Mineola, NY 11501, USA.
| | - Stan Weiss
- Department of Radiology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - Ian Amber
- Department of Radiology, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, USA.
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Sadigh G, Duszak R, Macura KJ, Rosenkrantz AB. Gender Differences in Modality Interpretation Among Radiologists: An Exploratory Study of Occupational Horizontal Segregation. Acad Radiol 2020; 27:710-714. [PMID: 31281081 DOI: 10.1016/j.acra.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/26/2019] [Accepted: 06/06/2019] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES Occupational "horizontal segregation," defined as disparity in the distribution of responsibilities between genders, could discourage women from seeking careers in radiology, as well as impact women within radiology in terms of compensation, promotion, and career advancement. We aimed to explore the existence of horizontal workplace segregation in radiology, as potentially manifested as intergender differences in the distribution of clinical work effort among imaging modalities for radiologists. MATERIALS AND METHODS Medicare-participating general radiologists, neuroradiologists, abdominal, cardiothoracic, and musculoskeletal radiologists were identified from the 2016 Medicare Physician and Other Supplier Public Use File. Work effort in radiography, ultrasound, CT, and MRI was stratified by gender. Univariable and multivariable analyses were performed. RESULTS 22,445 radiologists were included (19.0% female; 19.6% in academic practices). At univariable analysis, female (vs. male) generalists had lower work effort in MRI (10.2% vs. 13.2%) (p < 0.001); abdominal radiologists had higher work effort in ultrasound (27.1% vs. 21.9%), with lower work effort in CT (53.7%. vs. 56.0%) and MRI (8.1%. vs. 9.4%) (p < 0.001); and musculoskeletal radiologists had higher work effort in radiography (41.6% vs. 34.8%) and less in MRI (44.8% vs. 49.6%) (p = 0.007). In multivariable analyses, female gender was independently associated with lower work effort in advanced imaging (CT and MRI) for generalists (coefficient, -0.020; p < 0.001), abdominal radiologists (coefficient, -0.042; p < 0.001), and neuroradiologists (coefficient -0.010; p = 0.035). CONCLUSION Horizontal occupational segregation exists in radiology with female radiologists devoting lower work effort to advanced imaging modalities. Further investigation is warranted to better understand the sources and downstream implications of such variation.
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Affiliation(s)
- Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, 1364 Clifton Rd NE, Suite BG20 GA 30322.
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, 1364 Clifton Rd NE, Suite BG20 GA 30322
| | - Katarzyna J Macura
- Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland
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The Alternative Payment Model Pathway to Radiologists’ Success in the Merit-Based Incentive Payment System. J Am Coll Radiol 2020; 17:525-533. [DOI: 10.1016/j.jacr.2019.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
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Radiology Practice Consolidation: Fewer but Bigger Groups Over Time. J Am Coll Radiol 2020; 17:340-348. [DOI: 10.1016/j.jacr.2019.02.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022]
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Guichet PL, Duszak R, Chaves Cerdas L, Hughes DR, Hindman N, Rosenkrantz AB. Changing National Medicare Utilization of Catheter, Computed Tomography, and Magnetic Resonance Extremity Angiography: A Specialty-focused 16-Year Analysis. Curr Probl Diagn Radiol 2020; 50:308-314. [PMID: 32029351 DOI: 10.1067/j.cpradiol.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/23/2019] [Accepted: 01/06/2020] [Indexed: 11/22/2022]
Abstract
To assess changing utilization of extremity angiography from 2001 to 2016, focusing on modalities and provider specialties. Medicare PSPS Master Files from 2001-2016 and POSPUF from 2016 were used to determine overall and specialty utilization of diagnostic catheter angiography (DCA), CT angiography (CTA), and MR angiography (MRA). From 2001 to 2016, extremity angiography increased from 1107 to 1590 extremities imaged per 100,000 beneficiaries, with rapid expansion of CTA (22 in 2001 to 619 in 2009; plateau of 645 in 2016), but declines in DCA (1039 to 914) and MRA (45 to 30). Over time, extremity angiography shifted from 94% DCA, 4% MRA, and 2% CTA to 58% DCA, 41% CTA, and 2% MRA. For radiologists, extremity angiography increased slightly (741 to 767) with increases in CTA (20 to 595) and large decreases in DCA (681 to 145), with MRA remaining low (40 to 27). Extremity angiography increased for cardiologists (197 to 349) and vascular surgeons (87 to 351), both overwhelmingly performing DCA. Radiologists' share of all extremity angiography shifted from 67% to 48%, with interventionalists (47%), generalists (43%), and abdominal radiologists (7.4%) providing most radiologist services in 2016. Throughout, radiologists were the dominant providers of CTA (89% to 92%) and MRA (89% to 90%). Extremity angiography utilization in Medicare beneficiaries increased nearly 50% from 2001 to 2016, largely related to CTA performed by radiologists. Of radiologists, interventionalists and generalists together render most services. Cardiologists and surgeons assumed a large share of DCA previously performed by radiologists.
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Affiliation(s)
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, VA; School of Economics, Georgia Institute of Technology, Atlanta, GA
| | - Nicole Hindman
- Department of Radiology, NYU Langone Health, New York, NY
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Rosenkrantz AB, Fleishon HB, Hudgins PA, Bender CE, Duszak R. Characteristics of Radiologists' Clinical Practice Patterns by Career Stage. Acad Radiol 2020; 27:262-268. [PMID: 31076329 DOI: 10.1016/j.acra.2019.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess characteristics of radiologists' clinical practice patterns by career stage. METHODS Radiologists' 2016 billed services were extracted from the Medicare Physician and Other Supplier Public Use File. Billed clinical work was weighted using work relative value units. Medical school graduation years were obtained from Medicare Physician Compare. Practice patterns were summarized by decades after residency. RESULTS Among 28,463 included radiologists, 32.7% were ≤10 years postresidency, 29.3% 11-20 years, 25.0% 21-30 years, 10.5% 31-40 years, 2.4% 41-50 years, 0.1% ≥51 years. Billed clinical work (normalized to a mean of 1.00 among all radiologists) ranged 0.92-1.07 from 1 to 40 years, decreasing to 0.64 for 41-50 years and 0.43 for ≥51 years. Computed tomography represented 34.7%-38.6% of billed clinical work from 1 to 30 years, decreasing slightly to 31.5% for 31-40 years. Magnetic resonance imaging represented 13.9%-14.3% from 1 to 30 years, decreasing slightly to 11.2% for 31-40 years. Ultrasonography represented 6.2%-11.6% across career stages. Nuclear medicine increased steadily from 1.7% for ≤10 years to 7.0% for 41-50 years. Mammography represented 9.9%-12.9% from 1 to 50 years. Radiography/fluoroscopy represented 15.1%-29.8% from 1 to 50 years, but 65.9% for ≥51 years. CONCLUSION The national radiologist workforce declines abruptly by more than half approximately 30 years after residency. Radiologists still working at 31-40 years, however, contribute similar billed clinical work, both overall and across modalities, as earlier career radiologists. Strategies to retain later-career radiologists in the workforce could help the specialty meet growing clinical demands, mitigate burnout in earlier career colleagues, and expand robust patient access to both basic and advanced imaging services.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Medical Center, 660 First Avenue, 3rd Floor, New York, NY 10016.
| | - Howard B Fleishon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Patricia A Hudgins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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DiPiro PJ, Alper DP, Giess CS, Glazer DI, Lee LK, Lacson R, Khorasani R. Comparing Breast and Abdominal Subspecialists' Follow-Up Recommendations for Incidental Liver Lesions on Breast MRI. J Am Coll Radiol 2020; 17:773-778. [PMID: 32004482 PMCID: PMC7549431 DOI: 10.1016/j.jacr.2019.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
- Pamela J DiPiro
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - David P Alper
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Catherine S Giess
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel I Glazer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leslie K Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ramin Khorasani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
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Trinh B, Calabrese E, Vu T, Forman HP, Haas BM. Low-Volume and High-Volume Readers of Neurological and Musculoskeletal MRI: Achieving Subspecialization in Radiology. J Am Coll Radiol 2019; 17:314-322. [PMID: 31883842 DOI: 10.1016/j.jacr.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Differentiate high- versus low-volume radiologists who interpret neurological (Neuro) MRI or musculoskeletal (MSK) MRI and measure the proportion of Neuro and MSK MRIs read by low-volume radiologists. METHODS We queried the 2015 Medicare Physician and Other Supplier Public Use File for radiologists who submitted claims for Neuro or MSK MRIs. Radiologists were classified as high-volume versus low-volume based on their work relative value units (wRVUs) focus or volume of studies interpreted using three different methodologies: Method 1, percentage of wRVUs in Neuro or MSK MRI; Method 2, absolute number of Neuro or MSK MRIs interpreted; and Method 3, both percentage and absolute number. Multiple thresholds with each methodology were tested, and the percentage of Neuro or MSK MRIs interpreted by low-volume radiologists was calculated for each threshold. RESULTS With Method 1, 33% of Neuro MRI and 50% of MSK MRI studies were interpreted by a radiologist whose wRVUs in Neuro or MSK MRI were less than 20% (Method 1). With Method 2, 22% of Neuro MRIs and 37% of MSK MRIs were interpreted by radiologists who read fewer than the mean number of Neuro or MSK MRIs interpreted by an "average full-time radiologist" whose wRVUs in Neuro or MSK MRI were approximately 20%. With Method 3, 38% of Neuro MRIs and 57% of MSK MRIs were interpreted by "low-volume" radiologists. If instead a 50% wRVU threshold is used for Methods One, Two, and Three, then 70%, 58%, and 77% of Neuro MRIs and 86%, 80%, and 90% of MSK MRIs are read by low-volume radiologists. DISCUSSION A large number of radiologists read a low volume of Neuro or MSK MRIs; these low-volume Neuro or MSK MRI radiologists read a substantial portion of Neuro or MSK MRIs. It is unknown which of the methods for distinguishing low-volume radiologists, combined with which threshold, may best correlate with high-performing or low-performing radiologists.
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Affiliation(s)
- Brian Trinh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Evan Calabrese
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Thienkhai Vu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Brian M Haas
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
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Amemiya S, Mori H, Takao H, Abe O. Association of volume of self-directed versus assigned interpretive work with diagnostic performance of radiologists: an observational study. BMJ Open 2019; 9:e033390. [PMID: 31852709 PMCID: PMC6936980 DOI: 10.1136/bmjopen-2019-033390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To understand the sources of variability in diagnostic performance among experienced radiologists. DESIGN All prostate MRI examinations performed between 2016 and 2018 were retrospectively reviewed. SETTING University hospital in Japan. PARTICIPANTS Data derived from 334 pathology-proven cases (male, mean age: 70 years; range: 35-90 years) that were interpreted by 10 experienced radiologists were subjected to the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES Diagnostic performance measures of the radiologists were compared with candidate factors, including interpretive volume of prostate MRIs, volume of self-directed and assigned total annual interpretive work, and years of experience. The potential influence of fatigue was also evaluated by examining the effect of the report's issue time. RESULTS There were 186 prostate cancer cases. Performance was based on accuracy, sensitivity and specificity (86%, 85% and 84%, respectively). While performance was not correlated with the volume of prostate MRIs, per se (ρ=-0.15, p=0.69; ρ=-0.01, p=0.99; ρ=-0.33, p=0.36) or the total MRIs assigned for each radiologist (p>0.6) or years of experience (p>0.4), all measures were strongly correlated with voluntary work represented by the interpretive volume of abdominal CTs (r=0.79, p<0.01; r=0.80, p<0.01; r=0.64, p=0.048). The performance did not differ based on the issue time of the report (morning, afternoon and evening) (χ2(2)=3.65, p=0.16). CONCLUSIONS Greater autonomy, represented as enhanced self-directed interpretive work, was most significantly correlated with the performance of prostate MRI interpretation. The lack of a correlation between the performance and assigned volume confirms the complexity of human learning. Together, these findings support the hypothesis that successful promotion of internal drivers could have a pervasive positive impact on improving diagnostic performance.
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Affiliation(s)
| | - Harushi Mori
- Radiology, The University of Tokyo, Tokyo, Japan
| | | | - Osamu Abe
- Radiology, The University of Tokyo, Tokyo, Japan
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MRI Interpretation Volumes: Consideration of Setting a Bar. J Am Coll Radiol 2019; 17:312-313. [PMID: 31790676 DOI: 10.1016/j.jacr.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/24/2022]
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Clinical Practice Patterns of Interventional Radiologists by Gender. AJR Am J Roentgenol 2019; 213:867-874. [DOI: 10.2214/ajr.19.21321] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rosenkrantz AB, Nicola GN, Hirsch JA, Duszak R. Board Certification Characteristics of Practicing Neuroradiologists. AJNR Am J Neuroradiol 2019; 40:1610-1616. [PMID: 31558498 DOI: 10.3174/ajnr.a6225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Insight into the status of neuroradiology subspecialty certification across the United States could help to understand neuroradiologists' perceived value of subspecialty certification as well as guide efforts to optimize pathways for broader voluntary certification participation. Our aim was to assess board certification characteristics of practicing US neuroradiologists. MATERIALS AND METHODS The American Board of Radiology public search engine was used to link Medicare-participating radiologists with American Board of Radiology diplomates. Among linked diplomates, 4670 neuroradiologists were identified on the basis of 3 criteria: current or prior neuroradiology subspecialty certification or currently >50% clinical work effort in neuroradiology based on work relative value unit-weighted national Medicare claims ("majority-practice neuroradiologists"). Subspecialty certification status was studied in each group, using Centers for Medicare & Medicaid Services data to identify additional physician characteristics. RESULTS Of 3769 included radiologists ever subspecialty certified, 84.1% are currently subspecialty certified. Of 1777/3769 radiologists ever subspecialty-certified and with lifetime primary certificates (ie, nonmandated Maintenance of Certification), only 66.6% are currently subspecialty certified. Of 3341 included majority-practice neuroradiologists, 73.0% were ever subspecialty certified; of these, 89.1% are currently subspecialty certified. Of 3341 majority-practice neuroradiologists, the fraction currently subspecialty certified was higher for those in academic (81.3%) versus nonacademic (58.2%) practices, larger versus smaller practices (72.1% for those in ≥100 versus 36.1% for <10-member practices), US regions other than the West (64.1%-70.6% versus 56.5%), fewer years in practice (77.5% for 11-20 years versus 31.3% for >50 years), and time-limited (73.5%) versus lifetime (54.9%) primary certificates. CONCLUSIONS More than one-quarter of majority-practice neuroradiologists never obtained neuroradiology subspecialty certification. Even when initially obtained, that certification is commonly not maintained, particularly by lifetime primary certificate diplomates and those in nonacademic and smaller practices. Further investigation is warranted to better understand neuroradiologists' decisions regarding attaining and maintaining subspecialty certification.
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Affiliation(s)
- A B Rosenkrantz
- From the Department of Radiology (A.B.R.), NYU Langone Medical Center, New York, New York
| | - G N Nicola
- Hackensack Radiology Group, P.A. (G.N.N.), River Edge, New Jersey
| | - J A Hirsch
- Department of Radiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - R Duszak
- Department of Radiology and Imaging Sciences (R.D.), Emory University School of Medicine, Atlanta, Georgia
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Diagnostic Radiologists' Participation in the American Board of Radiology Maintenance of Certification Program. AJR Am J Roentgenol 2019; 213:1284-1290. [PMID: 31532255 DOI: 10.2214/ajr.19.21724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Physicians across specialties have expressed concerns about Maintenance of Certification (MOC) programs of American Board of Medical Specialties member boards, calling for research about MOC acceptance, adoption, and value. The purpose of this study was to characterize diagnostic radiologists' participation in the American Board of Radiology (ABR) MOC program, the framework for its new Online Longitudinal Assessment program. MATERIALS AND METHODS. Practicing U.S. radiologists were identified from the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File. Corresponding ABR diplomate certification information was obtained through the ABR public search engine. Focused on diagnostic radiologists (defined as those whose only ABR certificate is in diagnostic radiology), MOC participation rates were calculated across various physician characteristics for those whose participation was mandated by the ABR (time-limited certificates) and for those whose participation was not mandated (lifetime certificates). RESULTS. Among 20,354 included diagnostic radiologists, 11,479 (56.4%) participated in MOC. Participation rates were 99.6% (10,058/10,099) among those whose MOC was ABR mandated and 13.9% (1421/10,225) among those whose participation was not mandated (p < 0.001). The rates of nonmandated participation were higher (all p < 0.001) for academic than for non-academic radiologists (28.0% vs 11.3%), subspecialists than for generalists (17.0% vs 11.5%), and those in larger practice groups (< 10 members, 5.0%; 10-49 members, 12.6%; ≥ 50 members, 20.7%). State-level rates of nonmandated participation varied from 0.0% (South Dakota, Montana) to 32.6% (Virginia) and positively correlated with state population density (r = 0.315). CONCLUSION. Although diagnostic radiologists with time-limited certificates nearly universally participate in MOC, those with lifetime certificates (particularly general radiologists and those in smaller and nonacademic practices) participate infrequently. Low rates of nonmandated participation may reflect diplomate dissatisfaction or negative perceptions about MOC.
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Rosenkrantz AB, Heilbrun ME, Nielsen ME, Duszak R. Characteristics of Physicians and Other Providers Frequently Ordering Intravenous Pyelograms. J Am Coll Radiol 2019; 16:1153-1157. [DOI: 10.1016/j.jacr.2018.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
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Rosenkrantz AB, Shanbhogue KP, Duszak R. In comparison with other abdominal imaging modalities, which radiologists interpret abdominal MRI? Abdom Radiol (NY) 2019; 44:2656-2662. [PMID: 30968185 DOI: 10.1007/s00261-019-02009-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess subspecialty mix and case volumes of general and abdominal subspecialty radiologists interpreting abdominal MRI. METHODS The 2016 CMS Physician/Supplier Procedure Summary Master File was used to obtain billed counts of radiologist-interpreted abdominal fluoroscopy, US, CT, and MRI examinations. The CMS Physician and Other Supplier Public Use File was used to assess the subspecialty mix and case volume of the radiologists interpreting those examinations. RESULTS The fraction of all abdominal imaging examinations interpreted by generalists and abdominal subspecialty radiologists was 70.7% and 16.5% for fluoroscopy; 68.7% and 21.0% for US; 71.4% and 19.2% for CT; and 41.9% and 52.5% for MRI. In 2016, the fraction of general and abdominal radiologists interpreting > 50 fluoroscopy examinations on Medicare fee-for-service beneficiaries was 15.1% and 16.2%. For > 50 US examinations, the fraction was 61.5% and 60.5%; for > 50 CT examinations, 91.2% and 79.6%; and for > 50 MRI examinations, 4.0% and 28.5%. The fraction of abdominal imaging examinations interpreted overall by low-volume providers (those interpreting ≤ 50 examinations in 2016) was 59.5% for fluoroscopy, 17.5% for US, 6.3% for CT, and 50.6% for MRI. CONCLUSION Nationally, most abdominal fluoroscopy, US, and CT examinations are interpreted by general radiologists, who have similar annual volumes of these examinations as abdominal subspecialty radiologists. In contrast, most abdominal MRI examinations are interpreted by abdominal subspecialty radiologists, who attain considerably higher volumes. These findings have implications for workforce planning and abdominal imaging fellowship design to ensure their graduates are optimally prepared to contribute to their future practices.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Krishna P Shanbhogue
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
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Rosenkrantz AB, Hawkins CM, Deitte LA, Hemingway J, Hughes DR, Duszak R. Invasive Procedural Versus Diagnostic Imaging and Clinical Services Rendered by Radiology Trainees Over Two Decades. J Am Coll Radiol 2019; 16:845-855. [DOI: 10.1016/j.jacr.2018.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 11/25/2022]
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Increasing Utilization of Chest Imaging in US Emergency Departments From 1994 to 2015. J Am Coll Radiol 2019; 16:674-682. [DOI: 10.1016/j.jacr.2018.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 11/17/2022]
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