RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020.

The coronavirus disease 2019 pandemic has challenged and changed health care systems around the world. There has been a heterogeneity of disease burden, health care resources, and nonimaging testing availability, both geographically and over time. In parallel, there has been a continued increase in understanding how the disease affects patients, effectiveness of therapeutic options, and factors that modulate transmission risk. In this report, radiology experts in representative countries from around the world share insights gained from local experience. These insights provide a guidepost to help address management challenges as cases continue to rise in many parts of the world and suggest modifications in workflow that are likely to continue after this pandemic subsides.

Lessons on Leadership.

Leadership is increasingly recognized as a distinct set of trainable skills that are different from the skills of management. Dedicated attention to these skills by future leaders and the people who hire them is necessary to stem the tide of failed leadership that continues to remain all too common. Effective leaders prioritize others over self and are skilled communicators. They integrate information from disparate parties, encourage collaborative engagement, create a sense of urgency, and set the organizational vision. Never complacent, effective leaders look for disruptive influences and confront them without fear. Effective leaders are change agents. If you wish to be a leader but believe that you first need a title, think again. The most effective leaders do not need one. Practice, train, and emphasize your colleagues and organization above yourself, and the rest will take care of itself. ©RSNA, 2018.

Indirect Cost and Harm Attributable to Oral 13-Hour Inpatient Corticosteroid Prophylaxis before Contrast-enhanced CT.

PURPOSE: To estimate the effect of an oral 13-hour inpatient corticosteroid premedication regimen on length of stay, hospital cost, and hospital-acquired infections (HAIs) by using a combination of real and hypothetical study populations. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consent waived for this HIPAA-compliant retrospective study. Inpatients who received an oral 13-hour corticosteroid premedication regimen before contrast material-enhanced CT (n = 1424) from 2008 to 2013 were matched by age, sex, and year when CT was performed to a control cohort (n = 1425) of patients who underwent contrast-enhanced CT without premedication and who had similar rates of 13 comorbid diseases. Length of stay in the hospital and time from admission to CT were compared by using the Mann-Whitney U test. Rates of prospectively reported HAIs were compared by using χ(2) tests. The indirect cost and risk of HAI with premedication were estimated by using published data. RESULTS: Premedicated inpatients had a significantly longer median length of stay (+25 hours; 158 vs 133 hours, P < .001), a significantly longer median time to CT (+25 hours, 42 vs 17 hours, respectively; P < .001), and a significantly greater risk of HAI (5.1% [72 of 1424] vs 3.1% [44 of 1424], respectively; P = .008) compared with nonpremedicated control subjects. On the basis of these data and existing references, the prolonged length of stay was estimated to result in 0.04 HAI-related deaths and a cost of $159 131 (in U.S. dollars) for each prevented reaction of any severity and 32 HAI-related deaths and a cost of $131 211 400 for each prevented reaction-related death. CONCLUSION: Oral 13-hour inpatient corticosteroid prophylaxis is associated with substantial cost relative to its modest benefit, and may cause more indirect harm than the direct harm that it prevents.

CT imaging characteristics of oncocytic adrenal neoplasms (OANs): comparison with adrenocortical carcinomas.

OBJECTIVE: Oncocytic adrenal neoplasms (OANs) are rare, but are an important subtype of adrenal tumors that is being diagnosed with increasing frequency. Unfortunately, the imaging characteristics of this tumor have not been well described. Our purpose was to identify CT features to differentiate OANs from adrenocortical carcinomas (ACC). MATERIALS AND METHODS: From 1991 to 2012, 18 patients with OANs were identified from our institution's pathology database. Twelve had CT examinations available for review. CT characteristics of five benign and seven malignant OANs were reviewed by two abdominal radiologists, and compared to ACC (n = 10). Morphologic characteristics and density measurements were recorded for each imaging phase. Absolute contrast washout was calculated and compared. RESULTS: Benign OANs were smaller [mean size 3.7 cm (range 2.6-5.3)] and more homogeneous than malignant OANs and demonstrated greater washout [mean washout percentage 72.3% (range 61-88)]. Malignant OANs demonstrated features similar to ACCs, including size [mean 9.4 cm (range 5.2-9.8)] and internal necrosis (n = 6). Mean enhancement washout percentage for malignant OANs was 12% (range -8 to 32). CONCLUSION: Benign OANs (oncocytomas) may be distinguished from lipid-rich adenomas on non-contrast CT but may be indistinguishable from lipid-poor adenomas. Malignant oncocytic neoplasms can demonstrate features similar to ACCs, including larger size, internal necrosis, and lower percentage enhancement washout.

Framed and Reframed! The Art of Using Cognitive Behavioral Techniques to Combat Burnout.

The incidence of burnout among radiologists has been increasing exponentially, largely attributed to increased work volumes, expectations for more rapid turn-around times and decreasing interpersonal interactions. While personal wellness activities have been described in the literature, there is little information on the role of cognitive behavioral therapy strategies to mitigate burnout. This manuscript will describe the value of naming automatic negative emotions which can lead to burnout and will provide an overview of strategies that can be used to combat them, using cognitive behavioral therapy techniques.

Perspective on the New IR Residency Selection Process: 4-year Experience at a Large, Collaborative Training Program.

Interventional Radiology (IR) was officially approved by the American Board of Medical Specialties in 2012 and the Accreditation Council of Graduate Medical Education as a unique, integrated residency in 2014. Its establishment and distinction from diagnostic radiology was compelled by the increasing emphasis on clinical care delivery by IRs. The shift in the IR training paradigm, as exemplified in the Integrated IR residency programs, appeals to a distinct cohort of applicants, prompting the need to re-evaluate the recruitment and selection process. This article discusses selection criteria for identifying ideal candidates for the new IR training model (focusing on Integrated IR residency training), highlights the importance of collaboration between the IR and DR selection committees, and illustrates the changes made at a single institution over the course of 4 selection cycles prior to the COVID-19 pandemic as well as significant changes in the current climate of the global pandemic.

A collaborative enterprise for multi-stakeholder participation in the advancement of quantitative imaging.

Medical imaging has seen substantial and rapid technical advances during the past decade, including advances in image acquisition devices, processing and analysis software, and agents to enhance specificity. Traditionally, medical imaging has defined anatomy, but increasingly newer, more advanced, imaging technologies provide biochemical and physiologic information based on both static and dynamic modalities. These advanced technologies are important not only for detecting disease but for characterizing and assessing change of disease with time or therapy. Because of the rapidity of these advances, research to determine the utility of quantitative imaging in either clinical research or clinical practice has not had time to mature. Methods to appropriately develop, assess, regulate, and reimburse must be established for these advanced technologies. Efficient and methodical processes that meet the needs of stakeholders in the biomedical research community, therapeutics developers, and health care delivery enterprises will ultimately benefit individual patients. To help address this, the authors formed a collaborative program-the Quantitative Imaging Biomarker Alliance. This program draws from the very successful precedent set by the Integrating the Healthcare Enterprise effort but is adapted to the needs of imaging science. Strategic guidance supporting the development, qualification, and deployment of quantitative imaging biomarkers will lead to improved standardization of imaging tests, proof of imaging test performance, and greater use of imaging to predict the biologic behavior of tissue and monitor therapy response. These, in turn, confer value to corporate stakeholders, providing incentives to bring new and innovative products to market.

Quantitative imaging test approval and biomarker qualification: interrelated but distinct activities.

UNLABELLED: Quantitative imaging biomarkers could speed the development of new treatments for unmet medical needs and improve routine clinical care. However, it is not clear how the various regulatory and nonregulatory (eg, reimbursement) processes (often referred to as pathways) relate, nor is it clear which data need to be collected to support these different pathways most efficiently, given the time- and cost-intensive nature of doing so. The purpose of this article is to describe current thinking regarding these pathways emerging from diverse stakeholders interested and active in the definition, validation, and qualification of quantitative imaging biomarkers and to propose processes to facilitate the development and use of quantitative imaging biomarkers. A flexible framework is described that may be adapted for each imaging application, providing mechanisms that can be used to develop, assess, and evaluate relevant biomarkers. From this framework, processes can be mapped that would be applicable to both imaging product development and to quantitative imaging biomarker development aimed at increasing the effectiveness and availability of quantitative imaging. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100800/-/DC1.

Global trends in hybrid imaging.

At the 2009 Scientific Assembly and Annual Meeting of the Radiological Society of North America, a special session was devoted to global trends in hybrid imaging. This article expands on the key points of the session, focusing primarily on positron emission tomography/computed tomography. Global trends in hybrid imaging equipment acquisition, usage, and image interpretation practices are reviewed, and emerging requirements for training and clinical privileging are discussed. Also considered are the current benefits of hybrid imaging for patient care and workflow and the potential of hybrid imaging for advancing drug development and personalized medicine.

Adjusted Citation Rate, an Alternative Metric to Measure the Impact of General Radiology Journals.

RATIONALE AND OBJECTIVES: The journal impact factor (JIF) is often used to assess the prestige of scientific journals. Citations from original articles and reviews as well as citations from noncitable items contribute to the numerator in these calculations. However, since noncitable articles are not included in the denominator, the JIF may be skewed by the types of articles and not accurately reflect the prestige of the journal. The purpose of our study was to develop an alternative and complementary metric by which journals may be assessed. This "adjusted citation rate metric" is based on citations that originate only from citable items in the journal. MATERIAL AND METHODS: We tabulated the number of citations and citable items for original articles from the Web of Science Core Collection for 5 consecutive years (2010-2014) for 20 general radiology journals. The adjusted citation rates (CR) per original article and reviews were calculated using only citations that originated from citable items. RESULTS: The adjusted CR in 2015 was similar to the JIF in 14 of the 20 journals, higher in four journals, and lower in two journals. Using this system, Radiology, Investigative Radiology, and European Radiology remained first, second, and third respectively among journals published in the field of general radiology. To allow for equal distribution of original articles vs reviews among general radiology journals, we calculated the adjusted CR where the standard distribution of original articles is 50%. CONCLUSION: Adjusted citation rate is an objective index for assessing journal impact that can serve as an alternative and complementary metric with which to measure the journal impact.

Establishing a Surgical Preliminary Year in the IR Residency: Keys to Success.

The training paradigm of the interventional radiologist has quickly evolved with the approval of the integrated interventional radiology (IR) residency by the American Board of Medical Specialties and the Accreditation Council of Graduate Medical Education. Prior to appointment in an integrated IR program, a resident must complete a preliminary clinical year, which may be surgical, medical, or transitional. The unique procedural- and clinical-based skillset required of the IR resident is best aligned with a surgical preliminary year. The following is a review of the steps to successful creation of a surgical preliminary year based on a single institution's experience.

Environmental Impacts of Abdominal Imaging: A Pilot Investigation.

PURPOSE: Clinical decision making regarding the use of imaging is appropriately centered on diagnostic efficacy and individual patient factors. However, health policy and imaging guidelines may incorporate other inputs, such as cost-effectiveness and patient preference. In the context of climate change and resource scarcity, the environmental impacts of imaging modalities including ultrasound, CT, and MRI will also become relevant. The purpose of this study was to estimate the environmental impacts of various abdominal imaging examinations. METHODS: Using commercially available software (SimaPro) and data from user manuals and field experts, a streamlined life cycle assessment was performed to estimate multifactorial environmental impacts of the production and use of ultrasound, CT, and MRI per abdominal imaging examination. RESULTS: Ultrasound consumed less energy in both production and use phases (7.8 and 10.3 MJ/examination, respectively) than CT (58.9 and 41.1 MJ/examination) or MRI (93.2 and 216 MJ/examination). Ultrasound emitted fewer CO2 equivalents in production and use phases (0.5 and 0.65 kg/examination) than CT (4.0 and 2.61 kg/examination) or MRI (6.0 and 13.72 kg/examination). Potential human health effects from pollutant emissions were found to be smallest with ultrasound in both production and use phases. CONCLUSIONS: Among the three imaging modalities, ultrasound was found to have the least environmental impact, by one or more orders of magnitude in various domains. This analysis provides an initial framework for comparing environmental impacts across imaging modalities, which may provide useful inputs for cost-effectiveness analyses and policymaking.

Junior faculty satisfaction in a large academic radiology department.

RATIONALE AND OBJECTIVES: Retention of academic faculty is a pressing issue for many radiology departments. The departure of junior faculty members to private practice may be driven in part by economics; however, the choice may be influenced by many other elements of faculty satisfaction. The purpose of this study was to evaluate how satisfied junior (assistant professors and instructors) and senior (associate professors and professors) faculty in an academic radiology department are with respect to their work and to determine which factors most affected the decision to stay in academics. MATERIALS AND METHODS: We conducted a survey of junior and senior faculty in the department of radiology. Questions included attitudes regarding work, home, and family issues. Among the 27 junior faculty (73%) who responded to the survey, 14 were instructors and 13 were assistant professors. Among the 11 senior faculty (21%) who responded to the survey, 3 were associate professors and 8 were professors. RESULTS: Academic radiology faculty are very happy with work and derive enjoyment and fulfillment from their work. The working week excluding call (average 52 hours) and including call (average 61 hours) was not regarded as too long. The average academic faculty works 72% clinical time (range 15% to 100%) and gets 0.96 day a week of professional development. Fifty-nine percent are funded at an average of 0.91 day a week. Forty-one percent are on tenure track, and of the remainder, 40% expressed a desire for tenure track. Fifty-five percent of faculty have mentors and 57% receive adequate mentoring. When it comes to teaching, 50% have enough time to teach juniors. Of the remainder, all but one cited high clinical workload as an impediment to teaching juniors. Forty-one percent of faculty reported not getting enough academic time. Fifty-nine percent felt pressure to publish and 34% felt pressure to obtain external funding. Seventy-six percent surveyed felt it has become more difficult to publish. The main reasons cited were increasing clinical workload (34%), higher standards required (25%), lack of academic time (25%), and institutional review board constraints (16%). Twenty-eight percent of faculty work on research projects during weekends, 25% during professional development time, and 21% on weekday evenings. However, 63% said they had too little time to spend at home, with family, or on hobbies. The main reasons cited were demands on time caused by clinical work (45%), research (42%), and teaching (24%). Fifty-three percent said that their work regularly causes conflicts at home. CONCLUSIONS: The main reasons to stay in academics were the opportunity for teaching (68%), working with expert colleagues (58%), to pursue research (55%), and an interesting mix of cases (47%). Disincentives to stay in academics included insufficient financial remuneration (82%), the high clinical workload (45%), academic center "politics," and the lack of academic time (42%).