Era Of Value-based Health Care Research Articles

(P14) Cost Effectiveness of Radiation and Chemotherapy for High-Risk Low Grade Glioma

The standard of care treatment for maximally resected, high risk (≥ 40 years old or sub-totally resected) low grade glioma (LGG) patients was established by RTOG 9802, which showed an overall survival (OS) of 13.3 years for patients treated with radiotherapy (RT) + PCV (procarbazine, lomustine [CCNU], vincristine) chemotherapy compared to 7.8 years for RT alone. In the era of value-based health care, cost-effectiveness analyses (CEA) have the potential to inform coverage decisions and patient care. To our knowledge, there has been no study assessing the value of RT+PCV as adjuvant therapy for high risk LGG. We sought to analyze the cost-effectiveness of this strategy. The base case comprised patients with high risk LGG after maximal safe resection with indications for adjuvant therapy. A decision tree with an integrated three-state Markov model was created to follow patients treated with RT and RT + PCV. Patients existed in one of 3 health states: stable, progressive, and dead. All patients were assumed to be free of progression at baseline. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using time-dependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Starting at initial age of 40 years (median age on RTOG 9802), patients were followed monthly over a maximum time horizon of 60 years after diagnosis (effectively over their remaining lifetimes). Analysis was conducted from the healthcare perspective. Probabilistic sensitivity analysis of modeled parameter distributions was conducted with Monte Carlo simulation of 10,000 samples. Modeled outcomes demonstrated agreement with clinical data in OS, progression free survival (PFS), and expected benefit of addition of PCV to adjuvant RT. In our model, 5-year and 10-year OS rates for RT+PCV vs RT alone were 71.5% vs. 64.8%, and 62.1% vs. 39.2%, respectively; 5-year and 10-year PFS rates for RT+PCV vs RT alone were 61.7% vs. 45.2%, and 50.5% vs. 20.1%, respectively. Patients treated with RT alone accrued 5.17 quality-adjusted life-years (QALYs) (9.63 life-years) at a cost of $139,598. Patients treated with RT+PCV accrued 9.94 QALYs (21.45 life-years) at a cost of $188,234. The addition of PCV to RT yielded an incremental benefit of 4.77 QALYs at an incremental monetary cost of $48,637, leading to an incremental cost-effectiveness ratio of $10,188 per QALY gained. Probabilistic sensitivity analysis demonstrates that cost-effectiveness of RT+PCV was insensitive to variations in modeled distributions of input parameters, with 99.96% probability of cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY. Based on the impressive benefits in outcomes observed in RTOG 9802, the addition of PCV chemotherapy to RT provides high value for cost in the treatment of patients with high-risk low grade glioma.

Abstract P3-10-03: Effects of guideline-concordant treatment on ED visits, hospitalizations, and cost in metastatic breast cancer

Abstract Purpose: The National Comprehensive Cancer Network (NCCN) developed treatment guidelines that have directed care of patients with cancer for over 20 years. Receipt of treatment according to these guidelines is increasingly recognized as a marker of high quality care. A knowledge gap exists regarding concordance of treatment regimens for metastatic breast cancer with NCCN guidelines, as well as the potential impact of this concordance (or lack thereof) on resource utilization and costs – an issue that assumes significance in the new era of value-based healthcare. Methods: From 2007-2013, women with de novo (n=988) or recurrent, treated metastatic breast cancer (n=5,651) were evaluated for concordance of first-line systemic therapy with NCCN guidelines within the SEER–Medicare linked database. Types of non-concordant treatments were reviewed and categorized. Outcomes include monthly rates of ED visits, monthly rates of hospital admissions, total overall and Medicare costs, and mortality. Specific (hospitalizations, antineoplastic agents, growth factor) and total costs to Medicare (excluding home health, hospice, skilled nursing facility) were calculated from initiation of treatment until death or available follow-up and examined by concordance status. Part D costs were excluded because costs are shared by Medicare, other payers, and patients. Cox regression was used to evaluate mortality risk. Student's t-tests, generalized linear models, and generalized mixed effects models were utilized to evaluate the relationship between concordance status and outcomes. Results: We previously reported the prevalence of non-concordant first-line systemic therapy for de novo metastatic breast cancer (19%) and recurrent metastatic breast cancer (18%). The adjusted risk of mortality was comparable by concordance status. In the current analysis, non-concordant treatments were associated with a 9% increased rate of ED visits and a 7% increased rate of hospitalizations (p<.01). Total Medicare cost for patients receiving concordant and non-concordant treatments was $79,372 and $109,471, respectively (p<.001). Significant cost differences were found when comparing patients receiving concordant and non-concordant treatments by antineoplastic agents ($14,256 vs $24,817, p<.001) and growth factor ($1,754 vs $3,414, p<.001). A trend toward lower cost attributed to hospitalizations was observed for patients receiving concordant treatment compared to those receiving non-concordant treatment ($28,113 vs $34,134, p=.06). Overall, hospitalizations, antineoplastic agents, and growth factor accounted for 56% of total Medicare costs. Average monthly Medicare costs were higher for non-concordant patients by $1,761 (p<.01). Conclusions: While not associated with increased overall mortality, non-concordant treatment is associated with higher health care utilization rates and cost. Increased costs attributed to non-concordant care were largely driven by antineoplastic agents and growth factor use. These findings may have policy implications for payment reform initiative, in particular pathway programs which aim to reduce variability in care and spending on medications. Citation Format: Rocque GB, Williams CP, Jackson BE, Halilova KL, Adewakun SA, Pisu M, Forero A, Bhatia S. Effects of guideline-concordant treatment on ED visits, hospitalizations, and cost in metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-10-03.

Cost-Effectiveness of Radiation and Chemotherapy for High-Risk Low Grade Glioma

The standard of care treatment for maximally resected, high risk (≥ 40 years old or sub-totally resected) low grade glioma (LGG) patients was established by RTOG 9802, which showed an overall survival (OS) of 13.3 years for patients treated with radiotherapy (RT) + PCV (procarbazine, lomustine [CCNU], vincristine) chemotherapy compared to 7.8 years for RT alone. In the era of value-based health care, cost-effectiveness analyses (CEA) have the potential to inform coverage decisions and patient care. To our knowledge, there has been no study assessing the value of RT + PCV as adjuvant therapy for high risk LGG. We sought to analyze the cost-effectiveness of this strategy. The base case comprised patients with high risk LGG after maximal safe resection with indications for adjuvant therapy. A decision tree with an integrated three-state Markov model was created to follow patients treated with RT and RT + PCV. Patients existed in one of three health states: stable, progressive, and dead. All patients were assumed to be free of progression at baseline. Survival and freedom from progression were modeled to reflect the results of RTOG 9802 using time-dependent transition probabilities. Health utility values and costs of care were derived from the literature and national registry databases. Starting at initial age of 40 years (median age on RTOG 9802), patients were followed monthly over a maximum time horizon of 60 years after diagnosis (effectively over their remaining lifetimes). Analysis was conducted from the healthcare perspective. Probabilistic sensitivity analysis of modeled parameter distributions was conducted with Monte Carlo simulation of 10,000 samples. Modeled outcomes demonstrated agreement with clinical data in OS, progression free survival (PFS), and expected benefit of addition of PCV to adjuvant RT. In our model, 5-year and 10-year OS rates for RT + PCV vs RT alone were 71.5% vs. 64.8%, and 62.1% vs. 39.2%, respectively; 5-year and 10-year PFS rates for RT + PCV vs RT alone were 61.7% vs. 45.2%, and 50.5% vs. 20.1%, respectively. Patients treated with RT alone accrued 5.17 quality-adjusted life-years (QALYs) (9.63 life-years) at a cost of $139,598. Patients treated with RT+PCV accrued 9.94 QALYs (21.45 life-years) at a cost of $188,234. The addition of PCV to RT yielded an incremental benefit of 4.77 QALYs at an incremental monetary cost of $48,637, leading to an incremental cost-effectiveness ratio of $10,188 per QALY gained. Probabilistic sensitivity analysis demonstrates that cost-effectiveness of RT + PCV was insensitive to variations in modeled distributions of input parameters, with 99.96% probability of cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY. Based on the impressive benefits in outcomes observed in RTOG 9802, the addition of PCV chemotherapy to RT provides high value for cost in the treatment of patients with high-risk low grade glioma.

Establishing Maximal Medical Improvement After Arthroscopic Rotator Cuff Repair

Background: As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. Purpose: Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. Study Design: Systematic review. Methods: A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. Results: The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. Conclusion: After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1 year after surgery, but not beyond this. This information is important not only to establish appropriate patient expectations but also to determine a time frame for outcome collection after surgery to better define value in orthopaedic care.

Quality Indicators in Endoscopic Ablation for Barrett's Esophagus.

Barrett's esophagus (BE) is a well-established premalignant condition for esophageal adenocarcinoma (EAC); a cancer that is associated with a poor 5-year survival rate. Several strategies have been explored in the context of reducing the burden of EAC. Endoscopic eradication therapy (EET) is considered the standard of care for the management of patients with BE with dysplasia and early neoplasia; a practice that has been endorsed by all gastroenterology societal guidelines. The effectiveness of EET has been demonstrated in multiple studies and contemporary management includes a combination of endoscopic mucosal resection (EMR) of all visible lesions followed by eradication of the remaining BE using ablative techniques of which radiofrequency ablation (RFA) has the best evidence supporting effectiveness and safety. These techniques are being used increasingly at academic tertiary care centers and community practices. In this era of value-based health care, there is increased focus on the establishment, documentation, and reporting of quality indicators; indicators that are important to physicians, patients, and payers. The purpose of this review is to highlight the current status of quality indicators in EET for the management of patients with BE-related neoplasia and discuss the future steps required to ensure that these quality indicators are uniformly incorporated into practice.

Funds Flow in the Era of Value-Based Health Care

Health care reform is creating significant challenges for hospital systems and academic medical centers (AMCs), requiring a new operating model to adapt to declining reimbursement, diminishing research funding, market consolidation, payers’ focus on higher quality and lower cost, and greater cost sharing by patients. Maintaining and promoting the triple mission of clinical care, research, and education will require AMCs to be system-based with strong alignment around governance, operations, clinical care, and finances. Funds flow is the primary mechanism whereby an AMC maintains the triple mission through alignment of the hospital, physician practices, school of medicine, undergraduate university, and other professional schools. The purpose of this article is to discuss challenges with current funds flow models, impact of funds flow on academic and private practice radiology groups, and strategies that can increase funds flow to support radiology practices achieving clinical, research, and teaching missions in the era of value-based health care.

Using Cost-Effectiveness Analysis to Measure Value in Musculoskeletal Imaging.

In the era of value-based health care, adding value is a key element in providing care. The choice of appropriate imaging modality and protocol should be based on consideration of patients' values, health care outcomes, and cost-effectiveness, taking into account the perspective of the decision maker, the health care system, and society at large. This article provides an overview of the available tools to measure value, outcomes, and cost-effectiveness in musculoskeletal radiology, illustrated with relevant examples.

Value-Based Assessment of Radiology Reporting Using Radiologist-Referring Physician Two-Way Feedback System-a Design Thinking-Based Approach.

In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define "value," beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study. These new dimensions of value measurement will directly impact the cascade of further medical management. We share our continued experience with this project that had two components: RESP (Referrer Evaluation System Pilot) and FRACI (Feedback from Radiologist Addressing Confounding Issues), which were introduced to the clinical radiology workflow in order to capture referrer-based and radiologist-based feedback on radiology reporting. We also share our insight into the principles of design thinking as applied in its planning and execution.

Appropriate Use Criteria for Echocardiography: Evolving Applications in the Era of Value-Based Healthcare.

The current climate in healthcare is increasingly emphasizing a value-based approach to diagnostic testing. Cardiac imaging, including echocardiography, has been a primary target of ongoing reforms in healthcare delivery and reimbursement. The Appropriate Use Criteria (AUC) for echocardiography is a physician-derived tool intended to guide utilization in optimal patient care. To date, the AUC have primarily been employed solely as justification for reimbursement, though evolving broader applications to guide clinical decision-making suggest a far more valuable role in the delivery of high-quality and high-value healthcare.

Cardiac Rehabilitation in Patients with Established Atherosclerotic Vascular Disease: New Directions in the Era of Value-Based Healthcare.

Exercise-based cardiac rehabilitation (CR) is associated with significant improvements in coronary disease outcomes, but has been underutilized. However, new developments within the field, some spurred by healthcare reform and the transition to more accountable and coordinated care, offer hope for closing the large CR treatment gap. This review presents new CR-related research, policy, and analyses, and discusses how evolving eligibility criteria, referral processes, performance measures, care models, and delivery and payment options could increase CR utilization over the next decade and enable this life-saving secondary prevention intervention to thrive in the era of value-based health care.

Report of the 2014-2015 Professional Affairs Standing Committee: Producing Practice-Ready Pharmacy Graduates in an Era of Value-Based Health Care

Background and Charges According to the Bylaws of the American Association of Colleges of Pharmacy (AACP), the Professional Affairs Committee is to study issues associated with the professional practice of pharmacy as they relate to pharmaceutical education, and to establish and improve working relationships with other organizations in the field of health affairs. The Committee is encouraged to address related agenda items relevant to its Bylaws charge and to identify issues for consideration by subsequent committees, task forces, commissions, or other groups. President Patricia Chase established the themes of Access, Affordability and Accountability for the 20142015 standing committees. (1) The 2014-2015 Professional Affairs Committee (PAC) was charged with examining the contributions of experiential education to the development of practice-ready pharmacy school graduates who are educated and trained for current and future practice. Experiential education, comprised of Introductory Pharmacy Practice Experiences (IPPEs) and Advanced Pharmacy Practice Experiences (APPEs) and represents up to 30% of the pharmacy school curricula, are the entry points for student pharmacists into pharmacy and patient care practice. Specifically, the 2014-2015 Professional Affairs Committee is charged to: (1) Describe the elements that should be present for access to exemplary experiential sites; (2) Identify how student pharmacist readiness for and contributions to experiential education should be considered to illustrate the value to experiential practice sites; and (3) Recommend strategies to the academy to demonstrate its accountability that graduates are practiceready. Members of the 2015 PAC include individuals representing multiple disciplines across various colleges and schools of pharmacy, as well as professional staff representation from the American Pharmacists Association (APhA), the American Society of Health-Systems Pharmacy (ASHP) and the National Association of Chain Drug Stores (NACDS). The committee began its work by reviewing pertinent background information and resource materials and participating in a conference call to develop an initial strategy for addressing committee charges. The committee members met for a day and a half in Crystal City, Virginia on October 27-28, 2014 to discuss the various facets related to the committee charges, as well as to develop a process and strategies for addressing the charges. Following the process development and delegation of assignments related to the committee charges, the PAC communicated via electronic communications as well as through personal exchanges via telephone and email. In developing the strategy to address their charges, the PAC considered numerous factors that contribute to the current needs, future needs and contributions of practice-ready pharmacists. Examination of pertinent issues relevant to both experiential education and pharmacy practice were explored from the perspectives of access, value (the PAC examined the value of experiential education as an applicable aspect of affordability) and accountability. The continued evolution of the healthcare environment, including implications for pharmacists and team-based care from the Patient Protection and Affordable Care Act (PPACA), (2) the expanding role of pharmacists in a dynamically-changing health care system, (3, 4 5 6) and emerging interprofessional, collaborative practice models, such as Patient Centered Medical Homes (4, 7 8) and Affordable Care Organizations, (9) were discussed. The Accreditation Council for Pharmacy Education (ACPE) release of Draft Standards 2016 (10) and the Guidance Document to Draft Standards 2016, (11) which was finalized February 2015, (12,13) are other important aspects that should forecast the content and impact of experiential education. The recently revised Joint Commission of Pharmacy Practitioners (JCPP) Vision for Pharmacists' Practice (14) and the recently approved Pharmacist Patient Care Model, (15) which describes a consistent process of care in the delivery of patient care services by pharmacists, are additional avenues that must be included in all aspects of pharmacy education. …

The financial impact of intraoperative adverse events in abdominal surgery

Little evidence currently exists regarding the clinical or financial impact of intraoperative adverse events (iAEs). We sought to study the additional health care charges attributable to the occurrence of an iAE. The administrative and ACS-NSQIP databases at our tertiary academic medical center were linked for all patients undergoing abdominal surgery (January 2007-October 2012). The ICD-9-CM-based Patient Safety Indicator "accidental puncture/laceration" was used to screen the linked database for potential iAEs. All iAEs were confirmed subsequently through standardized review of all flagged medical records. Multivariate analyses controlling for demographics, comorbidities/laboratory values, procedure type, and approach and complexity of surgery were performed to assess the increase in health care charges independently predicted by the occurrence of iAEs. Of 9,111 patients, 183 were confirmed to have iAEs. Patients in the iAE group had higher median total charges ($27,169 [IQR, 17,302-44,952] vs $13,312 [IQR, 8,586-22,012]; P < .001), direct charges ($17,808 [IQR, 11,520-28,930] vs $8,738 [IQR, 5,686-14,227]; P < .001) and indirect charges ($9,396 [IQR, 5,932-16,144] vs $4,568 [IQR, 2,887-7,824]; P < .001) when compared with patients without iAEs. Multivariate analyses demonstrated that iAEs independently predict an increase in total hospitalization charges by 41% (95% CI, 30-52%; P < .001). Specifically, the direct, indirect, operating room, laboratory/radiology, and alimentation/medical therapy charges increased by 42, 39, 27, 54, and 48%, respectively (all P < .001). In addition to the morbidity incurred by patients, the occurrence of an iAE is associated with major additional health care charges. In an era of value-based health care, understanding and preventing iAEs can lead to major cost savings alongside improvements in patient safety and surgical quality.

Fostering Healthy Work Environments Through Nursing Education Initiatives

In this era of value-based health care, the knowledge, competence, and professionalism of the front-line nurse and other clinical staff are paramount. Everyone involved in patient care must maximize their skill set and drive high performance in the clinical arena. Healthy work environments will be key to achieving and sustaining quality outcomes and developing and retaining high-performing teams.

Personalized healthcare in the era of value-based healthcare.

Medical care in the USA is plagued by high costs, poor quality and fragmented care delivery. In response, new methods of integrated healthcare delivery are needed, including the patient-centered medical home. At the same time, we need to revitalize our approach to the practice of medicine, moving to a personalized approach, even as we increasingly focus on population management. Some aspects of personalized healthcare have the potential to add significant cost to the system, while others can improve value. This article aims to provide an overview of the current healthcare climate, discuss evolving models of care in the era of healthcare reform and describe the increasingly important role of personalized healthcare in this process.

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