Faculty Bibliography

PURPOSE/OBJECTIVE:In March 2017, the ACGME relaxed resident duty-hour restrictions to allow first-year residents to work 24-hour shifts, affecting the internship experience of incoming radiology residents. The aim of this study was to assess the media response to this duty-hour change, comparing news articles with favorable and unfavorable views. METHODS:Google News was used to identify 36 relevant unique news articles published over a 4-week period after the announcement. Articles' stance was categorized as favorable, unfavorable, or neutral. Additional article characteristics were explored. RESULTS:Article sources were 58% national, 22% local, and 20% medical news. Article stance was most commonly unfavorable for national news sources (48%), compared with neutral for local (62%) and medical (72%) news sources. Most common reasons for unfavorable stance were sleep deprivation (n = 11), medical errors (n = 11), residents' health (n = 9), risk for car accidents (n = 9), a patriarchal hazing system (n = 6), and work-life balance (n = 5). Most common reasons for favorable stance were impact on resident education (n = 7) and continuity of care (n = 7). Supporting data were cited by 38% of unfavorable and 100% of favorable articles. Unfavorable articles most commonly quoted physicians affiliated with resident advocacy groups; favorable articles most commonly quoted physicians affiliated with the ACGME. CONCLUSIONS:The relaxed duty-hour restrictions received an overall unfavorable media response, particularly in nonmedical news sources, driven by concerns regarding sleep-deprived doctors. Favorable articles ubiquitously cited data supporting the safety of relaxed duty hour restrictions. Further research is warranted to better understand the impact of relaxed resident duty-hour limits on sleep deprivation, residents' health and education, and the quality of patient care.

INTRODUCTION/BACKGROUND:The purpose of this study was to explore associations between CT and MRI utilization and cost savings achieved by Medicare Shared Savings Program (MSSP)-participating accountable care organizations (ACOs). METHODS:Summary data were obtained for all MSSP-participating ACOs (n = 214 in 2013; n = 333 in 2014). Multivariable regressions were performed to assess associations of CT and MRI utilization with ACOs' total savings and reaching minimum savings rates to share in Medicare savings. RESULTS:In 2014, 54.4% of ACOs achieved savings, meeting minimum rates to share in savings in 27.6%. Independent positive predictors of total savings included beneficiary risk scores (β = +20,265,720, P = .003) and MRI events (β = +19,964, P = .018) but not CT events (β = +2,084, P = .635). Independent positive predictors of meeting minimum savings rates included beneficiary risk scores (odds ratio = 2108, P = .001) and MRI events (odds ratio = 1.008, P = .002), but not CT events (odds ratio = 1.002, P = .289). Measures not independently associated with savings were total beneficiaries; beneficiaries' gender, age, race or ethnicity; and Medicare enrollment type (P > .05). For ACOs with 2013 and 2014 data, neither increases nor decreases in CT and MRI events between years were associated with 2014 total savings or meeting savings thresholds (P ≥ .466). CONCLUSION/CONCLUSIONS:Higher MRI utilization rates were independently associated with small but significant MSSP ACO savings. The value of MRI might relate to the favorable impact of appropriate advanced imaging utilization on downstream outcomes and other resource utilization. Because MSSP ACOs represent a highly select group of sophisticated organizations subject to rigorous quality and care coordination standards, further research will be necessary to determine if these associations are generalizable to other health care settings.

Purpose To assess subspecialty practice characteristics of the U.S. radiologist workforce. Materials and Methods This study used the Medicare Physician and Other Supplier Public Use File and did not constitute human subject research. The authors identified 33 090 radiologists who billed for professional services between 2012 and 2014 and used a validated classification system to map services to seven subspecialties and quantify subspecialty-focused effort on the basis of work relative value units (RVUs). Radiologists with more than half of their billed work RVUs in a single subspecialty were designated subspecialists; the remainder were classified as generalists. Matching radiologists with various characteristics extracted from other publicly available data sets, associations were explored through use of analysis of variance and multivariable logistic regression. Results More than half (55.3%) of U.S. radiologists practice predominantly as generalists but dedicate on average 36.0% effort to one subspecialty. Among radiologists practicing as majority subspecialists, neuroradiologists (10.1% of all radiologists) and breast imagers (8.4%) are most common. Subspecialization is more common (P < .001) among radiologists who are female, are earlier in their career, work in larger practices, have academic affiliations, and practice in the Northeast. By subspecialty, female representation varies from 8.6% (interventional radiology) to 63.1% (breast imaging); cardiothoracic imagers were more commonly early career radiologists, and nuclear medicine physicians were later career radiologists. Subspecialization is considerably more common in larger (>/=100 members) practices (63.1%). An academic affiliation is the strongest independent predictor of subspecialization (odds ratio, 3.56; 95% confidence interval: 3.30, 3.84). Conclusion Despite an increased focus on radiology subspecialization, most U.S. radiologists are majority general radiologists on the basis of their work RVUs. Subspecialization is by far more prevalent in larger and academic practices. ((c)) RSNA, 2017 Online supplemental material is available for this article.

This article reviews basic concepts of report documentation for abdominal imaging examinations, focusing on practical elements for ensuring appropriate physician reimbursement. Nuances of abdominal radiography, CT, MRI, and ultrasonography codes are highlighted. Special considerations for the coding of 3D-rendering and contrast administration are also described. Greater abdominal radiologist awareness of these codes and their reporting requirements can help ensure proper documentation within radiology reports, thereby optimizing legitimate reimbursement.

PURPOSE/OBJECTIVE:The Medicare Access and CHIP Reauthorization Act (MACRA) provides CMS flexibility to evaluate radiologists using hospital outpatient quality measures in place of conventional physician measures. We explore radiologist characteristics associated with variation in performance in two such measures: abdomen and chest CT "double scan" rates (percentage of total examinations performed both with and without intravenous contrast). METHODS:Radiologists' claims for abdomen and chest CT examinations in a facility setting were identified using 2014 Medicare Physician and Other Supplier data. Individual radiologist double scan rates were computed. Associations were explored between rates and radiologist characteristics extracted from the CMS public data sets using multivariable regression with cross-validation. RESULTS:Radiologists' double scan rates averaged 5.9% ± 10.0% (0.0% for 52.8% of radiologists) for abdomen CT (19,867 radiologists) and 1.0% ± 4.7% (0.0% for 91.3% of radiologists) for chest CT (18,684). At multivariable analysis, abdomen rates were best predicted by geography (lowest in Northeast, greatest in West), practice size (greatest for small practices), and specialty practice pattern (lowest for general radiologists; greatest for nuclear medicine physicians). Agreement for double scan rates among radiologists within the same practice was moderate, though slightly higher for chest (intraclass correlation = 0.70) than abdomen (0.59). CONCLUSION/CONCLUSIONS:Radiologists' facility double scan rates vary systematically based on an array of professional characteristics. MACRA grants CMS the authority to use these measures for evaluating radiologists, thereby aligning Medicare's hospital and physician performance programs and better incentivizing population radiation dose and cost reduction. Greater variation in abdomen CT double scan rates, compared with ubiquitously excellent chest CT performance, supports a particular role for abdomen rates in distinguishing disparities in radiologist performance.

Multiparametric MR imaging provides detailed anatomic assessment of the prostate as well as information that allows the detection and characterization of prostate cancer. To obtain high-quality MR imaging of the prostate, radiologists must understand sequence optimization to overcome commonly encountered technical challenges. This review discusses the techniques that are used in state-of-the-art MR imaging of the prostate, including imaging protocols, hardware considerations, and important aspects of patient preparation, with an emphasis on the recommendations provided in the prostate imaging-reporting and data system version 2 guidelines.

In patients with metallic hip implants, distortions, and other artifacts relating to the echo-planar imaging acquisition may render prostate diffusion-weighted imaging (DWI) nondiagnostic. Reduced field-of-view (rFOV) acquisition, using parallel transmission and focused excitation, is a novel DWI approach that reduces distortions and improves images quality. This article presents images from both standard and rFOV DWI acquisitions in 2 prostate cancer patients with hip implants, showing the effect of rFOV DWI for improving tumor localization. The findings have implications for the potential application of magnetic resonance imaging for guiding targeted biopsy and planning focal therapy in the growing population of patients with hip implants.