SCBT-MR Spotlight

SCBT-MR Quarterly Newsletter

Editors: SCBT-MR Communications Committee

Spring│2015

IN THIS ISSUE

► President’s Address

► Executive Director Report

► Information Overload

► Corporate Corner

► Member News

► Call For Abstracts

► Physics Tip of the Day!

► Case of the Quarter

President’s Address Neil M. Rofsky, MD, FSCBTMR

I write to you as we are com-pleting the planning phase of the 2015 educational program for this year’s meeting and I want to rec-ognize Erik Paulson’s vision, com-mitment, and leadership in guid-ing the planning committee to assemble a truly superb program. As I reflect on this effort, I am once again struck by the talent, creativity, and incredible knowledge base of our society,

and our ability to deliver the highest quality CME course for body imaging. Our society can be proud of this effort, but we also owe it to ourselves to express that pride. We can start at the grassroots level.

There are many opportunities to display pride in your affilia-tion with SCBTMR. This could involve including the SCBTMR acronym in your title, such as Neil M. Rofsky, MD, FSCBTMR, FACR, FISMRM. A bit long perhaps, and somewhat unwieldy, but it comes with a lot of pride! In addition, we will be

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making PowerPoint slides available to all members as an option to include when giving talks, as you deem appropriate. In so doing, we will be able to generate interest in our society and buzz about our annual meeting, contributing positively to our membership and registration numbers. Details regarding how to access this material will be available in the near future.

The expression of pride emphasizes and reinforces the three principal areas I am focusing on during my tenure as president: community, connectedness, and rele-vance (see my prior address). How can we engage? Well, one way is by adding material to our archive, which will be organized by a dedicated committee that is currently in development. This is a wonderful op-portunity for you to submit materials from the past, including fun memories and meaningful, poignant mo-ments you have shared as a society member. This is most easily accomplished through digital photography of memorabilia but tangible items can be submitted as well. I am absolutely sure that this collection will gener-ate lots of smiles, important reflections and, at times, some bittersweet emotions. Another way to promote pride in our society is by wearing, using, and displaying SCBTMR paraphernalia. Fellows wear your lapel pin proudly, and generate more interest in our logo and society. At the 2014 meeting, you may have received a royal blue baseball cap that displays our acronym and logo. Whenever I wear this cap in social settings, I’m asked about our logo, which prompts interesting discussions and pro-vides an opportunity to introduce our society to an ar-ray of individuals, including professionals and laypeo-ple. Got an SCBTMR beach bag or towel from the past? Use it! A society jacket? Wear it! While that may not have the same impact as carrying a musical instrument, strolling with a puppy, or wearing a clown suit, it will most likely generate interest and, often, an interesting conversation!

Best wishes for a wonderful spring!

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Executive Director Report

Michele Wittling

SCBT-MR Executive Director

Over the past several months, The So-

ciety of Computed Body Tomography

& Magnetic Resonance has collaborat-

ed with other societies to advance is-

sues important to the membership and

subspecialty. The leadership of SCBT-

MR endorsed a joint letter from the

Lung Cancer Alliance, The Society of Thoracic Surgeons, and

The American College of Radiology to the Centers for Medi-

care & Medicaid Services regarding National Coverage for

Lung Cancer Screening with Low Dose Computed Tomogra-

phy. As you probably know, the CMS released a positive cov-

erage decision for lung cancer screening last November and

in March they approved the ACR lung cancer screening regis-

try.

The Society was also a co-signer of the letter to Congress

opposing any new reimbursement cuts to

diagnostic imaging services.

The SCBT-MR website has added a new Career Center! Visit

to see job openings, set up alerts or post your resume anony-

mously. If you are recruiting, SCBT-MR members receive a

discount to post your open positions. While you are there,

check out the case of the quarter, share your protocols and

review the other resources available to you as members of

SCBT-MR.

Spring│2015

Click the above images to read complete letters

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ACR Bulletin: March 2015

Getting the Message How can radiologists best communicate critical test results?

Nearly every radiologist has been there: you discover an inci-dental finding that requires prompt clinical attention.

But figuring out who to alert, and how to alert them, can be a difficult act. You contact the emergency department physi-cian, who is too busy to reply — plus, the patient has already been admitted, and no one seems fully responsible for the patient just yet. Hours later, a series of missed pages and voicemails have only interrupted your daily workflow without yielding tangible results. What's more, the failure to convey critical test results could have dire consequences for patient care.

Critical test results management (CTRM), the process of com-municating important imaging findings for future action, can be challenging due to its several-step process. First, you have to figure out the finding's level of importance, including the time frame during which communication is vital. Next, you must decide to whom you should communicate that result. Finally, you have to choose the best method of communica-tion — from phones and pagers to secure email and automat-ed alerts. Even then, it's not always easy to figure out how to find the correct number or means of contact, thus ensuring the information is passed on and the communication loop is closed.

Despite these obstacles, CTRM is extremely important with-in radiology. The failure to communicate findings properly can harm the patient or lead to malpractice claims. Today, many hospitals have adopted CTRM systems to help ensure no critical finding falls through the cracks.

Categorizing the Response: The Joint Commission's National Patient Safety Goals include "report[ing] critical results of tests and diagnosis procedures on a timely basis." This goal relies on the fact that radiologists can seamlessly determine what constitutes a critical result. According to Tessa S. Cook, MD, PhD, assistant professor of radiology at Perelman School of Medicine at the University of Pennsylvania in Phil-adelphia, "CTRM really demonstrates the role of the radiolo-gist at every step in the process: before, during, and after interpretation and management of findings from the study. I think it's so important that we take some ownership of these recommendations." In this sense, CTRM also helps fulfill the ACR Imaging 3.0™ campaign goals to standardize communication and provide quality care to patients. "Understanding what's urgent and what's not is the easy part," says David S. Hirschorn, MD, director of radiology in-formatics at Staten Island University Hospital in Staten Is-land, N.Y. From there, published guidelines can offer recom-mendations on how to respond. In a recent JACR® article, the ACR Actionable Reporting Work Group categorized the time frame during which it's crucial to report an actionable find-ing into three groups: communication within minutes, com-munication within hours, and communication within days. The article splits different findings into these three catego-ries, in an appendix table found here.

The JACR article authors emphasize that they did not intend to create formal guidelines for actionable findings manage-ment, but rather, a paper to "support local practices in their efforts to develop such categories and processes." The arti-cle suggests that radiologists consult their hospital's policy before determining which results are critical and how quick-ly they should be conveyed.

Other radiologists have also met success in defining and communicating critical test results. At Virginia Common-wealth University, radiology department staff implemented a new CTRM process and presented a poster at RSNA about their findings. Presenters found that their prioritization pro-cess was overly complicated because of more than 50 time-frame designations, ranging from "ASAP (within 4–6 hours)" to "Life threatening (1 hour)" to vague options like "Soon," "Stat," and "Today." Radiologists at the university success-fully condensed the list to a handful of more concrete desig-

Spring│2015

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nations and created a daily auditing system to ensure timely reporting of critical results. Whom to Contact (And How): After categorization, the next step, Hirschorn says, is to figure out to whom you should communicate a critical result. And it's not always the attend-ing physician or the primary care physician who ordered that particular test. According to Hirschorn, sometimes it's a resident or intern who's taking care of the patient and knows his or her status. "There's a lot of hoopla involved with figuring out who is taking care of a patient," says Hirschorn, who adds that the process of finding that clini-cian differs greatly based on whether the patient is in the emergency department, admitted to an inpatient facility, or is an outpatient.

For inpatient facilities, Cook believes part of the problem is maintaining an accurate directory of providers. At teaching institutions, there's an opportunity each July to update the directory as new trainees arrive and old ones graduate. "Even among the faculty, we are required to update our contact information annually," Cook says. In the outpatient setting, an electronic medical record can typically connect you with the referring physician who ordered the imaging test. At Cook's practice, radiologists have the ability to send notifications about critical results through the dictation system: "You can leave a voicemail and receive almost instant acknowledgement of the find-ing," she says, adding that the greatest benefit of this sys-tem is it barely disrupts the radiologist's workflow. Brian D. Gale, MD, MBA, managing member of Safer MD, LLC, and director of radiology informatics at the SUNY Downstate Medical Center in Brooklyn, N.Y., says not to overlook the importance of double-checking the patient's status — especially emergency department patients — which can help determine if the patient has changed depart-ments since being admitted.

"How to communicate is still a big challenge," Gale adds, "because clinicians can be in many places: seeing a patient, traveling between patients, or on a day off." Once you de-termine the correct person to contact, it's hard to know whether you should pick up the phone, page them, email them, or use an automated alert system — none of which are sure-fire ways to reach the physician. However, manual-ly relaying critical results isn't the only option. Many hospi-tals have adopted CTRM systems, which help ensure the smooth flow of information between radiologist and physi-cian.

Tools of the Trade: Gale says he has previously worked at hospitals that have implemented CTRM systems. The first step if you are considering implementing one is, he says, "to get buy-in from your clinical staff and administration. Imple-mentation is incredibly important, and you want confirma-tion that everyone is going to use this system." CTRM systems have a wide set of features, most of which are customizable based on your needs. Some alert the proper physician directly when there is a critical result, asking for confirmation that the message was received. Others alert administrators, who then put the radiologist and physician in contact with each other directly to speak about results via phone or in person. All of these systems exist to help radiolo-gists and physicians close the communication loop when it comes to CTRM, and radiologists can work directly with staff and other departments to determine what features will work best for them.

Despite many benefits, some worry about the automation of communicating such critical information. However, Hirschorn says it's important to remember that all systems require the human touch too: "Technology is not going to solve the prob-lem for you by itself. CTRM systems require a human being to interact with them and flag a result as critical. They require staff to oversee them and to make sure the physicians gets the individual messages."

Gale agrees: "It's not really automated. A radiologist has to use his or her judgment to figure out how urgently something needs to be communicated, and to whom it needs to be com-municated. It's not a machine doing all the work, and that is how radiologists can continue to add value."

Learn More at ACR 2015 If you want to learn more about CTRM systems, David S. Hirschorn, MD, and Tessa S. Cook, MD, PhD, are presenting a session at ACR 2015. The session, "Critical Test Result Man-agement: The Battle to Close the Communication Loop," will feature three speakers, addressing such questions as, What constitutes a critical result? What are the ways to deliver critical result messages? and, What are the challenges and successes of using CTRM systems? Hirschorn states that the main learning objectives will be to understand the basics of CTRM and explore the capabilities and limitations of the systems on the market today. He em-phasizes, "We're going to talk about real-world experiences, what has and has not worked, and future directions and ways to improve CTRM." More information here.

By Alyssa Martino, freelance writer for the ACR Bulletin

Spring│2015

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Corporate Corner

Discovering Value in a Fee-for-Service Culture By Tom Szostak Manager, Healthcare Economics, Toshiba America Medical Sys-tems, Inc. October 1, 2013 marked the single most significant change in the history of the United States healthcare sector. Citizens and legal residents could no longer be denied access to purchasing health insurance based upon age, gender, family health histories or prior medical conditions. In addition, health plans sold on the marketplace were required by statute to contain a minimum of 10 essential health benefit requirements. Since passage of the ACA in 2010, there have been challenges regarding constitutionality, the election of 2012 and well over 40 votes in the House to repeal the law. All of which have helped to underscore doubt and uncertainty as to why the country should move forward with such sweeping changes in health insurance and delivery reform. From this stakeholder’s perspective, the real issue as it relates to the need for meaningful health reform originates from the proponents of the law and a lack of making the general public aware of the consequences of remaining with the status quo. The issue with healthcare is not political, but economic. Accord-ing to the recent Congressional Budget Office (CBO) report titled “The Budget and Economic Outlook: 2014 to 2015,” there are four key concerns as it relates to federal spending and the na-tional debt:

Aging population Rising cost of healthcare Expansion of Medicaid and federal subsidies under provi-

sions of the ACA Interest payments on the debt

Interestingly enough, three of the four concerns are directly related to healthcare and the fourth is indirect. These four con-cerns are the same concerns expressed by the CBO in their 2014 report. It’s a known fact that the United States spends more on healthcare than any other country. In 2012, healthcare repre-sented 17.8 percent of GDP, or $2.8 trillion, in spending. For the Medicare population, per capita spending was estimated at $11,722. The spending rate for this demographic is anticipated to increase by 44.3 percent by 2022 (data from National Health Expenditure Projections 2012 - 2022).

So, why should the rising cost of healthcare be a concern to the federal government? Well, back in 1965 when the Medicare pro-gram came into existence, the average life expectancy in the Unit-ed States was around 70.2 years of age. Times have changed sig-nificantly since the launch of Medicare in 1965. Innovation in med-icine, increased awareness of disease and reduced infant mortality helped to advance life expectancy to 78.8 years. As of 2011, the baby boomer generation started to become eligi-ble for Medicare benefits. Over the course of the next 19 years, the Medicare program will experience a seismic shift in its benefi-ciary population, as it is estimated that enrollment will reach 79 million. This translates to 20 percent of the U.S. population by 2030. In the United States, healthcare has developed in a silo environ-ment with little connectivity between providers and facilities as it relates to the needs of the patient. Healthcare became transac-tional in nature and there was no accountability for the service provided. If patients were readmitted to a hospital or went to spe-cialists for primary care services, there were no penalties and pay-ment was usually assured. This fragmented and fractured healthcare system that is support-ed by fee-for-service payment schedules rewards providers by the volume of services versus the value of care that is offered. Pro-viders of healthcare services that are focused on high quality care for the population that they treat are penalized. More than likely, they will see fewer patients because they work to ensure their population is well and active within their community. In turn, no reward is provided for the service they deliver and they receive less compensation. This misaligned payment system supports the “treatment” aspect of healthcare and does not address “wellness.” So, as we review the facts regarding our healthcare system, the reality is that based on current payment models, rate of consump-tion, burden to the federal deficit, employers and consumers, this approach to care is financially unsustainable. As healthcare contin-ues to consume a greater portion of the gross domestic product and costs shift more to consumers, spending is reduced in other sectors of our economy – savings rates decline, people might fore-go purchasing a new car, or funding for education might take a backseat. As the debt level increases with the federal government, borrowing rates increase and that trickles down into all sectors of our economy. The viability of the Medicare program will be in question as insol-vency looms on the horizon. Continued funding for an insolvent program will come under the guise of bonds and borrowing against the Treasury. One thing that most experts would agree upon is that the U.S. has developed the most expensive and ineffi-cient healthcare system in the world.

Spring│2015

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Spring│2015

Send us your member news!!

SCBT-MR members are invited to share news and update their

fellow members. This is a great opportunity to share awards,

achievements, promotions, or praise a fellow

member. Member News will be published in the SCBT-MR

quarterly newsletter. Please send the information you wish to

share to info@scbtmr.org, with the subject line

“ Member News”

MEMBER NEWS

Member News

Dr. Judy Yee Named President of the Society of Abdominal Radiology Judy Yee, MD, FACR, Professor and Vice Chair of Radiology and Biomedi-cal Imaging at the University of Cali-fornia, San Francisco and Chief of Radiology at the San Francisco VA Medical Center is the newly appointed President of the Society of Abdominal Radiology

(SAR) for 2015-2016. Dr. Yee is an accomplished renowned abdominal radiologist with expertise in CT Colonogra-phy.The Society of Abdominal Radiology

was created in 2012 out of the merger of the Society of Gastrointestinal Radiologists and the Society of Uroradiolo-gy.The mission of the society is to provide leadership and to foster advances in diagnosis and intervention within the areas of gastrointestinal and genitourinary radiology. SAR is the premier organization for abdominal radiologists in this country.

Dr. Lynne Steinbach Named President of the International Skeletal Society Dr. Lynne Steinbach just assumed the role of President of the International Skeletal Society (ISS) for the next two years. The ISS is an interdisciplinary society dedicated to the learning, un-derstanding and teaching of musculo-skeletal disorders. Dr. Steinbach is the first woman to be president of this

prestigious society. She is a Professor of Clinical Radiology and Orthopaedic Surgery, and is one of the country’s top radiologists in sports imaging. Dr. Steinbach is a Past Presi-dent of the American Association for Women Radiologists and the San Francisco Radiological Society. She has as-sumed leadership positions in the International Society for Magnetic Resonance Imaging in Medicine. Dr. Steinbach was the former Chief of Musculoskeletal Imaging at UCSF and now director of Musculoskeletal Imaging Fellowship at UCSF.

Member News Congratulations to the below members for being named the 25 Top Radiology Professors by MedicalTechnology-Schools.com Kimberly Applegate, MD, MS, FACR Emory University School of Medicine - Atlanta , GA Richard Baron, MD University of Chicago - Chicago , IL Richard L. Ehman MD Mayo Clinic - Rochester , MN Katarzyna J. Macura MD, PhD

John Hopkins James Buchanan Brady Urological Institution - Baltimore , MD

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Spring│2015

The Society of Computed Body Tomography and Magnetic

Resonance (SCBT-MR) welcomes the submission of original

scientific abstracts related to Body CT or MR for its 38th An-

nual Meeting, October 7-11, 2015 at the

Westin Harbour Castle in Toronto, Canada via its NEW online

system

DEADLINE - MAY 10, 2015 at 11:59 PM EST

Selected abstracts will be presented and/or displayed at the

BEFORE YOU SUBMIT

Review the 2015 Abstract Guidelines Review tips of completing your abstract All abstract presenters must be members of

SCBT-MR to be eligible for review.

Become a member! Free membership for

In-Training Members!

ABSTRACT CATEGORIES

Oral Presentations:

Selected abstracts will present at an assigned date/

time in a formal moderated meeting room setting

Educational Exhibits (Posters):

Hard-copy poster displayed throughout conference

hall.

New This Year!

Power Posters: A select number of posters will be

chosen for Power Poster presentations. Presenters

will be assigned a time in a moderated room setting

for a short PowerPoint presentation of their work.

Afterwards Power Poster presenters will be asked to

move to the location of the traditional poster (hard

copy) to answer potential questions about their work

from the meeting attendees.

Each abstract will be eligible for one of the following major awards: · Young Investigator (Resident , Medical Student, or Fellow in Training Award -no restriction to type of research) · Junior Faculty Award (7 year post training) · Hounsfield Award (best CT oral presentation) · Lauterbur Award (best MR oral presentation) · Poster Awards (first, second and third)

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Spring│2015

Physics Tip of the Day! Kalpana Kanal, PhD, DABR, FSCBTMR, FAAPM, FACR

The American Association of Physicists in Medicine

(AAPM)’s position statement on radiation risks from medi-

cal imaging states that “risks of medical imaging at effective

doses below 50 mSv for single procedures or 100 mSv for

multiple procedures over short time periods are too low to

be detectable and may be nonexistent.”

Reference:

The American Association of Physicists in Medicine (AAPM) Posi-

tion Statement

http://www.aapm.org/org/policies/details.asp?

id=318&type=PP&current=true

Case of the Quarter: Spring 2015

The above case was also approved for JCAT. Submit your case for

COQ & JCAT review

Visit SCBT-MR’s Website! Click on the links below to view

2015 Annual Meeting Information

2015 Call for Abstracts

Membership Information; Including Directory

Over 50 CT and MRI Protocols

Annual Meeting Lectures from 2014, 2013, 2012,

Archives of the Spotlight Newsletter

Test your knowledge with our Case of the Quar-

ter

Follow SCBT-MR