Faculty Bibliography

PURPOSE/OBJECTIVE:To assess radiologists' performance in the Merit-Based Incentive Payment System (MIPS), with attention to the impact of the novel MIPS-Alternative Payment Models (APMs) participation option created under the Medicare Access and CHIP Reauthorization Act. METHODS:Data regarding radiologists' 2017 MIPS performance was extracted from the Physician Compare 2017 Individual EC Public Reporting-Overall MIPS Performance data set, and additional physician characteristics were extracted from multiple CMS data sets. RESULTS:Among 20,956 MIPS-participating radiologists, 16.6% participated using individual reporting, 68.9% group reporting, and 13.4% APM reporting. Average Quality scores were 59.7 84.0, and 92.5, respectively. The fractions of radiologists scored in Advancing Care Information were 4.1%, 27.0%, and 100.0%. When scored, average scores in this category were 61.9, 94.6, and 80.9. A total of 27.7% and 42.7% of interventional radiologists were scored in this category using individual and group reporting, respectively. However, general radiologists and subspecialists other than interventional radiologists were rarely (<5%) scored. Average scores in Improvement Activities were 37.5, 92.5, and 100.0 for individual reporting, group reporting, and APM reporting, respectively. Average Final Scores were 56.5, 85.6, and 90.6. The better performance of APM versus group reporting was most apparent for smaller practices (ie, for practice sizes ≤15, average Final Score of 84.1 for APM versus 75.0 for group reporting). CONCLUSION/CONCLUSIONS:Although radiologists perform much better in MIPS using group versus individual reporting, performance improves even further through APM reporting, particularly for smaller practices. Radiologists seeking better performance under MIPS should carefully explore APM opportunities.

CONTEXT/BACKGROUND:There is a lack of comprehensive data regarding the factors that influence the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) to detect and localize clinically significant prostate cancer (csPCa). OBJECTIVE:To systematically review the current literature assessing the factors influencing the variability of mpMRI performance in csPCa diagnosis. EVIDENCE ACQUISITION/METHODS:A computerized bibliographic search of Medline/PubMed database was performed for all studies assessing magnetic field strength, use of an endorectal coil, assessment system used by radiologists and inter-reader variability, experience of radiologists and urologists, use of a contrast agent, and use of computer-aided diagnosis (CAD) tools in relation to mpMRI diagnostic accuracy. EVIDENCE SYNTHESIS/RESULTS:A total of 77 articles were included. Both radiologists' reading experience and urologists'/radiologists' biopsy experience were the main factors that influenced diagnostic accuracy. Therefore, it is mandatory to indicate the experience of the interpreting radiologists and biopsy-performing urologists to support the reliability of the findings. The most recent Prostate Imaging Reporting and Data System (PI-RADS) guidelines are recommended for use as the main assessment system for csPCa, given the simplified and standardized approach as well as its particular added value for less experienced radiologists. Biparametric MRI had similar accuracy to mpMRI; however, biparametric MRI performed better with experienced readers. The limited data available suggest that the combination of CAD and radiologist readings may influence diagnostic accuracy positively. CONCLUSIONS:Multiple factors affect the accuracy of mpMRI and MRI-targeted biopsy to detect and localize csPCa. The high heterogeneity across the studies underlines the need to define the experience of radiologists and urologists, implement quality control, and adhere to the most recent PI-RADS assessment guidelines. Further research is needed to clarify which factors impact the accuracy of the MRI pathway and how. PATIENT SUMMARY/UNASSIGNED:We systematically reported the factors influencing the accuracy of multiparametric magnetic resonance imaging (mpMRI) in detecting clinically significant prostate cancer (csPCa). These factors are significantly related to each other, with the experience of the radiologists being the dominating factor. In order to deliver the benefits of mpMRI to diagnose csPCa, it is necessary to develop expertise for both radiologists and urologists, implement quality control, and adhere to the most recent Prostate Imaging Reporting and Data System assessment guidelines.

The increasing age of the US population is increasing the demand for healthcare services for elderly patients. However, elderly patients, particularly those over the age of 75, may encounter unique challenges when seeking healthcare services, including radiological imaging. Radiology practices need to recognize the needs of this cohort and develop strategies to provide elderly patients with compassionate, high quality care. In this article, we highlight obstacles that elderly patients may face in undergoing imaging examinations, and approaches that radiology practices may take in addressing these.

CT technologists, like radiologists, are at risk of increased stress and burnout due to ever increasing clinical and workload demands. To mitigate these issues, radiology facilities need to be prepared to actively address and resolve issues that impact the technologist satisfaction. At our institution, a Process Improvement Committee was formed to identify and alleviate workplace stressors faced by CT technologists. As a result of the initiative, our CT department has evolved into a technologist-driven department in which experienced and effective technologists play a large role in fostering efficient and patient-centered care, while feeling empowered to function as leaders in their work environment. In this article, a senior CT technologist provides a first-hand account of the process changes from the technologist's perspective, focusing on strategies for establishing a supportive system that allows technologists to thrive in providing patient-centered care even in the busiest of clinical contexts.

PURPOSE/OBJECTIVE:The aim of this study was to assess recent trends in US radiology practice consolidation. METHODS:Radiologist practice characteristics were obtained from the Medicare Physician Compare database for 2014 and 2018. Radiologists were classified on the basis of their largest identifiable practice affiliations. Single-specialty radiology practices were identified using practice names. Temporal trends in practice sizes were assessed. RESULTS:At the individual radiologist level from 2014 to 2018, the fraction of all radiologists in groups with 1 or 2 members declined from 3.2% to 2.1%, 3 to 9 members from 10.2% to 6.7%, 10 to 24 members from 18.2% to 14.1%, 25 to 49 members from 16.6% to 15.1%, and 50 to 99 members from 13.3% to 11.5%. In contrast, the fraction in groups with 100 to 499 members increased from 15.7% to 21.8% and with ≥500 members from 22.9% to 28.7%. At the practice level, the fraction of all radiologists' practices with 1 or 2 members decreased from 26.9% to 22.8%, whereas the fraction with 100 to 499 members increased from 7.6% to 10.2% and with ≥500 members from 2.5% to 4.1%. Similar shifts were present for single-specialty radiology practices and all geographic regions nationally. The 30,492 radiologists identified in 2014 were affiliated with 4,908 group practices, including 2,812 single-specialty practices. In comparison, the 32,096 radiologists identified in 2018 were affiliated with 4,193 group practices (a 14.6% decline), including 2,216 single-specialty practices (a 21.2% decline). CONCLUSIONS:In very recent years, the US radiologist workforce has consolidated, leading to increased practice sizes and a substantial decline in the number of distinct practices, disproportionately affecting single-specialty radiology practices. The impact of this consolidation on cost, quality, and patient access merits further attention.

OBJECTIVE:To assess medical school characteristics associated with school tuition. MATERIALS AND METHODS/METHODS:US medical schools' tuitions, and various medical school characteristics, were extracted from the Association of American Medical Colleges' online MSAR database, using in-state tuition when applicable. US News ranking and National Institutes of Health (NIH) award ranking from the Blue Ridge Institute for Medical Research were obtained, when available. Geographic population density was obtained using Governing magazine's online database. Cost of living estimates were obtained from online American Chamber of Commerce Research Association Cost of Living Index. Spearman correlations were determined, and multivariable linear regression was performed. RESULTS:Among 148 included medical schools, adjusted average ± standard deviation tuition was $47,612 ± $23,765 (range $12,761-$141,464). Tuition demonstrated positive correlations with regional population density (r = +0.577) and years established (r = +0.265). Among ranked schools, tuition showed negative correlations with US News rank (r = -0.469) and NIH rank (r = -0.336). Average tuition varied by geographic region: Northeast: $49,662, Midwest: $43,560, West: $37,701, and South: $34,270. Among states with at least 3 medical schools, average tuition was highest in MA ($53,520), PA ($53,034), $51,547 (DC), and lowest in TX ($21,002), FL ($30,440), LA ($36,066). At multivariable linear regression, the strongest independent predictor of tuition was US News rank (β = -396.0, P= 0.05). CONCLUSIONS:US medical school tuition is highly variable by over a 10:1 ratio. Tuition is greater in higher ranked, longer established schools, in more densely populated regions. Objective data regarding medical education quality may be warranted to assess whether higher tuition in schools with higher US News and NIH rankings is justified.

OBJECTIVE. The objective of this article is to assess radiologist concordance in characterizing thyroid nodules using the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS), focusing on the effect of radiologist experience on reader concordance. MATERIALS AND METHODS. Three experienced and three less experienced radiologists assessed 150 thyroid nodules using the TI-RADS lexicon. Percent concordance was determined for various endpoints. RESULTS. Interreader concordance for the five TI-RADS categories was 87.2% for shape, 81.2% for composition, 76.1% for echogenicity, 72.9% for margins, and 69.8% for echogenic foci. Concordance for individual features was 96.3% for rim calcifications, 90.8% for macrocalcifications, 90.1% for spongiform, 83.5% for comet tail artifact, and 77.7% for punctate echogenic foci. Concordance for the TI-RADS level and recommendation for fine-needle aspiration (FNA) were 50.4% and 78.9%, respectively. Concordance was significantly (p < 0.05) higher for less experienced readers in identifying margins (84.3% vs 67.4%), echogenic foci (76.9% vs 69.3%), comet tail artifact (89.6% vs 79.2%), and punctate echogenic foci (85.3% vs 75.5%), and lower for peripheral rim calcifications (95.0% vs 97.8 %), but was not different (p > 0.05) for the remaining categories and features. CONCLUSION. A range of TI-RADS categories, features, and recommendations for FNA had generally moderate interreader agreement among six radiologists. Our results show that concordance for numerous characteristics was significantly higher for the less experienced versus the more experienced readers. These results suggest that less experienced readers relied more on the explicit TI-RADS criteria, whereas the experienced radiologists partially relied on their accumulated experience when forming impressions. However, the overall TI-RADS level and recommendation for FNA were unaffected, supporting the robustness of the TI-RADS lexicon and its continued use in practice.

OBJECTIVE. The purpose of this study is to assess the perceptions of radiologists and emergency medicine (EM) providers regarding the quality, value, and challenges associated with using outside imaging (i.e., images obtained at facilities other than their own institution). MATERIALS AND METHODS. We surveyed radiologists and EM providers at a large academic medical center regarding their perceptions of the availability and utility of outside imaging. RESULTS. Thirty-four of 101 radiologists (33.6%) and 38 of 197 EM providers (19.3%) responded. A total of 32.4% of radiologists and 55.3% of EM providers had confidence in the quality of images from outside community facilities; 20.6% and 44.7%, respectively, had confidence in the interpretations of radiologists from these outside facilities. Only 23.5% of radiologists and 5.3% of EM physicians were confident in their ability to efficiently access reports (for outside images, 47.1% and 5.3%). Very few radiologists and EM providers had accessed imaging reports from outside facilities through an available stand-alone portal. A total of 40.6% of radiologists thought that outside reports always or frequently reduced additional imaging recommendations (62.5% for outside images); 15.6% thought that reports changed interpretations of new examinations (37.5% for outside images); and 43.8% thought that reports increased confidence in interpretations of new examinations (75.0% for outside images). A total of 29.4% of EM providers thought that access to reports from outside facilities reduced repeat imaging (64.7% for outside images), 41.2% thought that they changed diagnostic or management plans (50.0% for outside images), and 50.0% thought they increased clinical confidence (67.6% for outside images). CONCLUSION. Radiologists and EM providers perceive high value in sharing images from outside facilities, despite quality concerns. Substantial challenges exist in accessing these images and reports from outside facilities, and providers are unlikely to do so using separate systems. However, even if information technology solutions for seamless image integration are adopted, providers' lack of confidence in outside studies may remain an important barrier.