A Voice of One

Daffner_Richard_2_webRichard H. Daffner, MD, FACR, a retired radiologist who practiced at Allegheny General Hospital for over 30 years, contributed this post.

In today’s polarized political climate, we often hear friends and neighbors say they are not going to vote because they feel their vote will not make a difference. So, I ask, can a voice of one make a difference? A recent report in the ACR Bulletin, Demystifying Policymaking, led me to recall my own experience.

In 1998, I was a Councilor for Pennsylvania to the American College of Radiology (ACR). Councilors vote upon resolutions introduced since the previous year at the College’s annual meeting. A resolution is submitted, given to one of four Reference Committees and presented to the membership for comments. They then decide to recommend one of four courses of action: adoption as written, adoption following amendment(s), referral either to the Council Steering Committee or to the Board of Chancellors for further consideration, or defeat.

In 1998, the job market for residents and fellows finishing their training programs was reaching an all-time low. Reimbursement reductions by Medicare (and other insurers following suit) at that time had led many radiology groups to defer new hiring. Furthermore, the usual attrition rate from retirement was also slowed, as many senior radiologists continued to work because of drops in the stock market and hence, in the value of their pension accounts.

In this context, the ACR Residents and Fellows Section proposed a resolution asking the College to use its influence to reduce the number of residency slots available, and thus reduce the competition for the few jobs that would be available following training. This resolution was presented to the appropriate Reference Committee who, hearing no objections, recommended that it be adopted.

The ACR Council presented the resolution for a final vote. The Speaker of the Council opened the floor for discussion. I went to the microphone and said, “Mr. Speaker, I speak against the resolution.” This was followed by a chorus of boos. After the Speaker restored order, I presented my opposition and asked how many of the delegates were from practices that had residency training programs. About 20 percent raised their hands. I then told them that I was from an academic private practice at a community teaching hospital that had twelve residents. Each year, prior to 1998, we received an average of 300 applications for three available resident slots. That year, we received only ten! I also pointed out that the total number of positions was determined by the Residency Review Committee and by Congress, who reimbursed training programs. I concluded that the system was, in fact, correcting itself and that the ACR should not intercede.

As soon as I sat down, several other academicians from large and small programs voiced their own similar experiences in a decline in residency applications. They agreed that the system was correcting itself and felt the resolution should be defeated. Ultimately, the Council defeated the resolution. I truly believe we made the right decision. Had I not spoken up, the resolution would have unanimously passed and become ACR policy.

In a free society, all are entitled to express their opinion. If they make a cogent argument for their position, reasonable people will listen and their opinions can change. A voice of one can and does make a difference. And most importantly, everybody’s vote counts.

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Why Quality CT Matters in Lung Cancer Screening Programs

Supanich_Mark 1Mark Supanich, PhD, chair of the Alliance for Quality CT and an ACR member, contributed this post.

Lung cancer is the leading cause of cancer death in the United States, but we can make a difference through quality, lifesaving screenings with low-dose computed tomography (CT). Research shows that early screening can reduce lung cancer mortality by up to 26 percent among smokers, yet only 2 to 4 percent of the eligible population is actually being screened.

The medical physics community plays an important role in facilitating Lung Cancer Screening (LCS) by working with radiologists, technologists and industry partners to develop and implement optimized CT protocols.

In 2010, the American Association of Physics in Medicine (AAPM) formed a collaborative committee in response to concerns about the misuse and misunderstanding of CT equipment. The group, Alliance for Quality CT (AQCT), includes representatives from CT manufacturers, the American College of Radiology, the American Society of Radiologic Technologists and a diverse group of practicing medical physicists from the AAPM.

AQCT’s goal is to publish, in the public domain, safe and reasonable CT protocols for select exams and educational material about the use of CT. In 2016, the committee first published LCS CT protocols, which were most recently updated on July 24, 2019. The update incorporates the latest CT models and software advances from each of the manufacturers represented in the group.

Our collaboration has changed the future of developing LCS programs. There are many obstacles to establishing an LCS program, including economic viability, physician buy-in for shared decision-making, addressing population disparities and more. These protocols simplify one major step in the comprehensive process, all while putting safety and effectiveness at the forefront of every patient’s screening.

  • Learn more about AQCT and check out our latest projects.

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A Sad Day for Radiology and Patients

ACR-18This post was contributed by Howard B. Fleishon, MD, MMM, FACR, vice chair of the American College of Radiology Board of Chancellors.

I grew up and received my medical training in Philadelphia, so the news that Hahnemann University Hospital (HUH) will close this fall impacted me personally and professionally.

The closure displaces two advanced match radiology residents. Their program director sent an open letter to radiology facilities nationwide hoping to find these young doctors new training programs.

The ACR put out the call to members and I am proud to say that many of you contacted ACR to let us know your programs have openings. Their program director may be in touch.

But personally, this closing is a sad event for medicine and the people of Philadelphia. For more than 150 years, Hahnemann has been considered a critical center city institution.

Hahnemann’s bankruptcy is a valuable case study in the finance of medicine versus serving the needs of the regional population.

Unfortunately, HUH will not be the last facility to close its doors. Due to financial difficulties and the emerging consolidation trend, there will undoubtedly be others.

The ACR is closely monitoring consolidation and closure trends. We will work to arm you with the latest information to help you make the best decisions for your practices, your patients and your families.

Especially in these changing times, we are all in this together. Let’s continue to work together to help each other, radiology and medicine move forward.

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