Physician self-referral for imaging and the cost of chronic care for Medicare beneficiaries.

BACKGROUND: As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship between self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. OBJECTIVE: To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. RESEARCH DESIGN: Using Medicare's 5% Research Identifiable Files for 2004 to 2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and total episode cost, episode imaging cost, and episode nonimaging cost. Analyses were controlled for patient characteristics (eg, age and general health status), the condition's severity, and treating physician specialty. RESULTS: Self-referral in imaging was significantly (P < 0.01) associated with total episode costs in 41 of the 76 medical condition and imaging modality (computed tomography, magnetic resonance imaging, etc.) combinations studied. Total costs were higher in 38 combinations and lower in 3. Even nonimaging costs were much more often significantly higher (in 24 combinations) with self-referral than being lower (in 4 combinations). CONCLUSIONS: We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs.

Clarifying the relationship between nonradiologists' financial interest in imaging and their utilization of imaging.

OBJECTIVE: Several limitations and deficiencies have been identified in existing studies of physician financial interest in imaging that show financial interest is associated with more imaging. We conducted extensive quantitative analysis of seven deficiencies that have been identified. MATERIALS AND METHODS: Using Symmetry's Episode Grouper, we created episodes of care from all the 2004-2007 health care claims for a random 5% sample of Medicare fee-for-service beneficiaries. We compared utilization of imaging in nonhospital episodes having a nonradiologist physician who had a financial interest in imaging with utilization in episodes with no such physician. We studied 23 combinations of medical conditions with imaging modalities commonly used for these conditions. RESULTS: Across four different definitions of financial interest and the 23 combinations, the relative probability (risk ratio) of imaging was uniformly higher for episodes of physicians with a financial interest, predominantly at p < 0.001. The mean relative probability was 1.87. This mean was little affected by the definition of financial interest used or the definition of the physician deemed responsible for the imaging. Controlling for patient characteristics, illness severity, and physician specialty likewise had little effect. Physicians who had acquired a financial interest averaged a 49% increase in the odds of imaging relative to physicians who had not. Physicians with a financial interest in an imaging modality used other modalities more than did physicians without a financial interest in the index modality. The Deficit Reduction Act's 2007 payment reductions had little effect. CONCLUSION: A financial interest in imaging is associated with higher utilization, probably causally. Limiting nonradiologists' financial interest in imaging may be desirable.

Effect of advanced imaging technology on how biopsies are done and who does them.

PURPOSE: To assess national levels and trends in utilization of biopsy procedures during the past decade and investigate the relative roles of biopsy approaches (open, endoscopic, and percutaneous) and physician specialties. MATERIALS AND METHODS: Institutional review board approval was not necessary because only public domain data were used. Aggregated Medicare claims data were used to determine utilization of biopsies performed in 10 anatomic regions from 1997 to 2008. Utilization levels according to biopsy approach and anatomic region were calculated. Trends in the relative utilization of percutaneous needle biopsy (PNB) and imaging-guided percutaneous biopsy (IGPB) were assessed. The relative roles of radiologists and nonradiologists in the performance of all biopsies, PNBs, and IGPBs were evaluated. RESULTS: Biopsy procedures with all approaches increased from 1380 to 1945 biopsies per 100,000 Medicare enrollees between 1997 and 2008, which represents a compound annual growth rate (CAGR) of 3%. Utilization of non-PNBs fell, while the absolute level and relative share of PNBs increased. In 2008, 67% of all biopsies were performed by using a percutaneous route. IGPB as a percentage of all PNBs increased over time in the regions for which data were available. Radiology was the leading specialty providing biopsy services. The total number of biopsies performed by radiologists increased at a CAGR of 8%, and radiologists' share of all biopsies increased from 35% to 56%. CONCLUSION: During the past decade, there was continuing substitution away from invasive approaches and non-imaging-guided percutaneous approaches in favor of PNBs and IGPBs, likely related to increasing use of advanced imaging modalities for biopsy guidance. Consequently, radiologists are performing an increasing share of biopsies across all anatomic regions.

What factors affect the productivity and efficiency of physician practices?

BACKGROUND: Increasing the productivity and efficiency of physician practices could help relieve the rapid growth of US healthcare costs and the expected physician shortage. Radiology practices are an attractive specific focus for research on practices' productivity and efficiency because they are home to many purportedly productivity-enhancing operational technologies. This affords an opportunity to study the effect of production technology on physicians' output. As well, radiology is a leader in the general movement of physicians out of very small practices. And imaging is by the fastest-growing category of physician expenditure. RESEARCH DESIGN: Using data from 2003 to 2007 surveys of radiologists, we estimate a stochastic frontier model to study the effects of practice characteristics, such as work hours, practice size, and output mix, and technologies used in work production, on practices' productivity and efficiency. RESULTS: At the mean, the elasticities of output with respect to practice size and annual hours worked per full-time physician were 0.73 and 0.51, respectively. Some production technologies increase productivity by 15% to 20%; others generate no increase. Using "nighthawks"--ie, contracting out after-hours work to external firms that consolidate workflow--significantly increases practice efficiency. CONCLUSIONS: The general US trend toward larger practice size is unlikely to relieve cost or physician shortage pressures. The actual effect of purportedly productivity-enhancing operational technologies needs to be carefully evaluated before they are widely adopted. As the recently-developed innovations of nighthawks and hospitalists show, practices should give more attention to a possible choice to "buy," rather than "make," part of their output.

Who's underworked and who's overworked now? An update on radiologist shortage and surplus.

OBJECTIVE: The purpose of this study was to present an updated report on the radiologist surplus and shortage situation using a recently developed improved measure-namely, the extent to which radiologists desire less or more work if their income were to change by the same percentage as their workload. MATERIALS AND METHODS: Non-individually identifiable data from the American College of Radiology's (ACR's) 2007 Survey of Diagnostic Radiologists were used. Responses were weighted to be representative of all posttraining professionally active radiologists in the United States. Information is presented for all radiologists and according to such factors as type and size of practice, radiologist subspecialty, and geographic region. Multivariable regression analysis was used to identify the probable causal links between desired workload change and characteristics of radiologists and the practices where they work. Comparisons were made with ACR's similar 2003 Survey of Radiologists. RESULTS: The net average workload change sought in 2007 was an approximately 3% increase. In 2003, radiologists on average did not desire a statistically significant change in workload. Regression analysis for 2007 showed a pattern of relative shortages and surpluses that was generally, but not entirely, different from that found in 2003. CONCLUSION: The overall balance between the demand and the supply of radiologists shifted toward a surplus between 2003 and 2007. According to our measure, we judge there was a close balance in 2003, but a 3% surplus in 2007. The employment market seems generally, but not universally, to self-correct relative shortages and surpluses in individual geographic areas and subspecialties within a few years.

Imaging evaluation for suspected pulmonary embolism: what do emergency physicians and radiologists say?

OBJECTIVE: The utility of various imaging techniques and strategies for the diagnosis of pulmonary embolism has been studied in randomized control trials and extensively described in the literature. CT and ventilation-perfusion scintigraphy are the mainstays of diagnosis, and MRI is emerging. The purpose of this study was to assess the diagnostic approach to pulmonary embolism practiced by emergency physicians and advised by radiologists. MATERIALS AND METHODS: Questionnaires were sent to emergency physicians and radiologists in Pennsylvania. The questions covered diagnostic strategies for the detection of pulmonary embolism in the usual situations and in clinical circumstances in which the primary imaging technique is considered less desirable. RESULTS: Sixty-two radiologists and 52 emergency physicians completed the survey. Ninety percent of radiologists and 96% of emergency physicians answered that CT was their first-line choice for the diagnosis of pulmonary embolism. The use of ventilation-perfusion scintigraphy increased in the care of patients with renal failure and allergy to iodinated contrast material. MRI was chosen infrequently. CONCLUSION: CT is the overwhelmingly preferred technique for the diagnosis of pulmonary embolism. The role of ventilation-perfusion scintigraphy increases when the use of iodinated contrast material is contraindicated. MRI does not seem to have an important role in practice.

Frequency of use of imaging tests in the diagnosis of pulmonary embolism: effects of physician specialty, patient characteristics, and region.

OBJECTIVE: The purpose of this study was to ascertain whether clinical practice in diagnosing pulmonary embolism is consistent with recommendations in the literature and to explore variations in practice across site of care (e.g., emergency department), physician and patient characteristics, and geographic location. MATERIALS AND METHODS: Medicare 5% research identifiable files were analyzed. The cases of patients with emergency department visits or inpatient stays for a diagnosis of pulmonary embolism or for symptoms related to pulmonary embolism (shortness of breath, chest pain, and syncope) were identified. We determined the number of patients who underwent each type of relevant imaging test and evaluated variations in the first non-chest-radiographic test by site of care and treating physician specialty. Using logistic regression, we studied variations in the use of common imaging tests, exploring variations associated with patient characteristics, physician specialty, site of care, and geographic location. RESULTS: For patients in whom pulmonary embolism might have been suspected, the most common tests were echocardiography (26% of the patients), CT or CT angiography of the chest (11%), cardiac perfusion study (6.9%), and duplex ultrasound (7.3%). For patients with an inpatient diagnosis of pulmonary embolism, the most common tests were chest CT or CT angiography (49%), duplex ultrasound (18%), echocardiography (10.9%), and ventilation-perfusion scintigraphy (10.9%). For patients for whom pulmonary embolism might have been suspected, many large variations were found in practice patterns among physician specialties and geographic locations. There were fewer variations among patients with the inpatient diagnosis of pulmonary embolism. CONCLUSION: Physician practice in the diagnosis of pulmonary embolism is broadly consistent with recommendations. However, variations by physician specialty and geographic location may be evidence of inappropriate imaging.

Workload of radiologists in United States in 2006-2007 and trends since 1991-1992.

PURPOSE: To determine radiologists' workloads in 2006-2007, as measured by both procedures per full-time equivalent (FTE) radiologist and relative value units (RVUs) per FTE radiologist, and to discover trends since 1991-1992. MATERIALS AND METHODS: Non-individually identifiable data from the American College of Radiology (ACR) 2007 Survey of Radiologists were compared with data from previous ACR surveys; all surveys were weighted to make them nationally representative. Under National Institutes of Health rules for protection of human subjects, studies based on anonymized surveys do not require approval by an institutional review board. Workload according to individual practice characteristics, such as type (eg, academic, private, multispecialty) and setting, was tested for statistically significant differences from the average for all radiologists. Time trends and the independent effect on workload of practice characteristics were measured with regression analyses. Changes in average procedure complexity were calculated in physician work RVUs per Medicare procedure. RESULTS: In 2006-2007, the average annual workload per FTE radiologist was 14,900 procedures, an increase of 7% since 2002-2003 and 34.0% since 1991-1992. Annual RVUs per FTE radiologist were 10 200, an increase of 10% since 2002-2003 and 70.3% since 1991-1992. Academic practices performed about one-third fewer procedures per FTE radiologist than others. In most types of practice, radiologists in a 75th-percentile practice performed at least 65% more procedures annually than radiologists in a 25th-percentile practice. Regression analysis showed that practices that used external off-hours teleradiology services performed 27% more procedures than otherwise similar practices that did not use these services. CONCLUSION: Radiologists' workload continued to increase in recent years. Because there is much unexplained variation, averages or medians should not be used as norms. However, such statistics can help practices to understand how they compare with other, similar practices. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/2522081895/DC1.

Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources--1950-2007.

The U.S. National Council on Radiation Protection and Measurements and United Nations Scientific Committee on Effects of Atomic Radiation each conducted respective assessments of all radiation sources in the United States and worldwide. The goal of this article is to summarize and combine the results of these two publicly available surveys and to compare the results with historical information. In the United States in 2006, about 377 million diagnostic and interventional radiologic examinations and 18 million nuclear medicine examinations were performed. The United States accounts for about 12% of radiologic procedures and about one-half of nuclear medicine procedures performed worldwide. In the United States, the frequency of diagnostic radiologic examinations has increased almost 10-fold (1950-2006). The U.S. per-capita annual effective dose from medical procedures has increased about sixfold (0.5 mSv [1980] to 3.0 mSv [2006]). Worldwide estimates for 2000-2007 indicate that 3.6 billion medical procedures with ionizing radiation (3.1 billion diagnostic radiologic, 0.5 billion dental, and 37 million nuclear medicine examinations) are performed annually. Worldwide, the average annual per-capita effective dose from medicine (about 0.6 mSv of the total 3.0 mSv received from all sources) has approximately doubled in the past 10-15 years.

Radiology practices' use of external off-hours teleradiology services in 2007 and changes since 2003.

OBJECTIVE: Our objective is to report patterns of utilization of external off-hours teleradiology services (EOTSs) in 2007 and changes since 2003. MATERIALS AND METHODS: We analyzed non-individually identified data from the American College of Radiology's 2007 Survey of Member Radiologists and its 2003 Survey of Radiologists. Responses were weighted to be nationally representative of individual radiologists and radiology practices. We present descriptive statistics and multivariable regression analysis results on the use of EOTSs in 2007 and comparisons with 2003. RESULTS: Overall, 44% of all radiology practices in the United States reported using EOTSs in 2007. These practices included 45% of all U.S. radiologists. Out-of-practice teleradiology had been used by 15% of practices in 2003. Regression analysis indicates that, other practice characteristics being equal, in 2007, primarily academic practices had lower odds of using EOTSs than private radiology practices. Also, large practices (>or= 30 radiologists) had lower odds of using EOTSs than practices with 15-29 radiologists. Small practices (1-10 radiologists) had high odds, but nonmetropolitan practices did not. There were no significant differences by geographic region of the United States. CONCLUSION: Use of EOTSs was widespread by 2007, and it had been increasing rapidly in the preceding few years. Patterns of use were generally as might be expected except that nonmetropolitan practices did not have high odds of using EOTSs.

The actual role of CT and ventilation-perfusion scanning in workup for suspected pulmonary embolism: evidence from hospitals.

OBJECTIVE: Over the past two decades, CT has been found valuable in the diagnosis of pulmonary embolism (PE). We sought to ascertain the relative roles of CT and ventilation-perfusion (V/Q) scanning, the previously preferred technique, in the diagnosis of PE in recent practice and whether there is variation among hospital types. MATERIALS AND METHODS: Using the Medicare anonymized 5% of beneficiaries complete claims file for 2005, we studied the use of relevant CT and V/Q scanning in the evaluation of patients with a diagnosis of PE and of patients with symptoms that might have been due to PE (chest pain, syncope, difficulty breathing). In 2008, we surveyed the radiology departments of Pennsylvania hospitals about the use of CT and V/Q scanning for PE, service availability hours, and what equipment was used. RESULTS: In all data, we found that CT was used approximately six times as frequently as V/Q scanning. In the Medicare data, only small differences in frequency of use of CT and V/Q scanning were associated with hospital characteristics. Academic hospitals did not differ in a major way from other hospitals, nor did small or rural hospitals. In the survey, 97% of radiology departments reported that CT was available for evaluation of PE 24 hours a day 7 days a week. Ninety-three percent of departments reported V/Q scanning was available at some times; 77% reported V/Q available at all times. CONCLUSION: CT was a fully disseminated and dominant technique for the diagnosis of PE by 2005, and it was readily available at small and rural hospitals. The lack of availability of off-hours V/Q scanning at a substantial fraction of hospitals may be a problem for patients with contraindications to CT.

Nuclear medicine exposure in the United States, 2005-2007: preliminary results.

Medical radiation exposure of the U.S. population has not been systematically evaluated for almost 25 years. In 1982, the per-capita dose was estimated to be 0.54 mSv and the collective dose 124,000 person-Sv. The preliminary estimates of the National Council on Radiation Protection and Measurements Scientific Committee 6-2 medical subgroup are that, in 2006, the per-capita dose from all medical exposure (not including radiotherapy) had increased almost 600% to 3.0 mSv and the collective dose had increased more than 700% to approximately 900,000 person-Sv. >Nuclear medicine accounted for only about 2% of all procedures but 26% of the total collective dose from diagnostic studies in medicine. In 1982, the estimated number of nuclear medicine procedures was about 7.5 million. The per-capita effective dose from nuclear medicine was 0.14 mSv and the collective dose was 32,000 person Sv. By 2005, the estimated number of procedures had increased to about 19.6 million. The per-caput effective dose increased to about 0.75 mSv and the collective dose to about 220,000 person Sv. There also has been a marked shift in the type of procedures being performed with cardiac scanning accounting for about 70% of procedures.

Diagnostic radiologists' subspecialization and the new final board examination.

OBJECTIVE: Recognizing that subspecialization can consist of concentration in multiple fields as well as in a single main field, we conducted this study to profile in detail the subspecialization of diagnostic radiologists in the United States in ways that illuminate issues related to the American Board of Radiology plan for a new final examination. MATERIALS AND METHODS: We tabulated nonindividually identified data from the American College of Radiology 2003 Survey of Radiologists, a stratified random-sample mail survey with 1,924 responses and a 63% response rate. Respondents were guaranteed confidentiality. Responses were weighted to make them representative of all radiologists in the United States. RESULTS: Sixty-nine percent of respondents reported specializing at least to a small extent. If concentration in a field is defined as spending 10% or more of clinical work time in the field, 51% of radiologists concentrated in one or two fields, 24% in three or four fields, and 21% in more than four fields. An examination covering a radiologist's four most time-intensive fields would cover 80% of the clinical work of the median radiologist. However, the one fourth of radiologists whose work is most varied would have 40% or more not covered by the examination, but the one fourth with the most concentrated work would have 100% covered. CONCLUSION: Most radiologists concentrate in a few fields, making the American Board of Radiology plan for an examination that covers four fields--or fewer, at an examinee's discretion--a major step forward in recognizing the nature of current practice. Four fields, however, are too many for the practice patterns of many radiologists but too few for the practice patterns of a substantial minority. We offer for consideration more far-reaching reforms.

Prevalence of productivity-enhancing technologies in radiology.

OBJECTIVE: The objective of our study was to describe the prevalence of different operational technologies in radiology practices and to identify which characteristics of radiology practices are plausibly causal factors in a practice's use of a technology. MATERIALS AND METHODS: We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that guaranteed respondents' confidentiality and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists and radiology practices in the United States. We used univariate analysis and multiple logistic regression. RESULTS: In 2003, PACS, wet-reading telephone lines, film-hanging staff, and templates (standard report language) were each used in practices that encompassed approximately half of U.S. radiologists. In contrast, only 42% of radiologists were in practices that used nurse practitioners or physician assistants for tasks beyond what technologists may do, and only 18% were in practices that used speech recognition software (SRS). Twenty-one percent of radiologists were in practices reported to have neither film-hanging staff nor PACS. The percentage of practices (as opposed to radiologists) that used various technologies ranged from 13% for SRS to 49% for templates. Multiple logistic regression showed that, other factors equal, academic practices were particularly likely to use some of the technologies and solo practices and other small practices were particularly likely not to have some of the technologies. CONCLUSION: Most operational technologies are fairly widely diffused, but a surprising number of radiologists work without some basic supports.

Feasibility of using administrative claims data for cost-effectiveness analysis of a clinical trial.

OBJECTIVE: This study was performed retrospectively to determine if Medicare claims data could be used to evaluate the cost effectiveness, from a payer perspective, of different radiation treatment schedules evaluated in a national clinical trial. METHODS: Medicare costs from all providers and all places of service were obtained from the Centers for Medicare & Medicaid Services for patients treated in the period 1992-1996 on Radiation Therapy Oncology Group 90-03, and combined with data on outcomes from the trial. RESULTS: Of the 1,113 patients entered, Medicare cost data and clinical outcomes were available for 187 patients. Significant differences in tolerance of treatment and outcome were noted between patients with Medicare data included in the study and patients without Medicare data, and non-Medicare patients excluded from it. Ninety-five percent confidence ellipses on the incremental cost-effectiveness scatterplots crossed both axes, indicating non-significant differences in cost effectiveness between radiation treatment schedules. CONCLUSIONS: Claims data permit estimation of cost effectiveness, but Medicare data provide inadequate representation of results applicable to patients from the general population.

The state of teleradiology in 2003 and changes since 1999.

OBJECTIVE: The purpose of our study is to describe in detail the use of teleradiology in 2003 and to report on changes since 1999 in this rapidly evolving field. MATERIALS AND METHODS: We analyze non-individually identified data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample mail survey that achieved a response rate of 63%, and data from the American College of Radiology's 1999 Survey of Practices. Responses were weighted to represent the distribution of individual radiologists and radiology practices nationwide. We present descriptive statistics and multivariable regression analysis results on the prevalence and uses of teleradiology in 2003 and comparisons with 1999. RESULTS: Overall, 67% of all radiology practices in the United States, which included 78% of all U.S. radiologists, reported using teleradiology. A significant increase (p < 0.05) was seen in the prevalence of teleradiology or PACS, from 58% of practices in 1999 to 73% in 2003. Regression results indicate that, other practice characteristics being equal, in 2003, primarily academic practices were less likely to use teleradiology than private radiology practices, and medium-sized practices (5-14 radiologists) were more likely to have teleradiology than larger ones. In practices using teleradiology, home was the most frequent receiving site in both 1999 (81%) and 2003 (75%), the percentages being not significantly different. CONCLUSION: Already a fixture of radiology practice in 1999, teleradiology increased in prevalence substantially by 2003. The primary use of teleradiology, transmission of images to home, did not change, suggesting that easing the burden of call remains the main use of teleradiology.

A portrait of breast imaging specialists and of the interpretation of mammography in the United States.

OBJECTIVE: Because of the importance of breast imaging as a radiology subspecialty and concerns about malpractice, the purpose of our study is to provide a detailed portrait of breast imaging specialists, their professional activities and practices, and information on all radiologists who interpret mammograms. MATERIALS AND METHODS: We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a large, stratified random sample survey that achieved a 63% response. Responses were weighted to make them representative of all radiologists in the United States. RESULTS: Approximately 10% of all radiologists, or 2,700-2,800 radiologists, are breast imaging specialists, but 61% of radiologists interpret mammograms, and only approximately 30% of mammograms are interpreted by breast imaging specialists. Of radiologists who reported that breast imaging was their primary specialty, only 21% took a fellowship in the field (much lower than for other subspecialties), 59% spent > or = 50% of their clinical work time in the specialty, 82% interpret > or = 2,000 mammograms annually, and only 11% (also well below other subspecialties) report that the main subspecialty society (the Society of Breast Imaging) is one of the two most important professional organizations for them. On average, breast imaging specialists, like other radiologists, report that their workload is about as heavy as desired. Their level of enjoyment of radiology does not differ significantly from average. CONCLUSION: Breast imaging appears not to be as strongly organized to raise awareness of and support for its problems as are other subspecialties. Although others find evidence of likely future problems, breast imaging specialists are not currently overworked or less satisfied in their profession than other radiologists, despite relatively low revenue generation and a particularly high risk of a malpractice lawsuit.

Radiologists' reading times using PACS and using films: one practice's experience.

RATIONALE AND OBJECTIVES: To measure the change in radiologists' productivity in terms of interpretation time per examination when using picture archiving and communication system (PACS) workstations in a particular private practice, Valley Radiologists, Ltd, as part of a feasibility study and subsequent business plan to implement a digital enterprise. MATERIALS AND METHODS: Time to process a series of exams was measured for 18 radiologists during an uninterrupted period of a working day. Radiologists in the practice served in multiple locations. The data were analyzed in aggregate and by modality (plain film, ultrasound, computed tomography, and magnetic resonance imaging). Average time per exam, with and without PACS, was measured for each modality. Regression analysis was used to determine the independent effect of PACS on radiologist productivity. RESULTS: The mean time to process an exam was 1.4 minutes (SE = 0.04) for plain film, 1.96 minutes (SE = 0.14) for ultrasound, 5.08 minutes (SE = 0.44) for computed tomography, and 6.83 minutes (SE = 0.31) for magnetic resonance imaging. Regression results indicate that PACS had no effect on the time taken to read a series of exams. CONCLUSIONS: When considering a PACS purchase or implementation, decrease in radiologists' time to process an examination may not be realized. In this specific practice setting, we did not find evidence that PACS workstations alone, without any other changes in workflow design, improved radiologists' interpretation time.

What characterizes academic radiology departments that secure large amounts of external funding for research?

RATIONALE AND OBJECTIVES: We sought to identify factors associated with high levels of external research funding in order to provide departments with information that may help them increase their external research funding. MATERIALS AND METHODS: National Institutes of Health (NIH) data on grants were analyzed to identify the 72 radiology departments receiving funds for diagnostic radiology research. A survey was sent to these departments. We placed them into one of three categories according to total NIH funds to the department. The survey asked about department characteristics such as size; breakdown of full-time faculty among MDs, MD/PhDs, and PhDs; research space; equipment type; and number and types of trainees. RESULTS: Thirty-nine surveys were returned, including 20 from the 21 departments with the most NIH funding. PhDs played a larger role in the most research funding-intensive departments than in others. These departments also were more likely than others to give protected time to all MDs and to devote over 5% of clinical revenues to research, and they had a lower clinical workload per MD. NIH was the source of 70% of their research funding, The role of MD/PhDs and research space per 1000 research dollars did not vary by research intensity. CONCLUSIONS: These findings only demonstrate associations; they do not show the direction of causality. Nonetheless, they suggest what departments need to do if they wish to increase their external research funding.

Data from a professional society placement service as a measure of the employment market for radiation oncologists.

PURPOSE: To aid in understanding the employment market for radiation oncologists, we present annual data for 1991 to 2000 from the American College of Radiology's placement service, the Professional Bureau. This data series is twice as long as any previously available. Secondarily, we compare these data with other data on the employment market. METHODS AND MATERIALS: The trends in job listings, job seekers, and listings per seeker in the Bureau are tabulated and graphed. We calculate correlations and graph relationships between the last of these and measures of the job market calculated from annual surveys. RESULTS: Bureau data show listings per job seeker declined from 0.53 in 1991 to a nadir of 0.30 in 1995 and then recovered to 1.48 in 2000. Bureau listings and job seekers, each considered separately, show a similar pattern of job market decline and then eventual recovery to better than the 1991 situation. Bureau listings per job seeker correlate 0.895 with a survey-derived index of program directors' perceptions of the job market, but statistical significance is limited (p = 0.04), because very few years of survey data are available. CONCLUSIONS: The employment market for radiation oncologists weakened in the first half of the 1990s, as had been widely reported; we present the first systematic data showing this. Data from a professional society placement service provide useful and inexpensive information on the employment market.