The Imperative for Diversity and Inclusion in Interventional Radiology.

OBJECTIVE. The purpose of our study was to review key social justice and competitive advantage arguments for diversity in interventional radiology (IR) to substantiate the need for a more inclusive workforce. CONCLUSION. As a specialty based on innovation and flexibility of thought, IR is well positioned to be a driver of diversity and inclusion in medicine. The status quo is far from ideal. Social justice and business advantage arguments provide us with the imperative for change.

Eye Lens Dosimetry in Interventional Radiology: Assessment With Dedicated Hp(3) Dosimeters.

PURPOSE: To quantify eye lens dose in interventional radiology and assess whether neck dosimeter is a good surrogate to evaluate eye lens dosimetry. METHODS: Radiation exposure was prospectively measured in 9 interventional radiologists between May and October 2017. Standard Hp(0,07) thermoluminescent dosimeters (TLDs) were worn at the neck outside the lead apron, and 2 dedicated eye lens Hp(3) TLDs were placed just above the eyes, one midline and another at the outer edge of the left eye. Correlations between eye lens and neck TLD doses were assessed with Pearson coefficient, and linear regression was used to predict eye lens dose from neck TLD values. RESULTS: Eye lens dose without eye protection was 0.18 ± 0.11 (mean ± standard deviation; 0.08-0.41) mSv per workday and 35.3 ± 6.6 mSv (16.3-82.9) annually (200 workdays/year). Five (56%) radiologists exceeded the 20 mSv annual eye lens dose limit. Eye lens doses from left and central TLDs were 12.46 ± 3.02 and 9.29 ± 3.38 mSv, respectively (P = .027). Mean eye lens (left and central) and neck TLD doses were 10.87 ± 2.67 and 16.56 ± 5.67 mSv, respectively (P = .008). Pearson correlation coefficient between both eye lens TLD and between mean eye lens TLD and neck TLD doses were 0.91 and 0.92, respectively. Average of eye lens dose was 0.0179 + (0.5971 × neck dose). CONCLUSION: Full-time interventional radiologists are likely to suffer from deterministic radiation effects to the eye lens, especially on the left side. Neck TLD significantly overestimates eye lens dose. However, eye lens doses are highly correlated with neck doses and may be predicted from the neck TLD values.

Overall Impact of the COVID-19 Pandemic on Interventional Radiology Services: A Canadian Perspective.

PURPOSE: The aim of this national survey was to assess the overall impact of the coronavirus disease 2019 (COVID-19) pandemic on the provision of interventional radiology (IR) services in Canada. METHODS: An anonymous electronic survey was distributed via national and regional radiology societies, exploring (1) center information and staffing, (2) acute and on-call IR services, (3) elective IR services, (4) IR clinics, (5) multidisciplinary rounds, (6) IR training, (7) personal protection equipment (PPE), and departmental logistics. RESULTS: Individual responses were received from 142 interventional radiologists across Canada (estimated 70% response rate). Nearly half of the participants (49.3%) reported an overall decrease in demand for acute IR services; on-call services were maintained at centers that routinely provide these services (99%). The majority of respondents (73.2%) were performing inpatient IR procedures at the bedside where possible. Most participants (88%) reported an overall decrease in elective IR services. Interventional radiology clinics and multidisciplinary rounds were predominately transitioned to virtual platforms. The vast majority of participants (93.7%) reported their center had disseminated an IR specific PPE policy; 73% reported a decrease in case volume for trainees by at least 25% and a proportion of trainees will either have a delay in starting their careers as IR attendings (24%) or fellowship training (35%). CONCLUSION: The COVID-19 pandemic has had a profound impact on IR services in Canada, particularly for elective cases. Many centers have utilized virtual platforms to provide multidisciplinary meetings, IR clinics, and training. Guidelines should be followed to ensure patient and staff safety while resuming IR services.

Nationwide Analysis of Endovascular Thrombectomy Provider Specialization for Acute Stroke.

BACKGROUND AND PURPOSE: Determine the extent of cerebrovascular expertise among the specialties of proceduralists providing endovascular thrombectomy (ET) for emergent large vessel occlusion stroke in the modern era of acute stroke among Medicare beneficiaries Methods: Retrospective cohort study using validated International Classification of Diseases, Tenth Revision, Clinical Modification codes to identify admissions with acute ischemic stroke and treatment with ET. We identified proceduralist specialty by linking the National Provider Identifier provided by Medicare to the specialty listed in the National Provider Identifier database, grouping into radiology, neurology, neurosurgery, other surgical, and internal medicine. We calculated the number of proceduralists and hospitals who performed ET, ET team specialty composition by hospital, and number of proceduralists who performed ET at multiple hospitals. RESULTS: Forty-two percent (n=5612) of ET were performed by radiology-background proceduralists, with unclear knowledge of how many were cerebrovascular specialists. Neurosurgery- and neurology-background interventionalists performed fewer but substantial numbers of cases, accounting for 24% (n=3217) and 23% (n=3124) of total cases, respectively. ET teams included a neurology- or neurosurgery-background proceduralist at 65% (n=407) of hospitals that performed ET and included both in 26% (n=160) of teams. CONCLUSIONS: Almost two-thirds of ET teams nationwide include a neurology- or neurosurgery-background proceduralist and higher volume centers in urban areas were more likely to have neurology- or neurosurgery-background proceduralists with cerebrovascular expertise on their team. It is unclear how many radiology-background interventionalists are cerebrovascular specialists versus generalists. Significant work remains to be done to understand the impact of proceduralist specialty, training, and cerebrovascular expertise on ET outcomes.

Gender Disparity in Industry Relationships With Academic Interventional Radiology Physicians.

OBJECTIVE. Industry relationships drive technologic innovation in interventional radiology and offer opportunities for professional growth. Women are underrepresented in interventional radiology despite the growing recognition of the importance of diversity. This study characterized gender disparities in financial relationships between industry and academic interventional radiologists. MATERIALS AND METHODS. In this retrospective cross-sectional study, U.S. academic interventional radiology physicians and their academic ranks were identified by searching websites of practices with accredited interventional radiology fellowship programs. Publicly available databases were queried to collect each physician's gender, years since medical school graduation, h-index, academic rank, and industry payments in 2018. Wilcoxon and chi-square tests compared payments between genders. A general linear model assessed the impact of academic rank, years since graduation, gender, and h-index on payments. RESULTS. Of 842 academic interventional radiology physicians, 108 (13%) were women. A total $14,206,599.41 was received by 686 doctors (81%); only $147,975.28 (1%) was received by women. A lower percentage of women (74%) than men (83%) received payments (p = 0.04); median total payments were lower for women ($535) than men ($792) (p = 0.01). Academic rank, h-index, years since graduation, and male gender were independent predictors of higher payments. Industry payments supporting technologic advancement were made exclusively to men. CONCLUSION. Female interventional radiology physicians received fewer and lower industry payments, earning 1% of total payments despite constituting 13% of physicians. Gender independently predicted industry payments, regardless of h-index, academic rank, or years since graduation. Gender disparity in interventional radiology physician-industry relationships warrants further investigation and correction.

Clinical Practice Patterns of Interventional Radiologists by Gender.

OBJECTIVE. Given recent specialty attention to workforce diversity, we aimed to characterize potential gender differences in the practice patterns of interventional radiologists (IRs). MATERIALS AND METHODS. Using Medicare claims data, we identified IRs on the basis of the distribution of their billed clinical work effort and descriptively characterized practice patterns by gender. RESULTS. Women represented 8.2% (241/2936) of all IRs identified nationally. Female representation varied geographically (≤ 2% in nine states, ≥ 20% in three states) and by career stage (9.4% among early-career IRs and 6.4% among late-career IRs; 18.8% among early-career IRs in the Northeast). For both female IRs and male IRs, interventional case mixes were similar across service categories (e.g., venous and hemodialysis access, arterial and venous interventions, biopsies and drainages) and by procedural complexity (e.g., 5.7% vs 4.3% for low-complexity procedures and 59.5% vs 61.3% for high-complexity procedures). Average patient complexity scores were also similar for female (2.7 ± 12 [SD]) and male (2.8 ± 12) IRs. Female IRs spent slightly lower portions of their work effort rendering invasive services (66.5% vs 70.0%, respectively) and noninvasive diagnostic imaging (19.0% vs 22.2%) than male IRs but spent more time in evaluation and management clinical visits (14.5% vs 7.9%). Both female IRs and male IRs rendered a majority of their services to female patients (53.4% vs 53.1%). CONCLUSION. Although women remain underrepresented in interventional radiology, female IRs' interventional case composition, procedural complexity, and patient complexity are similar to those of their male colleagues. Female IRs' higher proportion of evaluation and management clinical visits supports the specialty's increased focus on longitudinal care so that interventional radiology will thrive alongside other clinical specialties.

The Physician Payment Sunshine Act: Evaluating Industrial Payments in Radiology.

RATIONALE AND OBJECTIVES: The characterization of payments made to physicians by pharmaceutical companies, device manufacturers, and group purchasing organizations is crucial for assessing potential conflicts of interest and their impact on practice patterns. This study examines the compensation received by general radiologists (GR) in the United States, as well as radiologists in the following five subspecialties: body imaging, neuroradiology, pediatric radiology, nuclear radiology and radiological physics, and vascular and interventional radiology. MATERIALS AND METHODS: Data were extracted from the Open Payments database for radiology subspecialists in the United States who received installments in calendar year 2015 from pharmaceutical and device manufacturing companies. RESULTS: In 2015, a total of $43,685,052 was paid in 65,507 payments (mean $667/payment; median $32/payment) to radiologists, including 9826 GR, 362 body imaging radiologists, 479 neuroradiologists, 127 pediatric radiologists, 175 physicians in nuclear radiology and radiological physics, and 1584 vascular and interventional radiologists. Payments were unequally distributed across these six major subspecialties of radiology (p < 0.01), with GR receiving the largest number of total payments (44,695), and neuroradiologists receiving significantly higher median payments than any other subspecialty ($80 vs $32 for all radiologists; p < 0.01). Medtronic Neurovascular was the single largest payer to all radiologists combined. CONCLUSION: Commercial entities make substantial payments to radiologists, with a significant variation in payments made to the different radiology subspecialties. While the largest number of total payments was made to GGR, the highest median payments were made to neuroradiologists, and significant dispersion in these payments was seen across different geographic regions. The impact of these payments on practice patterns remains to be elucidated.

The Challenges of Providing Interventional Radiology Services to Rural and Smaller Community Hospitals.

OBJECTIVE: Recruitment and retention of interventional radiologists for rural and smaller community hospital practices is a serious physician staffing issue. This article explores rural interventional radiology and perspectives of various stakeholders, such as rural radiology group practices, rural hospitals, interventional radiologists, public and private academic institutions, and urban health care providers, and considers the unique health care needs of rural patients. CONCLUSION: Some early solutions are evident. Collaboration among all stakeholders will be necessary to properly address the challenges.

Current Clinical Practice Patterns of Self-Identified Interventional Radiologists.

OBJECTIVE: The purpose of this study was to assess patterns of procedural, clinical evaluation and management (E/M), and diagnostic imaging services rendered by self-identified interventional radiologists (IRs) across the United States. MATERIALS AND METHODS: Recent Medicare Physician and Other Supplier Public Use and Physician Compare national downloadable files were linked. IRs were defined as physicians self-identifying interventional radiology as their primary specialty on Medicare claims or as a specialty during Medicare enrollment. The primary outcome measure was percentage of work (in work relative value units [WRVU]) attributed to interventional services (both procedural and E/M) per IR. Secondary outcome measures included sociodemographic factors per interventional WRVU quartile and percentage of E/M service units per IR. Statistical analysis included chi-square and t tests and logistic regression. RESULTS: Overall, 3132 physicians nationally self-identified to Medicare as IRs. The distribution of WRVU attributed to interventional services was strongly bimodal. Procedures and E/M together accounted for ≥ 91% and ≤ 5% of total work for the most and least intervention-oriented quartiles, respectively, but were widely distributed in the middle two quartiles. The most intervention-oriented self-identified IRs were more likely out of medical school ≤ 30 years (odds ratio [OR], 2.5; p < 0.0001), men (OR, 2.2; p < 0.0001), and in academic practice (OR, 4.3; p < 0.0001). E/M accounted for only 1.4% of all billed services. CONCLUSION: Although most self-identified IRs perform both interventional and diagnostic imaging services, the subspecialty distribution is strongly bimodal, one-quarter each focusing ≤ 5% and ≥ 91% of work on interventional services. Despite ongoing emphasis on clinically focused interventional radiology, E/M services remain rarely reported.

Physician Specialty and Radiologist Characteristics Associated with Higher Medicare Patient Complexity.

RATIONALE AND OBJECTIVES: Meaningfully measuring physician outcomes and resource utilization requires appropriate patient risk adjustment. We aimed to assess Medicare patient complexity by physician specialty and to further identify radiologist characteristics associated with higher patient complexity. MATERIALS AND METHODS: The average beneficiary Hierarchical Condition Category (HCC) risk scores (Medicare's preferred measure of clinical complexity) were identified for all physicians using 2014 Medicare claims data. HCC scores were compared among physician specialties and further stratified for radiologists based on a range of characteristics. Univariable and multivariable analyses were performed. RESULTS: Of 549,194 physicians across 54 specialties, the mean HCC risk score was 1.62 ± 0.75. Of the 54 specialties, interventional radiology ranked 4th (2.60 ± 1.29), nuclear medicine ranked 16th (1.87 ± 0.45), and diagnostic radiology ranked 21st (1.75 ± 0.61). Among 31,175 radiologists, risk scores were higher (P < 0.001) for those with teaching (2.03 ± 0.74) vs nonteaching affiliations (1.72 ± 0.61), practice size ≥100 (1.94 ± 0.70) vs ≤9 (1.59 ± 0.79) members, urban (1.79 ± 0.69) vs rural (1.67 ± 0.59) practices, and subspecialized (1.85 ± 0.81) vs generalized (1.68 ± 0.42) practice patterns. Among noninterventional radiology subspecialties, patient complexity was highest for cardiothoracic (2.09 ± 0.57) and lowest for breast (1.08 ± 0.32) imagers. At multivariable analysis, a teaching affiliation was the strongest independent predictor of patient complexity for both interventional (ß = +0.23, P = 0.005) and noninterventional radiologists (ß = +0.21, P < 0.001). CONCLUSIONS: Radiologists on average serve more clinically complex Medicare patients than most physicians nationally. However, patient complexity varies considerably among radiologists and is particularly high for those with teaching affiliations and interventional radiologists. With patient complexity increasingly recognized as a central predictor of clinical outcomes and resource utilization, ongoing insights into complexity measures may assist radiologists navigating emerging risk-based payment models.

Cross-sectional study of the provision of interventional oncology services in the UK.

OBJECTIVE: To map out the current provision of interventional oncology (IO) services in the UK. DESIGN: Cross-sectional multicentre study. SETTING: All National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards. PARTICIPANTS: Interventional radiology (IR) departments in all NHS trusts/health boards in the UK. RESULTS: A total of 179 NHS trusts/health boards were contacted. We received a 100% response rate. Only 19 (11%) institutions had an IO lead. 144 trusts (80%) provided IO services or had a formal pathway of referral in place for patients to a recipient trust. 21 trusts (12%) had plans to provide an IO service or formal referral pathway in the next 12 months only. 14 trusts (8%) did not have a pathway of referral and no plans to implement one. 70 trusts (39%) offered supportive and disease-modifying procedures. One trust had a formal referral pathway for supportive procedures. 73 trusts (41%) provided only supportive procedures (diagnostic or therapeutic). Of these, 43 (59%) had a referral pathway for disease-modifying IO procedures, either from a regional cancer network or through IR networks and 30 trusts (41%) did not have a referral pathway for disease-modifying procedures. CONCLUSION: The provision of IO services in the UK is promising; however, collaborative networks are necessary to ensure disease-modifying IO procedures are made accessible to all patients and to facilitate larger registry data for research with commissioning of new services.

Needlestick Injuries in Interventional Radiology Are Common and Underreported.

Purpose To determine the prevalence of and risk factors for needlesticks in interventional radiology physicians, as well as the attitudes, behaviors, and conditions that promote or interfere with reporting of these injuries. Materials and Methods A total of 3889 interventional radiologists from academic and private practice in the United States were surveyed by emailing all interventional radiologist members of the Society of Interventional Radiology, including attending-level physicians and trainees (April-August 2016). The institutional review board waived the need for consent. Questions inquired about the nature, frequency, and type of needlestick and sharps injuries and whether and to whom these incidents were reported. Stepwise regression was used to determine variables predicting whether injuries were reported. Results In total, 908 (23%) interventional radiologists completed at least a portion of the survey. Eight hundred fourteen (91%) of 895 respondents reported a prior needlestick injury, 583 (35%) of 895 reported at least one injury while treating an HIV-positive patient, and 626 (71%) of 884 reported prior training regarding needlestick injury. There was, on average, one needlestick for every 5 years of practice. Most needlestick or sharps injuries were self inflicted (711 [87%] of 817) and involved a hollow-bore device (464 [56%] of 824). Only 566 (66%) of 850 injuries were reported. The most common reasons for not reporting included perceived lack of utility of reporting (79 [28%] of 282), perceived low risk for injury (56 [20%] of 282), noncontaminated needle (53 [19%] of 282), too-lengthy reporting process (37 [13%] of 282), and associated stigma (23 [8%] of 282). Only 156 (25%) of 624 respondents informed their significant other. Stepwise regression assessing variables affecting the likelihood of reporting showed that male sex (P = .009), low-risk patient (P < .0001), self injury (P = .010), trainee status (P < .0001), and the total number of prior injuries (P = .019) were independent predictors of not reporting. Conclusion Needlestick injuries are ubiquitous among interventional radiologists and are often not reported. © RSNA, 2017 Online supplemental material is available for this article.

Match day: online search trends reflect growing interest in IR training.

Google Trends was used to characterize the relationship between the interventional radiology (IR) applicant pool and related Internet queries for "IR fellowship" from July 2006 to July 2013. Results were compared with National Residency Match Panel data by regression analysis and one-way analysis of variance. Search traffic for IR fellowship demonstrated a statistically significant linear annual increase (R(2) = 0.87; P = .0013). Total IR applicants increased by 184% (R(2) = 0.98; P = .0216). Search traffic was predictive of applicants for each match year (R(2) = 0.92; P = .0004) and programs filled (R(2) = 0.93; P = .0003). Internet queries mirror trainee professional interests, with significant increases in search traffic related to IR fellowship and strong correlation with growth in applicants.

Multispecialist Care and Mortality in Hepatocellular Carcinoma.

PURPOSE: Multidisciplinary physician care has increased for many cancers yet little evidence exists for hepatocellular carcinoma (HCC). The purpose of this study was to explore the association between multispecialist care and mortality in HCC. METHODS: Treated patients with an HCC primary diagnosis from 2000 to 2007 were studied using Surveillance, Epidemiology, and End Results-Medicare data. A surrogate variable for multidisciplinary care was defined-multispecialist care-as the number of disciplines among surgeons, radiology oncologist, intervention radiologist, hematologist/medical oncologist, gastroenterologist, and generalist in the pretreatment period. Multivariate survival analysis was conducted and adjusted for selection and survival bias. RESULTS: Of 3588 treated HCC patients, 1434 (40%) saw 1, 1343 (37%) saw 2, and 811 (23%) saw 3 or more specialists. Patients with multispecialist care received treatment that differed from patients who saw a single specialist. In propensity score-adjusted survival analysis, patients who saw 3 or more specialist types were associated with 10% (P=0.04) reduced mortality, compared with those who saw 1 specialist. When stratified by treatment received, patients on chemotherapy who saw 3 or more specialist types were associated with 28% (P=0.002) reduced mortality, compared with those who saw 1 specialist. CONCLUSIONS: Multispecialist care for treated HCC patients was associated with reduced mortality, particularly among chemotherapy recipients. While adjusting for selection and survival bias, our study is limited in capturing a causal relationship between coordinated multidisciplinary care and mortality. Our findings may provide support for the development of coordinated care delivery models but should be confirmed through more rigorous examination in future studies.

Quality of life assessment in interventional radiology.

The aim of this review was to describe quality of life (QoL) questionnaires relevant to interventional radiology. Interventional radiologists perform a large number of palliative procedures. The effect of these therapies on QoL is important. This is particularly true for cancer therapies where procedures with marginal survival benefits may result in tremendous QoL benefits. Image-guided minimally invasive procedures should be compared to invasive procedures, with respect to QoL, as part of comparative effectiveness assessment. A large number of questionnaires have been validated for measurement of overall and disease-specific quality of life. Use of applicable QoL assessments can aid in evaluating clinical outcomes and help to further substantiate the need for minimally invasive image-guided procedures.

Launching a permanent out-of-hour interventional radiology service: single-center experience from a German University Hospital.

PURPOSE: To evaluate the feasibility, frequency of use, types of intervention and labor costs of a formal round-the-clock interventional radiology on-call service. MATERIALS AND METHODS: In 11/2011 a formal and permanent out-of-hour interventional radiology rota in addition to the general radiology out-of-hour rota (OOHR) was established. We retrospectively screened the interventional radiology database for procedures completed outside regular working hours, reviewed all interventions and manually selected cases in which the on-call interventionist was called in from home. We determined the type, frequency of use and costs (€/year and procedure) of this service between 1/2012 and 12/2012. The referring physicians' (sub-) specialties were evaluated. RESULTS: During the 12-month period, the on-call interventionists (n = 3) performed 92 procedures OOH. The procedures included angiography and hemorrhage control (n = 36, 39.1 %), angiography and intervention for acute limb ischemia (n = 25, 27.2 %), percutaneous biliary drainage (PTCD) (n = 10, 10.9 %), angiography for non-occlusive ischemia (n = 7, 7.6 %), and other (n = 14, 15.3 %). The total labor costs for the OOHR were €â€Š42,312.21 (€â€Š32,982.60 lump sum for stand-by, €â€Šâ€Š9,329.61 for hours spent on procedures). The labor costs per procedure totaled €â€Š459.92. The referring physicians' specialties were general/visceral (n = 25), vascular surgery (n = 24), internal medicine (n = 21), cardiac/thoracic vascular (n = 9), trauma surgery (n = 5), urology (n = 5), and anesthesiology (n = 3). CONCLUSION: A formal interventional OOHR is practicable in a university hospital setting. Most procedures were requested by general, vascular, and thoracic surgery as well as internal medicine with a focus on hemorrhage control, treatment of acute limb ischemia, and PTCD. The overall labor costs for the OOHR appear moderate. KEY POINTS: • In a university setting an OOHR for IR is feasible.• Labor costs per procedure appear moderate.• Hemorrhage control and treatment of limb ischemia were the most frequent procedures. Citation Format: • Goltz JP, Janssen H, Petritsch B et al. Launching a Permanent Out-of-Hour Interventional Radiology Service: Single-Center Experience from a German University Hospital. Fortschr Röntgenstr 2014; 186: 136 - 141.

Central venous access: evolving roles of radiology and other specialties nationally over two decades.

PURPOSE: The aim of this study was to evaluate national trends in central venous access (CVA) procedures over 2 decades with regard to changing specialty group roles and places of service. METHODS: Aggregated claims data for temporary central venous catheter and long-term CVA device (CVAD) procedures were extracted from Medicare Physician/Supplier Procedure Summary Master Files from 1992 through 2011. Central venous catheter and CVAD procedure volumes by specialty group and place of service were studied. RESULTS: Between 1992 and 2011, temporary and long-term CVA placement procedures increased from 638,703 to 808,071 (+27%) and from 76,444 to 316,042 (+313%), respectively. For temporary central venous catheters, radiology (from 0.4% in 1992 to 32.6% in 2011) now exceeds anesthesiology (from 37% to 22%) and surgery (from 30.4% to 11.7%) as the dominant provider group. Surgery continues to dominate in placement and explantation of long-term CVADs (from 80.7% to 50.4% and from 81.6% to 47.7%, respectively), but radiology's share has grown enormously (from 0.7% to 37.6% and from 0.2% to 28.6%). Although volumes remain small (<10% of all procedures), midlevel practitioners have experienced >100-fold growth for most services. The inpatient hospital remains the dominant site for temporary CVA procedures (90.0% in 1992 and 81.2% in 2011), but the placement of long-term CVADs has shifted from the inpatient (from 68.9% to 45.2%) to hospital outpatient (from 26.9% to 44.3%) setting. In all hospital settings combined, radiologists place approximately half of all tunneled catheters and three-quarters all peripherally inserted central catheters. CONCLUSIONS: Over the past 2 decades, CVA procedures on Medicare beneficiaries have increased considerably. Radiology is now the dominant overall provider.

Capture of complexity of specialty care in pediatric cardiology by work RVU measures.

OBJECTIVE: We sought to determine the relationship between relative value units (RVUs) and intended measures of work in catheterization for congenital heart disease. METHODS: RVU was determined by matching RVU values to Current Procedural Terminology codes generated for cases performed at a single institution. Differences in median case duration, radiation exposure, adverse events, and RVU values by risk category and cases were assessed. Interventional case types were ranked from lowest to highest median RVU value, and correlations with case duration, radiation dose, and a cases-predicted probability of an adverse event were quantified with the Spearman rank correlation coefficient. RESULTS: Between January 2008 and December 2010, 3557 of 4011 cases were identified with an RVU and risk category designation, of which 2982 were assigned a case type. Median RVU values, radiation dose, and case duration increased with procedure risk category. Although all diagnostic cases had similar RVU values (median 10), adverse event rates ranged from 6% to 21% by age group (P < .001). Median RVU values ranged from 9 to 54 with the lowest in diagnostic and biopsy cases and increasing with isolated and then multiple interventions. Among interventional cases, no correlation existed between ranked RVU value and case duration, radiation dose, or adverse event probability (P = .13, P = .62, and P = .43, respectively). CONCLUSIONS: Time, skill, and stress inherent to performing catheterization procedures for congenital heart disease are not captured by measurement of RVU alone.

A single institution's 1-year experience with uterine fibroid embolization marketing.

PURPOSE: To assess the impact of various marketing techniques on the referral pattern for uterine fibroid embolization (UFE) at an academic interventional radiology practice over a 1-year period. MATERIALS AND METHODS: All referrals to the interventional radiology clinic for UFE from January 1, 2009, to December 31, 2009, were retrospectively reviewed. A standard intake sheet was completed by the interventional clinic secretary at the time of initial patient contact that included the source of the referral (radio, television, newspaper, mailing, Internet, physician, friend, other). All patients who proceeded to consultation were seen in the interventional radiology clinic by attending interventional radiologists in a university-based academic center. The referral pattern was analyzed with respect to the number of patients who contacted the clinic, the number of actual clinic visits, the number of magnetic resonance (MR) imaging examinations performed before and after the procedure, the total number of embolization cases performed, and the subsequent downstream revenue. RESULTS: During the 1-year period, 344 patients contacted the interventional radiology clinic regarding UFE resulting in 171 consultations and 100 pelvic MR imaging examinations performed before the procedure. Sixty-two patients proceeded to UFE, and 32 patients underwent follow-up pelvic MR imaging. These results show a significant increase from eight cases the previous year and are presumably attributable almost entirely to the directed marketing campaign. The marketing initiative consisted primarily of print and radio advertisements, with the latter being the most effective. The total advertising cost for the year was approximately $24,706, of which $20,520 was for radio advertisements. The radio advertisements generated 69% (237 of 344) of the referrals and 69% (43 of 62) of the UFE procedures. Using Medicare reimbursement rates, the radio advertisements generated $281,994 in UFE technical fees and $50,329 in MR imaging technical fees. CONCLUSIONS: Direct patient marketing techniques can promote significant growth for a fibroid embolization practice. In our market, radio advertisements proved to be the most cost-effective strategy.