JACR® August Highlights
Unifying the Silos of Subspecialized Radiology: The Essential Role of the General Radiologist
While there have been various predications about the fate of the general radiologists, current data suggests that over half of all practicing radiologists spend the greater part of their time working as generalists. However, the definition of a general radiologist, and the environment in which they practice, may be more variable than in the past. Even mid-sized practices will task subspecialty radiologists with general call responsibilities after hours and overnight. The Veterans Health Administration retains a steady demand for generalist radiology services, particularly in caring for active duty Armed Forces members. Many emergency radiologists also practice as generalists, or have fellowship training in another subspecialty. Increasing consolidation of healthcare systems have also lead to academic centers providing coverage for rural or community-based sites —necessitating a level of comfort with general radiology even among academic subspecialists. The landscape of radiology may be shifting towards increased subspecialty training, but demand for general radiology expertise remains high.
ACR Neck Imaging Reporting and Data Systems (NI-RADS): A White Paper of the ACR NI-RADS Committee
The ACR convened the Neck Imaging Reporting and Data Systems (NI-RADS) Committee in 2016 to provide unifying recommendations for surveillance imaging in patients with treated head and neck cancers, standardize lexicon to differentiate between posttreatment change and malignancy, and propose a reporting template with defined levels of suspicion and subsequent management recommendations. Much like other “-RADS” systems, the NI-RADS proposed score system allows for the categorization of findings based on level of suspicion from NI-RADS 1 reflecting “no evidence of recurrence” up to NI-RADS 4 reflecting “definitive recurrence.” A NI-RADS 0 correlates with a technically inadequate or incomplete study. Currently, the National Comprehensive Cancer Network guidelines provide no official recommendations for surveillance imaging after 6 months posttreatment in an asymptomatic patient. The NI-RADS committee addressed this issue by making the following recommendations in asymptomatic posttreatment patients:
- PET/CECT at 8 to 12 weeks after completion of definitive therapy as a baseline
- If this is negative, then a CECT or PET/CECT 6 months later
- If CECT is negative, a CECT neck alone 6 months later (if two consecutive PET/CECTs are negative, then stop surveillance imaging)
- If second CECT is negative, CECT neck and chest 12 months later.
Transitioning From Peer Review to Peer Learning: Experience in a Radiology Department
Until 2016, the radiology department at Texas Children’s Hospital used a peer review process involving random auditing of cases which were assigned during radiologists’ individual work rotations. Reviews were based on a 1-4 point scoring system with scores of 3-4 considered discrepancies or errors. In the event of a discrepancy, the initial interpreting radiologist was notified anonymously, although the overall error rate was tracked for individuals as a component of their evaluation. The switch to Peer Collaborative Improvement (PCI) was prompted, in part, to highlight high-yield cases for learning, rather than identify poor clinical performance. The major changes for the deployment of PCI included four components: (1) method of case identification: emphasis of active pushing of identified errors, (2) abandonment of numerical scoring of errors for qualitative descriptors, (3) PCI learning conferences, and (4) sequestering learning and improvement activities from monitoring performance. Active pushing resulted in a yield of “learning opportunities” of 96.3 percent compared to 3.88 percent of randomly audited cases. A subsequent faculty survey demonstrated the new process was perceived as positive, nonpunitive, and improvement-focused.
Navigating the Rapidly Changing Business Landscape: Managing and Motivating Your Team
Even for radiologists practicing in an academic setting, teams within a radiology department require a certain level of management and motivation to provide the most effective, highest quality care. In the private practice setting, the concepts of team-building and motivation are even more essential. These sorts of management skills are typically deemphasized during a physician’s training, but can play a large role in our ability to deliver appropriate care. Trust and psychological safety have been identified as key components of effective teams, regardless of the workplace environment. These can be developed via leaders soliciting and responding to clear feedback from team members, and maintaining transparent communication throughout the group. Additionally, team members should be empowered by establishing reasonable work-life balance and being allowed to manage non-clinical time as they see fit.