Safeguarding the Future of Radiology

Dayal_AnupriyaAnupriya Dayal, MD, radiation oncologist at Temple Health-Fox Chase Cancer Center and Pennsylvania delegate, American Medical Association Resident and Fellow Section House of Delegates, contributed this post.

As a member of the American Medical Association (AMA)’s Resident and Fellow Section House of Delegates (HOD), I recently attended the AMA Interim Meeting to help represent the views and perspective of radiation oncologists like myself. The HOD is the AMA’s policy-making body and is made up of a diverse group of physicians, medical students and residents representing every state and medical field. We work together in a democratic process to create and implement policy on various health care conflicts to ensure safe, high-quality and efficient care for patients and communities around the country. Our recent meeting focused on the protection of residents and fellows displaced by unexpected hospital closures and radiation oncology safety measures.

The Hahnemann hospital closure earlier this year was an unexpected event that disrupted the training of 960 resident and fellow physicians. There were no safeguards in place to protect affected residents and fellows. As a result, trainees were left unsure of the future of their careers. On top of that, the incurred relocation costs – added to an average debt of around $200,000 – have left many in an unexpected financial strain.

The AMA, along with the AMA Resident and Fellow Section coauthors, intervened to help find a solution for these residents and fellows. Our new policy allows us to partner with interested parties to identify viable options to secure malpractice tail-end insurance for residents and fellows impacted by the Hahnemann closure and for those impacted by any future teaching hospital closures, at no cost to those who are displaced. We’ve also committed to working with the Centers for Medicare and Medicaid Services to establish regulations that will help protect residents and fellows affected by training program closures.

Additionally, we discussed the recently released CMS Hospital Outpatient Prospective Payment System final rule, which includes a provision to change all radiation therapy services from “direct supervision” to “general supervision.” This rule is supported by the misguided notion that radiation therapy can be administered without the presence of an MD and is a glaring safety and scope of practice issue.

Radiation oncologists are the only medical professionals trained in reviewing toxicity of treatment, daily patient setup variability, real-time imaging interpretation for accurate radiation guidance and other clinical parameters which determine the safety of further radiation treatment administration. Our role is critical to ensuring safety in delivering high doses of radiation that may otherwise be fatal without supervision. As such, the AMA provided convincing testimony to encourage reconsideration by CMS.

As physicians, we are compelled to be advocates for not only our profession but also – and more importantly – for our patients. As radiologists, we provide expertise not only to other health care professionals, but also specialty-specific health policymaking. Membership in the American College of Radiology and the AMA help ensure that we have a seat at the table of health policy discussions that impact both our daily work and the future of medicine.

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It’s Time to Ditch the Disk: On Cancer

Rand, AlexAlexander Rand, MD, University of Vermont, and Michael Chorney, MD, Penn Medicine, University of Pennsylvania Health System, contributed to this post.

Opinions are the authors’ own and do not reflect their institutions’ opinions.

Imaging is critical for the detection and evaluation of cancer. Cancers manifest on dedicated screening and diagnostic studies as well as incidentally on other studies. Tumors may change in size, distribution and enhancement pattern during treatment, which directly impacts treatment decisions. Radiologists must be able to assess cancer’s complex evolution over time on imaging to provide the best patient care. Unfortunately, health care’s current reliance on compact discs (CDs) for image transfer often leaves radiologists without prior examinations for comparison.

Cancer screening imaging enables early detection and prompt treatment to reduce patient mortality. Radiologists strive both to detect cancers and discriminate between benign and malignant masses or nodules. Some cancers, particularly breast cancers, may only become apparent with subtle changes in size and morphology over time. Long-term stability of a mass makes cancer less likely. If suspicion for cancer remains very low, or biopsy carries high risk for morbidity, follow-up imaging can help determine if intervention is warranted. However, patients often forget to bring their CDs or discover that the images are missing or corrupted. When prior images are unavailable, the radiologist may be compelled to recommend another imaging study or biopsy. Unnecessary follow-up studies and biopsies may cause patients anxiety, stress or complications, as well as burden the already strained health care system. Chorney, Michael

Cancer patients may receive follow-up imaging at multiple institutions, especially for emergent complications. Radiologists’ frequent lack of comparison examinations from other institutions hinders the interpretation of these studies. Direct comparison to historical images ought to be readily available to better assess tumors, therapeutic response and emergent oncologic complications.

We encourage practices to transition from CDs to cloud-based file-sharing to have patients’ prior examinations readily available to interpreting providers at all institutions at which a patient may seek care. The comparison image availability would enable faster, better cancer screening interpretation, diagnosis, assessment of disease progression and detection of complications. Costly and sometimes unnecessary biopsies and additional rounds of follow-up examinations would be reduced.

The #DitchTheDisk Task Force actively seeks patient and practitioner advocates as we embark on a journey to change the method of personal health record storage. Please fill out this form or email ditchthedisk@acr.org to get involved.

Stay tuned for our next blog on how CDs impact patient care in the trauma setting. Share your thoughts using #DitchTheDisk on social media, commenting below or by joining the discussion on Engage (login required).

Certification in Radiology

ACR-18

This post was contributed by Howard B. Fleishon, MD, MMM, FACR, vice chair, American College of Radiology (ACR) Board of Chancellors.

The American College of Radiology (ACR) Task Force on Certification in Radiology has been busy since it was created in January 2019.

I want to thank Eric Friedberg, MD, for founding and previously leading this task force – along with his duties as Vice Chair of the ACR Commission on General, Small, Emergency and/or Rural Practice (GSER).

As this task force is intended to function across ACR commissions and committees, and in recognition of the importance of Dr. Friedberg’s work on the GSER, leadership of this task force has recently been transferred to the ACR Board of Chancellors vice chair.

As an update – under Dr. Friedberg’s leadership, four subcommittees have been developed to:

  • Research the history of certification in medicine and radiology
  • Examine best practices for credentialing and future trends in medical specialties and other industries
  • Develop and implement focus groups and general surveys to get feedback from the membership
  • Organize information and references

At RSNA 2019, this ACR task force will meet with representatives from the American Board of Radiology (ABR), American Board of Medical Specialties (ABMS) and others.

The next planned immediate task force deliverable is a report to the ACR Board of Chancellors and ACR Council in May. We also anticipate development of a more comprehensive white paper on certification in radiology.

This is an important member-driven initiative.

We will continue to keep you informed.

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