Radiology Professionals Research Articles

Optimizing Radiation Doses for Computed Tomography Across Institutions

Radiation doses for computed tomography (CT) vary substantially across institutions. To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers. In this before/after interventional study, we prospectively collected radiation dose metrics on all diagnostic CT examinations performed between October 1, 2013, and December 31, 2014, at 5 medical centers. Using data from January to March (baseline), we created audit reports detailing the distribution of radiation dose metrics for chest, abdomen, and head CT scans. In April, we shared reports with the medical centers and invited radiology professionals from the centers to a 1.5-day in-person meeting to review reports and share best practices. We calculated changes in mean effective dose 12 weeks before and after the audits and meeting, excluding a 12-week implementation period when medical centers could make changes. We compared proportions of examinations exceeding previously published benchmarks at baseline and following the audit and meeting, and calculated changes in proportion of examinations exceeding benchmarks. Of 158 274 diagnostic CT scans performed in the study period, 29 594 CT scans were performed in the 3 months before and 32 839 CT scans were performed 12 to 24 weeks after the audit and meeting. Reductions in mean effective dose were considerable for chest and abdomen. Mean effective dose for chest CT decreased from 13.2 to 10.7 mSv (18.9% reduction; 95% CI, 18.0%-19.8%). Reductions at individual medical centers ranged from 3.8% to 23.5%. The mean effective dose for abdominal CT decreased from 20.0 to 15.0 mSv (25.0% reduction; 95% CI, 24.3%-25.8%). Reductions at individual medical centers ranged from 10.8% to 34.7%. The number of CT scans that had an effective dose measurement that exceeded benchmarks was reduced considerably by 48% and 54% for chest and abdomen, respectively. After the audit and meeting, head CT doses varied less, although some institutions increased and some decreased mean head CT doses and the proportion above benchmarks. Reviewing institutional doses and sharing dose-optimization best practices resulted in lower radiation doses for chest and abdominal CT and more consistent doses for head CT.

2016 RAD-AID Conference on International Radiology for Developing Countries: Gaps, Growth, and United Nations Sustainable Development Goals

The 2016 RAD-AID Conference analyzed the accelerated global activity in the radiology community that is transforming medical imaging into an effective spearhead of health care capacity building in low- and middle-income countries. Global health efforts historically emphasized disaster response, crisis zones, and infectious disease outbreaks. However, the projected doubling of cancer and cardiovascular deaths in developing countries in the next 15 years and the need for higher technology screening and diagnostic technologies in low-resource regions, as articulated by the United Nations’ new Sustainable Development Goals of 2016, is heightening the role of radiology in global health. Academic US-based radiology programs with RAD-AID chapters achieved a threefold increase in global health project offerings for trainees in the past 5 years. RAD-AID’s nonprofit radiology volunteer corps continue to grow by more than 40% yearly, with a volunteer base of 5,750 radiology professionals, serving in 23 countries, donating close to 20,000 pro bono hours globally in 2016. As a high-technology specialty interfacing with nearly all medical and surgical disciplines, radiology underpins vital health technology infrastructure, such as digital imaging archives, electronic medical records, and advanced diagnosis and treatment, essential for long-term future health care capacity in underserved areas of the world.

Big Data and Machine Learning—Strategies for Driving This Bus: A Summary of the 2016 Intersociety Summer Conference

The 38th radiology Intersociety Committee reviewed the current state and future direction of clinical data science and its application to radiology practice. The assembled participants discussed the need to use current technology to better generate and demonstrate radiologists’ value for our patients and referring providers. The attendants grappled with the potentially disruptive applications of machine learning to image analysis. Although the prospect of algorithms’ interpreting images automatically initially shakes the core of the radiology profession, the group emerged with tremendous optimism about the future of radiology. Emerging technologies will provide enormous opportunities for radiologists to augment and improve the quality of care they provide to their patients. Radiologists must maintain an active role in guiding the development of these technologies. The conference ended with a call to action to develop educational strategies for future leaders, communicate optimism for our profession’s future, and engage with industry to ensure the ethics and clinical relevance of developing technologies.

Association of XRCC1 gene polymorphism and low dose ionizing radiation with peripheral blood lymphocyte micronucleus

Objective: To explore the effects of X-ray repair cross complementing gene 1 (XRCC1) polymorphism and low dose ionizing radiation exposure on radiology professionals' peripheral blood lymphocyte micronucleus. Methods: A matched case-control study was designed. From 2013 to 2015, 1 102 radiology professionals with micronucleus test rusults, and 45 cases with present micronucleus were enroled into case group. 180 diagnostic radiology technicians detecting no micronucleus were chosen as control group, cases and controls were 1∶4 mached on gender, age ≤40 or >40 years old. According to the detection of micronucleus levels (0‰, 1‰, 2‰) , the objects of our study were divided into the reference group, the low detection group and the medium detection group. The form of radiation workers' occupational health examination was used to collect the general baseline of the research objects, history of smoking, drinking, poisonous and harmful material exposure, past medical history, accumulated illuminated dose and lymphocyte micronucleus rates (‰) , etc. Using restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR) technology for genotyping; Compared the baseline data and radiation exposure level between the differentmicrokernel detection groups; Adopted multivariate logistic regression to analysis the combination effect of XRCC1 Arg399Gln gene polymorphism and accumulated illuminated dosefor micronucleus rate. Results: The accumulated illuminated dose in the reference group, the low detection group and the medium detection group were (23.44±15.23) , (21.76±2.56) , (24.22±18.61) mSv, respectively. There was no statistically significant difference among the groups (P>0.05) . Under the dominant inheritance mode, after adjusted age, smoking and drinking factors, the results suggested that XRCC1 Arg399Gln micronucleus medium detection group compared with the reference group, Arg399Gln-GG as reference, Arg399Gln-GA+AA decreased the occurrence of micronucleus (OR=0.175, 95%CI: 0.036-0.848) . Arg194Trp and Arg280His did not affect the incidence of micronucleus (P>0.05) . Did not find the combination effect of XRCC1 Arg399Gln gene polymorphism and accumulated illuminated dose for micronucleus rate (P>0.05) . Conclusion:XRCC1 Arg399Gln gene polymorphism can affect the incidence of micronucleus, and carrying the XRCC1 Arg399Gln-GA+AA genotype is a protective factor of micronucleus's occurrence, but low dose ionizing radiation may not affect the occurrence of micronucleus independently.

The Illusion of Choice: Gender Segregation and the Challenge of Recruiting Women to Radiology

In recent decades, the feminization of medicine has promised equal educational and professional opportunities for women pursuing medical careers [ 1 Ross S. The feminization of medicine. Virtual Mentor. 2003; 5 Google Scholar , 2 Boulis A.K. Jacobs J.A. The changing face of medicine: women doctors and the evolution of health care in America. ILR, Ithaca, New York2008 Google Scholar , 3 Alers M. van Leerdam L. Dielissen P. Lagro-Janssen A. Gendered specialties during medical education: a literature review. Perspect Med Educ. 2014; 3: 163-178 Crossref PubMed Scopus (35) Google Scholar ]. Yet despite encouraging statistics that now show near even numbers of women (48%) and men (52%) enrolled in US medical schools [ 4 Association of American Medical Colleges. Total enrollment by U.S. medical school and sex 2012-2013 through 2016-2017. Available at: https://www.aamc.org/download/321526/data/factstableb1-2.pdf. Accessed January 14, 2017. Google Scholar , 5 Zener R. Lee S.Y. Visscher K.L. Ricketts M. Speer S. Wiseman D. Women in radiology: exploring the gender disparity. J Am Coll Radiol. 2016; 13: 344-350 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar ], vast inequalities remain. Radiology is just one example of the persistent gender gap that plagues many medical specialties, with women representing fewer than 30% of total practicing radiologists and trainees in the United States [ 6 Chapman C.H. Hwang W.T. Both S. Thomas C.R. Deville C. Current status of diversity by race, Hispanic ethnicity, and sex in diagnostic radiology. Radiology. 2014; 270: 232-240 Crossref PubMed Scopus (118) Google Scholar , 7 Fielding J.R. Major N.M. Mullan B.F. et al. Choosing a specialty in medicine: female medical students and radiology. AJR Am J Roentgenol. 2007; 188: 897-900 Crossref PubMed Scopus (61) Google Scholar , 8 Deitch C.H. Sunshine J.H. Chan W.C. Shaffer K.A. Women in the radiology profession: data from a 1995 national survey. AJR Am J Roentgenol. 1998; 170: 263-270 Crossref PubMed Scopus (52) Google Scholar ]. Radiology educators have long debated the most effective means by which to improve the recruitment of women to our field, but they have managed to identify only potential contributing factors [ 9 Potterton V.K. Ruan S. Sunshine J.H. Applegate K. Cypel Y. Forman H.P. Why don’t female medical students choose diagnostic radiology? A review of the current literature. J Am Coll Radiol. 2004; 1: 583-590 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar , 10 Lightfoote J.B. Deville C. Ma L.D. Winkfield K.M. Macura K.J. Diversity, inclusion, and representation: it is time to act. J Am Coll Radiol. 2016; 13: 1421-1425 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar ].

Thirteenth Annual Warren K. Sinclair Keynote Address: Where Are the Radiation Professionals (WARP)?

In July 2013, the National Council on Radiation Protection and Measurements convened a workshop for representatives from government, professional organizations, academia, and the private sector to discuss a potential shortage of radiation protection professionals in the not-too-distant future. This shortage manifests itself in declining membership of professional societies, decreasing enrollment in university programs in the radiological sciences, and perhaps most importantly, the imminent retirement of the largest birth cohort in American history, the so-called "baby boomer" generation. Consensus emerged that shortages already are, or soon will be, felt in government agencies (including state radiation control programs); membership in professional societies is declining precipitously; and student enrollments and university support for radiological disciplines are decreasing with no reversals expected. The supply of medical physicists appears to be adequate at least in the near term, although a shortage of available slots in accredited clinical training programs looms large. In general, the private sector appears stable, due in part to retirees joining the consultant ranks. However, it is clear that a severe problem exists with the lack of an adequate surge capacity to respond to a large-scale reactor accident or radiological terrorism attack in the United States. The workshop produced a number of recommendations, including increased funding of both fellowships and research in the radiological sciences, as well as creation of internships, practicums, and post-doctoral positions. A federal joint program support office that would more efficiently manage the careers of radiological professionals in the civil service would enhance recruiting and development, and increase the flexibility of the various agencies to manage their staffing needs.

Implications of Direct Patient Online Access to Radiology Reports Through Patient Web Portals

In an era of increasing health information transparency and informed decision making, more patients are being provided with direct online access to their medical records, including radiology reports, via web-based portals. Although radiologists’ narrative reports have previously been the purview of referring physicians, patients are now reading these on their own. Many potential benefits may result from patients reviewing their radiology reports, including improvements in patients’ own understanding of their health, promotion of shared decision making and patient-physician communication, and, ultimately, improvements in patient outcomes. However, there may also be negative consequences, including confusion and anxiety among patients and longer patient-physician interactions. The rapid adoption of this new technology has led to major questions regarding ethics and professionalism for radiologists, including the following: Who is the intended audience of radiology reports? How should content be presented or worded? How will open access influence radiologists’ relationships with patients and referring physicians? What legal ramifications may arise from increased patient access? The authors describe the current practices and research findings associated with patient online access to medical records, including radiology reports, and discuss several implications of this growing trend for the radiology profession.

A study for assessing radiation protection awareness of radiology professionals

A study for assessing radiation protection awareness of radiology professionals

Traditional Payment Models in Radiology: Historical Context for Ongoing Reform

The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on quality and alternative payment model participation. The general structure of payment under MACRA is included in the statute, but the rules and regulations defining its implementation are yet to be formalized. It is imperative that the radiology profession inform policymakers on their role in health care under MACRA. This will require a detailed understanding of prior legislative and nonlegislative actions that helped shape MACRA. To that end, the authors provide a detailed historical context for payment reform, focusing on the payment quality initiatives and alternative payment model demonstrations that helped provide the foundation of future MACRA-driven payment reform.

Personal and Network Dynamics in Performance of Knowledge Workers: A Study of Australian Breast Radiologists.

Materials and MethodsIn this paper, we propose a theoretical model based upon previous studies about personal and social network dynamics of job performance. We provide empirical support for this model using real-world data within the context of the Australian radiology profession. An examination of radiologists’ professional network topology through structural-positional and relational dimensions and radiologists’ personal characteristics in terms of knowledge, experience and self-esteem is provided. Thirty one breast imaging radiologists completed a purpose designed questionnaire regarding their network characteristics and personal attributes. These radiologists also independently read a test set of 60 mammographic cases: 20 cases with cancer and 40 normal cases. A Jackknife free response operating characteristic (JAFROC) method was used to measure the performance of the radiologists’ in detecting breast cancers.ResultsCorrelational analyses showed that reader performance was positively correlated with the social network variables of degree centrality and effective size, but negatively correlated with constraint and hierarchy. For personal characteristics, the number of mammograms read per year and self-esteem (self-evaluation) positively correlated with reader performance. Hierarchical multiple regression analysis indicated that the combination of number of mammograms read per year and network’s effective size, hierarchy and tie strength was the best fitting model, explaining 63.4% of the variance in reader performance. The results from this study indicate the positive relationship between reading high volumes of cases by radiologists and expertise development, but also strongly emphasise the association between effective social/professional interactions and informal knowledge sharing with high performance.

'You're looking for different parts in a jigsaw': foetal MRI (magnetic resonance imaging) as an emerging technology in professional practice.

Magnetic resonance imaging (MRI) was first introduced into clinical practice during the 1980s. Originally used as a diagnostic tool to take pictures of the brain, spine, and joints, it is now used to visualise a range of organs and soft tissue around the body. Developments in clinical applications of the technology are rapid and it is often viewed as the 'gold standard' in many areas of medicine. However, most existing sociological work on MRI tends to focus on the profession of radiology, little is known about the impact of MRI on a broader range of clinical practice. This article focuses on MRI use in pregnancy, a relatively new application of the technology. Drawing on empirical research with a range of health professionals (from radiologists to pathologists) in the North of England, this article asks: how do different types of health professionals engage with the technology and to what end? It will argue that MRI use in pregnancy offers an increasingly important piece of the diagnostic jigsaw, often acting as a bridging technology between medical specialties. The implications of this will be explored in the context of broader sociological debates on the 'visualisation' of medicine and its impact on professionals.

Search for a New Editor

Search for a New Editor

Summary of the proceedings of the International Summit 2015: General and subspecialty radiology.

The need for subspecialisation in radiology and the relationship of general and subspecialist radiologists is very diverse in different regions of the world according to the reports presented at the ESR International Summit, organised by the ESR during the European Congress of Radiology in March 2015 in Vienna. The International Summit is held once a year by the ESR and its national and international radiological partner societies from outside Europe with the aim to address and discuss selected subjects of global relevance in radiology. In 2015, the relationship between general and subspecialist radiologists was analysed. It was shown that the situation differs immensely between developed and developing countries; in developed countries, a considerable proportion of radiologists are subspecialty trained; subspecialty radiologists practise mainly in large and academic departments, and many radiologists practise as multispecialty radiologists. In many developing countries only general radiologists—if available at all—practise radiology, and imaging interpretation is often performed by physicians with very limited relevant training or in some cases even by non-physicians.Main messages• Subspecialisation and preservation of the integrity of the radiology profession are relevant for improved patient care.• Subspecialisation is needed in large departments, providing the basis for innovation and research.• Subspecialty sections should preferably remain within the overarching radiology department.• Shared facilities, efficient use of resources and common organisational structures are beneficial.• A multispecialty radiologist model is an option to build robust academic and private practices.

Portrayal of radiology in a major medical television series: How does it influence the perception of radiology among patients and radiology professionals?

To assess how the portrayal of Radiology on medical TV shows is perceived by patients and radiology professionals. In this IRB-approved study with patient consent waived, surveys were conducted among adult patients scheduled for radiological examinations and radiology professionals. The questionnaire investigated medical TV watching habits including interest in medical TV shows, appearance of radiological examination/staff, radiology's role in diagnosis-making, and rating of the shows' accuracy in portraying radiology relative to reality. One hundred and twenty-six patients and 240 professionals (133 technologists, 107 radiologists) participated. 63.5% patients and 63.2% technologists rated interest in medical TV shows ≥5 (scale 1-10) versus 38.3% of radiologists. All groups noted regular (every 2nd/3rd show) to >1/show appearance of radiological examinations in 58.5-88.2% compared to 21.0-46.2% for radiological staff appearance. Radiology played a role in diagnosis-making regularly to >1/show in 45.3-52.6%. There is a positive correlation for interest in medical TV and the perception that radiology is accurately portrayed for patients (r = 0.49; P = 0.001) and technologists (r = 0.38; P = 0.001) but not for radiologists (r = 0.01). The majority of patients perceive the portrayed content as accurate. Radiologists should be aware of this cultivation effect to understand their patients' behaviour which may create false expectations towards radiological examinations and potential safety hazards. • Radiology in medical TV shows is conveyed as important in diagnosis making • Presence of radiological staff is less frequent compared to examinations shown • Positive correlation for interest in medical TV and radiology perceived as accurate • TV experience may create false expectations and potential safety hazards.

Radiologic Professionalism in Modern Health Care.

Modern radiology is at the forefront of technological progress in medicine, a position that often places unique challenges on its professional character. This article uses "Medical Professionalism in the New Millennium: A Physician Charter," a document published in 2002 and endorsed by several major radiology organizations, as a lens for exploring professional challenges in modern radiology. The three main tenets of the Charter emphasize patient welfare, patient autonomy, and the reduction of disparities in health care distribution. This article reviews the ways in which modern technology and financial structures potentially create stressors on professionalism in radiology, while highlighting the opportunities they provide for radiologists seeking to fulfill the professional goals articulated in the Charter. Picture archiving and communication systems (PACS) and voice recognition systems have transformed the speed of radiology and enhanced the ability of radiologists to improve patient care but also have brought new tensions to the workplace. Although teleradiology may improve global access to radiologists, it may also promote the commoditization of radiology, which diminishes the professional stature of radiologists. Social media and patient portals provide radiologists with new forums for interacting with the public and patients, potentially promoting patient welfare. However, patient privacy and autonomy are important considerations. Finally, modern financial structures provide radiologists with both entrepreneurial opportunities as well as the temptation for unprofessional conduct. Each of these advances carries the potential for professional growth while testing the professional stature of radiology. By considering the risks and benefits of emerging technologies in the modern radiology world, radiologists can chart an ethical and professional future path.

Recent Changes to ABR Maintenance of Certification Part 4 (PQI): Acknowledgment of Radiologists’ Activities to Improve Quality and Safety

The ABR has recently reviewed and revised its policy establishing how ABR diplomates may comply with requirements for Maintenance of Certification Part 4: Practice Quality Improvement (PQI). The changes were deemed necessary by the Board of Trustees to acknowledge and credit the numerous ways in which radiology professionals contribute to improving patient care through existing and evolving activities available to them within the radiology community. In addition to meeting requirements by completing a traditional PQI project, the policy revision now allows diplomates to meet criteria by completing one of a number of activities in an expanded spectrum of PQI options recognized by the ABR. The new policy also acknowledges the maturing state of quality improvement science by permitting PQI projects to use “any standard quality improvement methodology,” such as Six Sigma, Lean, the Institute for Healthcare Improvement’s Model for Improvement, and others in addition to the previously prescribed three-phase plan-do-study-act format.

How the ACR Works: The Board of Chancellors

TheACR, establishedby21 radiologists at the 1923 annual meeting of the AMA, adopted a constitution and bylaws in 1924 at the first ACR assembly and convocation. Since that time, theACR’smembership has grown from a society of honorary fellows to a membership of about 30,000, and it is the principal organization representing radiology professionals on issues of quality, safety, economics, health policy, and government advocacy in the rapidly changing health care environment. ACR by-laws allow up to 34 members of the Board of Chancellors (BOC), includingofficers of theCollege (the chair andvice chair of theBOC; the treasurer, president, and vice president of the ACR; the speaker and vice speaker of the ACR Council) and the editor of JACR. There are positions on the board for representatives of the RSNA, the ARRS, the American Society for Radiation Oncology, the American RadiumSociety, and theCanadian Association of Radiologists. Additionally, there are up to nine appointed BOC members, and the ACR Council may elect up to 15 members. Over the past years, the board has been well balanced between academic and private practice. The term of office for BOC members is three years, and members may serve up to two terms. The ACR by-laws consider the BOC to be the executive body of the College; the board exists to “diligently promote the purposes of the College,” according to the College policies set forth by the ACR Council [1].

Patient perspectives on radiation dose: reporting a survey of patient opinions.

With the marked increase in the number of CT scans, nuclear medicine tests and interventional radiological procedures, it is no longer possible to ignore the patients' increasingly vocal question: how much radiation is too much? The Powerful Patient conducted a survey of patient opinions in March-May 2014 to gather patient input for the International Conference on Radiation Protection in Medicine. Patients are eager to work with their physicians and radiology professionals to gather the data needed to answer their very real concerns. They clearly know and appreciate the value of these applications of radiation but want to use them wisely and without long-term consequences.

The ESR Patient Advisory Group (ESR-PAG).

The European Society of Radiology (ESR) Patient Advisory Group addresses the issue of communication among radiologists, radiographers and their patients. Initiated in 2013, the group represents many patient groups, working together with the ESR to raise awareness of medical imaging amongst patients, improve patient knowledge about imaging procedures, liaise on policy issues of common interest, involve patient representatives in strategic decisions regarding medical imaging and ensure that a patient-centred, “human” approach is embedded in the structure of the ESR. The ESR strongly believes that close collaboration with patient organisations is beneficial for both stakeholders, helping radiologists to understand patients’ needs, to adapt their practice accordingly and to improve their communication skills. These factors are important to help radiologists find acknowledgement as clinicians and overcome the specialty’s poor visibility. Close collaboration with professionals will allow patients to obtain a better understanding of the work of everyone involved in a radiological department, of the advantages and limitations of imaging, and what to expect from a radiological examination or an imaging-guided interventional procedure. Thus, this collaborative effort is not simply limited to improving patient satisfaction; the ultimate goal is to enhance the faith and trust that patients place in the medical imaging profession and all the radiology professionals involved.Main messages• Good communication between patient and doctor is important for proper patient care. • The ESR Patient Advisory Group specifically addresses this communication issue. • The activities aim at developing a reciprocal relationship between radiologists/radiographers and patients. • Both radiologists/radiographers and patients need to be “educated” to improve communication.

A systems life cycle approach to managing the radiology profession: an Australian perspective.

Although the medical system has expanded considerably over the past two decades in almost all countries, so too has the demand for health care. The radiology specialisation may be an early system indicator, being especially sensitive to changes in supply and demand in both rural and urban environments. The question is whether the new policies of increasing the number of radiologists can be a proper long-term solution for the imbalance of workforce supply and demand or not. Using system dynamics modelling, we present our integrated descriptive models for the supply and demand of Australian radiologists to find the actual gap. Followed by this, we pose a prescriptive model for the supply in order to lessen the identified imbalance between supply and demand. Our system dynamics models compare the demand and supply of Australian radiologists over 40 years between 2010 and 2050. The descriptive model shows that even if the radiology training program grows at a higher rate than the medical training growth rate and its own historical growth, the system will never be able to meet demand. The prescriptive model also indicates that although changing some influential factors (e.g the intake rate) reduces the level of imbalance, the system will still stay unstable during the study period. We posit that Australia may need to design a new system of radiology provision to meet future demands for high-quality medical radiation services. We also suggest some strategies, such as greater development of radiographers' role, are critical for enabling sustainable change over time. What is known about the topic? Long-term workforce planning for medical services at the national level has been very challenging for policy makers of the 21st century. The current demographic imbalance in the supply and demand of the Australian radiologist workforce makes it difficult to plan the effects of extra inflow of radiology students over time.