Historic ACR-VHA Collaboration to Improve Patient Care

Ian Weissman 3336 EThis post was contributed by Ian A. Weissman, DO, FACR and chair, GSER Network Veterans Affairs Subcommittee

A new sharing of ideas will take place on May 22 at the 2018 American College of Radiology (ACR) Annual Meeting during a groundbreaking Veterans Health Administration (VHA) forum.

Due to hard work from ACR and VHA leadership and staff, VHA will be represented at a session for the first time in the College’s history. The goal of this ACR-VHA collaborative effort is to investigate ways to share resources and develop projects that will advance radiology.

Welcoming increased participation from U.S. Department of Veterans Affairs (VA) radiologists is important as VHA is the largest integrated health care system in the United States. The VHA represents 1,240 inpatient and outpatient facilities, trains more than 120,000 health care professionals each year, and provides care to over 9 million Veterans enrolled in the VA health care program.

William Thorwarth Jr., MD, FACR, CEO of the ACR has stated that the “VHA, with their single medical record and long term coverage of the VA population, has tremendous potential for initiatives like validation of Consensus Incidental Findings algorithms, comparative effectiveness research, demonstration of the benefits of Clinical Decision Support (CDS) and development of meaningful and impactful performance measures.”

The College has advocated for VA radiologists through several recent initiatives. First, ACR convinced the VA to abandon a proposal that would allow advanced practice nurses and certified nurse practitioners to interpret advanced medical imaging studies. Second, ACR launched Engage (an online members-only community fostering member engagement) and developed VAROCKS for VA radiologists, an important new member community. Third, ACR provides substantial educational support for VA radiologists through multiple CME-bearing activities.

Several global initiatives of ACR encourage both VA and non-VA radiologists alike to become more patient- and family-centered in their practice, including the creation of the ACR’s Commission on Patient- and Family-Centered Care (PFCC) and the new resource rich ACR PFCC Toolkit. Another useful resource is RadiologyInfo.org. Established to inform and educate the public about radiologic procedures and the role of radiologists in healthcare, and to improve communications between physicians and their patients, RadiologyInfo.org serves more than 1 million visitors each month.

Other global initiatives helping radiologists include the ACR’s new Data Science Institute™ that facilitates the development and implementation of artificial intelligence (AI) applications that will help radiology professionals provide improved medical care; Imaging 3.0™, that provides radiologists with highly actionable initiatives for immediate implementation; and leadership training through the Radiology Leadership Institute.

Opportunities for leadership and advocacy exist for both VA and non-VA radiologists at the local, state and national level. Participation in radiology and non-radiology medical organizations affords opportunities for personal growth and professional satisfaction. Advocacy improves the health of our patients. Engagement builds relationships and trust amongst our colleagues.

Your participation is welcomed at the new ACR-VHA forum on May 22 in the Hoover room off the Wilson Foyer, in the VAROCKS community on Engage, and the new Veterans Subcommittee.

Your voice matters.

  • Would you like to get involved in this new ACR-VHA collaborative initiative? Please reach out to me or my colleagues in the comments section below or on the Engage discussion board (login required).

TMIST Trial Is Gaining Momentum

Etta Pisano 16May17_0002 headshotThis post was contributed by Etta Pisano, MD, principal investigator for the TMIST Trial, chief science officer of the ACR Center for Research and Innovation, and professor of radiology at Beth Israel Deaconess Medical Center/Harvard Medical School. 

The Tomosynthesis Mammographic Imaging Screening Trial (TMIST) is up and running with 37 sites now open for accrual. An additional 93 sites will open over the next several months.

In fact, more than 4,100 women are enrolled to date, including 3,000 in a preliminary protocol at four Canadian sites. TMIST will ultimately enroll 164,946 women across approximately 130 sites over the next 3–4 years.

The trial will determine whether screening with tomosynthesis (TM) reduces the number of potentially life-threatening cancers in women compared with digital mammography (DM) detected over a 4.5-year period.

TMIST will randomize asymptomatic women ages 45–74 who present for breast cancer screening at participating clinics to either TM or DM. These women will be screened annually or biennially based on specific breast cancer risk factors during the first five years of participation. They will then be followed through a combination of chart review and patient interview for up to an additional three years.

Secondary aims will compare the two modalities regarding health care utilization, recall rates, biopsy rates, diagnostic accuracy, interval cancer rates, and pathologic and genetic (PAM50) analysis, with correlation to imaging findings. Blood and buccal smears will be collected from consenting participants to allow for biomarker discovery.

The study is open to institutions with membership in any of the National Cancer Institute (NCI) adult National Clinical Trials Research Bases across the United States — ECOG-ACRIN, Alliance, NRG, SWOG and NCORP. The study is also open to institutions in Canada through the Canadian Clinical Trials Group membership.

A mixture of academic centers, private imaging centers and community based hospital practices are participating in the trial. TMIST is a federally funded study sponsored by the NCI Division of Cancer Control and Prevention and is being led by the ECOG-ACRIN Research Base.

  • Is your institution participating in TMIST?
  • What’s been your experience with digital mammography and/or tomosynthesis?

Please provide your thoughts the comments section below or on the Engage discussion board (login required).

Moving Toward More Patient-Centered Care

Hoque, KristinaThis post was contributed by Kristina E. Hoque, MS MD PhD.

Recently, I was fortunate to be invited to speak at the Minnesota Radiological Society Spring meeting on the topic of Patient-Centered Care.  As physicians in a rapidly evolving health care system, it is critical we work to continually refocus, keeping patients at the center of our practice.

Some interesting ideas emerged this week in the move toward more patient-centered radiology —and more patient-centered health care in general.

The United States Department of Veterans Affairs (VA) announced that their My HealtheVet portal now gives veterans online access to their medical imaging and associated reports.

Patients can view, download and print their radiology images and information, or copy them to a flash drive, DVD, or any other portable drive they choose. They can also install a free viewer on their computer to view the Digital Imaging and Communications in Medicine (DICOM) images.

The VA says this cuts down on patient visits to the VA to get this information and helps share this information if/when veterans may seek care outside of the VA system.

Personally, I have found that empowering patients with easy access to their own images and reports helps each to better navigate their unique health care journey and engages the patient as an active participant in the decision making process.

Meanwhile, a study by a PhD student at the University of Twente showed that forgoing appointments in favor of walk-in systems enabled departments to provide CT scans to patients more quickly, while capacity utilization rates remained the same or even increased.

The study reports that if patients can get CT scans without an appointment, they may wait a few minutes longer in the waiting room, but tend to be more satisfied. They also do not have to make so many trips to the hospital. The scans are carried out earlier, and patients get their results sooner.

A wide variety of different practices, both academic and private, are making palpable changes to move towards value-based patient-centered imaging. Consider checking out the R-SCAN initiative (the Radiology Support, Communication and Alignment Network)at  www.rscan.org, read through the many inspiring case studies and perhaps plan a project of your own.

I urge you to check out the ACR Commission on Patient- and Family-Centered Care (PFCC) resources section for tools to help you make your practice facility more patient-centered and get ideas on how other practices and departments  are doing so nationwide.

  • What is your practice or department doing to ensure the care you provide is patient-centered?
  •  Have you already begun using the PFCC toolkit? What resources have been most beneficial for you?

Please provide your thoughts the comments section below or on the Engage discussion board (login required).