American Board Of Radiology Research Articles

Trust in Residents and Board Examinations: When Sharing Crosses the Boundary

Recently, illegal reproduction and transmission of board certification examination questions has received public attention. In 2010, the American Board of Internal Medicine suspended or revoked the certification of 139 physicians found to be either disclosing or soliciting examination questions for a board review company that encouraged physicians to relay questions from memory. In 2012, CNN reported on two circumstances of residents preparing for board certification examinations using questions reproduced by previous examinees.1,2 Immediately after taking the American Board of Radiology (ABR) medical physics examination, radiology residents wrote down test questions to which they were assigned. These questions, known as “recalls,” were then shared among future trainees. Dermatology residents also reproduced questions (referred to as “airplane notes”) minutes after their certification examination, often in groups. In these two cases, 20% to 50% of test questions have appeared on previous examinations.1,2 Reproduction of the questions clearly violates examination copyright policies, breaching the agreement to which their signature binds them.3,4 In a relevant study, nearly all medical students and faculty members surveyed considered using a stolen copy of a board examination unethical.5 Moreover, the ABR considers using recalls cheating.1 A profession is distinguished from a craft guild on the basis of educational standards, coupled with an established code of ethics in which a service rather than profit orientation is enshrined to engender the public trust.6 For this reason, ethical breaches and unprofessional behavior, such as the morally misguided use of reproduced questions, undermine the integrity of our entire profession. Yet, some physicians interviewed by CNN rationalized recall use as simply a study guide, whereby test questions are used to confirm understanding of the underlying knowledge rather than rote memorization of answers. Cheating of this nature casts an overarching ethical pall over the moral formation and integrity of physicians, eroding public trust in professional practice, teaching, and scholarship. Cheating on examinations in medical school correlates with falsifying information in a patient’s medical record.7 Surprisingly, one third of medical students engaged or would consider engaging in such falsification.8 This behavior reflects poor moral reasoning and/or willingness to subordinate morality to the achievement of goals. Such morally unacceptable conduct violates the primacy of medicine’s beneficence-based responsibility and undermines the integrity of our profession. From the patient’s perspective, physicians should be certified on the basis of a valid assessment of the knowledge requisite to provide high-quality care. If patients cannot trust the knowledge that board certification is expected to measure, the medical profession loses the public’s trust and confidence. Moreover, patients will only benefit from certification if it indicates the ability to care for them, rather than efficient preparation for board examinations. The distinction between cheating and guided study is crucial. Historical test questions are routinely used throughout higher education,9 and recent examination experience is commonly used to create focused study materials. The American College of Physicians produces the Medical Knowledge Self-Assessment Program, which includes a summary of high-yield information likely to appear on the examination.10 The introduction states, “The content was turned over to 11 carefully selected chief residents and fellows who had recently passed the certification exam. These physicians strained the essential testable points.” The editor continues, “As a frequent lecturer on Board preparation, I rely on input from hundreds of post-examination residents. With their ideas in mind, I refined the outline of Board Basics to target important topics and eliminate nonessential information.”10 Used by medical students for over 2 decades, the First Aid series is updated annually based on examinee reports. Using a focused study guide and sample questions created with examinees’ input bears some similarity to using practice questions that may have been on a recent examination as a vehicle for targeted learning. The difference lies in the detail and specificity of the information conveyed to future examinees. Nevertheless, from the public’s perspective, both practices represent shortcuts for examination success. Surprisingly, only 43% of medical students surveyed thought that it was clearly wrong for a student completing a clinical examination to convey information regarding its content to another student taking the examination.7 There is clearly a commonality between this finding and the interviewed physicians’ rationalized view of recalls.

Maintenance of certification: part 2—continuous certification

In the first article of this series, we explored the historical development of medical specialty societies, and how this process ultimately resulted in the formation of the American Board of...

DASSIM-RT is likely to become the method of choice over conventional IMRT and VMAT for delivery of highly conformal radiotherapy

Lei Xing, Mark H. Phillips, and Colin G. Orton Citation: Medical Physics 40, 020601 (2013); doi: 10.1118/1.4773025 View online: http://dx.doi.org/10.1118/1.4773025 View Table of Contents: http://scitation.aip.org/content/aapm/journal/medphys/40/2?ver=pdfcov Published by the American Association of Physicists in Medicine Articles you may be interested in Lung sparing and dose escalation in a robust-inspired IMRT planning method for lung radiotherapy that accountsfor intrafraction motion Med. Phys. 40, 061705 (2013); 10.1118/1.4805101 Comparison of Elekta VMAT with helical tomotherapy and fixed field IMRT: Plan quality, delivery efficiency andaccuracy Med. Phys. 37, 1350 (2010); 10.1118/1.3326965 Frontiers of Radiation Therapy and Oncology, Vol. 40: IMRT, IGRT, SBRT: Advances in the Treatment Planningand Delivery of Radiotherapy Med. Phys. 35, 3822 (2008); 10.1118/1.2957612 Quantifying the interplay effect in prostate IMRT delivery using a convolution-based method Med. Phys. 35, 1703 (2008); 10.1118/1.2897972 Segmentation of IMRT plans for radical lung radiotherapy delivery with the step-and-shoot technique Med. Phys. 31, 892 (2004); 10.1118/1.1668372

Performance Assessment for the Advancement of Radiation Oncology Treatment (PAAROT): A Practical Approach for Informing Practice Improvement

The American Society for Radiation Oncology's PAAROT program has been qualified by the American Board of Radiology (ABR) to meet the Maintenance of Certification requirements for a Type 2 Practice Quality Improvement project. PAAROT requires physicians to perform periodic chart reviews and self-report quality measures. We present an overview of PAAROT to describe mean performance rates of participating physicians; and identify opportunities for performance improvement.

It is not appropriate to “deform” dose along with deformable image registration in adaptive radiotherapy

It is not appropriate to “deform” dose along with deformable image registration in adaptive radiotherapy

The American Board of Radiology Holman Research Pathway: 10-Year Retrospective Review of the Program and Participant Performance

In 1999, the American Board of Radiology (ABR) implemented an innovative training program track in diagnostic radiology (DR) and radiation oncology (RO) designed to stimulate development of a cadre of future academic researchers and educators in the 2 disciplines. The program was designated the Holman Research Pathway (HRP). An in-depth retrospective review of initial certification examination performance, post-training career choices, and academic productivity has not been written. This report represents a 10-year retrospective review of post-training performance of a cohort of trainees who have had sufficient time to complete their training and initial certification process and to enter practice. All pertinent proceedings of the ABR and Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committees for DR and RO between 1997 and May 2011 were reviewed. Thirty-four HRP candidates who fulfilled the established evaluation criteria were identified, and their ABR data files were analyzed regarding performance on the qualifying and certifying examinations. All candidates were contacted directly to obtain a current curriculum vitae. Twenty candidates in RO and 14 candidates in DR were identifiable for review. All candidates attained initial certification. At the time of analysis, 23 of 33 (66.6%) candidates were employed in full-time academic practice (1 DR candidate remained in a fellowship and was not evaluated regarding employment status). Fifteen of 20 (75%) RO candidates were in faculty positions compared with 7 of 13 (53.8%) DR trainees. Additional academic productivity metrics are reported. A high percentage of HRP trainees remained in academic practice and demonstrated significant academic productivity as measured by manuscript authorship and research support. Additional time and observation will be needed to determine whether these findings will be sustained by past, current, and future HRP trainees.

MO-E-211-01: ABR 2014: Trained for Competence.

1. The ABR requirements c2014: Why they're needed and how they were established 2. Physics Residency Programs: Importance for our profession and methods to fund 3. Essential elements for competency: didactic, scientific and clinical.

WE-D-213AB-01: Preparing for the ABR Part I Board Exam

The first step in the process of obtaining board certification for radiotherapy physics by the American Board of Radiology can be an overwhelming experience, but it doesn't have to be. This talk will start with an overview of the requirements that must be met in order to sit for Part I of the ABR board exam. We will then identify the wide range of topics that have been emphasized during recent years and the overall exam procedure. You'll be pointed in the direction of relevant study material and given an efficient organizational-framework to help guide you through the preparatory process. Both self-study, and group-based study techniques, along with their advantages will be discussed. The main focus of the presentation will be to provide an outline of the exam material and an overview of the eligibility requirements in order to sit for the exam. Learning Objectives: 1. Review the eligibility requirements for Part I of the ABR radiotherapy physics exam. 2. Understand what material is covered in Part I of the ABR Exam. 3. Identify possible examination topics and appropriate study material. 4. Be able to design and execute an efficient study plan.

The ABR and Resident Recall “Cheating”

In my opinion, the American Board of Radiology would best handle the current controversy by making previous examination questions, but not answers, publicly available.

Informatics in Medical Imaging

Informatics in Medical Imaging presents a comprehensive overview of concepts and principles of medical imaging informatics. The book has 23 chapters divided into six major sections: Introduction to Informatics in Medicine, Standard Protocols in Imaging Informatics, Key Technologies, Information Systems in Healthcare Informatics, Operational Issues, and Medical Informatics beyond the Radiology Department. The book is 367 pages long and is written by 33 contributing authors from around the world, including many well-known experts in their respective fields. Today's technologies of medical imaging and radiation oncology are so complex and computer-driven in the digital era, it is difficult for medical specialists and technologists responsible for their clinical use to know exactly what is happening at the point of patient care. Medical physicists are facing these new challenges too. They are best trained to understand the technologies involved and their applications and are taking more clinical responsibilities than before to ensure that the best patient care is delivered safely and effectively. Medical imaging informatics is about medical image and healthcare information management, integration, storage, transmission, distribution, and security during these processes. In this book, the authors tried to provide an integrated publication dealing with the fundamental and updated issues within the scope of medical imaging informatics. Readers will understand the principal components of modern computing, networks, storage systems, and their extensive applications in medical imaging informatics after reading each focused chapter which give a broad overview. The field of medical imaging informatics is still changing rapidly. Because of the comprehensive nature of this book with many topics in medical imaging informatics, the targeted readers include professionals in medical physics and biomedical imaging, as well as students and researchers. It may also be used as a helpful reference guide for medical physicists, radiologists, and administrative staff seeking additional information on medical imaging informatics. The book discusses basic concepts in medical imaging informatics, data representation and transmission, primary imaging informatics protocols, picture archiving and communication systems (PACS), and the electronic medical record. It also details key instrumentation and data mining technologies used in medical imaging informatics, typical information systems used within imaging departments such as orders and result systems, acquisition systems, reporting systems, archives, and information-display systems, as well as practical operational issues. For HL7, DICOM, and IHE that are fundamental communication protocols used to support various aspects of information in the health care enterprise, not only basic concepts are discussed but also in-depth information is covered, making them useful for readers with different backgrounds in medical imaging informatics. Readers with administrative responsibilities may be interested in special topics discussions about equipment procurement, operational issues, and ethics in the radiology department. In addition to radiology, issues concerning other medical specialties such as pathology, cardiology, dermatology, surgery, and radiation oncology that use digital imaging are also addressed in the book. Although these 23 chapters are written by many authors, unlike an integrated one by only a few authors, most chapters are well written and easy to read even for readers without much prior knowledge in medical imaging informatics. Since this book is one volume of the series “Imaging in Medical Diagnosis and Therapy,” some chapters may have been better included in other volumes of the series. With abundant respective information from various resources, this book is an attempt to cover fundamental principles and state-of-the-art technologies as well as major challenges for future advances with the radiology and radiation oncology community in mind. From background information in medical informatics including a detailed overview of key technologies such as operating systems, networks, standard protocols, digital storage, and image compression in Sections I–III, to principles of PACS, display technologies, hospital information systems, and special topics about operational issues in medical imaging and beyond the radiology department in Sections IV–VI, the book provides a comprehensive survey of the field of medical imaging informatics. Overall, this book is well written by experts in their respective fields and has good coverage. Readers may also obtain a wealth of information in medical imaging informatics from references listed at the end of each chapter which supplement materials discussed in this book. Yu Liu is a Senior Imaging Physicist certified by the American Board of Radiology in the Radiology Department at St. Luke's Medical Center of Aurora Healthcare, Milwaukee, Wisconsin. He has been involved in PACS implementation, operation, and quality control since 1997. His expertise and current interests are in PACS and MRI physics.

John F. Roach

In the 1960s, John F. Roach, professor and chairman of radiology at the Albany Medical College, future president of the American Board of Radiology (ABR), and a member of the American Board of Medical Specialties (ABMS), found himself in the dilemma to accept an American Board of Nuclear Medicine and also preserve nuclear imaging as diagnostic radiology.

Educating Radiology Residents in the New Era: Implementation and Evaluation of Online End-of-Rotation Examinations

The aim of this report is to describe preliminary experience with an educational tool implemented to improve radiology education and documentation, in anticipation of upcoming changes from the American Board of Radiology and the Accreditation Council for Graduate Medical Education. Monthly online end-of-rotation examinations were developed for junior radiology residents. Examinations were administered over a period of 6 months, after which satisfaction surveys were administered to residents and faculty members. Satisfaction with end-of-rotation examinations was high for residents and faculty members, but the level of resident satisfaction was not statistically different when compared to that of residents who had taken fewer examinations. End-of-rotation examinations are relatively straightforward to implement and facilitate recurring, structured, and meaningful resident evaluation and feedback. Future studies will explore whether examinations such as these result in improved clinical competency.

The Practice of Radiology: Current and Future Trends

W559 At the end of a partnership track, the majority of radiologists will become partners. As a partner, the radiologist will typically share equally in the profits of the practice, which after accounting for geography, payer, and case mix, are primarily determined by one factor: volume. In general, this is a path that has been secure and predictable. Year 2020: The neophyte radiologist will be more likely to be employed by a hospital, multispecialty group, or nonhospital corporation. Those entering private practice will likely join groups that are large by the standards of today. The largest practices may be national corporations. Outpatient practice independent of a hospital will be uncommon. There will be less security in many practices because local groups may need to compete with national practices for hospital contracts. The American Board of Radiology (ABR) examination will no longer be the definitive imprimatur of quality and value, rather, radiologists must provide additional evidence to hospitals and payers that what they do is valuable. Currently, one can expect reimbursement for performing and interpreting an imaging study regardless of the quality and value of the examination. In the future if this study does not meet certain metrics for performance and interpretation, it may be reimbursed at a lesser rate or not at all. Under bundled-payment systems, this study may actually add to provider costs rather than profit margins. This will also affect nonradiology imaging providers, who may find that the financial incentives for self-referral are further decreased and that the quality standards are too hard to meet. I have sometimes heard sentiments to the effect that imaging volume will continue to increase because of our aging population and the current widespread use of imaging in clinical medicine and that radiologists always come up with new imaging techniques. Neither of these is, in my opinion, very likely. The Practice of Radiology: Current and Future Trends

The Potential of using a Commercial Treatment Planning System for Physician Quality Reporting for Maintenance of ABR Certification and CMS Reimbursement

Purpose/Objective(s): Physicians are now asked to create quality reports for American Board of Radiology (ABR) certification and Centers for Medicare and Medicaid Services (CMS) reimbursement incentives. Analyzing multiple charts for dosimetric quality of treatment plans is difficult and time consuming. The objective of this study was to investigate if a commercial treatment planning system would be able to provide this information in an automated manner.

Medical physics graduate programs should adjust enrollment to achieve equilibrium between graduates and residents

Medical physics graduate programs should adjust enrollment to achieve equilibrium between graduates and residents

MO-D-224-01: ABR 2014: Trained for Competence

Medical physicists are the only non‐physician professionals recognized by the American Board of Medical Specialties through certification by the American Board of Radiology (ABR). The ABR has always set high standards of clinical competency and now with the endorsement of the AAPM, is able to raise these standards by mandating that in 2014, to sit as a candidate for board certification, enrollment in an accredited physics residency program is required. This is an enormous step to elevate our profession, as now we have the means to specify only one method for achieving board certification that is through an accredited residency program, which leads to an increase of clinical competency. This will have a positive impact on our profession's recognition. Most challenges are being met, namely the number of residency positions is increasing exponentially to meet the manpower needs. In addition, funding mechanisms are being sought for government support of such training programs. However, we have to ensure that pathways for a residency and certification do not eliminate strong scientists; if for example, they do not have the prior educational pre‐requisite. Our profession has always, and must continue, to breed strong scientists who have clinical expertise though may not be seeking a clinical career. This requires developing skill sets that prepare scientists to be researchers or residents who can perform research. We will discuss the benefits of the 2014 mandate along with the challenges that still exist. Learning Objectives: 1. The ABR requirements c2014: Why they're needed and how they were established 2. Physics Residency Programs: Importance for our profession and methods to fund 3. Essential elements for competency: didactic, scientific, and clinical.

SU‐E‐E‐06: The New ABR Exam: What Have We Done to Change the Way We Teach Physics to Residents?

Purpose: Our purpose is to develop a new physics course integrated with radiology clinical content and practice to prepare radiology residents to take the new American Board of Radiology (ABR) diagnostic radiology exam that went into effect on July 2010. Methods: Our old physics course was taught over a period of one year, and consisted mainly of lectures taught from an imaging physics textbook. We now offer a two year course that primarily uses the RSNA/AAPM physics modules supplemented with other resources such as the AAPM physics curriculum and AAPM/RSNA physics tutorials. Various physics topics will be discussed in a non‐serial order so that the residents develop an understanding of a breadth of topics in the first year. Each class session requires assigned reading or review before class. During class, we focus on important and relevant concepts from the assigned reading. We meet with the residents every other week and have one scheduled clinical lecture a month. The clinical lecture may come in the form of a radiologist teaching physics with emphasis on clinical relevance, a lab demonstrating physics concepts, a show and tell of radiology equipment, or a guest speaker from another institution. We are using audience response systems to encourage participation and discussion, and using tag‐team teaching to generate interest and discuss clinically relevant questions and answers. We have also redesigned the physics course website to make it more user‐friendly. Results: We donˈt know yet. Only time and the success of our residents taking the board exam in 2013 will demonstrate whether the new format is working Conclusions: We anticipate that the new format will work, but this is only possible providing time and effort is expended by physicists in making changes to the old teaching methods to benefit the residents and the radiology community as a whole.

MO-D-BRA-01: Leibel Memorial Symposium: Advanced IMRT Planning and Delivery and Future Directions

Steven Leibel MD was an inspiring leader in radiation oncology who died prematurely, and this symposium honors his memory and his collegial relationships with medical physicists at Memorial‐Sloan Kettering Cancer Center, Stanford University, UCSF and the American Board of Radiology. Dr. Leibel was a major innovative force in development and application of Intensity‐Modulated Radiation Therapy(IMRT), and his vision and energy were instrumental in national and international adoption of this practice‐changing technology in radiation therapy. In this memorial symposium, three distinguished medical physicists will examine the current state of IMRT and provide their vision for its future, including considerations of biologically‐adaptive IMRT,tumormodeling integrated into IMRT, and advanced technical IMRT features. Specific issues to be addressed include: 1. Advanced IMRT planning, including a review of novel optimization techniques and delivery strategies. 2. Commissioning, routine quality assurance and safety considerations for clinical use of advanced IMRT planning and delivery techniques. 3. Future directions in advanced IMRT planning and delivery, including the incorporation of biological considerations, tumormodeling and normal tissue response in optimization.

WE‐E‐224‐01: Preparing for ABR Board Exams

The process of obtaining board certification in one of the specialties of Radiological Physics by the American Board of Radiology is a complex and often daunting experience. The candidateˈs first introduction to board certification is the Part I written examination, also known as the Initial Qualification Examination. There are two key components to successfully completing this examination. The first component is understanding the process and the eligibility requirements for the exam. The second is to prepare for and pass the examination. This talk will be divided into two sections to address each of these components individually. The first half of the talk will describe present and future requirements which must be met in order for the candidate to sit for the Part I examination. The second portion of the talk will cover the wide range of topics that will be covered on the exam and the overall exam procedure. This talk is not designed to be a complete review course for Part I of the ABR examination, while possible examination topics will be discussed, the focus of the presentation will be to provide an outline of exam material along with an introduction into the process and overall eligibility.Educational Objectives1. Understand the prerequisites and application process for the Initial Qualification Examination for the ABR Radiological Physics Board Certification.2. Understand different pass levels for the examination.3. Have a general understanding of possible examination topics and recommend appropriate study materials for the Part 1 examination.

The Many Faces of Papillary Lesions of the Breast

Dr. McArthur is Resident Physician, and Dr. Umphrey is Assistant Professor, Breast Imaging Section, Department of Diagnostic Radiology, The University of Alabama at Birmingham, 619 19th Street South, JTN 338A, Birmingham, AL 35249; E-mail: [email protected]. After participating in this activity, the radiologist should be better able to evaluate the clinical presentation, imaging features, and management of benign and malignant papillary lesions of the breast. All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no relationships with, or financial interests in, any commercial organizations pertaining to this educational activity. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This continuing medical education activity expires on June 24, 2011. From the Editor: We are pleased to announce that Contemporary Diagnostic Radiology will be providing several articles in the coming year that will qualify for one Self-Assessment Module (SAM) credit approved by the American Board of Radiology (ABR). This credit will be provided in addition to the customary Category 1 CME credit and at no additional charge. The next issue (Volume 34, Number 10) will be the first of these SAM articles.