Academic Radiology Research Articles

Recent Trends in Academic Vs Non-academic Radiologist Compensation and Clinical Productivity.

Recent radiologist compensation and clinical productivity trends have not been well characterized, especially across academic vs. non-academic practice settings. To assess recent trends in in financial compensation and clinical productivity between academic and non-academic settings in diagnostic (DR) and interventional radiology (IR). We studied deidentified data from the Medical Group Management Association (MGMA) for both DR and IR radiologists in academic and non-academic practices from 2014 to 2023. Median, 25th and 75th percentile, and mean values were analyzed for compensation, collections and work relative-value-units (wRVUs). Compensation and productivity data were compared by radiology subspecialty (DR vs IR), practice type (academic vs non-academic provider), geographical region of the US, and practice size. Trends in absolute changes were analyzed with linear regression. The MGMA Survey data for 2023 included responses for 3769 radiologists (2883 in DR and 886 in IR). In 2023, non-academic radiologists had greater total median compensation than academic faculty in both DR (by 27%) and IR (by 32%). From 2014 to 2023, median compensation increased faster for academic DRs (3.2% annually) than for non-academic DRs (1.9% annually). In 2023, DRs produced greater median wRVUs than IRs (by 53 % for non-academic and 46 % for academic radiologists) with higher collections, but IRs had higher compensation (by 16% in non-academic and 10% in academic settings). Over the last decade, IR physician compensation increased by 3.9% and 3.4% annually for non-academic and academic IR physicians respectively while median work RVUs trended downward (by -1.5 % for non-academic and -2.4 % for academic physicians) with declining collections (by -4.4 % annually for non-academic and -2.1 % for academic physicians). Over the last decade, the salary gap between academic and non-academic radiologists has narrowed. Physician compensation has increased at a faster pace in IR, despite relatively lower clinical productivity and declining collections.

Academic Radiology Physician Financial Compensation in the United States: Trends and Distribution.

Background The overall trends in academic radiology physician compensation are not well studied. Purpose To assess recent trends in academic radiology financial compensation and distribution based on rank, gender, race/ethnicity, and geography in U.S. medical schools. Materials and Methods This secondary analysis used deidentified data from the Association of American Medical Colleges (AAMC) Faculty Salary Report, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for full-time academic radiology faculty was collected from 2017 to 2023, stratified by rank, gender, race/ethnicity, and geography. The faculty salary report includes median, 25th, and 75th percentile compensation values for each rank, which were used to analyze trends with linear regression. Median compensation values were used to compare groups based on gender, race/ethnicity, and region. Results The AAMC Faculty Salary Report data for 2023 included responses for 5847 faculty members across all radiology departments, including 306 instructors, 2758 assistant professors, 1409 associate professors, 1004 full professors, 226 chiefs, and 144 chairs. On average, median faculty compensation increased by 2.6%-4.4% per year from 2017 to 2023, with the greatest increase (by 4.4% per year) at the instructor level and smaller increases (3.4%-2.6%) at the more senior ranks. Male faculty members were consistently compensated more than women at all ranks throughout the study period. The overall salary gap remained at 6% ($455 000 for women vs $483 000 for men) throughout the study period but increased numerically from $24 000 in 2019 to $28 000 in 2023. Black/African American faculty had a lower median compensation compared with White faculty (by 4% overall; $452 000 for Black/African American faculty vs $472 000 for White faculty) at all ranks except at professor rank. Instructor compensation in the Northeast region was substantially higher (by $278 000) than other regions, but this geographic differential did not exceed $35 000 at other ranks. Conclusion This study summarized the trends of full-time academic radiology faculty compensation and showed persistent salary inequities that should be addressed as part of a broader drive to increase diversity, equity, and inclusion. © RSNA, 2024 Supplemental material is available for this article.

Formal wellness training of academic radiology leaders improves work-life conflict.

To investigate the effect of formal leadership training of academic radiology leaders within an academic center on their own burnout and professional fulfillment. The study cohort was academic radiology leaders within one of the largest academic organizations of academic radiologists within the United States. All academic radiology leaders within the organization were electronically mailed a weblink to a confidential IRB-approved survey in April 2021. The survey included validated questions from the Stanford Professional Fulfillment Index (PFI), values alignment, teamwork, overload, and work-family conflict. Academic leaders were invited in May 2021 to participate in instructor-led formal training on leading wellness focusing on 5 core leadership skills - emotional intelligence, self-care, resilience support, demonstrating care, and managing burnout. An identical follow-up survey was electronically mailed 6 months after initial training in November 2021. The overall response rate of academic radiology leaders was 59% (19/32). For both measures, there was acceptable internal consistency (Cronbach's α = 0.63 for work exhaustion and α = 0.90 for fulfillment). There was a statistically significant improvement in work-family conflict (3.32 vs 2.86; p = 0.04). No statistically significant differences were identified for fulfillment, work exhaustion, alignment, work overload, and teamwork scores after training. Formal instruction in leading wellness improved work-life conflict for academic radiology leaders. There was no significant change in burnout, fulfillment nor organizational alignment of the leaders. Formal instruction in leading wellness raised awareness and improved work-life conflict in academic radiology leaders.

Status and perceptions of work from home in three academic musculoskeletal radiology divisions.

The objective of this study is to assess the status and perception of work from home (WFH) in three academic musculoskeletal radiology divisions. A 17-item anonymous online survey related to WFH was administered to all musculoskeletal (MSK) faculty (n = 27) of three academic radiology divisions between April and July 2023. Survey items included demographics, clinical work environment, presence of a WFH policy, number of days WFH and desired WFH days, commute, perceived benefits and drawbacks of WFH, and symptoms of burnout. Statistical analysis included the Cochrane-Armitage trend test and Fisher exact test. The study was exempt from IRB approval. The survey response rate was 85% (57% men, 57% white, 57% established career, defined by > 10years in practice). In 47%, an informal policy allowed WHF on certain rotations including moonlighting/call. Seventeen percent had no opportunity to WFH. WFH 1-2days/week was reported in 73% of respondents while 27% did not WFH. None of the respondents worked from home more than 2days/week. Women worked from home more compared to men (p = 0.02). Perceived advantages of WFH included efficiency (no commute/parking) (76%), flexibility (52%), autonomy (33%), and increased productivity (29%). Fifty-seven percent preferred in-person read out particularly for first year trainees, with 52% preferring a virtual or hybrid model. WFH is common in academic MSK practices and perceived to be beneficial to MSK faculty. These findings should be taken into consideration when designing WFH policies.

Impact of Structured Reporting of Lower Extremity CT Angiography on Report Quality and Workflow Efficiency.

We assessed the effects of structured reporting (SR) of lower extremity CT angiography (CTA) on report quality and workflow efficiency compared with conventional reports (CR). Surveys were conducted at an academic radiology department before and after the introduction of an SR template. Participants (n = 39, 21) rated report quality and report creation effort (1: very dissatisfied/low to 10: very satisfied/high) and whether SR represents an improvement over CR (1: completely disagree to 5: completely agree). Four residents and two supervising radiologists created both CR and SR of 40 CTA examinations. Report creation time was measured and the factual accuracy of residents' reports was judged. Report completeness (median 8.0 vs. 7.0, p = 0.016) and clinical usefulness (7.0 vs. 4.0, p = 0.029) were rated higher for SR. Supervising radiologists found report clarity improved by SR (8.0 vs. 4.5, p = 0.029). Report creation effort was unchanged (7.0 vs. 6.0, p > 0.05). SR was considered an improvement over CR (median 4.0, IQR,3.0-5.0). Report supervision was shortened by SR (6.2 ± 2.0 min vs. 10.6 ± 3.5 min, p < 0.001) but total time for report creation remained unchanged (36.6 ± 12.8 min vs. 36.4 ± 11.0 min, p > 0.05). Factual accuracy of residents' SR was deemed higher (8.0/9.5 vs. 7.0/7.0, p = 0.006/ < 0.001). In conclusion, SR has the potential to improve report quality and workflow efficiency for lower extremity CTA.

Status of LGBTQ+ Inclusion: Multi-Institution Assessment of US Radiology Residencies

IntroductionAn inclusive residency program is crucial to the recruitment and retention of competitive and diverse applicants. The radiology lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) inclusion audit was published in 2022, which provided a road map for assessing the inclusivity of a program’s policies, facilities, culture, and engagement. In this multi-institutional trial, we detail the results of the LGBTQ+ inclusion audit for nine US radiology residency programs. MethodsA volunteer cohort of academic radiology programs was recruited through the Radiology Residency Education Research Alliance. The LGBTQ+ inclusion audit was modified to apply to a multi-institutional study. Participating programs performed the audit from December 2023 to February 2024. Pre- and postaudit surveys were distributed to capture participants subjective assessment of inclusivity at their programs. ResultsNine US radiology residency programs completed the audit. Audit scores ranged from 6 out of 10 to 9 out of 10; no program received a perfect 10 out of 10 score. Inclusive facilities and institutional culture scored highly, with eight of nine programs reporting all milestones met in these areas. The lowest-performing areas were department culture and community engagement with only three of nine and four of nine programs reporting “all milestones met.” After the audit, programs overall reported improved self-perceived inclusivity, with postaudit survey scores increasing in areas related to department policy, inclusive facilities, and LGBTQ+ community outreach. DiscussionParticipating radiology residency programs demonstrated an overall high level of LGBTQ+ inclusivity; however, all programs identified inclusion shortcomings in department policy and practice. Intentional review of a department can be a helpful tool to promote a welcoming and healthy environment for a diverse radiology practice.

Intersectionality and Faculty Compensation in Academic Radiology in U.S.

The impact of intersectionality on academic radiology physician compensation is not well known. The aim of this study was to assess impact of intersectionality on academic radiology financial compensation, based on rank, gender and race/ethnicity in US medical schools. Data werecollected from the AAMC Faculty Salary Survey, which collects information for full-time faculty at U.S. medical schools. Financial compensation data for radiology faculty with MD or equivalent degree in diagnostic radiology (DR) as well as interventional radiology (IR) was collected for 2023, stratified by rank, gender, and race/ethnicity. The AAMC Faculty Salary Survey data for 2023 included responses for 683 IR (138 women, 545 men) and 2431 DR (862 women, 1569 men) faculty. Men had a higher median compensation than women at all ranks, for both IR and DR, except DR instructors. The gender pay gap was greater in IR faculty compared to DR faculty of the same rank. All intersectional groups among IR faculty reported a lower median compensation compared to White men of the same rank. All intersectional groups among DR faculty, except Asian Men, had a lower median compensation than White men of the same rank. Among IR faculty, Asian women assistant professors faced the greatest disparity in median compensation, down to $75K (15%) lower than White men. Among DR faculty, Black/African American women assistant professors faced the greatest disparity on median compensation, down to $48K (10.5%) lower than White men. The study results raise important concerns about impact of intersectionality on faculty compensation in radiology which needs further study and should be addressed as part of broader drive to increase diversity, equity, and inclusion in academic radiology.

Gender and race in radiology: An intersectional analysis of the American Association of Medical Colleges (AAMC) database from 1966 to 2021

PurposeTo describe trends in gender and racial representation within academic radiology in the United States over a 55-year period from 1966 to 2021. MethodsA retrospective analysis of the American Association of Medical Colleges database of radiology faculty members from 1966 to 2021 was conducted. Trends in academic rank and tenure status for five different ethnoracial groups (White, Asian, Black, Hispanic, and Native American) each subdivided into two gender identities (men and women) were analyzed. The proportional change over time of each demographic group per outcome was analyzed with linear regression models. ResultsBetween 1966 and 2021, White men comprised the largest demographic in academic radiology each year. A significant decrease in both White individuals (−0.51 % per year) and men (−0.30 % per year) were observed over the study period. Additionally, the only demographic groups with meaningful changes in representation were White women (+0.20 % per year) and Asian men (+0.23 % per year), followed by Asian women in later years. Underrepresented minority groups (Black, Hispanic and Native American) collectively comprised less than 5 % of all academic radiologists. Finally, within each demographic group, the representation of women consistently lagged behind men. Despite these relative increases, in 2021, the majority of US academic radiologists were White (59.1 %) and male (70.1 %). ConclusionHistorically underrepresented minorities, especially women within these groups, continue to face discrimination and are consistently the least represented in radiology. Initiatives that incorporate the intersectionality framework are imperative to break this cycle.

Flipping the script: A multiyear assessment and comparison of flipped classroom versus traditional didactic teaching at two academic institutions

Rationale and objectivesHistorically radiology resident education has taken the form of workstation and didactic teaching. Due to increasing clinical demand and administrative burden for academic radiologists, the need for more efficient and effective teaching has increased. Flipped classroom teaching, where trainees independently learn material prior to interactive teaching sessions with faculty, is a possible alternative. While the use of flipped teaching in radiology has been studied in the medical student setting, its use in the radiology residency setting has been less published. Materials and methodsAt two academic institutions (University of Washington and Northwestern), exam scores from five PGY-2 Core rotations were collected. Flipped teaching was used for one rotation at the University of Washington (FR). The influence of teaching method, rotation, and institution on exam score was examined. Resident surveys were also collected to understand perceptions of flipped classroom teaching. ResultsAt the University of Washington, the mean exam score for the flipped rotation was significantly higher than the majority of other rotations utilizing traditional teaching (p<0.05). Between the University of Washington and Northwestern, there was no difference in exam scores when comparing comparable rotations. Among residents at the University of Washington, the flipped teaching rotation was perceived as more educationally valuable than traditional teaching rotations. ConclusionFlipped classroom teaching is at least as effective as the traditional teaching model and associated with better performance on standardized exams at one institution. Among residents, flipped learning is also associated with higher perceived educational value.

Near-Peer Paradigms in Medical School: Integrating Student Teaching Assistants Into a Core Radiology Clerkship

Rationale & ObjectivesNear-peer paradigms have been demonstrated effective in supporting how students navigate novel clinical environments. In this study, we describe an innovative model of incorporating teaching assistants (TAs) into a core radiology clerkship and investigate both its perceived educational value by clinical-year learners and its perceived impact on professional growth by TAs. Materials & MethodsAt one U.S. medical school, the core clinical year includes a clerkship in radiology incorporating both reading room exposure and a didactic curriculum. Radiology faculty delivery a variety of traditional and interactive, “dynamic” lectures, while medical student TAs deliver additional dynamic sessions, including a final TA-created review session. The educational value of each didactic session by clerkship students was assessed using a five-point scale survey, and the professional value of the experience by TAs was assessed using a five-point Likert survey. ResultsSpanning from 2020 to 2023, 268 (74.4%) clinical-year students submitted the post-clerkship survey, with the didactic review sessions created and led by TAs receiving the highest ratings of any didactic session. Of 16 former TAs, 12 (75%) completed the post-service survey, with all respondents agreeing or strongly agreeing that they enjoyed and would recommend their experience, and that it enhanced their interest in radiology and in academic medicine. ConclusionNear-peer education in a core radiology clerkship enhances the experience of the learner through peer guidance and the experience of the teacher through professional development. These findings may increase student interest in pursuing academic radiology as a career and invite opportunities for broadening medical school education in radiology.

The 2023 AUR Academic Radiology and Industry Leaders Roundtable

The 2023 AUR Academic Radiology and Industry Leaders Roundtable

Writing and publishing papers in academic radiology: Why it needs to be more than a box checked for promotion

An ongoing challenge in academic radiology is balancing the need to read the scans and generate relative value units (RVUs) with the need to ensure academic leadership and the consistent production of impactful publications. Indeed, the tripartite mission of academic radiology (i.e. clinical care, research, and teaching) does not lend itself to obvious answers in an era when institutions and departments are increasingly focused on RVU generation. Even the minority of radiologists who are interested in pursuing the academic mission and accept academic jobs are likely to find their time increasingly squeezed by massive volumes of scans to read and the priority placed on RVU generation. There are often no incentives for impactful academic work, leading to a decreasing relative number of manuscript submissions from U.S.-based researchers. With the lack of external incentivization for publication, writing and publishing papers must instead be driven by intrinsic enjoyment and a sense of accomplishment. The ability to think of an idea, to get a group of co-authors together, to acquire the data and/or put together the idea into a form that is ready for final publication, and to see that process through to the end is rewarded only by personal satisfaction. Perhaps, in the era of RVU generation, publishing papers in a form of defiance of a system that is hampering the academic mission.

Women in leadership matters: Achieving diversity in radiology residency recruitment

Rationale and objectivesTo assess whether academic radiology departments and residency programs with efforts toward supporting and augmenting Diversity, Equity, and Inclusion (DEI) are associated with a higher proportion of residents from diverse backgrounds. Materials and methodsProgram Directors within the Radiology Residency Education Research Alliance were surveyed to gather information about program characteristics, incorporation of diversity in resident recruitment, the sponsoring department's commitment to efforts at expanding diversity, and a summary of their current and past residents, staff and faculty members (academic years 2020 and 2023) with respect to a list of diversity characteristics. ResultsSurvey response rate was 51 %. Sixty-three percent (15/24) of participating programs have departmental committees dedicated to DEI work; 46 % (11/24) of programs' departments have a Vice Chair for DEI. Sixty percent (15/24) of programs use their social media accounts to advertise their DEI programming efforts. Ninety-six percent (23/24) of programs participating in the survey use diversity factors to select candidates for their program. Women Leadership was associated with above-median diversity of residents and faculty. ConclusionThis study of radiology residency programs encourages a more prominent role for women in leadership positions within academic radiology departments to drive diversity and inclusion efforts.

Transitioning from interventional radiology: ideas for the inevitable.

Interventional Radiology (IR) is a highly rewarding specialty, both for its salutary effects for patients, as will as the satisfaction it provides for the operating radiologists. Nonetheless, arduous work and long hours have led to numerous reports of burnout amongst interventional radiologists (IRs). Six long-term academic radiologists in leadership positions briefly chronicle their becoming IRs, their type of transitioning from IR, and the pros and cons of those respective transitions. The specific transitions include reduced time in IR, switching to diagnostic radiology, becoming involved in medical school education, ceasing IR leadership, and retirement. Pros and cons of the various transition strategies are highlighted. As the taxing work and long hours are so ubiquitous for IRs, and as burnout is so common, transitioning from IR is highly likely eventually for IRs. The varied transition experiences highlighted in this report hopefully will be helpful for current and aspiring IRs.

Academic radiology department subspeciality organization & fellowship offerings: A hodgepodge

IntroductionAs opportunities for radiologists to subspecialize have increased, many avenues to organize Radiology department subspecialties exist. This study seeks to determine how academic U.S. Radiology departments structure themselves with respect to subspecialty divisions/sections, as there are no current standards for how Radiology departments are subdivided. Additionally, the extent of Radiology fellowships offered are assessed. The websites of academic U.S. Radiology departments, a highly influential source of information, were analyzed to perform this study. Materials & methodsRadiology department websites of all allopathic U.S. medical schools (n = 148) were assessed for the following: presence/absence of Radiology department subdivisions, division/section labels, number of divisions/sections, division/section titles, presence/absence of Radiology fellowships, number of fellowships, and fellowships titles. Results114/148 (77 %) medical schools had Radiology department websites. According to their respective websites, 66/114 (58 %) academic Radiology departments had subspecialty divisions/sections, whereas 48/114 (42 %) had no divisions/sections listed. Of the departments that had divisions/sections, the median number of divisions/sections per department was nine, and ranged from two to 14. Fellowships were offered at 82/114 (72 %) academic Radiology departments that had websites, and the median number was six, ranging from one to 13. ConclusionThere is marked heterogeneity of departmental organization across Radiology departments nationwide, likely due to the lack of current standards for how Radiology departments are subdivided into divisions/sections. Of the 77 % of medical schools that have Radiology department websites, only 58 % of departments listed divisions/sections, and 72 % posted fellowship offerings.

Nine Steps in the Entrepreneurial Journey for Academic Radiologists

In this article, we explore the nine steps that we have found to be critical for success in our journeys in taking ideas in imaging to commercial products. These nine steps include 1) findings ideas that resonate, 2) protecting your intellectual property, 3) developing a great team that shares in the vision for the product, 4) building a low-fidelity prototype, 5) customer discovery to test your business hypothesis, 6) forming a company, 7) serving on a study section as a prelude to 8) seeking non-dilutive funding, and finally, 9) angel/venture funding.

A Novel Design-Thinking, Hospital Innovation Core Certificate Curriculum for Radiologists and Trainees: Creation, Implementation, and Multiyear Results

Innovation is a crucial skill for physicians and researchers, yet traditional medical education does not provide instruction or experience to cultivate an innovative mindset. This study evaluates the effectiveness of a novel course implemented in an academic radiology department training program over a 5-year period designed to educate future radiologists on the fundamentals of medical innovation. A pre- and post-course survey and examination were administered to residents who participated in the innovation course (MESH Core) from 2018 to 2022. Respondents were first evaluated on their subjectivecomfort level, understanding, and beliefs on innovation-related topics using a 5-point Likert-scale survey. Respondents were also administered a 21-question multiple-choice exam to test their objective knowledge of innovation-related topics. Thirty-eight residents participated in the survey (response rate 95%). Resident understanding, comfort and belief regarding innovation-related topics improved significantly (P<.0001) on all nine Likert-scale questions after the course. After the course, a significant majority of residents either agreed or strongly agreed that technological innovation should be a core competency for the residency curriculum, and that a workshop to prototype their ideas would be beneficial. Performance on the course exam showed significant improvement (48% vs 86%, P<.0001). The overall course experience was rated 5 out of 5 by all participants. MESH Core demonstrates long-term success in educating future radiologists on the basic concepts of medical technological innovation. Years later, residents used the knowledge and experience gained from MESH Core to successfully pursue their own inventions and innovative projects. This innovation model may serve as an approach for other institutions to implement training in this domain.

Rad Path in a Flash: Creation of the First AMSER Sponsored Digital Flashcard Deck and a Review of Digital Flashcard Use among? Medical Students

Digital flashcards are an increasingly popular study method for medical students today. The purpose of this study is to assess students' opinions on digital flashcards and to evaluate the need for radiology-focused digital flashcards. We created the first official Radiology-Pathology (Rad-Path) Correlation course digital flashcard deck sponsored by the Alliance of Medical Student Educators in Radiology (AMSER), and evaluated its effectiveness in increasing medical students' confidence levels of understanding Rad-Path concepts. A 16-question survey was developed and publicly shared with medical students to assess the need for a high-quality radiology deck. In addition, students who trialed the AMSER Rad-Path Anki deck were assessed on their confidence of radiology pathology concepts prior to and after using these digital flashcards. 185 survey responses were received for the first survey about digital flashcard use. Overall, 87.6% of medical student respondents had used digital flashcards during medical school, and 33.5% had used digital flashcards to study radiology topics specifically. 67.6% of respondents stated they would use a digital flashcard deck if sponsored by an academic radiology society. Regarding the survey of the students who used the AMSER Rad-Path flashcards, 31 responses were received in the pre- and follow-up survey. Mean confidence in understanding the radiology pathology learning objectives increased when the Rad-Path Anki deck was utilized, and students rated the flashcards favorably. Students reported a high use of digital flashcards for studying topics in medical school. We identified a perceived need in students for a series of high-quality digital flashcards covering radiology topics. We created the first deck of AMSER Rad-Path flashcards which was well received by the medical students.

Teach the Mentor: A Six-Session Program Universally Improves Mentorship Skills Among a Diverse Group of Radiology Faculty

Determine if a case-based, in-person mentorship teaching program would improve self-reported mentorship skills among a diverse group of faculty members at a large multi-site academic institution. All radiology faculty members were recruited to participate in a mentorship course focused on exploring through discussion different challenges posed by mentorship. Participants met weekly for two hours over 6 weeks in an informal and confidential setting. Participants completed the same 19 question survey about mentorship skills before the first session (pre-test) and within one week following the last session (post-test). Respondents rated their abilities with respect to various mentorship skills based on a Likert scale ranging from 1 (not at all skilled) to 7 (highly skilled). Wilcoxon Signed Ranks tests were performed to assess differences in median responses. Eleven faculty completed the course and their survey response rate was 100%. The group was gender balanced (six women and five men) and at varying career stages (4 Professors, 2 Associate Professors, and 5 Assistant Professors). Median score for each of the 19 survey questions significantly improved on the post-test by an average of 2 points, from 4 to 6 (p < .001). For 18 of the 19 questions there was no significant difference in score improvement between Professors and Associate/Assistant Professors. By discussing provocative mentorship dilemmas in a confidential small group of peers, radiology faculty with varied experience reported a significant improvement in mentorship skills after six sessions. Further study is needed to assess the long-term impact of the course.

Actionability of Recommendations for Additional Imaging in Head and Neck Radiology

PurposeThe aims of this study were to measure the actionability of recommendations for additional imaging (RAIs) in head and neck CT and MRI, for which there is a near complete absence of best practices or guidelines; to identify the most common recommendations; and to assess radiologist factors associated with actionability. MethodsAll head and neck CT and MRI radiology reports across a multi-institution, multipractice health care system from June 1, 2021, to May 31, 2022, were retrospectively reviewed. The actionability of RAIs was scored using a validated taxonomy. The most common RAIs were identified. Actionability association with radiologist factors (gender, years out of training, fellowship training, practice type) and with trainees was measured using a mixed-effects model. ResultsTwo hundred nine radiologists generated 60,543 reports, of which 7.2% (n = 4,382) contained RAIs. Only 3.9% of RAIs (170 of 4,382) were actionable. More than 60% of RAIs were for eight examinations: thyroid ultrasound (14.1%), neck CT (12.6%), brain MRI (6.9%), chest CT (6.5%), neck CT angiography (5.5%), temporal bone CT (5.3%), temporal bone MRI (5.2%), and pituitary MRI (4.6%). Radiologists >23 years out of training (odds ratio, 0.39; 95% confidence interval, 0.15-1.02; P = .05) and community radiologists (odds ratio, 0.53; 95% confidence interval, 0.22-1.31; P = .17) had substantially lower estimated odds of making actionable RAIs than radiologists <7 years out of training and academic radiologists, respectively. ConclusionsThe studied radiologists rarely made actionable RAIs, which makes it difficult to identify and track clinically necessary RAIs to timely performance. Multifaceted quality improvement initiatives including peer comparisons, clinical decision support at the time of reporting, and the development of evidence-based best practices, may help improve tracking and timely performance of clinically necessary RAIs.