ACR White Paper Research Articles

ACR White Paper on Magnetoencephalography and Magnetic Source Imaging: A Report from the ACR Commission on Neuroradiology.

Magnetoencephalography, the extracranial detection of tiny magnetic fields emanating from intracranial electrical activity of neurons, and its source modeling relation, magnetic source imaging, represent a powerful functional neuroimaging technique, able to detect and localize both spontaneous and evoked activity of the brain in health and disease. Recent years have seen an increased utilization of this technique for both clinical practice and research, in the United States and worldwide. This report summarizes current thinking, presents recommendations for clinical implementation, and offers an outlook for emerging new clinical indications.

Impact of a Multifaceted Information Technology-Enabled Intervention on the Adoption of ACR White Paper Follow-Up Recommendations for Incidental Adnexal Lesions Detected on CT.

OBJECTIVE. The objective of our study was to improve adherence to American College of Radiology (ACR) white paper follow-up imaging recommendations for incidental adnexal lesions seen on pelvic CT (herein referred to as "adherence rate to recommendations"). MATERIALS AND METHODS. This quality improvement project was conducted at a large academic teaching hospital. The baseline adherence rate to recommendations was assessed by screening all pelvic CT reports for the period from October 22, 2016, through December 22, 2016, for incidental adnexal findings, followed by manual review. Forty abdominal and cancer imaging radiologists were surveyed to understand the barriers to adoption of the recommendations. Interventions to address the most common identified barriers were implemented on December 23, 2016. The postintervention adherence rate was assessed from December 23, 2016, through February 15, 2017, by again screening CT pelvis reports for incidental adnexal lesions followed by manual review. The change in pre- and postintervention adherence rates was assessed using the Fisher exact test and statistical process control (SPC) p-chart with 3-sigma control limits. RESULTS. The adherence rate to recommendations at baseline was 67% (121/181). Of the 28 of 40 (70%) radiologists who completed the survey, only 29% (8/28) often or consistently used the recommendations. Not remembering the details of the recommendations or not having time to look them up accounted for 83.3% of the barriers cited by radiologists. Interventions consisted of radiologist education and creation of an easily accessible clinical decision support tool incorporated into radiology reporting workflow. The adherence rate to recommendations after the intervention increased to 87% (129/148; p < 0.0001), as also shown by the SPC chart. CONCLUSION. The rate of adherence to follow-up imaging recommendations significantly increased after radiologist education and incorporation of recommendations into the radiologist workflow.

Focal Cystic Pancreatic Lesion Follow-up Recommendations After Publication of ACR White Paper on Managing Incidental Findings

PurposeTo describe the variation in radiologists’ follow-up recommendations for focal cystic pancreatic lesions (FCPL) after publication of the 2010 ACR incidental findings White Paper and determine adherence to guidance of the ACR Incidental Findings Committee. MethodsInstitutional Review Board approval was obtained for this retrospective, HIPAA-compliant observational study. Patients with FCPL were identified from abdominal CT and MRI reports generated in 2013 using natural language processing software. Patient-, lesion-, and radiologist-specific variables were recorded. Primary outcome was whether a follow-up recommendation was made, and if it included a specific study or intervention and recommended time for follow-up. χ2 and logistic regression models were used to identify predictors and controlled for recommendation. These data were compared with 2009 data obtained before the White Paper’s publication. Secondary outcome was adherence to the ACR’s guidance. ResultsDuring calendar year 2013, 1,377 reports describing FCPLs were identified in 1,038 patients. After excluding examinations from low-volume readers (n = 80), radiologists recommended follow-up imaging in 13.5% (175/1,297) of cases, a decrease from 2009 when it was recommended in 23.7% (221/933) of cases (P < .001). Findings were consistent across radiologists after controlling for patient- and lesion-specific variables. Variability in follow-up recommendations persists between radiologists (2.4-fold difference in 2013 versus 2.8-fold difference in 2009). Radiologists adhered to ACR guidance principles 47.4% of the time. ConclusionsDespite published guidance recommendations and reported awareness of them, fewer than half of follow-up recommendations for FCPL are consistent with the guidance and considerable variability persists among radiologists.

ACR White Paper–Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT

PurposeIn 2010, the authors’ department implemented a comprehensive dose reduction strategy based on the ACR white paper on radiation dose in medicine. The aim of this study was to evaluate the effectiveness of the dose reduction program. MethodsIn total, 1,234 adult chest CT scans from 2007 to 2012 were analyzed retrospectively, with institutional review board approval and a waiver of the requirement for informed consent. The primary outcome was effective dose in millisieverts during the three-year periods before (2007-2009) and after (2010-2012) dose reduction implementation. Dose trends were analyzed by fitted linear modeling. The use and effects on total exposure of dose reduction strategies (high pitch, adaptive statistical iterative reconstruction [ASIR], and low tube voltage) were analyzed. ResultsThe overall mean dose for chest CT was 7.3 ± 5.1 mSv. The mean dose decreased by 30%, from 9.2 mSv (2007-2009) to 6.5 mSv (2010-2012) (P < .001). From 2007 to 2009, the mean dose increased by 1.2 mSv per year (P < .01). From 2010 to 2012, the mean dose decreased by 1.1 mSv per year (P < 0.01). High-pitch technique, ASIR, and low tube voltage increased significantly after dose reduction implementation. High pitch and ASIR were significantly associated with a reduced dose, whereas the effect of reduced voltage was not significant. ConclusionsReductions in radiation exposure from medical imaging rely on ongoing technical developments and consistent, vigilant use of dose reduction strategies. This comprehensive dose reduction strategy significantly reduced radiation exposure from chest CT. Annual increases in radiation dose reversed after the strategy was implemented and continued to decline over the study period.

ACR White Paper: New Practice Models—Hospital Employment of Radiologists: A Report From the ACR Future Trends Committee

In response to the current era of rapid evolution of health care delivery and financing, radiologists are increasingly considering, as well as confronting, new practice models. Hospital employment is one such opportunity. Within this report to the ACR membership, the potential advantages and risks for radiologists considering hospital employment are examined.

Falling prey to the sunk cost bias: a potential harm of patient radiation dose histories.

Although patient dose histories will make valuable contributions to quality improvement and research initiatives, care must be taken to avoid misuse by physicians when making imaging decisions for individual patients.

CT Radiation Dose: Trending in the Right Direction

Better definition of the cancer risk on the basis of patient age and clinical condition at exposure are just two small parts of the overall radiation risk equation.

Unintended Consequences of Health Care Legislation

Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders.

ACR White Paper: Strategies for Radiologists in the Era of Health Care Reform and Accountable Care Organizations: A Report From the ACR Future Trends Committee

Accountable care organizations have received considerable attention as a component of health care reform and have been specifically addressed in recent national legislation and demonstration projects by CMS. The role or roles of radiologists in such organizations are currently unclear, as are changes to the ways in which imaging services will be delivered. The authors review concepts fundamental to accountable care organizations and describe roles for radiologists that may facilitate their success in such health care delivery systems.

ACR White Paper on Radiation Dose in Medicine: Three Years Later

The benefits of diagnostic imaging are immense and have revolutionized the practice of medicine. The increased sophistication and clinical efficacy of imaging have resulted in its dramatic growth over the past quarter century. However, the evolution of imaging has also resulted in a significant increase in the population's cumulative exposure to ionizing radiation and a potential increase in cancer risk. The ACR, an advocate for radiation safety since its inception in 1924, convened the ACR Blue Ribbon Panel on Radiation Dose in Medicine in 2006 and issued 37 recommendations for the College to address these issues. This report updates the status of these recommendations.

Value in Radiology

HomeRadiologyVol. 253, No. 3 PreviousNext Value in RadiologyRichard B. Gunderman, Giles W. L. BolandRichard B. Gunderman, Giles W. L. BolandAuthor Affiliations1From the Department of Radiology, Indiana University School of Medicine, 702 Barnhill Dr, Room 1053, Indianapolis, IN 46202-5200 (R.B.G.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (G.W.L.B.).Address correspondence to R.B.G. (e-mail: [email protected]).Richard B. GundermanGiles W. L. BolandPublished Online:Dec 1 2009https://doi.org/10.1148/radiol.2533090741MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractWhen we set policies, whether at the level of individual practices, institutions, communities, or whole societies, we need to do so in ways that recognize and reward high value. References 1 Ruskin J. Unto this last: four essays on the first principles of political economy. Kent, England: George Allen, 1877; 58. Google Scholar2 Phillips KA, Johnson FR, Maddala T. Measuring what people value: a comparison of “attitude” and “preference” surveys. Health Serv Res 2002;37(6):1659–1679. Crossref, Medline, Google Scholar3 Boat TF, Chao SM, O'Neill PH. From waste to value in healthcare. JAMA 2008;299(5):568–571. Crossref, Google Scholar4 Porter ME, Teisberg EO. How physicians can change the future of health care. JAMA 2007;297(10):1103–1111. Crossref, Medline, Google Scholar5 Gunderman RB. We make a life by what we give. Bloomington, Ind: Indiana University Press, 2008. Google Scholar6 Patti JA, Berlin JW, Blumberg ALet al.. ACR white paper: the value added that radiologists bring to the healthcare enterprise. J Am Coll Radiol 2008;5(10):1041–1053. Crossref, Medline, Google Scholar7 Groopman J, Hartzband P. Why ‘quality’ care is dangerous. Wall Street Journal. April 8, 2009;A13. Google ScholarArticle HistoryReceived April 29, 2009; revision requested June 3; revision received June 9; final version accepted June 22.Published in print: Dec 2009 FiguresReferencesRelatedDetailsCited ByRadiology in the Era of Value-based Healthcare: A Multi-Society Expert Statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNAAdrian P. BradyJaqueline A. BelloLorenzo E. DerchiMichael FuchsjägerStacy GoergenGabriel P. KrestinEmil J. Y. LeeDavid C. LevinJosephine PressaccoVijay M. RaoJohn SlavotinekJacob J. VisserRichard E. A. WalkerJames A. Brink21 December 2020 | Radiology, Vol. 298, No. 3Journal of the American College of Radiology, Vol. 18, No. 6Journal of Medical Imaging and Radiation Oncology, Vol. 65, No. 1Canadian Association of Radiologists Journal, Vol. 72, No. 2American Journal of Roentgenology, Vol. 216, No. 1Insights into Imaging, Vol. 11, No. 1Insights into Imaging, Vol. 8, No. 5Journal of the American College of Radiology, Vol. 14, No. 4Journal of Vascular and Interventional Radiology, Vol. 28, No. 6PLOS ONE, Vol. 12, No. 2Realizing Improvement through Team Empowerment (RITE): A Team-based, Project-based Multidisciplinary Improvement ProgramDavid B. Larson, L. Jake Mickelsen, Kandice Garcia, 10 November 2016 | RadioGraphics, Vol. 36, No. 7Journal of Cardiovascular Magnetic Resonance, Vol. 18, No. 1The British Journal of Radiology, Vol. 89, No. 1061Academic Radiology, Vol. 19, No. 5Journal of the American College of Radiology, Vol. 8, No. 9Journal of the American College of Radiology, Vol. 7, No. 6Recommended Articles Forging Connections in Latin America to Advance AI in RadiologyRadiology: Artificial Intelligence2022Volume: 4Issue: 5Creating Value through Incremental Innovation: Managing Culture, Structure, and ProcessRadiology2018Volume: 288Issue: 2pp. 330-340Costing in Radiology and Health Care: Rationale, Relativity, Rudiments, and RealitiesRadiology2017Volume: 282Issue: 2pp. 333-347Are Radiologist Assistants the Quintessential Solution for Modern Radiology Departments?RadioGraphics2020Volume: 40Issue: 5pp. 1502-1503The Road to Wellness: Engagement Strategies to Help Radiologists Achieve Joy at WorkRadioGraphics2018Volume: 38Issue: 6pp. 1651-1664See More RSNA Education Exhibits Managing and Reducing the Scattered Radiation Dose in Dental RadiologyDigital Posters2020Neural Networks in Deep Learning: A Simplified Explanation for RadiologistsDigital Posters2019A MIPS (Merit-Based Incentive Payment System) Tutorial: The Transformation of Healthcare and What It Means for Your PracticeDigital Posters2018 RSNA Case Collection Medication Related Osteonecrosis of the Jaw RSNA Case Collection2021PyknodysostosisRSNA Case Collection2020Neurofibromatosis type 1RSNA Case Collection2021 Vol. 253, No. 3 Metrics Altmetric Score PDF download

ACR White Paper: Task Force on Timing of Oral Boards in Diagnostic Radiology

The direction that the American Board of Radiology intends to follow relative to the diagnostic radiology oral board examination has risen quickly up the list of fundamental challenges for the radiology community. The formation of an ACR task force to study these changes was necessary, because this issue carries a high stake for the future of the profession and the patients we serve. After a careful review of the potential impacts, the committee discovered that consensus would be difficult to achieve relative to the merits of these changes. Accordingly, this white paper is focused objectively on the potential impacts on radiologists, practices, academic institutions, the ACR itself, and the ACR's membership. It is suggested that these concepts be used as starting points for future discussion and consideration of potential action.

ACR White Paper: The Value Added That Radiologists Provide to the Health Care Enterprise

Radiologists represent arguably one of medicine's least heralded but most important specialties. Although they carry sterling credentials as imaging and radiation safety experts, radiologists have lacked widespread public recognition. As public and private stakeholders cast an even more intense spotlight on imaging, the vital role of radiologists must be better understood. During the January 2008 ACR Forum on Future Practice Models for Radiology, participants and ACR leaders discussed the value added that radiologists bring to the health care enterprise and recommended that the ACR further study that topic. The ACR, dedicated to providing quality patient care since its inception in 1924, convened the Task Force on Value Added to address these issues. The task force determined the component stakeholders in the health care enterprise to whom value is added, defined the nature of the value for each constituent component, described the process of adding that value, and anticipated future trends that may affect the value proposition. Recommendations to the ACR for future action are offered.

Pay for Performance in Radiology: ACR White Paper

Pay for Performance in Radiology: ACR White Paper

Pay for Performance in Radiology: ACR White Paper

During the next few years, some portion of physician reimbursement will be increasingly based on the quality and efficiency of service, a practice commonly referred to as pay for performance (P4P). Performance benchmarks are the discrete parameters of structure, process, or outcome metrics whose attainment defines good quality care. Private payers are already rewarding primary care physicians for practices that adhere to quality standards, are efficient, involve information technology, and result in high patient satisfaction. The Centers for Medicare and Medicaid Services will have completed the development of performance measures to be used in Medicare payment strategies for all specialties by the end of 2006 and anticipates phasing in the program fully by 2008. This article describes P4P, its importance to the ACR, the organizations involved in developing it, the ACR's activities to date, and the steps the ACR must take to ensure that radiologists are remunerated fairly as physician payment becomes based, in part, on performance.

Keeping it safe: MRI site design, operations, and surveillance at an extended university health system

Magnetic resonance imaging (MRI) safety has attracted increasing attention both within the radiology community and in general. Although much of this attention has been spurred by high-profile accidents, the wide distribution of increasingly powerful MRI technology makes safety a paramount concern. While the ACR has sponsored an overarching policy statement regarding MRI safety (The ACR White Paper on MR Safety), and many articles have reported specific hazards and evaluated myriad devices, this paper describes in detail the practical implementation of safe MRI practice at a large medical center. The implementation focuses on 3 key areas: (1) site access restriction, (2) personnel management, and (3) equipment. In addition, a comprehensive and proactive program for MRI safety surveillance and preemptive action is presented. This last step is key to maintaining the effectiveness of an MRI safety program.