Mind Matters

The ACR Commission on Neuroradiology is taking advantage of new initiatives and advancing the subspecialty.mind matters

Nearly 15 years after the "Decade of the Brain"1 (the 1990s), there remains a tremendous fascination with the organ that controls our thoughts, mood, and behavior.

Recent headlines have covered the association between sports and head injuries, the early detection of Alzheimer's disease, and the effect of music on our brains. Central to all of these issues is advances in brain imaging.

President Obama and NIH Director Francis Collins rolled out the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative in April 2013. The ACR, in partnership with the American Society of Neuroradiology (ASNR), RSNA, and the Academy of Radiology Research, is working to ensure that the imaging community's contributions are integrated in the planning and execution of BRAIN. This ambitious 10-year project aims "to accelerate the development and application of innovative new technologies to construct a dynamic picture of brain function that integrates neuronal and circuit activity over time and space."2

In consultation with the Commission on Quality and Safety, Pina C. Sanelli, MD, MPH, FACR, and Max Watermark, MD, led an effort to develop a white paper to clarify imaging recommendations for stroke, a leading cause of death and disability.3 Responding to a clear need in literature, this work addresses specific imaging approaches for relevant time windows after symptom onset. Indeed, this comprehensive and thoughtful work employed an evidence-based approach to appropriate imaging related to stroke and was jointly endorsed by the ACR, ASNR, and Society of Neurointerventional Surgery.

The Commission on Neuroradiology operates in close alignment with the Commission on Economics and the ASNR Health Policy Committee — led by Robert M. Barr, MD, FACR — to accurately calculate relative value units associated with the CPT codes in the Medicare Fee Schedule, inform efforts to develop quality metrics for risk-based payment constructs, and apply Imaging 3.0™ to the practice of neuroradiology. Members of the Commission on Neuroradiology have also actively participated in the development and evaluation of national performance measures for neuroimaging. A high level of involvement in organizations such as the National Quality Forum and the AMA Physician Consortium for Performance Improvement has supported performance measures related to stroke imaging in the CMS Physician Quality Reporting System.

The commission's Committee on Guidelines and Standards (chaired by Jacqueline A. Bello, MD, FACR, and vice chaired by John E. Jordan, MD, FACR) keeps very busy developing and maintaining practice guidelines devoted to neuroimaging. We have worked collaboratively with allied specialty societies, particularly the ASNR, to streamline the review and approval process while maintaining crucial subspecialty input.

The Commission on Neuroradiology was further strengthened by the recent appointment of Alexander M. Norbash, MD, FACR, as vice chair. Norbash also assumed leadership within the ACR for the new ACR Head Injury Institute. Traumatic brain injury is a huge societal concern given what we are now learning about the long-term effects of sports-related concussions and evidence of a relationship between significant head injury and a heightened risk of developing Alzheimer's disease later in life.

At AMCLC 2013, the second annual Women in Neuroradiology Leadership Award was bestowed to Pina C. Sanelli of Weill Cornell Medical College. The Commission on Neuroradiology joined with the Foundation of the ASNR, the ACR Commission for Women and General Diversity, and the ACR Commission on Leadership and Practice Development to both recognize promising women leaders in neuroradiology and radiology and support their further career development.

The ACR Commission on Neuroradiology Writing Group, which consists of leaders in neuroimaging, actively fields calls and responds to public relations matters related to neuroimaging. An issue that has received extensive media attention is the appropriate and ethical use of advanced brain imaging techniques in medicolegal cases. The Commission on Neuroradiology collaborated with the ASNR to hold a multidisciplinary consensus conference titled "The Use of Abuse of Neuroimaging in Medical Testimony." The resulting recommended guidelines have recently been published in the American Journal of Neuroradiology.4

As you can see, the Commission on Neuroradiology team has been busy serving the ACR membership on all matters related to brain, spine, and head and neck imaging. Please feel free to contact us if you have any questions, concerns, or suggestions!

1. Goldstein M. “The Decade of the Brain.” Neurology. February 1990;40:321.
3. Wintermark M, et al. “Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery.” American Journal of Neuroradiology. Published online: Aug. 1, 2013.
4. Meltzer CC, Sze G, Rommelfanger KS, Kinlaw K, Banja J, Wolpe JR. “Guidelines for the Ethical Use of Neuroimages in Medical Testimony: Report of a Multidisciplinary Consensus Conference.” American Journal of Neuroradiology. Published online: Aug. 29, 2013.

carolyn meltzerBy Carolyn C. Meltzer, MD, FACR, chair, ACR Commission on Neuroradiology

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