Enhancing Patient Care Through New Imaging Registries

Steven Don, MD, FACR, Chair of the American College of Radiology® (ACR®) Dose Index Registry (DIR) Digital Radiography (DR) Subcommittee, contributed this piece.

The pilot phase for the development of the ACR DIR DR module is underway. The initiative’s initial focus is to capture the state of practice nationally. Published research suggests that there is a 10-fold variation in exposure for the same exam for similar patients. The American Association of Physicists in Medicine’s Task Group 232 also showed a large variation in the recommended target exposure index values among participating centers for common examinations such as chest radiographs for adults and extremity radiographs for pediatrics. 

Similar to the well-established DIR Computed Tomography (DIR CT) module that includes more than 50 million exams from upwards of 2,100 facilities, we intend to develop diagnostic reverence levels and achievable dose levels for common DR examinations. We also plan to help establish recommended target exposure index values to help decrease radiation-dose variability. This work will enable facilities participating in the DIR DR to compare their data to regional and national aggregate data and to determine if changes in their DR image acquisition techniques are needed to improve patient care.

The DIR DR pilot announced in the Journal of the American College of Radiology builds on the work of the DIR DR subcommittee that has validated the DICOM Radiation Dose Structured Report from seven DR equipment vendors. We also initiated a pilot study that has accrued 435,399 exams from 33 sites as of Jan. 6 ,2021. Chest radiography, as expected, accounts for more than one-third of the examinations. 

Now, we are in the process of forming a working group from personnel at participating pilot facilities. Working group members will help identify issues and devise solutions. For example, how best to manage protocol-naming conflicts as, in the pilot data, we have sites that list chest exams 12 different ways for 2-view and portable examinations. Additionally, working group members will verify their facility is sending accurate data and will recommend the content and format for meaningful data summary reports. Finally, members will help provide future direction to the ACR DIR DR.

I invite you to enroll your facility in the ACR DIR DR pilot and participate with the working group. For centers already participating in the DIR CT module, it’s easy to get started by sending data via ACR TRIAD.  Sites not already DIR participants can consult the DIR Start-up Guide for step-by-step instructions.

If you decide to join, please provide your contact information using this online form, and a member of our team will be in contact with you shortly after.

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Increasing Visibility and Saving Lives: Introducing the New ACR Lung Cancer Screening Locator Tool

Ella A. Kazerooni, MD, MS, FACR, Chair of the American College of Radiology® (ACR®) Lung-RADS committee and Lung Cancer Screening Registry, contributed this piece.

For most of my life, lung cancer has been seen as that cancer that you didn’t want to get, had no hope and was considered self-inflicted. We’ve ignored the evidence that addiction to nicotine isn’t just a simple habit that could be overcome with willpower. It’s been the leading cause of cancer death in the United States (U.S.) for a few decades now. Thankfully we’re at a turning point, and the face of lung cancer is changing, with radiology practices leading the way!

In March of this year, the U.S. Preventive Services Task Force updated their lung cancer screening recommendation. Individuals who are 50-80 years of age (previously 55-80), and have a 20 pack-year or more smoking history (previously 30 pack-years), who either currently smoke or have quit in the last 15 years are eligible for screening. This update is projected to increase the number of individuals eligible from eight to 14 million, and helps to reach Blacks and women who have a higher risk of lung cancer at a younger age and with a lower smoking history. Within only a few weeks, the American Academy of Family Physicians, the largest primary care professional organization in the U.S., advised their membership to follow the USPSTF’s recommendations, and updated their own guidelines.

With these important changes, it’s more important than ever to help patients and primary care physicians locate a facility close to them that offers lung cancer screening. To help, the ACR has created a new Lung Cancer Screening Locator Tool. Plug in a zip code, set the distance from where you are and a list of facilities compiles that includes information such as address and phone number, along with a map. Importantly, more and more professional organizations, advocacy organizations and others are linking to the Lung Cancer Screening Locator Tool to help their members and visitors to their websites find screening facilities too.

If your lung cancer screening center’s information needs to be updated or added, please submit this update form.

Lung cancer screening with low-dose chest CT for early detection saves lives. Let’s make our screening facilities more visible to those who need them!

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Looking Ahead From ACR 2021

Amy L. Kotsenas, MD, FACR, American College of Radiology® (ACR®) Council Speaker, contributed this piece.

As I step into the role of ACR Council Speaker, I’m overwhelmed with gratitude for all who have contributed to the success of our second virtual annual meeting. ACR 2021 included a robust agenda full of opportunities to engage with ACR governance, advocacy, health equity efforts and more.

The ACR Council worked tirelessly to consider 48 resolutions, adopting a total of 44. The vote to adopt Resolution 48 supports parental, caregiver and medical leave during training residents in diagnostic radiology, interventional radiology, radiation oncology and nuclear medicine. The resolution includes support for 12 weeks of family/medical leave for residents without extension of training. Additional information on Council activity is available on acr.org and in the Report of Final Council Action (login required).

After an exciting election with a runoff, the ACR introduced several new officers. Internationally renowned radiologist and ultrasound expert Beverly G. Coleman, MD, FACR, was elected president – the first African-American in the nearly 100-year history of the ACR. I look forward to working with Dr. Coleman in the coming year.

The ACR proudly recognized a record 156 fellows during the virtual Convocation ceremony. These honorees are members in good standing who have demonstrated a history of service to the ACR, organized radiology, research or teaching. Only 10% of members have been awarded fellowship. Congratulations to this year’s recipients!

Gregory N. Nicola, MD, FACR, and William Donovan, MD, FACR, led the Economics Forum, which provided a venue to walk through the process from the time that a billable code is introduced or re-evaluated, through the actual valuation of a service. We also learned about change on the horizon in regard to payment for use of artificial intelligence, the trend toward corporatizations, and the impact of the COVID-19 pandemic on the future of teleradiology.

Health equity remains of paramount urgency for the ACR, as highlighted in several sessions, including a two-part CME opportunity focused on health equity and the Moreton Lecture. In her Presidential Address, Geraldine McGinty, MD, MBA, FACR, challenged radiology professionals to act to advance health equity in her Presidential Address, unveiling the Radiology Health Equity Coalition. This new, community-wide effort supports radiologists who aim to address health disparities in research, advocacy efforts, artificial intelligence development and medical student recruitment. I encourage you to learn more about the coalition, and commit to act today.

During the Moreton Lecture, Reshma Jagsi, MD, DPhil, presented a data-driven view of just how equitable the fields really are — or are not — and challenged attendees to think about how we can all do more to improve equity in our practices.

The success of this year’s meeting was made possible by the hard work and collaboration of ACR staff working alongside, you, our volunteers. I would especially like to thank the ACR Governance staff, Trina Behbahani, CAE, Catherine Herse and Tom Hoffman, JD, CAE, as well as Mr. Jim Jones, our parliamentarian and my predecessor, Richard Duszak Jr., MD, FACR. The work of this dedicated team at command central in Reston was critical to another successful annual meeting.

As we move forward on the heels of ACR 2021, I’m eager to get to work to further support our radiology community. I’m truly looking forward to what we will accomplish together over the next few years, and don’t forget – save the date for ACR 2022, April 24 to 28. I look forward to seeing you back at the Washington Hilton!

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