Number Of Radiologists Research Articles

Determinants of the number of mammography units in 31 countries with significant mammography screening.

In the 2000s, most of the female population of industrialised countries had access to mammography breast cancer screening, but with variable modalities among the countries. We assessed the number of mammography units (MUs) in 31 European, North American and Asian countries where significant mammography activity has existed for over 10 years, collecting data on the number of such units and of radiologists by contacting institutions in each country likely to provide the relevant information. Around 2004, there were 32 324 MU in 31 countries, the number per million women ranging from less than 25 in Turkey, Denmark, the Netherlands, the United Kingdom, Norway, Poland and Hungary to more than 80 in Cyprus, Italy, France, the United States and Austria. In a multivariate analysis, the number of MUs was positively associated with the number of radiologists (P=0.0081), the number of women (P=0.0023) and somewhat with the country surface area (P=0.077). There is considerable variation in the density of MU across countries and the number of MUs in service are often well above what would be necessary according to local screening recommendations. High number of MUs in some countries may have undesirable consequences, such as unnecessarily high screening frequency and decreased age at which screening is started.

Percutaneous tissue acquisition: a treatment for breast cancer? Vacuum-assisted biopsy devices are not indicated for extended tissue removal

Quite a number of radiologists indicate that complete removal of an imaged lesion in the breast by transdermal tissue acquisition is beneficial for the patient. Although this claim is technologically feasible with the vacuum-assisted biopsy (VAB) devices and, by virtue of a similar technology of aspiration, liposuction, there is no scientific or clinical proof that the extended procedure is indeed valuable for the patient. The optimal treatment of malignant or premalignant lesions remains open surgery with the goal to obtain pathologically free margins whenever possible. Complete removal by imaging is quite different from complete pathological removal. Hence, VAB elimination of suspect or malignant lesions can be considered less optimal and even malpractice in many cases. In addition, there is no evidence that complete removal of benign lesions is good for the patient. When benign lesions can be considered precursors for malignancy, they should be surgically removed as for other premalignant lesions. Most benign lesions can be treated medically as they are usually dispersed in the breast and hormone dependent. The rest of benign breast lesions need removal only to relieve the patient of psychological stress or because of symptoms. Evidence indicates furthermore that increase in cancer risk is related to the number and extent of breast interventions in the past. VAB and other large core biopsy devices remain a useful tool in the diagnosis of breast cancer but not for treatment purposes.

Author’s Reply

I am grateful to David Yankelevitz, MD, for pointing out what he believes to be errors in my February editorial in JACR [ 1 Hillman B.J. CT screening for lung cancer: appearances can be deceiving. J Am Coll Radiol. 2007; 4: 83-85 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. However, his “Who? Us?” response to my concern over the International Early Lung Cancer Action Program (I-ELCAP) [ 2 Henschke C.I. Yankelevitz D.F. Libby D.M. Pasmantier M.W. Smith J.P. Miettinen O.S. International Early Lung Cancer Action Program InvestigatorsSurvival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006; 355: 1763-1771 Crossref PubMed Scopus (1397) Google Scholar ] exhortation to promote generalized computed tomographic screening for lung cancer in high-risk populations on the basis of their findings seems to me naive. I leave it to the readers of JACR to reread the last paragraph of the discussion in the 2006 I-ELCAP report and review interviews [ 3 Goldberg P. Henschke says her observational study should change medical practice. Cancer Lett. 2006; 32: 1-8 Google Scholar ] given by I-ELCAP authors at the time of the publication to determine which of us more closely characterizes the situation. CT Screening for Lung Cancer: Editorials Can Be DeceivingJournal of the American College of RadiologyVol. 4Issue 6PreviewIn his editorial titled “CT Screening for Lung Cancer: Appearances Can Be Deceiving,” Bruce Hillman, MD, [1] addressed the most recent publication of the International Early Lung Cancer Action Program (I-ELCAP) [2]. The editorial’s title refers to Hillman’s point that the I-ELCAP investigators’ “simple message,” namely, that computed tomographic (CT) screening “works, and everyone at risk ought to undergo it,” has deceived an “unexpected” number of radiologists who “ought to better understand the flaws in drawing definitive conclusions from the I-ELCAP report.” Full-Text PDF

How Could the Radiologist Shortage Have Eased?

In 2000, a severe shortage of diagnostic radiologists existed in the United States. We seek to explain how the shortage eased greatly by 2003, despite the fact that the total imaging workload usually grows much faster than the number of radiologists in practice, which would be expected to intensify the shortage. We measured the contribution of eight possible explanations, predominantly using simple quantitative analyses. We analyzed published data, data on the volume of imaging from Medicare and from the Medical Expenditure Panel Survey, data on residents and fellows from the American College of Radiology's (ACR) membership department, data on residents from the American Board of Radiology, data from the ACR's 1995 and 2003 Surveys of Radiologists, and data from interviews about nighthawk services. From these data sources, we determined the following. Total imaging and imaging by radiologists continued to grow rapidly--by > 20% from 2000 to 2003 (measured in relative value units), which was somewhat faster than in the years preceding 2000 when the shortage was building. Foreign imagers took on a negligible portion of the workload. No reductions in retirement occurred among radiologists during 2000-2003, a 10-20% decrease in the annual number of residency graduates occurred, and no increase in residents going directly into the workforce rather than taking a fellowship was noted. Radiologists' average annual work hours were relatively constant, increasing by perhaps 2%. Work done per hour--that is, productivity--increased sharply (by approximately 15%) during this period. Increased productivity is the predominant explanation of how the radiologist shortage eased. The contribution of other factors was, in comparison, small or even in the opposite direction.

Grayscale calibration and quality assurance of diagnostic monitors in a PACS system

The aim of this study was to calibrate monitors used in soft-copy review of diagnostic images in a pictures archiving and communication system (PACS) and to assess critical quality assurance (QA) parameters through appropriate checks. Barco [cathode ray tube (CRT) and liquid crystal display (LCD)] and EIZO (LCD) monitors were evaluated. Calibration and QA controls were carried out during acceptance tests on the systems and every 6 months according to the Task Group 18 (TG18) report by the American Association of Physicists in Medicine (AAPM). The parameters in question include: maximum luminance, contrast ratio, luminance response, spatial resolution and angular response. A subjective evaluation of image quality was also conducted by a number of radiologists. Barco medical monitors' results were well within tolerances, with significant parameters persisting over time. EIZO nonmedical monitors showed rapid performance deterioration below the minimum requirements. Calibration had to be repeated only in a few cases. Radiologists' evaluations showed that monitor quality is equal to or even better than that of conventional films. Medical monitors turned out to be fully adequate to the task. Periodic QA tests are, however, absolutely necessary to ensure constant quality levels.

Get Paid for What You Do: Dictation Patterns and Impact on Billing Accuracy

No one would knowingly invest in a business whose principal executives knew little or nothing about the key components determining reimbursement for the services provided. Superimpose on that lack of knowledge a regulatory environment in that business sector that places owners and key employees at risk for accusations of fraud and abuse as well as in jeopardy of large fines and potential exclusion from the marketplace for the largest consumer of a company's product if billing is done incorrectly. Yet this is exactly the case in many radiology practices today. A significant number of radiologists who provide excellent quality medical care produce dictated reports that demonstrate complete ignorance of the parameters used by their billing personnel to generate accurately coded claims, thus losing significant legitimate clinical practice revenues while placing themselves and their practices in jeopardy. This article does not outline ways to game the system or inappropriately augment practice revenues. Rather, it describes many of the basic elements needed in the dictated reports produced by radiologists in their daily work, calculates examples of the financial impact of medically correct but poorly documented reports, and provides dictation guidelines for radiology residents and radiologists in practice that, if adopted, should ensure that you get paid properly for what you do.

Resource savings in the single reading of plain radiographs by oncologist only in cancer patient follow-up: A randomized study

The aim of this study was to estimate the need for a radiologist's clinical report in the interpretation of plain radiographs in cancer patient follow-up. Consecutive new cancer patients receiving primary treatment were randomized between two arms with different diagnostic modes: a double-reading arm (an oncologist and then a radiologist independently interpreted plain radiographs) and a single-reading arm (radiographs interpreted by an oncologist only; if necessary a radiologist's clinical report was obtained on separate request). Altogether 869 eligible patients participated. No differences were found in the total number of plain radiographs between the two arms. The number of radiologists was 20 and there were 28 oncologists. A separate clinical report was requested from a radiologist in 44% of all plain radiographs in the single-reading arm. This saving of radiologists’ work (56%) took place without detriment, as the indicators of earliness of diagnosis were the same in both arms. The role of the radiologist should be more in consultation than in routine interpretation during follow-up.

Multicenter clinical experience with large core soft tissue biopsy without vacuum assistance

The increasing interest in accurate pretreatment diagnosis of solid tumours by morphology, immunohistochemistry, genetics and molecular biology requires clinicians to obtain undamaged large core biopsies. Simultaneously, medical imaging and surgery give priority to minimal tissue injury, affordable technology and optimal patient compliance. A new large core soft tissue biopsy device has been developed to meet the above criteria. After intensive preclinical testing, 30 patients gave informed consent and 26 underwent the new diagnostic biopsy procedure. The sample was studied by morphology, immunohistochemistry and, where indicated, by molecular biology. Successful diagnosis was considered when in line with clinical follow-up and, as for all malignant lesions, when confirmed by open biopsy or surgery. No difficulties in the technique were encountered in 25 patients. In one patient the procedure was prematurely stopped because of anxiety. In all other 25 procedures a complete diagnosis was reached with regard to morphology, immunohistochemistry and molecular biology. A number of radiologists suggested some automation of the technique. This new large core soft tissue biopsy system performs well in the clinical context without injury to the breast parenchyma or artefacts in the harvested tissue specimen. The system meets almost all of the proposed technical and financial requirements. Automation is underway.

MRI of congenital heart disease: a paradigm of collaboration. new suggestions for a team approach from Madigan Army Medical Center.

Over the past decade, there has been increasing use of cardiac MRI in the evaluation of children with congenital heart disease. There has also been an increased number of radiologists and pediatric cardiologists desiring to perform cardiac MRI in the evaluation of these patients. At the present time, the number of pediatric cardiologists and radiologists fully trained in the use of MRI studies for CHD is inadequate to provide this modality at all institutions with MRI capabilities. This article describes the collaborative approach between pediatric cardiology and radiology at Madigan Army Medical Center and its implications for patient care and credentialing.

Obstetric ultrasound: What the radiologist needs to know.

Obstetric ultrasound forms an integral part of modern obstetric care. This includes the use of ultrasound for screening as well as in diagnostic and therapeutic roles. Radiologists involved in this field must have the appropriate training and expertise to match the type of investigation or screening procedure to be undertaken. There should be an explicit understanding of this training and expertise both for the referring obstetrician and expectant mother. All radiologists involved in the care of women should have a thorough understanding of the normal and abnormal appearances of the first trimester as early pregnancy disorders present to the generalist; however, a smaller number of radiologists are involved in anomaly screening and management of growth disorders and still fewer in tertiary referral work. Obstetric medical practice is increasingly litigious and the aims of screening ultrasound and the limitations (false-negative and false-positive rates) should be explicit not only to the referring clinician but also to the expectant parents prior to screening. The diagnostic accuracy of ultrasound should be known in order that the expectant mother can give informed consent.

Regulating radiology: ethical issues in mammography and federal legislation.

One in nine women can expect to develop breast cancer over the course of a lifetime, which suggests that a posture of vigilance is appropriate. The form of breast imaging known as mammography will detect masses that self-examination and yearly clinical examinations may miss. Given that most types of breast cancer are not clinically preventable, early detection of such masses offers the best opportunity for survival for the affected women. Recognizing the need to ensure quality testing and interpreting procedures for so many women, the federal government has enacted legislation that requires breast imagers to read 240 mammograms in 6 months to qualify for certification and another 960 mammograms in the following 2 years. The burdensome nature of these requirements has had the effect of reducing the number of radiologists certified to read mammograms, and this has decreased the overall availability of this service to women. I explore two possible rationales for instituting such strict federal regulation of breast imagers: that breast cancer is more prevalent than other diseases that affect women and that legislating such high standards ensures the accuracy of interpretation. On neither ground is such legislation justified. Instead, I contend that this regulation was instituted as a way for politicians to make up for disregarding women and women's health concerns in the past by focusing on a current issue that predominantly affects women. As a consequence, I argue that more women may be harmed than benefited by such legislation.

The cancer patient in the radiology department: do we live up to our responsibilities?

It is impossible to occupy the Presidential Chair of the Institute, especially in its 100th birthday year, without being acutely aware of the achievements of the last century and of the succession of great names who have held this of®ce. I make this point because I wish to express a strongly held personal view and I want my audience to feel that I do so with an apposite sense of humility, and an appropriate awareness of the long-term judgement of history. The various roles of imaging in cancer care are now well established. Radiology has been important in the diagnosis of tumours since its early days and this is a role familiar to all radiologists. In the 1980s, Godfrey Houns®eld's contribution of CT gave the subject new stimulus and spawned a new generation of radiologists skilled in issues of disease staging and treatment monitoring. This work is based on a radically different approach to that of the diagnostic radiologistÐcancer imaging begins after diagnosis has been madeÐand has been well practised in specialized centres such as the Royal Marsden Hospital, where I was privileged to work for 2 years. More recently, a planned devolution of cancer investigation to local hospitals [1] has meant that nearly all radiologists are concerned with cancer imaging in the widest sense. This has created new challenges, not least the need to standardize practice and ensure comparable standards of patient care. Cancer patients are now seen by a larger number of radiologists, many of whom may not have been trained in the way oncological imaging differs from purely diagnostic radiology. Models have been established for evaluating radiological practice, from the technical performance of equipment to the clinical outcome [2], and must form the bedrock of good clinical radiology. However, in this presentation I am not concerned with these principles, but with our wider role as caring, thinking doctors, and the implications of this to practice in our departments.

A survey of radiology reporting practices in veterinary teaching hospitals.

Radiologists from 28 veterinary schools and one private teaching hospital responded to a survey questionnaire focused on diagnostic image reporting. Radiologists at 26 hospitals generated a hard copy report on essentially all imaging studies performed. At 25 hospitals, radiologists dictated and transcriptionists typed all or most reports; radiologists at two institutions typed all or some of their reports. At five hospitals, preliminary and/or final handwritten reports were generated. The range of reports generated per day was <10 to 40 per radiologist on duty. Seven respondents generated reports as films came from the processor and another 12 routinely generated reports the day the studies were completed. Clinician access to a processed report averaged 2 to 4 days after study was completed (reported range: several hours to 7 or more days). Fifteen responding radiologists personally mounted films from storage jackets for a majority of their reporting. Fourteen respondents generated reports from films mounted on motorized or stationary viewers. Nineteen respondents generated reports in a busy viewing area where they were frequently interrupted. Radiologists' impression of clinician and resident satisfaction regarding availability of radiology reports was that they were satisfied or very satisfied at 15 of the 29 hospitals. Five respondents reported that clinicians and residents were not concerned about availability of processed radiology reports. Thirteen radiologists were planning to change their reporting method within the next 2 years. The change most frequently sought (12 respondents) was to decrease turn-around time of reports. Ten radiologists indicated an interest in trying a voice recognition dictation system. The most common reasons given for not planning any changes in radiology reporting in the next 2 years were: limited number of radiologists (8) and "satisfied as is" (7). Turn-around of radiology reports at these veterinary institutions averaged 2 to 3 times longer than for radiology departments in human health-care facilities.

Dr Henry Garland: the man, the myth, the legend, and the legacy. Garland Lecture from the 1991 California Radiological Society meeting.

In a century of American radiology, a relatively small number of radiologists have emerged as unquestioned leaders of the specialty. One of those was L. Henry Garland, late of San Francisco, whose multifaceted accomplishments and vigorous personality made him a significant contributor to advances in radiology during 3 decades. The Garland family has endowed an annual lecture at the meeting of the California Radiological Society. This essay is taken from the 1991 lecture, which was an assessment of Garland's significance.

Contributions of the Surgical Sciences to a Reduction of the Mortality Rate in the United States for the Period 1968 to 1988

The authors sought to determine whether advances in the surgical sciences have led to a reduction in mortality rates for diseases treated by surgery during the past 25 years. They also wished to study changes in health care manpower for perioperative care during this period. Surgical operations requiring general anesthesia in the United States have risen to 25 million per year at an annual cost of approximately $125 billion. During the period 1968 to 1988, the number of anesthesiologists per 100,000 persons in the United States increased 98%, although the number of surgeons remained relatively constant. Between 1980 and 1989, the number of radiologists per 100,000 persons decreased to 29% below the figure for 1965. Membership in specialized nursing societies increased dramatically. The authors used vital statistics data from the National Center for Health Statistics (NCHS) to examine the mortality rates for diseases of the prostate, appendix, and gallbladder; hernia and intestinal obstruction; and ulcerative disease of the stomach and duodenum for the years 1968, 1978, and 1988. NCHS hospital discharge data were used to derive the rates of hospitalization and surgery for these conditions. Information on changes in health care manpower was obtained from published and other sources. The mortality rates for the five diseases studied decreased from 40% to 69% between 1968 and 1978. Between 1978 and 1988, the mortality rates caused by benign prostatic hyperplasia declined an additional 54% and by appendicitis, an additional 43%. Deaths attributable to the other conditions remained relatively constant. The rates of hospitalization and surgery for these conditions varied. Advances in surgery, anesthesiology, and information transfer and the availability of intensive care units and specialized hospital personnel have resulted in reduced mortality rates for diseases treated by surgery.

A history of the AMA section council on radiology.

A history of the AMA section council on radiology.

Percutaneous feeding gastrostomy in patients with head and neck tumors: A 5‐year review

Since the beginning of this decade major advances have taken place in the alimentation of patients with tumors of the head and neck. Gauderer and Ponsky described a percutaneous method of gastrostomy and, in 1983, a number of radiologists, including the senior author, described a percutaneous radiologic method using the Seldinger technique to create a feeding gastrostomy. This method is ideally suited for patients with advanced tumors of the head and neck because it requires neither endoscopy nor general anesthesia. Over the past 5 years, 55 patients with tumors of the head and neck have undergone this procedure. Eighty-one percent of the patients had advanced disease at initial presentation. One patient (1.8%) had a procedure-related death and another patient (1.8%) had a complication that required a laparotomy. Three patients (5.4%) had minor complications that required minimal medical attention. None of the patients required general anesthesia and an endoscopy was not required. Patient discomfort during the procedure was minimal.

Interactive, Mathematical, and Sequential Consultative Methods in Diagnosing Renal Masses on Excretory Urograms

Using the clinical setting of diagnosing renal masses on excretory urograms, we compared the diagnostic efficacy and costs resulting from different consultative methods. These included face-to-face interactive consultation, mathematical combination of a fixed number of radiologists' confidence judgments, and computerized sequential decision making. This last method mathematically combines a variable number of individual judgments into an aggregate diagnosis based on diagnostic certainty. Six radiologists interpreted 42 proven urograms individually, with face-to-face consultation for selected cases, and interactively in groups of three. Individual diagnostic probability estimations were mathematically combined for the mathematical and sequential models. All models of consultation resulted in both higher diagnostic accuracy and lower costs than individual radiologists interpreting urograms alone. While the sequential model provided the highest diagnostic efficacy, it was only slightly more accurate than the other models tested. Radiologists interactively consulting on cases they considered difficult was the least costly method, approximating the projected costs of sequential decision making. Interactive consultation among radiologists is a cost-effective practice; sequential decision-making is a promising technique for improving diagnostic efficacy and reducing costs, and further evaluation is warranted.

The coming crisis in radiological manpower--shortage?

The 1966 NACOR Report spurred such a sharp growth in numbers of radiologists that today there is concern about an oversupply. Considering all the factors involved--panic reaction to an undocumented "surplus", sharp diminution of the residents in the training pool, and potantial massive increases in demand for radiological services--the authors believe it not unreasonable to anticipate a real shortage of radiologists in the near future. Any deliberate activity at the present time to reduce the output of radiologists in this country would seem premature and potentially disatrous.

Too many radiologists?

Many radiologists in community practice believe that the planned increases in numbers of radiologists and residents in training represent an over-reaction of planners of training programs to past manpower shortages. With the current plethora of radiologists, however, the quality and quantity of resident applications have improved dramatically, and radiology is much stronger as a profession than in the past. Perhaps the major problem is not numbers of radiologists in practice but their poor distribution in the country.