Community-Based Studies Lead to Success
Private practices take part in clinical trials to advance the field and enhance patient care.
Two community-based radiologists whose private practices maintain vibrant research departments make the case that devoting the time and resources in the beginning pays off in the end. They enthusiastically convey the benefits of radiology practice participation in clinical trials — particularly those sponsored by ACRIN® — and discuss the steps their practices took to establish clinical programs.
Clinical Radiologists, S.C.
Andrew D. Sherrick, MD, a member of the Clinical Radiologists, S.C. (CRSC), a large radiology practice based in central Illinois, considers his practice's robust participation in imaging research a significant factor behind its growth from 15 radiologists in 1995 to almost 70 today. "The academic environment created by carrying out clinical research has enriched CRSC and boosted its image within the community," says Sherrick.
CRSC's earliest research activities were spearheaded in 1995 by Charles E. Neal, MD, the group's president. "Dr. Neal understands the value of research and was willing to make the resources available to establish a research program. This included the recruitment of physicians and research coordinators to manage research activities such an institutional review-board approval, patient recruitment and screening, and oversight of trial activities," notes Sherrick.
A major impetus for CRSC's research efforts has been the desire to gain experience with more advanced imaging technologies, thereby enhancing the care provided to its referred oncology patients. As Sherrick explains, "We've been able to offer state-of-the-art experimental imaging modalities likely to become part of routine practice."
CRSC provides professional radiology services to 27 hospitals and more than 40 clinics. The practice also has affiliations with the local medical school and the regional community clinical oncology program. "The support of these institutions has been valuable for carrying out our research initiatives and negotiating reduced imaging technical fees, providing technologist training, and gaining physician cooperation in carrying out the research protocol," explains Sherrick.
As the practice has developed and cultivated lasting relationships with community physicians and their influential support staff, it has helped procure the successful enrollment of participants in its trials. "We have a core of dedicated and interested physicians who have been great research partners. Our research collaborations have helped create an awareness of our group's advanced practice environment and high quality of care," says Sherrick.
Clinical research participation has also enhanced CRSC's practice quality as a result of adopting research imaging protocols used for scanning study participants and providing technologists training on new imaging techniques. "We've been able to make the case in hospital equipment negotiations," notes Sherrick, "for a new software feature or a new piece of equipment because it has a positive impact on patient care, it's what people are asking for, and we believe it is what the future holds."
CRSC's commitment to quality extends to the group's clinical research conduct. The practice was the fifth highest accruing site out of 15 in the National CT Colongraphy Trial (ACRIN 6664) and achieved excellent data quality.
Although the financial aspect of clinical research participation hasn't always been lucrative, Sherrick and his partners believe it's been worth it. "We've had years in which funded trials provided resources to cover the cost of research coordinators and physician administrative time. However, the practice considers the benefits derived from its research program to be worth the investment even in years with the potential for small financial loss," he says.
“Today, oncology referrers complain that other radiology groups don’t provide this objective data needed to take care of their patients. They request that we provide RECIST criteria with our CT and MRI studies.” — Ronald L. Korn, MD, PhD
Scottsdale Medical Imaging
Like CRSC, Scottsdale Medical Imaging, Ltd. (SMIL) of Scottsdale, Ariz., has also received benefits beyond the bottom line. Ronald L. Korn, MD, PhD, believes that providing expertise and support to nonradiologists physicians participating in imaging clinical trials has helped grow SMIL's oncology radiology practice. "Participating in clinical research is not only about doing the science and being at the leading edge technologically; it's also about doing what radiologists do best — offering skills and assistance to oncologists who form our referral base," says Korn.
Among the 10 largest radiology groups in the country and one of the largest in Arizona, SMIL has 40 radiologists. The practice provides services to Scottsdale Healthcare, a hospital with a level I trauma center and a large oncology clinical trial network.
SMIL initially entered radiology trials during the late 1990s and early 2000s, a period of rapid development for new imaging technologies and equipment. "Using new equipment in a research environment was the best way to identify which imaging tools had the most merit for the community setting," says Korn. With 15 radiologists and one quarter of its current volume, SMIL began taking part in ACRIN protocols, including a breast MRI trial, the National CT Colonography Trial, and several PET studies. "ACRIN's checklist of requirements for image acquisition, processing, and submission served as a college for our research education. How the science needed to be done was laid out in a completely validated and controlled environment," adds Korn.
Learning from the ACRIN requirements transformed SMIL's approach to imaging studies. One prominent example of this is its adoption of Response Evaluation Criteria in Solid Tumors (RECIST) before other Arizona private practices. "We were previously unaware of this methodology governing how lesion size is measured," underscores Korn. "Today, oncology referrers complain that other radiology groups don't provide this objective data needed to take care of their patients. They request that we provide RECIST criteria with our CT and MRI studies."
SMIL's elevated visibility as an imaging expert in a nonuniversity environment has not only driven referrals and patients, according to Korn, but it has also boosted efforts to attract highly qualified radiology fellowship graduates who are at a critical decision point in their careers. According to Korn, "Being able to offer these students a blended practice has been a huge selling point. We tell them we're a private practice, but if they want to do research, we have the department in place to support them."
“We’ve been able to offer state-of-the-art experimental imaging modalities likely to become part of routine practice.” — Andrew D. Sherrick, MD
The Future of Research in the Community Setting
Sherrick and Korn both agree that the best way to give back to the ACR for its ongoing support of radiologists in private practice is by enrolling participants in ACRIN trials. Despite the current environment of reduced reimbursement for radiology services, which is expected to negatively impact research in the community more than the university setting, the practice leaders expect to continue their important roles in cooperative group-sponsored research in private radiology practice. "ACRIN is a shining example of a great resource to help radiologists enter the world of research," says Korn.
By Nancy Fredericks, MBA