Keeping Radiology at the Vanguard
It's more important than ever for radiologists to lead the way in technology innovation.
Radiology has always been at the vanguard of medical care, and it has been our scientific and technological innovation that has kept us there. In 2001, a survey of 225 leading internists rated the value of CT and MRI first among 30 medical innovations of the last 50 years.
As such, it is no surprise that the use of advanced medical imaging expanded in the decade that followed, and perhaps even less surprising (to radiologists at least) are more recent studies that show patients who are imaged earlier in their hospital stays have better outcomes and decreased lengths of stay.There is little doubt that we must continue our efforts to be the owners of the research that discovers the next diagnostic innovation and translates that innovation to practice, yet we also have to be aware of the impact health reform is having on research funding now and over the next decade.
Federal health care reform legislation, with its focus on providing incentives to decrease costs, has impacted federal funding for research. The "Stimulus Package" of 2009 and the Affordable Care Act of 2010 have allocated over $3 billion for comparative effectiveness research through the Patient-Centered Outcomes Research Institute (PCORI), the Agency for Healthcare Research and Quality, and the National Institutes of Health. The legislation not only provides more funding for health services research but also adds incentives for clinical research to shift away from just saying, "Can we do it?" to asking, "Should we do it?" Pandharipande and Gazelle5 have suggested a number of ways organized radiology can support radiology researchers, including providing a vehicle for multicenter and interdisciplinary collaboration and supporting educational efforts that promote study design to compare effectiveness and emphasize long-term outcomes. Radiology organizations should be the developers of regional and national databases to serve as repositories of comparative effectiveness information and then disseminate this information to ordering physicians, radiologists, and patients. Finally, and perhaps most importantly, the researchers challenged the specialty to support the training of new investigators in comparative effectiveness and health services research.
To help our young researchers navigate this changing world, the ACR, the Radiology Research Alliance, the Radiology Alliance of Health Services Research, and the Association of University Radiologists (AUR) partnered to host a one-day Scholars Program for young researchers at the 2014 AUR Annual Meeting. The program highlighted key elements necessary for the success of radiology research in the era of health care reform and the new emphasis on comparative effectiveness research. The Scholars Program provided 20 scholarships for radiology residents to attend and participate with radiology's leaders in discussions on health services research topics, radiation protection issues, translational research methodology, and multicenter trials. Specific focused sessions included "Funding Opportunities for Health Services Research in Radiology" and "How Do We Influence Health Policy to Support Practice?" Resident presentations highlighted many innovative research programs around the country that keep our specialty at the forefront of medical innovation and care.
In one notable presentation, Rebecca Rakow-Penner, MD, PhD, a diagnostic radiology resident at the University of California, San Diego (UCSD), presented her work on advances in diffusion-weighted imaging for prostate cancer. Then while I was in San Diego for the ARRS Annual Meeting, I was invited to the UCSD Multimodal Imaging Laboratory to meet with Anders M. Dale, PhD, the lab's director, Rakow-Penner, and their colleagues to discuss how radiology organizations like the ACR can help empower researchers to thrive in the era of health reform.
In my recent travels, I have been pleased to see that many of the goals set forth in Pandharipande and Gazelle's article are being realized. The RSNA Clinical Trials Methodology Workshop is one example of how radiology organizations are supporting education in comparative effectiveness research. ACRIN, which sponsored landmark trials such as the National Lung Screening Trial, is unique in its ability to support large multicenter trials. Meanwhile, the ACR National Radiology Data Registry program has the framework to be quite valuable to the specialty for collecting, storing, and disseminating data regarding outcomes in clinical practice. At the individual level, grants from organized radiology support many young researchers' projects.
But there will be more challenges ahead and, hopefully, more research opportunities for organized radiology. Understanding how the College can best assist and empower our researchers in the era of health care reform is an important mission of the ACR's Commission on Research. Our specialty cannot just be content with our past successes. Innovation is what will lead us into the future, and without innovation the entire specialty will suffer.
By Bibb Allen Jr., MD, FACR, Chair