The Crossroads of Radiology

amykpatel

August%202016

AUG.2016 | VOL.71 | NO.8

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ACR 2016 Special Report

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Contents

AUGUST 2016 | VOL.71 | NO.8

ALSO INSIDE

ACR 2016 TM SPECIAL REPORT

9 The Crossroads of Radiology ®

P.9

MORETON LECTURE

13 Stepping Out of the Dark Into the Light

CONVOCATION

14 Medal of Honor

ECONOMICS FORUM AND ELECTION RESULTS

16 The Story of Radiology

CAPITOL REPORT

17 A Day on the Hill

SOCIAL MEDIA

18 The Crossroads in 140 Characters

Archives of past issues are available at www.acr.org.

QUESTIONS? COMMENTS? Contact us at bulletin@acr.org.

19 The Power of Navigation

The Harvey L. Neiman Molecular Imaging

Fund honors the legacy of a medical visionary

who dedicated his professional life to improving

patient care.

DEPARTMENTS

4 From the Chair of the Board of Chancellors

This year’s annual meeting highlighted

upcoming technologies and emerging shifts

in the patient experience.

5 Dispatches

News from the College and beyond

8 From the Chair of the Commission on Economics

Looking into the future, the College focuses

on ensuring radiology’s place in future

payment systems.

21 Job Listings

22 Final Read

How do you include patients in their health care

decision-making?

MISSION STATEMENT

The ACR Bulletin supports the American College of

Radiology’s Core Purpose by covering topics relevant to

the practice of radiology and by connecting the College

with members, the wider specialty, and others. By

empowering members to advance the practice, science,

and professions of radiological care, the ACR Bulletin

aims to support high-quality patient-centered health care.


NEWS FROM THE CHAIR OF THE

Board of Chancellors

By James A. Brink, MD, FACR, Chair

Looking Into the Future at ACR 2016

Much of the discussion at this year’s annual meeting revolved around upcoming technologies

and emerging shifts in the patient experience.

THE ACR 2016 MEETING provided a wonderful

venue for radiologist from all types of practice

to gather and exchange ideas regarding

the topics most important to our specialty.

Session tracks were focused on advocacy, economics

and health policy, clinical education,

clinical research, governance, informatics and innovation,

leadership, and quality and safety. Radiologists

chose sessions in their particular area of excellence or

sampled topics of interest from many tracks.

An important feature of a professional society is the

ability to foster expressions of ideas and exchange of

knowledge. While some may shy away from controversial

subjects or speakers who are likely to express divergent

opinions, I for one celebrate the opportunity to hear

what policymakers and others outside our specialty are

thinking about our profession and its future.

One of these controversial voices was Ezekiel

Emanuel, PhD, MD, MSc, our keynote speaker.

Emanuel gave a dire prognosis in which radiologists

are replaced by machines in the not-too-distant future.

While the technical evolution toward artificial intelligence

is inevitable, it is likely that many disciplines

in medicine and beyond will be affected. Lawyer-less

lawsuits, author-less journalism, and oncologist-less

chemotherapy may be the future. (Read more about

Emanuel’s address on page 10.)

As Emanuel stated, our future success lies in our

ability to collectively preserve the human element of

our profession. As David C. Kushner, MD, FACR, said

in his presidential address, it is critical that radiologists

Radiologists will be able to harness

the power of machine learning without

becoming obsolete in the process.

make themselves invaluable members of the care team.

So long as we keep the patients at the center of our

focus, I’m confident that we can leverage the technical

evolution toward machine learning and artificial

intelligence for improved diagnosis, reduced error, and

greater efficiency.

Certainly, the overflow attendance at the educational

session focused on machine learning speaks to

the thirst for knowledge about this important area.

Moreover, I was very pleased to see the rich attendance

Communicating openly and

constructively will help avoid

the fear that this technology

will replace our jobs.

at the Clinical Data Science Industry Council Meeting,

which took place during the ACR 2016 meeting. Here,

ACR leaders convened a group of industry representatives

focused on machine learning and artificial

intelligence. The group discussed important trends in

this emerging industry.

A key action item that emerged from this council

meeting also surfaced during the Economics Forum.

Rosemarie Ryan, co-CEO and a founder of customer

service strategy company Co:Collective, highlighted

the need for good storytelling for our profession.

According to Ryan, effective storytelling can lead to

organizational change that engenders customer loyalty.

Ryan’s message to radiologists was a simple one: you

must figure out what radiology’s story is. By conveying

your value to patients, referring physicians, and

the broader health system, radiologists will be able to

harness the power of machine learning without becoming

obsolete in the process.

In this same vein, the Clinical Data Science Industry

Council identified the need for uniform messaging

around the potential benefits of machine learning for

our specialty. Communicating openly and constructively

will help avoid the fear that this technology will replace

our jobs. Instead, we can change the conversation and

take control of this important technical evolution for the

benefit of our patients and our profession.

4 Bulletin | AUGUST 2016


DISPATCHES

NEWS FROM THE ACR AND BEYOND

CALENDAR

september

8–10 Coronary CT Angiography,

ACR Education Center,

Reston, Va.

8–11 2016 RLI Leadership

Summit, Babson Executive

Conference Center,

Wellesley, Mass.

12–14 ACR-Dartmouth PET/CT

Course, ACR Education

Center, Reston, Va.

19–20 Breast MR with Guided

Biopsy, ACR Education

Center, Reston, Va.

october

3–4 CT Colonography, ACR

Education Center,

Reston, Va.

14–16 Cardiac MR, ACR Education

Center, Reston, Va.

28–29 Prostate MR, ACR Education

Center, Reston, Va.

november

8 International Day of

Radiology (learn more

at internationaldayof

radiology.com)

8–9 Breast MR with Guided

Biopsy, ACR Education

Center, Reston, Va.

1 in 3 Radiologic Recommendations Not Followed

ONE-THIRD OF RADIOLOGIST RECOMMENDATIONS — including calls for additional imaging,

clinical correlation, laboratory studies, and consultation with a specialist — are not followed,

according to a large retrospective study done at Boston Medical Center. Patient management

review also showed that almost one-half of these missed recommendations were not acknowledged

in the referring physician’s notes; disturbingly, serious health issues such as cancer were

among this group.

Possible causes of these communication breakdowns include electronic or fax messages

that fail to deliver, information going to a physician who is not the patient’s primary care

doctor, and patients who do not return for care. Solutions for improved follow-through may

be staff dedicated to communicating results, improved IT systems, and information delivered

through a portal. Read more at bit.ly/Diagnostic_Missed.

Here’s What You Missed

#SoMe

Beyond its function as a social sharing and communication tool, social media can have far-reaching

impacts on global radiology education, particularly in traditionally underserved areas. Read

more at bit.ly/Social_Educ.

GETTING THE WORD OUT

Community outreach, patient education, and collaboration are all ways you can market your practice

while building community. Learn from your colleagues at bit.ly/Word_Out.

THE PERFECT RADIOLOGY REPORT

Clear, concise communication has not lost its value in the digital age. Tips for writing reports that serve

patient care can be found at bit.ly/Report_Tips.

WWW.ACR.ORG 5

©iStock/ Er Ten Hong


DISPATCHES

Connect With the ACR 2016 Virtual Meeting

DIDN’T MAKE IT TO the Crossroads of Radiology®, or want to catch up on sessions

you missed? Connect with the ACR 2016 Virtual Meeting for convenient access to

over 100 hours of programming — at an unbeatable value.

Celebrating Excellence

©iStock/ chokkicx

• Enjoy 24/7, on-demand access from your desktop or mobile device

• Claim CME, SA-CME, and RLI credits for up to 12 months

• Access full-motion video of slides with audio

Order today and learn more at acrvirtualmeeting.org.

MAINTAINING A SUCCESSFUL STATE CHAPTER

is a more intense undertaking than most realize.

State chapters provide educational opportunities,

coordinate important local advocacy efforts, and

dedicate themselves to making a positive impact

in their communities and in the specialty. Each

year, the College honors chapters that have gone

above and beyond in one of five areas: membership,

meetings and education, quality and safety,

government relations, and overall excellence. Below

are the winners. Divisions are based on chapter size.

EXCELLENCE IN GOVERNMENT RELATIONS

Division A: Rhode Island

Division B: Oklahoma

Division C: Colorado

Division D: New York

EXCELLENCE IN MEETINGS & EDUCATION

Division A: Puerto Rico

Division B: Arkansas

Division C: Alabama

Division D: Florida

EXCELLENCE IN MEMBERSHIP

Division A: Rhode Island

Division B: Iowa

Division C: South Carolina

Division D: North Carolina

EXCELLENCE IN QUALITY AND SAFETY

Division A: Hawaii

Division C: Indiana

Division D: Michigan

OVERALL EXCELLENCE

Division A: Hawaii

Division B: Arkansas

Division C: District of Columbia

Division D: Texas

6 Bulletin | AUGUST 2016

Personalize Your Online ACR Experience

VISIT ACR.ORG AND CLICK the green “My ACR” tab to personalize your online

experience and email communications with the College. From this tab you can

manage your profile, change your password, renew your membership, and more.

Get started now!

Check Out the

ACR Career Center

LOOKING FOR A NEW JOB? Don’t overlook the

ACR Career Center, the premier electronic

recruitment resource for the radiology profession.

The Career Center had over 400 live jobs in

May — and numbers continue to climb. You can

access the Career Center at acr.org/career-center.

Check out several of the open listings on page 21.

©iStock/ peshkov


Announcing the 2017 Bruce J. Hillman Fellowship

in Scholarly Publishing

Description of the Fellowship

ACR is seeking applications for the Bruce J. Hillman Fellowship in Scholarly

Publishing. The fellowship is designed to provide a concentrated, two-week

experience in medical editing, journalism, and publication for an interested and

qualified staff radiologist. The goal is to sufficiently engage talented junior and

mid-career radiologists and encourage them to pursue some aspect of medical

journalism as part of their subsequent careers.

During the summer/fall of 2017, the selected fellow will travel for two weeks to

Reston, VA, and receive hands-on experience editing and publishing the Journal of

the American College of Radiology (JACR ® ) with the JACR Editor-in-Chief, Bruce J.

Hillman, MD, FACR, Deputy Editor Ruth Carlos, MD, MS, FACR, and JACR staff.

He or she will also travel to New York City to spend time with the JACR’s publisher,

Elsevier, and complete a project in scholarly publishing.

Eligibility

To qualify for the fellowship, the radiologist must meet the following criteria:

• A minimum of three years in a post-training staff position at an academic or private practice

• Membership in the ACR

• Evidence of interest in medical journalism, including publishing articles and serving as a reviewer for medical journals

or participating on an editorial board

Application and Deadline

No later than Aug. 31, 2016, please submit the following materials to Brett Hansen, JACR senior managing editor, at

bhansen@acr.org, 1891 Preston White Drive, Reston, VA 20191-4326. Applicants will be notified about whether they have

been selected no later than Oct. 31.

• A single page with the applicant’s name, position, institution and contact information that lists in bullet format his/her

accomplishments in writing, editing, serving on editorial boards for medical journals and other related items

• A current curriculum vitae

• A written statement explaining how the fellowship might relate to the applicant’s career goals

• A letter from the applicant’s chair or group president expressing support for the applicant and agreeing to release

the fellow for the time necessary to complete the activities

Visit jacr.org for additional information concerning

timelines and responsibilities.

08.16


FROM THE CHAIR OF THE

Commission on Economics

By Ezequiel Silva III, MD, FACR, Chair

New Chairs, Same Mission

As the cast of volunteers evolves, the Commission on Economics continues to work

to maintain payments and ensure radiology’s place in future payment systems.

THE COMMISSION ON ECONOMICS THANKS

the outgoing chairs and welcomes the

new chairs who will lead the following

important committees: Managed Care, the

Radiology Integrated Care (RIC) Network,

Interventional Radiology (IR), Academic

Radiology, and Reimbursement (RUC). I discussed

our new MACRA Committee and its chair, Greg

Nicola, MD, in last month’s July column. The newly

appointed committee members are recognized experts

in their respective areas of payment policy. The chairs

and their committees will collaborate to maintain the

commission’s unwavering commitment to protecting

radiology’s place in legacy payment systems, such as

fee for service. In addition, they will work to ensure

radiology’s place in future payment models, such

as those defined by the Medicare Access & CHIP

Reauthorization Act (MACRA).

Mark O. Bernardy, MD, FACR, previously the

chair of the Managed Care Committee, is now the

vicechair of the Commission on Economics. He will

help oversee our broader economic actions. Robert G.

Berkenblit, MD, FACR, will continue our efforts to

ensure favorable coverage for such important services

as mammography/tomosynthesis, lung cancer

screening, and CT colonography.

Joaquim M. Farinhas, MD, and David A. Rosman,

MD, were the founding chairs of the RIC Network.

The RIC Network was developed to allow radiologists

with local experience working within new payment

models to share their experiences and is the ACR’s

vehicle for monitoring implementation strategies for

new and novel payment structures. The new chair

of the RIC Network is Seth M. Hardy, MD, who

brings to the job experience from his accountable

care organization in Maine. He will help facilitate the

broader exchange of ideas necessary for more farreaching

success.

The Commission on Economics maintains a

number of specialty committees in order to provide

the clinical expertise necessary to inform payment

policy. Sean M. Tutton, MD, has served as chair of

the IR Committee since 2012, helping us navigate the

rapid bundling and restructuring of the IR component

coding system. Our new chair, C. Matthew Hawkins,

MD, an expert on IR coding, authors the Coding

Q&A Column for the Society of Interventional

Radiology’s IR Quarterly.

James V. Rawson, MD, FACR, the founding chair

of the Commission on Patient- and Family-Centered

Care, leaves his role as chair of our Committee on

Economic Issues in Academic Radiology. The new

chair is Joshua A. Hirsch, MD, FACR, the perfect

choice to inform our actions. In fact, the ACR’s recent

strategic plan includes the following expectation

of economics: “Promote appropriate funding for

radiology graduate medical education and research

within health care reform.” This will require a high

level of experience and focus, which we are confident

that Dr. Hirsch can bring to the effort.

It has been a personal honor to serve as chair of

the Reimbursement Committee and as the advisor

to the Relative Value Scale Update Committee

(RUC) from 2012 to 2016. During that time, I led

a team committed to maintaining the valuation of

radiology services when confronted with a number

of challenges, including the far-reaching “potentially

misvalued” initiative, which brought forth dozens of

radiology codes for revaluation. The RUC processes

can be quite technical, and negotiations at the

RUC can be delicate. I am confident that under the

direction and leadership of the incoming chair, the

Reimbursement Committee will thrive. Our new

chair, Kurt A. Schoppe, MD, has a solid reputation

with the RUC, having served as the alternate advisor

to the RUC since 2012.

It is with deep gratitude that I thank our outgoing

chairs and welcome our new chairs. I am confident

that they are well prepared to lead their talented

committee members and staff. As health care policy

evolves from a volume- to a value-driven architecture,

having talented and motivated individuals to lead

that transition is critical. Success in this realm will

require collaboration within the ACR and external

collaboration with stakeholders and policymakers. I

thank our new chairs for providing that leadership.

8 Bulletin | AUGUST 2016


SPECIAL REPORT

THE CROSSROADS

OF RADIOLOGY

The ACR annual meeting armed today’s radiologists with the tools

to thrive in the health care’s future climate. The shift to patient- and

family-centered care was front and center as ACR members mapped

out a strategy for engaging patients more fully in their care.

Presidential Address: Things Change

David C. Kushner, MD, FACR, opened his

presidential address by acknowledging one

of the constants in the universe: change.

Radiology, he pointed out, is facing changes in

payment models, practice models, and patient

expectations — to name a few. The shift to

patient- and family-centered care is changing

the way radiologists work. Kushner pointed

to this paradigm shift as an opportunity for

radiology to reinforce its value. “The radiologist,

a member of the patient care team, has

personal investment in whether the patient

actually gets better or not,” said Kushner.

What’s driving this change? Kushner

noted several factors, including generational

thinking, technical advances, growing

emphasis on diversity, and increased patient

education and medical literacy. In addition,

our nation’s health system faces serious

challenges in caring for patients efficiently

and affordably.

As health systems and government

regulators take on these challenges, radiologists

will be called upon to demonstrate

their value to both patients and the health

system at large. “We will need to help define

what value means in concert with the rest

of medicine,” said Kushner. “A successful

practice will be the group that participates

in this change.” With R-SCAN, Imaging 3.0,

informatics tools (including clinical decision

support), and registries, the College is

preparing members to do just that.

WWW.ACR.ORG 9


SPECIAL REPORT

Left: Attendees gather for the ACR 2016 opening sessions.

Center: Ezekiel Emanuel, PhD, MD, MSc, presents his

keynote address. Bottom left: William T. Herrington,

MD, FACR, ACR Council speaker, addresses the audience.

Bottom right: David C. Kushner, MD, FACR, delivers his

presidential address.

In this time of change, Kushner encouraged

radiologists to keep patients at the forefront of

everything they do and prioritize interaction.

“If we claim we are the experts,” said Kushner,

“we must be the ones who explain the procedures,

the reports, and the implications to the

patient as a part of the health care team.”

Keynote Address: Predictions for the Future

Ezekiel Emanuel, PhD, MD, MSc, began

his keynote with some sobering statistics.

In 2015, U.S. health care spending was

estimated to top $3 trillion. 1 This figure is

larger than the entire economy of the United

Kingdom, emphasized Emanuel, a faculty

member at the Wharton School and School

of Medicine and University of Pennsylvania,

founding chair of the Clinical Center of the

National Institutes of Health, and former

special advisor on health policy for the

Office of Management and Budget.

5 TRENDS TO WATCH

During his keynote, Ezekiel

Emanuel, PhD, MD, MSc, outlined

five trends that will influence the

future of health care:

• Decline in the use of hospitals

• More outpatient care

• More care in patients’ homes

• Fewer medical tests

• Machine learning

Despite all this, Emanuel said, “I am

an optimist!” He pointed to the 2010

Affordable Care Act, which led to a drop in

the number of uninsured patients. 2 Recent

years have also seen a 17 percent reduction

in hospital-acquired conditions 3 and a slowing

in the growth of insurance premiums. 4

And radiology has not been left out of

these advances. The specialty has been

instrumental in flattening the use of imaging

and kicking off efforts to decrease radiation

risk to patients. Emanuel also pointed out,

“Radiologists are more visible and more

engaged in advising on patient care.”

While there’s much to be hopeful about,

Emanuel encouraged radiologists to prepare for

changes to the way they practice. He pointed to

machine learning as one of the most pressing

issues in the coming years. Emanuel called the

technology “the real threat to radiology.”

At its most basic, machine learning is a statistical

algorithm that automatically improves

with experience. “Unsupervised machine

learning occurs when the machine is left on its

own — with no human input or labels — to

find structure and relationships in the data,”

said Emanuel. (Read more about the future

of machine learning on page 16.) Emanuel

encouraged radiologists to recognize the

benefits of machine learning, which include

the following:

The technology combines predictors in

non-linear and interactive ways.

• Algorithms can handle significantly more

complex datasets with hundreds of billions

of data points.

There are already billions of digitized scans

to train machines to improve their predictive

accuracy.

• Machine learning enables shorter time for

reading and interpretation.

• Machine learning is not affected by fatigue,

emotion, or other human variables.

“Machine learning will only get better over

time, with larger datasets, greater computing

power, and more computer ‘experience,’”

said Emanuel. “The biggest barrier will not

be technical but human willingness to accept

machine-based diagnoses.”

ENDNOTES

1. Keehan SP, et al. National health expenditure projections,

2014–24: spending growth faster than recent trends. Health

Affairs. July 2015. Available at bit.ly/HealthAffairsSpending.

Accessed May 20, 2016.

2. U.S. Census Bureau. Health Insurance Coverage in the United

States: 2014. bit.ly/HealthInsuranceCensus. Published Sept.

2015. Accessed May 20, 2016.

3. Agency for Healthcare Research and Quality. Efforts

to improve patient safety result in 1.3 million fewer

patient harms. Available at bit.ly/AHRQstats. Accessed

May 20, 2016.

4. Henry J. Kaiser Family Foundation. 2015 Employer Health

Benefits Survey. Published Sept. 22, 2015. Available at bit.ly/

KaiserBenefits. Accessed May 20, 2016.

10 Bulletin | AUGUST 2016


BOC Chair Report: Part of the Care Team

“If you’re in medicine, you’re in politics.”

With these memorable words, Bibb Allen Jr.,

MD, FACR, began his final report as chair

of the ACR Board of Chancellors during

Tuesday’s Council Session. Allen’s opening

remarks centered on the ACR’s accomplishments

during his two-year tenure as BOC

chair, from helping to roll back the multiple

procedure payment reduction to the implementation

of the College’s strategic plan.

Allen went on to praise ACR’s work in

aligning radiologists to the coming era of

value-based health care. College initiatives

like R-SCAN that incorporate clinical

decision support, explained Allen, have been

prescient since participation in the CMS

Transforming Clinical Practice Initiative is

one activity that counts toward satisfying

the Merit-Based Incentive Payment System

(MIPS) Clinical Practice Improvement

Activity (CPIA) performance category.

Using CMS’ value-based mandates as a

pivot point, Allen also touted the College’s

efforts at advancing patient-centered care.

From its registries like the Dose Index Registry

to the Lung Cancer Screening Registry —

both of which satisfy the CPIA requirement

for participation in a Qualified Clinical Data

Registry within several MIPS performance

categories — to its Imaging 3.0 TM effort, ACR

has worked tirelessly to refocus radiologists

on doing what is best for patients. In addition,

Allen noted that the Commission on Patientand

Family-Centered Care has already made

strides toward embedding the patient perspective

into the practice of radiology.

Allen concluded by pointedly asking the

audience, “Do we want to be report generators,

or do we want to be part of the clinical

care team?” Given that CMS predicts radiologists

will come in near the bottom of physician

compliance with respect to value-based

payment measures, ACR members have an

uphill battle. However, Allen concluded by

issuing an impassioned plea to prove the

skeptics wrong before conveying his heartfelt

thanks for his time as BOC Chair.

CEO Report: Accountability Wave

William T. Thorwarth Jr., MD, FACR, began

his CEO report by highlighting a number of

Left: Bibb Allen Jr., MD, FACR, delivers his final report as chair of the ACR Board of Chancellors.

Right: William T. Thorwarth Jr., MD, FACR, gives the CEO report.

successes ACR has enjoyed since last year’s

annual meeting. Notable achievements

include deepening relationships with other

radiological associations and increasing recognition

at major medical organizations like the

AMA and the Council of Medical Specialty

Societies, all of which support ACR’s strategic

plan. Thorwarth also emphasized the importance

of every ACR member’s participation in

the R-SCAN program to position themselves

for the evolving value-based landscape.

In addition to R-SCAN, another recently

developed tool that will help radiologists navigate

the hills and valleys of value-based care

is the Inpatient Cost Evaluation Tool (ICE-T)

app. Created by the Harvey L. Neiman Health

Policy Institute TM , the ICE-T app evaluates

imaging costs for each diagnosis-related group

to assist members with negotiations for their

share of bundled payments. The app features

an easy-to-navigate interface that will help

radiologists make a credible case for joining

alternative payment models in the near future.

Turning to the future, Thorwarth underscored

the need for radiology to make itself

more appealing to medical students. Following

this year’s AUR meeting, ACR joined with

organizations like the Alliance of Medical

Student Educators in Radiology, the Alliance

of Clinician-Educators in Radiology, the

Association of University Radiologists, and the

Association of Program Directors in Radiology

to host a job fair that accentuated the positive

ACR 2016 ELECTION RESULTS

The following individuals were elected

at ACR 2016 to represent the College.

ACR President

Bibb Allen Jr., MD, FACR

ACR Vice President

Cheri L. Canon, MD, FACR

Board of Chancellors

Seth A. Rosenthal, MD, FACR

Robert S. Pyatt Jr., MD, FACR

Council Steering Committee

Catherine J. Everett, MD, MBA, FACR

Richard B. Gunderman, MD, FACR

Johnson B. Lightfoote, MD, FACR

Richard Strax, MD, FACR

College Nominating Committee

Kathryn G. Gardner, MD, FACR

Andrew V. Kayes, MD

Suzanne L. Palmer, MD

Member-in-Training Representative

to Intersociety Commission

David C. Gimarc, MD

Alexander S. Misono, MD, MBA

WWW.ACR.ORG 11


SPECIAL REPORT

aspects of radiology. Data suggest that the

nation’s aging population will provide today’s

residents and fellows with a lot of work for years

to come. The younger generation of radiologists

will be on the front line as what Thorwarth

called the “accountability wave” breaks in

performance year 2017. But the good news, he

concluded, is that ACR has been preparing for

this moment for decades and is well positioned

to help radiologists thrive into the future.

RFS Report: The Future of Imaging

Neil U. Lall, MD, outgoing chair of ACR’s

Resident and Fellow Section Executive

Committee, reported on several of the RFS’

recent noteworthy achievements. The RFS has

extended its reach to the radiology community

over the past year by increasing its blogging

activity. Spearheaded by Colin M. Segovis,

MD, PhD, outgoing RFS secretary, this effort

has resulted in dozens of articles. Blog posts

run the gamut, including a series spotlighting

one resident’s determination to bring PACS

technology to a hospital in Kathmandu. Check

out these blogposts at acrbulletin.org.

Lall also expounded on how RFS participants

are leading members of several College

commissions, committees, and work groups.

Members of particular note include Amy K.

Patel, MD, who is working within the ACR

Commission for Women and General Diversity

to recruit more women and minorities into

radiology. In addition, Ashley E. Prosper, MD,

heads the RFS Medical Student Task Force.

The task force’s mandate is to enact a plan to fill

radiology residency positions.

A cornerstone of the RFS has become its

Journal Club, and Lall thanked recent special

12 Bulletin | AUGUST 2016

guests, including Geraldine B. McGinty, MD,

MBA, FACR, and Frank J. Lexa, MD, MBA.

Together with ongoing efforts like strengthening

ties with resident and fellow sections in

other associations, the RFS has a bright future.

YPS Report: Active Engagement

Jennifer E. Nathan, MD, outgoing ACR Young

and Early Career Physician Section (YPS)

chair, said the primary goals of the YPS are to

attract and retain members and foster future

ACR leaders. The section is meeting these goals

with activities that focus on professional development,

networking, and certification.

For starters, the YPS had a dedicated Sunday

morning program at ACR 2016. The program

included two parts: how to succeed in your

practice and how to be a successful radiologist.

Outside of the annual meeting, the YPS

has created content for its members, including

an electronic newsletter plus a column

and podcasts in the JACR®, Nathan said. The

section also helped pilot Engage, an ACR

tool that promotes networking and facilitates

information sharing.

Nathan also mentioned that an amendment

under consideration to add a YPS

member to the ACR Board of Chancellors.

The YPS already has representation on over

90 percent of ACR committees and commissions,

she noted.

However, a recent survey showed that

many YPS members don’t understand their

roles on the committees and commissions

on which they serve. The section plans to

respond with welcome packets for new

committee and commission members and

mentorship programs, Nathan said.

WHY TAKE THE R-SCAN PLEDGE?

ACR 2016 attendees got a chance to learn more about the Radiology Support,

Communication, and Alignment Network (R-SCAN), a collaborative project that brings

radiologists and referring clinicians together to improve imaging utilization. Take the

pledge today to get started on the following:

• Optimize imaging care, reduce unnecessary exams, and lower the cost of care

• Access a free customized version of the ACR Select clinical decision support tool

• Work with ordering physicians to prepare for use of clinical decision support

• Receive free educational resources

• Prepare for the future of value-based care

• Meet MOC Part 4 requirements and earn free CME for participation

To learn more and take the pledge, visit the new R-SCAN website at rscan.org.

ABR UPDATE: EVOLVING MOC

Milton J. Guiberteau, MD, FACR, president

of the American Board of Radiology (ABR),

delivered updates to Maintenance of

Certification (MOC) Part 3: Assessment of

Knowledge, Judgement, and Skills and Part

4: Improvement in Medical Practice. The

ABR’s goal is to make MOC a more coherent,

continuous, and convenient process.

To that end, the ABR Board of Governors

has adopted a new MOC Part 3 online

assessment model to replace the existing

MOC exam. Guiberteau said the Online

Longitudinal/Continuous Assessment will

do the following:

• Minimize travel, expense, and time away

from work and families by bringing the

process to the participants online

• Result in a more continuous assessment

• Promote professional development

through assessments with learning

opportunities

• Incorporate modern learning models

The new model transforms the current traditional

examination from an assessment

of learning into an assessment for learning,

Guiberteau said. “Although we will never

have perfect physician assessment tools,

ABR is committed to offering one that is

consistent with our goals of demonstrating

competence while promoting professional

development,” he said.

With regard to Part 4, the ABR has added a

second category that radiologists can use to

satisfy the improvement requirements. Now

the requirements can be met through either

Practice Quality Improvement Projects or

Participatory Quality Improvement Activities.

Participatory Quality Improvement

Activities include serving in a local or

national leadership role in a national quality

improvement program, participating in

a clinical quality or safety review committee,

working on a peer review project,

engaging in a root-cause -analysis team, or

reporting to a national registry.

Guiberteau noted that these activities

encourage radiologists to engage with

their imaging colleagues, referring clinicians,

and other care partners. While it

may seem radiologists are more isolated

than ever before, these activities can help

change that while improving quality in

imaging practices, he said.


Moreton lecturer

and patient advocate

Andy DeLaO advises

radiologists to take

charge of their health

care stories.

STEPPING OUT OF THE

DARK INTO THE LIGHT

Radiologists must not let others tell their stories.

Moreton lecturer and patient advocate

Andy DeLaO began his Moreton

Lecture by reminding radiologists

why they are in the imaging profession.

“Revenue and payment are the results

of what you do, but the purpose, cause, and

belief you find in your work — that’s why

you do it,” said DeLaO. For radiologists,

the purpose, cause, and belief in their work

is making a profound difference in the lives

and health of their patients.

But there’s a problem. Medicine has

become industrialized, and the story of why

physicians are in their profession becomes

buried under the push to do more things

faster. Medicine is increasingly focused on

efficiency, metrics, and compliance. “The

words doctors use day to day have nothing

to do with patients,” said DeLaO. Essentially,

physicians are telling a story vastly different

than the one they set out to tell.

Right now, medicine belongs to the experience

economy. In these climates, businesses

evolve products from simple goods

to the point where people are willing to buy

products based on the experience they are

having. This is how most hospitals look at

the patient experience — they assume what

patients want and determine factors like

sharing a room vs. having a private room

or the color of the paint on the walls. Few

facilities include the patient in the process,

said DeLaO.

Radiologists must go beyond providing

what they assume is the ideal experience

and meet with their patients. Creating connections

allows patients to recognize that

radiologists have a profound impact on the

patient’s health care story.

“Those words you use in your interpretive

reports? That story is being told by

other people,” said DeLaO. Radiologists are

writing the stories but they’re allowing other

specialties to take those stories and make

them their own — to the patient, it’s that

specialist working with them and shaping

the patient’s world and experiences, not the

radiologist, despite the fact the radiologist

has laid the plan for their health care journey.

And there is a real danger in that.

If patients don’t understand your value,

it’s likely other entities don’t either — neither

the politicians that govern legislation

nor the insurance companies you may rely

on nor your own administration. “You

either choose to connect, or you will be

eliminated,” warned DeLaO.

Making connections with individuals

is easy. “It’s as simple as picking up your

phone and deciding to connect with

someone,” said DeLaO. He offered real

world examples of radiologists who are

already making connections, such as James

V. Rawson, MD, FACR, who participates

in a wide variety of social media activities

like the #HCLDR chat, a multidisciplinary

tweet chat designed to bring health care

leaders together and empower future

leaders. DeLaO also mentioned Ruth

C. Carlos, MD, FACR, who created the

JACR hackathon, which brought different

health care stakeholders together to solve a

common patient problem (read more about

the hackathon on page 15). You can also

do things like create a summary report and

give the patient your contact information,

said DeLaO. That way, you are telling your

story directly.

WWW.ACR.ORG 13


SPECIAL REPORT

MEDAL OF HONOR

Members gather to bestow the College’s highest honors.

Each year, the College recognizes individuals who stand above

the rest — their work supports quality patient care and

advances the specialty. In 2016, over 100 recipients donned

their caps, gowns, and colors representing their medical schools

and marched down the aisles in recognition of receiving their ACR

Fellowship. In addition to the fellows, the celebration honored the

2016 ACR Distinguished Achievement Award Recipient, Honorary

Fellows, and ACR Gold Medalists.

3

4

1

2

5

14 Bulletin | AUGUST 2016


8

6

9

7

1. The new ACR fellows vow to place

patients first.

2. The 2016 ACR fellows wait for Convocation.

3. Lawrence P. Davis, MD, FACR, receives the

ACR Gold Medal.

4. Professor Peter J. Hoskin, MD, accepts his

honorary fellowship.

5. Charles D. Williams, MD, FACR, becomes one

of 2016’s ACR Gold Medalists.

6. Anne C. Roberts, MD, FACR, outgoing ACR

vice president, carries the ceremonial mace.

7. Christoph L. Zollikofer, MD, becomes one of

this year’s Honorary Fellows.

8. Mary Jane Donahue proudly accepts the

Distinguished Achievement Award.

9. Walter J. Curran Jr., MD, FACR, accepts the

ACR Gold Medal.

JACR HACKATHON

Reinventing medical journal

access may have been the theme

of the JACR Hackathon, but the

collaboration and mutual respect

among individuals from different backgrounds stretched

the outcomes of the event far beyond the confines of the

scholarly publishing space. Radiologists, health IT experts,

developers, patients, and patient advocates all met for

the event, which began Saturday morning and extended

through Sunday during ACR 2016.

Gary L. Kreps, PhD, a university distinguished

professor and the director of the Center for Health

and Risk Communication at George Mason University,

admonished participants to come up with designs that

responded to key communication characteristics of

their audiences and took into consideration key demographic

and cultural variables.

Kreps’ presentation was one of several from experts

in patient advocacy, human-centered design, and

scholarly publishing. Six teams were then formed, and

each came up with a unique technological solution that

would provide patients with easier access to scholarly

publishing as well as access to those who could help

them interpret and digest peer-reviewed content. The

hackathon winner, Team PitchN, was among those that

worked through the night to develop a beta version of

their concept.

WWW.ACR.ORG 15


SPECIAL REPORT

ECONOMICS FORUM:

THE STORY OF RADIOLOGY

This year’s forum explored the intersection between patient

care and the economics of radiology.

The importance of storytelling and

placing patients at the center of care

took center stage at the two-part 2016

Economics Forum. Moderated by

Geraldine B. McGinty, MD, MBA, FACR,

outgoing chair of the Commission on

Economics, the presentations marked ACR’s

progress in patient-centered care while highlighting

opportunities for improvement.

Radiology: The Untold Story

McGinty kicked off the proceedings by

introducing Rosemarie Ryan, former CEO

of the marketing communications company

J. Walter Thompson. Ryan spoke

to the audience about the importance of

radiology communicating its story to the

public. Her concept of “StoryDoing” (learn

more at bit.ly/ACRStoryDoing) involves

storytelling that leads to organizational

change that, in turn, engenders

customer loyalty.

Grounding the theme of storytelling

firmly in the realm of radiology,

Ezequiel Silva III, MD, FACR,

incoming chair of the Commission on

Economics, spoke about the value of taking

ownership of radiology’s message for the

purpose of fair reimbursement. Instruments

like the Harvey L. Neiman Health Policy

Institute TM Inpatient Cost Evaluation Tool

(available at bit.ly/HPI-ICE-T), explained

Silva, are powerful storytelling mechanisms.

Silva went on to underscore the need for a

powerful narrative in radiology, especially in

light of the reimbursement uncertainty facing

imaging experts. A compelling narrative,

concluded Silva, will enable radiologists at the

local level to be successful no matter what the

final reimbursement rules look like.

MACHINE LEARNING AND RADIOLOGY

Machine learning is no radiology apocalypse. In fact, the technology presents many opportunities

for the specialty, according to ACR 2016 presenters on the topic.

“I, for one, am not worried about computers taking over,” said Ross W. Filice, MD, assistant

professor and chief of imaging informatics in the department of radiology at Medstar

Georgetown University Hospital and chief of imaging informatics at MedStar Medical

Group Radiology.

Simply put, machine learning is a statistical algorithm that improves with training.

Keith Dreyer, DO, PhD, FACR, associate professor of radiology at Harvard Medical School,

noted the ACR has two machine-learning solutions: ACR Select ® (a clinical decision support

tool) and ACR Assist TM (a structured reporting framework).

Such tools will “make us have to do less of the tedious kind of stuff,” said Tarik K.

Alkasab, MD, PhD, radiologist in the division of emergency imaging in the department

of radiology and service chief of informatics/IT and operations at Massachusetts

General Hospital.

To prepare, radiologists should start collecting the data to train the algorithms, said

J. Raymond Geis, MD, FACR, radiologist with Advanced Medical Imaging Consultants PC

and vice chair of the ACR IT Informatics Commission. “The limiting factor is not the

algorithms, it’s the data,” said Geis.

2

4

1. Geraldine B. McGinty, MD, MBA, FACR,

outgoing chair of the Commission on

Economics and incoming vice chair of the ACR

Board of Chancellors, moderates this year’s

Economics Forum.

2. Ezequiel Silva III, MD, FACR, incoming chair of the

Commission on Economics, compels radiologists

to take ownership of radiology’s narrative.

3.Rosemarie Ryan, former CEO of J. Walter

Thompson, emphasizes the importance of

communication radiology’s story.

4. Raymond K. Tu, MD, FACR, discusses the

economics of imaging.

The Patient-Centered Path

Part two of the Economics Forum featured a

snapshot of where radiology is now in terms

of its evolution toward providing value-based

care. James V. Rawson, MD, FACR, P.L., J.

Luther and Ada Warren Professor and chair of

radiology and imaging at the Medical College

of Georgia, implored radiologists to engage

patients. “If you don’t talk to the patient, you

won’t know what they’re looking for,” said

Rawson, who chairs the ACR Commission on

Patient- and Family-Centered Care.

Raymond K. Tu, MD, FACR, chief of staff

at the Not-for-Profit Hospital Corporation

and chair of the ACR Medicaid Network,

noted that Medicaid beneficiaries include

millions of children and disabled people. Tu

quoted Hubert Humphrey: “The moral test of

government is how it treats those at the dawn

of life, the children; at the twilight of life, the

elderly; and in the shadows of life — the sick,

the needy, and the handicapped.”

continued on page 21

1

3

16 Bulletin | AUGUST 2016


MAKING SENSE OF ALPHABET SOUP

During the session “How to Be a

Successful Radiologist,” Chris Sherin,

director of congressional affairs at the

College, and Richard Duszak Jr., MD,

FACR, briefed attendees on some of the

most talked about health care acronyms

of 2016 — MACRA, MIPS, and APMs.

ACR members meet with Rep. Pete

Sessions (R-TX), chair of the House

Rules Committee.

A DAY ON THE HILL

Radiologists from around the country flocked to Capitol Hill to take

radiology’s message to Congress.

The Medicare Access and CHIP

Reauthorization Act implements a new

system of incentive payments based on

quality metrics and risk sharing. MACRA,

implemented by CMS as the Quality

Payment Program, asks physicians to participate

in two kinds of payment systems:

MIPS, or the Merit-Based Incentive

Payment System, is essentially a

modified fee-for-service program, said

Sherin. MIPS streamlines programs

such as PQRS, Meaningful Use, and

others into one program. This is the

area most radiologists will fall under,

according to Duszak.

Over 500 radiologists, fellows, and

residents attended the annual Capitol

Hill Day during ACR 2016. This

year, we thanked our Senators and

Representatives for including provisions

within H.R. 2029, the Consolidated

Appropriations Act of 2016. This legislation

lowered the professional component

of the multiple procedure payment

reduction (MPPR) from 25 percent to

5 percent for advanced imaging studies

(such as CT, MRI, and US) performed on

the same patient, in the same session, on

the same day.

We also thanked our elected officials for

including additional provisions within H.R.

2029 that place a two-year moratorium on the

flawed United States Preventive Services Task

Force’s (USPSTF) mammography screening

recommendations. Thanks to Congress,

private insurance companies must continue to

provide women ages 40 and above with access

to annual mammograms without any form of

patient cost sharing through Jan. 1, 2018.

After thanking our Members of Congress

for these recent victories, our focus shifted

to gaining cosponsors for H.R. 1151/S.

1151, the USPSTF Transparency and

Accountability Act. This bipartisan legislation

seeks to reform the task force in a variety

of ways. First and foremost, the bill seeks

to increase the overall level of transparency

within the USPSTF’s recommendation

process, including the data and research

methodologies the task force uses to justify

its recommendations. H.R 1151/S. 1151

also mandates the inclusion of specialized

physicians on the USPSTF when it comes to

issues in a certain field of expertise and creates

a more standardized 60-day public comment

period for pending recommendations.

continued on page 21

Attendees prepare to visit their state

representatives in Congress.

Each physician under MIPS will earn a

composite score from 0 to 100 based on

the performance in these programs. The

score determines whether the physician

receives a bonus or penalty. Sherin

updated attendees on some of the new

facets of MIPS, including that those considered

non-patient-facing physicians

(those having 25 or fewer patient-facing

encounters during one year) will receive

consideration under MIPS due to their

unique situation compared to physicians

who see multiple patients a day.

APMs, or alternative payment models,

are the other track physicians can participate

in. APMs are a form of population-based

care. An entire group of physicians

assumes an amount of financial

risk for the continued care of a patient,

based on factors such as whether the

patient must be readmitted or not.

For more information on MACRA,

MIPS, and APMS, watch a webinar

at bit.ly/MACRAWeb or read “Catch

Your Wave?”from the July Bulletin

at bit.ly/CatchWave.

WWW.ACR.ORG 17


SPECIAL REPORT

THE CROSSROADS

IN 140 CHARACTERS

Members from throughout the College, along with patients and patient

advocates participated in tweet chats, voiced their opinions, and shared

their insights and memorable moments on Twitter. We’ve gathered some of

our favorite tweets from the meeting here. What are you tweeting about?

BY THE NUMBERS

Here are the stats on social

media at #ACR2016.

40,099,920 10,582 1,136

impressions (the amount of people who

potentially see or interact with tweets)

TWEETS

PARTICIPANTS

18 Bulletin | AUGUST 2016


ACR Foundation

iStock © rasslava

The Power of Navigation

The Harvey L. Neiman Molecular Imaging Fund honors the legacy of a medical visionary

who dedicated his professional life to improving patient care.

DURING HIS TENURE AT THE HELM of the

ACR, Harvey L. Neiman, MD, FACR,

guided the College to become one of the

world’s largest and most influential medical

specialty societies. Prior to his death in 2014,

Neiman expressed his belief that molecular

imaging would be the next advance in radiology. Today,

the Harvey L. Neiman Molecular Imaging Fund is

helping to transform that vision into reality.

“It was Dr. Neiman’s inspiration to establish an ACR

commission on molecular imaging,” says James H.

Thrall, MD, FACR, former chair of the ACR Board

of Chancellors, chair emeritus of the department of

radiology at Massachusetts General Hospital, and

professor of radiology at Harvard Medical School.

“Dr. Neiman understood the potential significance of

molecular imaging before it became a catchphrase in

the medical community.” Neiman tapped Thrall to head

up the first ACR commission on molecular imaging,

which later became part of the ACR Commission on

Nuclear Medicine and Molecular Imaging.

To continue Neiman’s focus on the future, the

ACR Foundation established the Harvey L. Neiman

Molecular Imaging Fund to support researchers

advancing the diagnosis and treatment of cancer,

neurological and cardiovascular diseases, and other

serious illnesses.

COMING OF AGE

Today molecular imaging is playing an increasingly

important role in patient care, medical research, and

pharmaceutical development. “We live in the era of

molecular medicine,” says Thrall. “Medicine of antiquity

had to do with the gross observation of the outside of

the human body. Today molecular imaging is a way to

understand the human organism at a molecular level.”

Ultimately, he says, the nano-scale is where radiology

researchers should be focused, because this is where the

earliest changes that lead to the development of a disease

or condition occur. “If you have to wait until changes

are manifest on gross anatomy imaging, in many cases

you are already too late to initiate effective therapy,” says

Thrall. “The closer we can get to the origins of disease in

our diagnostic imaging methods, the more value we’ll

bring to the care of our patients.”

"Anyone can steer the ship, but it takes

a leader to chart the course."— John C. Maxwell

Carolyn C. Meltzer, MD, FACR, the William P.

Timmie Professor and Chair of Radiology and Imaging

Sciences at Emory University School of Medicine and

former member of the ACR Board of Chancellors,

agrees. “Diagnostic radiology is a highly descriptive,

structurally driven field that looks at a cross section

of the appearance of organs and describes disease

processes,” she says. “Molecular imaging allows us to

look beneath the anatomic structures to see the function

of tissues, normal and not normal. It is the molecular

makeup that is the strongest opportunity for specifically

targeted and anatomically effective treatment.”

GETTING PERSONAL

In the ACR 2015 Moreton Lecture about imaging in

the age of precision medicine, Thrall indicated that

WWW.ACR.ORG 19


iStock © PeopleImages

precision medicine or personalized medicine is broadly

defined as the tailoring of medical treatment to the

individual characteristics of each patient. 1 This process

entails classifying patients into subpopulations that

differ in their susceptibility to a particular disease, in

the biology or prognosis of those diseases they may

develop, or in their response to a specific treatment.

“Imaging is poised to play major roles in the age of

precision medicine,” he says. “The imaging community

needs to think in terms of how imaging surveillance of

patients with known genetic mutations can contribute

to the concept.”

According to Meltzer, “Precision medicine is the

future of radiology. The way we practice now is often

about treating people as if they will all react similarly

to treatment. The overarching vision for how we’ll

practice medicine going forward is by understanding

each individual’s genetic and chemical makeup, as well

as other unique factors that might lead to better disease

identification and targeting with specific therapeutics.

For radiology, this is an exciting, promising field. Every

day, there are new technologies, imaging agents, and

specific molecular biomarkers and nano-particles that

DONATE TODAY

A contribution to the ACR Foundation directed to

the Harvey L. Neiman Molecular Imaging Fund

represents an opportunity to honor the legacy of

Harvey L. Neiman, MD, FACR, and contribute to the

future of the radiology specialty in molecular imaging.

Learn more at bit.ly/NeimanFund. Support the ACR

Foundation at donate.acrfoundation.org.

we can leverage to diagnose and treat each patient at

the cellular level.”

SEEDING THE FUTURE

Where will the next advances in molecular imaging take

root and begin to grow? Bruce J. Hillman, MD, FACR,

founder and past chair of the ACR Imaging Network

(ACRIN), believes that the future of the specialty

lies with young radiology researchers. “A primary

goal of the fund is to provide seed money for young

investigators who have an idea and are looking for proof

of concept. It’s important to offer small grants to new

investigators who want to build a scientific case, which

helps them attain comprehensive funding for broader

research,” he says.

The Neiman Fund helps young investigators get

started with a place to begin bench research that can

be translated into clinical trials and, ultimately, clinical

practice,” says Meltzer. “The focus of this fund is to

inspire and fund young investigators in the field of

molecular imaging. To do this promising work, it’s

important to have clinical radiologists involved along

with molecular scientists and chemists.”

Thrall emphasizes that the ACR Foundation plays

a key role in the competitiveness of the specialty and

supporting younger investigators. “There are so many

opportunities to keep the radiology specialty strong,”

he said. “We need to capitalize on these areas to remain

on the cutting edge, and one of the ways to do that is to

support the Neiman Fund.”

By Linda Sowers, freelance writer for ACR Press

ENDNOTE

1. Thrall JH. Moreton Lecture: imaging in the age of precision medicine.

JACR 2015;12(10):1106–1111.

20 Bulletin | AUGUST 2016


JOB LISTINGS

CLASSIFIED ADS These job listings are paid advertisements. Publication

of a job listing does not constitute a recommendation by the ACR. The ACR

and the ACR Career Center assume no responsibility for accuracy of

information or liability for any personnel decisions and selections made

by the employer. These job listings previously appeared on the ACR Career

Center website. Only jobs posted on the website are eligible to appear in

the ACR Bulletin. Advertising instructions, rates, and complete policies are

available at http://jobs.acr.org or e-mail careercenter@acr.org.

New York – Buffalo. Twenty-person radiology practice in greater western

New York seeks two full-time radiologists, fellowship preferred, ABR-certified

or eligible. General diagnostic responsibilities include evenings, nights, and

weekend rotations. Market competitive compensation, vacation, and benefits

offered. Interested candidates are encouraged to call or send their professional

CV for immediate consideration. Contact: John Bellomo by phone at 716-863-

6392 or by email at Jbellomo55@gmail.com.

Pennsylvania – State College. Diagnostic radiologist for a six-person hospital-based

private practice group. Job available due to recent retirement.

260-bed hospital in a university town. One imaging center operated by

hospital. Contact: Gregory Weimer, MD, by phone at 814-234-6137 or by

email at grgwmr@comcast.net.

Georgia – Atlanta. We are seeking a fellowship-trained neuroradiologist to

join our practice in Atlanta with experience in functional MR, tractography, and

MR perfusion imaging. Please submit your CV to Lroth@raadocs.com.

Contact: by email at Lroth@raadocs.com.

Utah – Salt Lake City. Due to program expansion, the abdominal imaging

fellowship at the University of Utah has an additional one-year position

available for the July 2016‒June 2017 academic year. Applicants must meet

requirements for Utah medical license, which requires two years of training in

an ACGME program. For more information, visit bit.ly/28PaXTm. Contact: Terri

Clayson by phone at 801-581-2868 or by email at terri.clayson@hsc.utah.edu.

Utah – Salt Lake City. The abdominal imaging fellowship at the University

of Utah is accepting applications for the 2017‒2018 academic year. The fellowship

is comprised of multimodality abdominal pelvic imaging with an MR

emphasis. Applicants must meet requirements for Utah licensure, requiring

two years of training in an ACGME program. For more information, visit bit.

ly/28PaXTm. Contact: Terri Clayson by phone at 801-581-2868 or by email at

terri.clayson@hsc.utah.edu.

Illinois – Champaign. Seeking full-time private-practice general radiologist

in central Illinois. Practice services two hospitals and a small private clinic.

As a smaller group, each radiologist interprets nearly all aspects of imaging,

from mammography to MRI. Attractive 1st and 2nd year salary with benefits

and full partnership after two years. Flexible start date. Contact: Ramaprasad

Chilakapati by phone at 217-477-2930 or by email at chilakapati1@yahoo.com.

CONTINUED

Economics Forum: The Story of Radiology

continued from page 16

Richard Duszak, MD, FACR, affiliate senior research fellow at the

Harvey L. Neiman Health Policy Institute TM , addressed health care

policy, saying radiologists need evidence to secure funding. “Without

good data, you’re just another constituent asking for money,” he said.

Duszak referenced several studies that have increased cash flow into

the specialty, calling them an investment in the future.

McGinty then took the stage to discuss commercial payers, saying

they like the radiology benefit managers, making the implementation of

clinical decision support a heavy lift. “But we’ve absolutely got to try,” she

said. Finally, McGinty gave a forecast for 2020, when the Medicare Access

and Chip Authorization Act will be live. She is confident the specialty

will remain strong: “It is in our DNA to learn from the best of the past to

inform our future.”

CONTINUED

A Day on the Hill

continued from page 17

The final bill we lobbied for was H.R. 4632/S. 2262, the CT

Colonography Screening for Colorectal Cancer Act. This bipartisan piece of

legislation mandates that Medicare cover the cost of CT colonography, or

virtual colonoscopy, as a colorectal cancer screening procedure. Radiologists

recognize the benefit of providing patients with a minimally invasive way to

be screened for colorectal cancer as screening rates for this deadly disease are

currently less than 60 percent in many parts of the country.

I always look forward to the annual Capitol Hill Day, and this year

was no exception. What makes the day so special for me is the stalwart

relationships we have built with our Kansas representatives. In 2014,

I was fortunate to help with Senator Pat Roberts’ (R-KS) re-election

campaign. Earlier this year, I spent extended time with the majority of

my Senators and Representatives through my participation in ACR’s

Rutherford-Lavanty Government Relations Fellowship. It is a truly gratifying

feeling when you know each of your federal representatives on a

first-name basis and understand that they support ACR’s many advocacy

goals. Fostering these types of relationships can play an integral role in

passing legislation favorable to the specialty of radiology.

I was also particularly elated this year that nearly 40 percent of all

Capitol Hill Day attendees were residents and fellows, proving that

the leaders of tomorrow truly care about the future of radiology and

want to play an active role in our specialty’s continued success.

Although ACR has one of the strongest government relations

teams advocating for us year round, it is imperative that individual

radiologists also make ourselves visible in Washington. Moreover,

a story that personally resonates with Senators and Representatives

and includes compelling facts and data to show how an issue affects

their constituents can be all it takes to gain support. Our efforts in

Washington really do translate to results.

To put it in perspective, 8,000 bills were introduced in Congress in 2015.

Of those, 90 percent did not get a vote. However, we were able to push

through the MPPR reduction, the mammography screening moratorium,

and the repeal of the sustainable growth rate, in a single calendar year.

We most definitely need radiologists tirelessly reading at the workstation;

they are invaluable assets to patient care. However, it is equally imperative

for radiologists to solidify their position in Washington by lobbying

Congress for fair reimbursement and affordable, accessible care for our

patients. This active involvement in federal advocacy efforts will collectively

ensure our specialty survives and thrives in the years to come.

By Amy K. Patel, MD, breast radiology fellow at Mallinckrodt Institute of Radiology

Washington University in St. Louis

WWW.ACR.ORG 21


Final Read

Join Y. Luh, MD, radiation oncologist at Dr. Russel Pardoe

Radiation Oncology Center at St. Joseph Hospital in Eureka, Calif.

Join Y. Luh, MD, poses with his team at the Doctor Russel Pardoe Radiation Oncology Center.

Q:

How do you include

patients in their health

care decision-making?

AS A RADIATION ONCOLOGIST, I have direct face-to-face interaction with patients

throughout the care process, from the initial consultation to long-term follow up.

These interactions ensure I cultivate lasting relationships with cancer survivors.

When my patients proceed with radiation therapy, their informed consent is

the result of a shared decision-making process between the patient and physician.

My initial consult may involve a healthy 75-year-old who is referred to me to

discuss the role of post-lumpectomy radiation therapy for her early-stage breast

cancer. I review the mature clinical trial evidence showing the local control

and potential overall survival benefit of adjuvant radiation, but I also help her

appreciate the smaller absolute benefit in healthy women over 70 who go on

endocrine therapy. I discuss the option of a shorter course of radiation using

hypofractionation over three to four weeks as opposed to the classic six and a

half weeks. After discussing the acute and potential long-term side effects of

radiation, she feels comfortable making an informed decision.

When I see patients for palliative radiation to relieve symptoms such as pain,

obstruction, or compression, I help them prioritize what matters most to them,

whether that is pain relief, survival, or functionality level. Some patients choose

to enroll in hospice with no further cancer directed treatment, while others may

choose to receive a short course of palliative radiation.”

Classically known as the therapeutic arm of radiology, radiation oncology

is a field where we can celebrate the successes of those that we can cure and be

thankful for palliative radiation’s ability to relieve suffering.

Courtesy Join Y. Luh

ACR BOARD OF CHANCELLORS

Bibb Allen Jr., MD, FACR (President)

Kimberly E. Applegate, MD, FACR

Richard L. Baron, MD, FACR

Jacqueline A. Bello, MD, FACR

Lincoln L. Berland, MD, FACR

Edward I. Bluth, MD, FACR

James A. Brink, MD, FACR (Chair)

Cheri L. Canon, MD, FACR (Vice President)

Beverly Coleman, MD, FACR

Philip S. Cook, MD, FACR

Keith Dreyer, D.O., PhD, FACR

Howard B. Fleishon, MD, MMM, FACR (Secretary

Treasurer)

Richard A. Geise, PhD, FACR

Marta Hernanz-Schulman, MD, FACR

William T. Herrington, MD, FACR (Vice Speaker)

Peter A. S. Johnstone, MD, FACR

Alan D. Kaye, MD, FACR

Jonathan B. Kruskal, MB, ChB, PhD

Emil J. Y. Lee, MD

Frank J. Lexa, MD, MBA

Katarzyna J. Macura, MD, PhD, FACR

Geraldine B. McGinty, MD, FACR (Vice Chair)

Debra Monticciolo, MD, FACR

Jennifer E. Nathan, MD

Alexander Norbash, MD, FACR

M. Elizabeth Oates, MD

Robert S. Pyatt Jr., MD, FACR

James V. Rawson, MD, FACR

Seth A. Rosenthal, MD, FACR

Mitchell D. Schnall, MD, PhD, FACR

Ezequiel Silva III, MD, FACR

Timothy L. Swan, MD, FACR (Vice Speaker)

Shawn D. Teague, MD, FACR

ACR BULLETIN ADVISORY GROUP

Scott M. Truhlar, MD, MBA (Chair)

Sammy Chu, MD

Taj Kattapuram, MD

Lawrence A. Liebscher, MD, FACR

Kay Spong Lozano, MD

M. Victoria Marx, MD

Richard Sharpe Jr., MD, MBA

Eric J. Stern, MD

Alysha Vartevan, DO

Colin M. Segovis, MD, PhD

ACR BULLETIN STAFF

G. Rebecca Haines Publisher

Brett Hansen ACR Press Assistant Director

Lyndsee Cordes Senior Managing Editor

Chris Hobson Imaging 3.0 Content Manager

Meghan Edwards Digital Content Editor

Jenny Jones Imaging 3.0 Content Specialist

Meg Nealis Publications Operations Manager

Bates Creative Group Design & Production

CONTACT US

To contact a member of the ACR Bulletin staff, email

bulletin@acr.org.

ACR Bulletin (ISSN 0098-6070) is published monthly

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22 Bulletin | AUGUST 2016


ACR Lung Cancer Screening Resources

Lung Cancer Screening

Registry




ACR is your best resource for providing safe,

effective lung cancer screening with the latest research,

toolkits and key patient information.

ACR Designated Lung Cancer Screening Center

Earn the ACR Designated Lung Cancer Screening Center

status and demonstrate to your referrers and patients that

you provide safe and effective care.

ACR Lung Cancer Screening Registry

The ACR Lung Cancer Screening Registry, approved by CMS

for reimbursement and PQRS participation, will calculate

audit measures and provide peer comparisons.

Lung Cancer Screening Education

Discover how to implement a patient-centered, multidisciplinary

screening program in your practice through this interactive

e-learning activity. Earn 15 CME Credits and equivalent SA-CME

and align with ACR requirements for lung cancer screening.





Lung-RADS

Standardize your lung cancer screening CT reporting

and management recommendations with the ACR Lung

Imaging Reporting and Data System (Lung-RADS).

ACR CT Accreditation

Earn the ACR gold seal in CT accreditation and show

that your facility meets the highest quality and safety

standards in medical imaging.

ACR Dose Index Registry ® (DIR)

Participate in the DIR and compare your CT dose indices

against peers and competitors to improve quality of

patient care.

Practice Parameters and Technical Standards

ACR and the Society of Thoracic Radiology offer a CT lung

cancer screening practice parameter to help you provide

safe and effective lung CT exams.

To learn more, visit acr.org/lungresources.

1 . 800 . 227 . 5463 |


Comment on 2017 ACR Practice

Parameters and Technical Standards

· Aug. 8–26

· Aug. 29–Sept. 16

· Sept. 19–Oct. 7

· Oct. 10–28

Visit acr.org/reviewguidelines.

ACR Bulletin

1891 Preston White Drive

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