Gain Mentors and Experience at Young Investigator Symposium

Rahbar_HabibHabib Rahbar, MD, co-chair, ECOG-ACRIN Radiomics Working Group, contributed this post.

Right now, the ECOG-ACRIN Cancer Research Group (ECOG-ACRIN) is soliciting abstracts for oral presentation at its Young Investigator Symposium on October 24th in Fort Lauderdale. This is a great event not only for presenting research, but it is also an opportunity to observe scientific committee meetings, participate in educational sessions for clinical trial professionals and meet one-on-one with potential mentors and other attendees.

ECOG-ACRIN is an excellent group with which to align during your career. Imaging and biomarker studies pervade and enrich disease-specific trials, while imaging-specific trials focus on disease-relevant trials and integrate with laboratory-based markers.

Imaging researchers in ECOG-ACRIN are a diverse group of members who share a common interest in advancing oncologic imaging clinical trials. Together, we represent radiology and nuclear medicine physicians, oncologists, clinical trial methodologists, imaging technologists, and research associates. Our collaborative approach lends a positive precedence for how all groups work together in the National Cancer Trials Network.

How does this research unfold?

It begins with the Imaging Committee —a hub for imaging scientists. The committee develops and conducts trials for early evaluation of new imaging agents and approaches, and plans for their broader application. Every disease-oriented committee or working group in ECOG-ACRIN includes an Imaging Chair. Additionally, members of the Radiation Oncology Committee provide specialized expertise during the conception of new therapeutic trials.

Opportunities extend to the Imaging Committee’s four working groups. In precision oncology, the Quantitative Imaging Working Group and the Radiomics Working Group develop and evaluate imaging-related biomarkers to predict and monitor targeted treatment response. The Quantitative Imaging Working Group oversees our strong collaboration with the National Cancer Institute’s Quantitative Imaging Network. The Experimental Imaging Science Working Group maintains a network of academic and commercial cyclotron facilities to supply IND radiopharmaceuticals for trials. The Immunotherapy Working Group provides specialized expertise across the group.

This is an exciting time to be involved. ECOG-ACRIN and the American College of Radiology are collaborating on the Tomosynthesis Mammographic Imaging Screening Trial (TMIST), a trial that will define the future of personalized screening for breast cancer and establish the largest ever biorepository for future research.

I encourage you to learn more about ECOG-ACRIN, and take advantage of the networking and mentorship opportunities available through the Young Investigator Symposium. Abstracts are due September 12th and up to eight individuals will be chosen. You can review the submission requirements at ecog-acrin.org.

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A Catalyst for Change

Raoof, SabihaSabiha Raoof, MD, FCCP, FACR, chief medical officer of MediSys Health Network and chair of radiology at Jamaica and Flushing Hospitals in Queens, NY who served as a TCPI National Faculty Member, contributed this post.

Recently, I had the opportunity to present the results of the American College of Radiology (ACR)’s Radiology Support, Communications and Alignment Network (R-SCAN) to other health care associations, physicians and leaders of the Centers for Medicare and Medicaid Services’ (CMS) Transforming Clinical Practice Initiative (TCPI) at the TCPI conference. This conference was a culmination of the four-year TCPI program.

I was fortunate to be selected as a National Faculty Member for TCPI in 2015 when the ACR recommended me to serve. Through this experience, I rediscovered the joy in caring for others and amplified my voice as a radiologist and subspecialist.

In addition to my role as chief medical officer of the MediSys Health Network, I  also serve as the chairperson of radiology at Jamaica and Flushing Hospitals Queens, NY. These private community hospitals provide safety net coverage to an incredibly diverse population and perform approximately 240,000 combined exams each year.

TCPI and R-SCAN provided us with a roadmap to transition our practice from volume-based to value-based imaging care. All 600 of our clinicians enrolled in the program, engaging in various educational sessions,  one-day seminars on performance improvement and a variety of performance improvement projects. Our physicians embraced the importance of learning more about the appropriateness of certain advanced imaging and leveraging clinical decision support (CDS) to make an educated decision about which imaging study would have the highest yield for an appropriate diagnosis. We began implementation on the inpatient side in both hospitals and moved toward the outpatient and ED settings. We also started a radiology consult service so if referring clinicians had any questions when ordering imaging, they could pick up the phone and call the radiologist. We were proud to be one of the first hospitals in the country to implement CDS and then to use the data from the CDS R-SCAN Registry to complete an R-SCAN quality improvement project that significantly improved the ordering of imaging for minor head trauma in the Jamaica emergency department. We graduated from TCPI in just one year, as opposed to the predicted four-year track; transformed into diagnostic centers of excellence; and changed the trajectory of value-based care at our facilities.

As we all prepare to fully implement the CDS requirements of the Protecting Access to Medicare Act (PAMA), beginning on January 1, 2020, we must be the voice of our specialty. Don’t just sit in the office – get involved in your communities and bring your voice to the table. We can and will be the catalysts of change for the good of our patients and the practice of medicine.

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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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