Radiologist, Interrupted

The following post was contributed by guest blogger and ACR Imaging 3.0 Content Manager, Chris Hobson  

See the companion video here.

I arrived at Golden Gate Radiology Medical Group, located in an outpatient clinic in San Francisco’s Chinatown neighborhood, on a crisp September morning. I had arranged to interview radiologist and group president Roger S. Eng, MD, MPH, FACR, about his role in convincing his client hospital to adopt electronic health records as part of his practice’s journey toward attesting to meaningful use. Since many practices much larger than his had failed to participate in the meaningful use program, I wanted to discover the secret to his success.

As I began setting up my video equipment in a small reading room that also served as Dr. Eng’s office, I heard a knock at his door.

“Can I get you to look at this CT? I need a second opinion…” It was a primary care doctor from a competing organization across town, calling on Dr. Eng as a friend to take a second look at a scan he’d recently had done on himself. Dr. Eng fed the CD into his computer to review it. Satisfied that the man’s condition was not serious, he assured his colleague that there was nothing to worry about, and the clinician left with a smile on his face.

When I asked Dr. Eng why he’d reviewed the physician’s scan, he said, “Not that this would have changed my looking at the study, but strategically providing support to clinicians outside our core practice community can increase opportunities to help this doctor’s organization — which is a large community clinic — officially someday. Relationship building is an essential activity for today’s radiologist.”

“Well, I guess we should start—” I began, before being cut off by a ringing phone.

“Hello,” said Dr. Eng into the receiver, nodding his head and listening to the person on the other end. “OK,” said Dr. Eng finally. “Let me look into that and get right back to you.” He hung up and turned to me. “That was the hospital chief of staff following up on a patient. So where were we?”

Right on cue, another knock sounded at the door.

“Dr. Eng, I have a patient with a history of renal insufficiency and a GFR of 31,” said a radiology tech, leaning his head in through the door. “Should we give IV contrast?”

“This is how it is every day around here. Lots of interruptions,” said Dr. Eng after answering the young tech’s question. Sensing my growing anxiety that we’d never get through the interview, he went on: “But you know what? This is exactly what every radiologist should want.” Noting my confused look, he explained that, although counterintuitive at first, a steady stream of interruptions should be seen as an opportunity. “It means I’m in demand,” he concluded, “that different people are calling on my expertise.”

We went on to have a very stimulating conversation, but I couldn’t forget this statement: radiologists should actually welcome interruptions as a sign of their value to the patient care team. I was reminded of a recent JACR article titled “The Radiologist’s Workflow Environment: Evaluation of Disruptors and Potential Implications.” Lead author John-Paul J. Yu, MD, PhD, and his co-authors studied how phone interruptions affect on-call radiologists. The study found that “(a)lthough communicating with referring providers is perhaps one of the most important aspects of radiologists’ responsibilities, it is also, unfortunately, one of the most disruptive.”

During the study, researchers catalogued over 10,000 calls during a 90-day period, leading the authors to write, “The implications of this are far reaching; not only does it suggest a marked loss of workplace efficiencies … but it also raises a patient safety issue.”

Despite the fact that interruptions inarguably disrupt radiologists’ workflow, and although reading images should remain a radiologist’s top priority, when seen from Dr. Eng’s perspective, interruptions ensure that radiologists provide as much value to as many stakeholders as possible. “Yes, more interruptions can increase the risk of interpretation errors,” concluded Dr. Eng. “The answer is not to close the door (literally and figuratively) to all consults, but perhaps to manage them efficiently on an organizational level. That way, our value added activities don’t come at the expense of image consultation excellence.”

Breast Imaging — A Natural Fit for Imaging 3.0™

The following post was contributed by guest blogger Dana Smetherman, MD, MPH, FACR, vice chair, department of radiology, section head, breast imaging, Ochsner Health System  

As many radiologists know, Imaging 3.0™ is the American College of Radiology’s (ACR) initiative to help its members chart their course in our changing health care environment and make the transition from volume-based to value-based care. As part of these efforts, the ACR has incorporated Imaging 3.0 into the content of the new Continuous Professional Improvement (CPI) Breast Radiology Module 2014. Imaging 3.0 is a practice model that encourages and highlights the contributions of imaging and imagers to patient-focused care. Breast imaging, in many ways, is a natural fit with Imaging 3.0, and radiologists already incorporate Imaging 3.0 philosophies into the breast imaging sections of their practices.

Actionable reporting? Just look at BI-RADS®. Transparency in communicating results to patients? The lay letters that explain the findings on breast imaging studies have been giving our patients clear, easily understandable results for years. Empowering patients as active participants in their health care? Consider the impact of patient advocacy groups for breast cancer causes.

The Imaging 3.0 content in the new breast imaging CPI module provides models of and suggestions for incorporating Imaging 3.0 principles into your practice. The first offering is a case study outlining how one radiology department embraced the challenges wrought by legislation mandating the inclusion of breast density information in mammography lay letters and helped their patients navigate this new landscape. The second is a two-part chart that identifies potential opportunities to engage in value-based efforts, like those promoted by Imaging 3.0, in radiology practices, hospitals and the community at large.

To learn more about the new CPI Breast Radiology Module 2014, visit

Fighting Anti-Mammography Bias

The following post was contributed by guest blogger Barbara Monsees, MD, chair of the American College of Radiology Breast Imaging Commission

In a recent op-ed, Daniel B. Kopans, MD, member of the American College of Radiology (ACR) Commission on Breast Imaging and the Society of Breast Imaging (SBI) Board of Directors, highlights anti-mammography bias among major scientific journals and its potential negative effect on mammography access. No question — articles confirming mammography effectiveness in major journals are scarce recently.

Maybe editors don’t consider articles reconfirming mammography’s lifesaving ability to be unusual or “sexy,” compared to those that contradict established guidelines.  It may be one of these biases that Dr. Kopans points to. Likely both.

The ACR and SBI, with the help of dedicated professionals like Dr. Kopans and others, work  to ensure that science forms the basis of proper  breast cancer screening  guidelines. These guidelines are used to establish  ACR/SBI policies and should be used to form those of government agencies and private insurers.

ACR continues to protect patient access to mammography and other breast imaging exams. By means of  breast imaging content  to be presented  at ACR 2015™ , the ACR Education Center, the ACR Daily News Scan, this blog, ACR advocacy in Action, plus other social media and  communications efforts, we continue to keep you aware of factors affecting your practice and your patients.

I invite you to support Dr. Kopans (and others), the ACR and our allies in this effort to ensure that your voices are heard in any discussion regarding breast imaging, medical imaging or radiation oncology. Together, we are making a difference.