's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest case quizzes and conference reports. Review the slideshow below to see this week's top content:

Diagnostic Imaging's Weekly Scan: September 18-September 24

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Catch up on the top radiology content of the past week.

In order to reflect the most recent research on the use of computed tomography (CT) in cardiovascular imaging, the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR), the North America Society of Cardiovascular Imaging (NASCI) and the American College of Cardiology (ACC) have unveiled an updated Coronary Artery Disease Reporting and Data System (CAD-RADS), also referred to as CAD-RADS™ 2.0.

, include an emphasis on the reporting of coronary plaque burden and ischemia findings on coronary CT angiography (CCTA). Here are five takeaways from the consensus recommendations.

1. Acknowledging emerging techniques for assessing CCTA and physiologic aspects of decision making with respect to coronary revascularization, the consensus panel recommended an “I” modifier to indicate testing for ischemia via computed tomography fractional flow reserve (CT-FFR) or stress computed tomography perfusion (Stress-CTP).

2. The consensus panel noted multiple benefits of utilizing stress myocardial CTP. In addition to enabling radiologists to discern fixed perfusion effects due to prior myocardial infarction (MI), stress myocardial CTP can prevent downstream testing by allowing radiologists to potentially exclude myocardial ischemia in cases of moderate coronary stenosis or severe coronary stenosis in the presence of mixed or densely calcified plaque.

In regard to stress CTP interpretation, the consensus authors recommended an “I+” modifier to denote myocardial ischemia or peri-infarct ischemia. An “I-” modifier could be employed when there is no detected ischemia, a previously fixed myocardial infarct or an ischemic segment that does not have a concordant anatomic lesion, according to the consensus panel. When there are indeterminate or questionable findings, or a high likelihood of false-positive results with stress CTP, the consensus authors recommended a “I=/-” modifier.

3. Noting recent research that has suggested a link between characteristics of high-risk plaque (previously referred to as vulnerable plaque) viewed on CCTA and acute coronary syndrome (ACS), the consensus authors said there is a need for a “HRP” modifier to denote high-risk plaque.

If CCTA reveals two or more high-risk plaque features, ranging from low attenuation plaque (less than 30 Hounsfield units) and positive remodeling to the “napkin ring sign” and spotty calcifications, the consensus panel suggested using the “HRP” modifier in these cases.

4. In order to reflect recent studies that have detailed a robust association between the coronary plaque amount found on CCTA and incident coronary heart disease, the consensus authors added the categories P1 to P4 to designate mild, moderate, severe and extensive coronary plaque. While reporting methods for coronary plaque burden assessment include qualitative visual estimates of plaque in coronary vessels, quantitative assessment of total coronary plaque, a segment involvement score (SIS) and coronary calcium (CAC) testing, the consensus authors maintained that CAC and SIS may provide more reproducible approaches for categorizing the amount of coronary plaque.

5. While non-atherosclerotic etiologies of coronary abnormalities, such as anomalous coronary arteries or coronary artery aneurysms, can be key considerations in a differential diagnosis, the consensus panel noted that CAD-RAD scores are commonly not utilized in these cases.

Accordingly, the consensus authors recommend using an “E” modifier to document exceptions in the form of non-atherosclerotic causes of coronary obstruction with CAD-RADS reporting. Not only could the E modifier aid in tracking these etiologies, it could also signal to referring clinicians that the case in question involves a coronary abnormality that may fall outside of the traditional CAD-RADS classification adherence to atherosclerotic coronary artery disease, according to the consensus panel.

Articles

In an update of the original CAD-RADS™ consensus document on coronary artery disease (CAD) imaging and reporting published in 2016, expert panelists incorporated emerging evidence for CAD-RADS 2.0 to recommend new categorization for coronary plaque burden and suggested modifiers to reflect the level of ischemia and high-risk plaque in patients undergoing cardiac computed tomography.

Five Takeaways from New Consensus Recommendations for CT Imaging and Reporting in Patients with CAD

The Food and Drug Administration (FDA) has granted 510(k) clearance to QT Imaging’s ultrasound-based device QTscan for fibroglandular volume calculations that can help clinicians assess the effectiveness of non-surgical breast cancer treatment.

In addition to aiding in the assessment of breast cancer risk, QT Imaging said the 

ability of QTscan to calculate the ratio of fibroglandular volume to total breast volume

 enables radiologists to gauge the progress of non-surgical therapies for patients undergoing treatment for breast cancer. One can also utilize the fibroglandular volume ratio to monitor the use of selective hormone receptor modulation treatment, according to the company.

QT Imaging emphasized that the QTscan is the first ultrasound-based modality to receive FDA clearance for the quantification of fibroglandular volume.

Elaine Iuanow, M.D., a breast imaging specialist, said the calculation of fibroglandular volume with QTscan is an “exciting” advance for the imaging and treatment of breast care patients.

“The ability to determine a therapeutic clinical response using a quantitative volumetric method is crucial for effective and timely treatment of breast cancer and for patients at high risk for developing breast cancer who are receiving hormonal therapy,” noted Dr. Iuanow, a consultant for QT Imaging.

Offering a combination of transmission ultrasound and reflection ultrasound, the QTscan provides “highly accurate” 3D imaging of breast tissue, according to QT Imaging. The company maintained the lack of radiation or compression with the QTscan device allows for more frequent monitoring of adjuvant chemotherapy or radiation therapy in the treatment of breast cancer.

The ability of QT Imaging’s QTscan, a quantitative transmission ultrasound modality, to calculate the ratio of fibroglandular volume to total breast volume may facilitate assessment of ongoing breast cancer treatments or selective hormone receptor modulation therapies.

Ultrasound-Based Breast Imaging Device Gets FDA Clearance for Fibroglandular Volume Metrics

Gadopiclenol, a new magnetic resonance imaging (MRI) contrast agent that offers high relaxivity and reduced dosing of gadolinium, has been approved by the Food and Drug Administration (FDA).

Approved for use with MRI in adults and pediatric patients two years of age or older, gadopiclenol is a macrocyclic gadolinium-based contrast agent that aids in the diagnosis of lesions with abnormal vascularity in the brain, spine, abdomen, and other areas of the body.

Recently published research demonstrated that gadopiclenol provides contrast enhancement and diagnostic efficacy at half of the gadolinium dosing of other gadolinium-based contrast agents (GBCAs) such as gadobutrol and gadobenate dimeglumine.

Co-developed by Bracco Diagnostics and Guerbet, gadopiclenol will be manufactured and marketed as Vueway™ (Bracco Diagnostics) and Elucirem™ (Guerbet).

Alberto Spinazzi, M.D., the chief medical and regulatory officer at Bracco Diagnostics, said gadopiclenol is “a first of its kind MRI agent that delivers the highest relaxivity and highest kinetic stability of all GBCAs on the market today.”

1. Bracco Diagnostics. Bracco announces FDA approval of gadopiclenol injection, a new macrocyclic high-relaxivity gadolinium-based contrast agent which will be commercialized as VUEWAY™ (gadopiclenol) injection and VUEWAY™ (gadopiclenol) phamarcy bulk package by Bracco. Cision PR Newswire. Available at: 

https://www.prnewswire.com/news-releases/bracco-announces-fda-approval-of-gadopiclenol-injection-a-new-macrocyclic-high-relaxivity-gadolinium-based-contrast-agent-which-will-be-commercialized-as-vueway-gadopiclenol-injection-and-vueway-gadopiclenol-pharmacy-bulk-p-301630124.html

 . Published September 21, 2022. Accessed September 21, 2022.

2. Bendszus M, Roberts D, Kolumban B, et al. Dose finding study of gadopiclenol, a new macrocyclic contrast agent, in MRI of central nervous system. 

3. Guerbet. Guerbet announces U.S. Food and Drug Administration (FDA) approval of Elucirem™ (gadopiclenol) injection for use in contrast-enhanced MRI. Cision PR Newswire. Available at: 

https://www.prnewswire.com/news-releases/guerbet-announces-us-food-and-drug-administration-fda-approval-of-elucirem-gadopiclenol-injection-for-use-in-contrast-enhanced-mri-301630085.html 

. Published September 21, 2022. Accessed September 21, 2022. 

Requiring only half of the gadolinium dose of current non-specific gadolinium-based contrast agents (GBCAs), gadopiclenol can be utilized with magnetic resonance imaging (MRI) to help detect lesions with abnormal vascularity in the central nervous system and other areas of the body.

FDA Approves New MRI Contrast Agent Gadopiclenol

Increases in breast density over three consecutive biennial mammography screenings led to significantly elevated breast cancer risks for pre- and postmenopausal women, according to a new longitudinal retrospective study of over 2.2 million Korean women who had no prior history of breast cancer.

Drawing from a Korean National Health Insurance Service database, the study authors retrospectively reviewed data from 2,253,963 women, including 1,356,846 women with fatty breasts at baseline and 897,117 women who had dense breasts at the baseline of the study.

, the researchers noted that premenopausal women with fatty breasts at the first mammography exam and a subsequent fatty to dense presentation for the second and third exams had a 1.45 hazard ratio for breast cancer in comparison to women who maintained fatty breasts throughout the three biennial screenings. Those with an initially fatty to dense to fatty progression had a 1.53 hazard ratio and those with initially fatty to dense-to-dense breast progression had a 1.93 hazard ratio according to the study.

In comparison to postmenopausal women with stable breast density, postmenopausal women with fatty breasts at baseline and a subsequent dense-to-dense progression had a 1.62 hazard ratio for breast cancer, according to the study.

For premenopausal women with dense breasts at baseline, the researchers noted that those with a subsequent fatty-to-fatty breast progression had a greater than 20 percent reduction in breast cancer risk (hazard ratio of 0.62) in comparison to those with a fatty-to-dense progression (hazard ratio of 0.85) or a dense-to-fatty progression (hazard ratio of 0.84).

“Cumulative evidence from this study and those of previous studies suggest that shifting the distribution of dense breasts to fatty or scattered fibroglandular breast density would considerably reduce breast cancer risk,” wrote study co-author Boyoung Park, M.D., Ph.D., who is affiliated with the Department of Preventive Medicine at the Hanyang University College of Medicine in Seoul, Republic of Korea, and colleagues. “Reductions in breast density among women with dense breasts could be achieved through increased breastfeeding and primary prevention with tamoxifen citrate for women at the highest risk.”

, Masako Kataoka, M.D., Ph.D. praised the subgroup analysis from the large study cohort and the inclusion of covariates of breast cancer risk that facilitated appropriate adjustments to hazard ratios.

“These epidemiologic analyses, which are often missing in imaging-based papers, are important to demonstrate the density-related factors are independent risk factors,” noted Dr. Kataoka, the chief of breast imaging and a lecturer in diagnostic imaging and nuclear medicine at Kyoto University Graduate School of Medicine in Kyoto, Japan.

“Reductions in breast density among women with dense breasts would avert 28.9% of breast cancers among premenopausal women and 14.4% among postmenopausal women, which would prevent more events than reducing any other risk factor in this study,” emphasized Park and colleagues.

In regard to study limitations, the authors noted the study cohort did not include women under the age of 40, which prohibited assessment of breast cancer risk in younger women with dense breasts. They also pointed out that information about genetic or molecular factors was not available. Employing the four categories of BI-RADS to assess breast density, Park and colleagues said they did not distinguish whether benign lesions were included in breast density assessments. The study authors also acknowledged a mixture of single and double reads of mammograms from the study database.

In a retrospective review involving over 2.2 million women with three consecutive biennial mammography screenings and no history of breast cancer, researchers noted that for premenopausal women with fatty breasts at baseline, increasing breast density at subsequent screenings led to significantly elevated hazard ratios ranging from 1.45 to 1.93 for the risk of breast cancer.

New Mammography Study Examines Association Between Breast Density Changes and Breast Cancer Risk

From entertainment to commerce, artificial intelligence (AI) is making a difference in many aspects of life and has the power to advance diagnostics. Next-generation healthcare technology has begun implementing many AI-powered tools to improve efficacy and patient safety, and enhance the clinician experience.

There are several image acquisition and analysis capabilities that can be enhanced by an AI application for each task.

• Classification – identifying objects that are present in the scan

• Segmentation – locating organ boundaries

• Navigation – visualizing how to best acquire an optimal scan

• Quality assessment – determining if a diagnosis can be made based on the scan

• Diagnosis – reviewing what is wrong with the imaged object

Nearly every woman requires an ultrasound at some point during their care. There is huge potential for AI to assist in repetitive tasks and provide promising workload-changing advances with the use of ultrasound in obstetrics and gynecologic (OB/GYN) care.

, AI has had little impact on the field of OB/GYN thus far.

 However, it is on track to make waves within the sector. Recently there’s been a push for collaboration between AI developers and ultrasound professionals.

 Medical device companies have listened to this call to action and have begun innovating and implementing AI technology within ultrasound solutions for women’s health.

It is critical to monitor and observe fetal growth and development throughout pregnancy. Ultrasound examination is one method of tracking these changes.

 One of the conditions that clinicians monitor for is congenital heart disease (CHD), which is one of the leading organ-specific birth defects as well as the leading cause of infant morbidity and mortality from congenital malformations. In regard to prenatal detection of CHD, two-dimensional sonography delivers low levels of accuracy – only 15 to 39 percent – due to the complex anatomy and small size of the fetal heart.

To address this, tools and solutions using AI have been developed to enhance visualization and allow physicians to provide a CHD diagnosis more accurately.

 One tool, known as Fetal Intelligent Navigation Echocardiography (FINE), integrates spatiotemporal image correlation volume data sets using “intelligent navigation” technology to simplify fetal cardiac examinations and reduce operator dependency.

Researchers have investigated FINE over the past several years to determine accuracy. In a 2020 publication, Yeo and Romero found that FINE:

• Helps healthcare providers assess both normal and abnormal fetal hearts.

• Can automatically provide nine standard fetal echocardiography views in 96 to 100 percent of normal fetal heart cases.

• Can provide clinically useful information about cardiac structure and function in both normal and abnormal fetal hearts when color Doppler is activated.

• Has high sensitivity (98 percent) and specificity (93 percent) for the detection of CHD.

FINE technology, which is exclusively known as 5D Heart™ on Samsung ultrasound systems, was created to provide high-quality prenatal screening and diagnosis of CHD to clinicians and pregnant mothers.

Since obstetric ultrasound is time-consuming, the use of AI may also reduce exam time and improve workflow.

 Working in very fast-paced environments, clinicians are looking for accuracy and speed in diagnostic tools. From administrative workflow to clinical documentation and patient outreach, AI can help with all aspects of the diagnostic process.

What The Future Holds for AI and Ultrasound Imaging

Experts and research trends continue to show how AI will revolutionize the medical imaging sector in the future. One recent study published in the 

 estimated that AI applications have the potential to cut annual U.S. healthcare costs by $150 billion in 2026.

Some worry that AI algorithms will replace health-care providers but they will actually act as clinical support tools. By working in tandem with AI algorithms, physicians can better ensure that tests are performed accurately, and the correct diagnosis is reached. To improve patient care and reduce costs, we must encourage and provide support for providers to learn more about AI applications and fully engage them in practice. We expect to continue seeing new and updated AI tools to stay at the forefront of the imaging sector and OB/GYN care.

1. Bohr A, Memarzadeh K. The rise of artificial intelligence in healthcare applications. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325854/

 . Published June 26, 2020. Accessed September 20, 2022.

2. Drukker L, Noble JA, Papageorghiou AT. Introduction to artificial intelligence in ultrasound imaging in obstetrics and gynecology. 

3. Chen Z, Liu Z, Du M, Wang Z Artificial intelligence in obstetric ultrasound: an update and future applications. 

https://www.frontiersin.org/articles/10.3389/fmed.2021.733468/full

 . Published August 27, 2021. Accessed September 20, 2022.

4. Yeo L, Romero R. New and advanced features of fetal intelligent navigation echocardiography (FINE) or 5D heart. 

Given the influx of artificial intelligence (AI)-powered tools in health care, this author examines the potential intersection of this technology and ultrasound examination in obstetrics and gynecologic (OB/GYN) care

Emerging Trends in AI, Ultrasound and OB/GYN Care

Could the addition of pre-biopsy magnetic resonance imaging (MRI) enhance conventional prostate cancer screening?

, suggest the combination of MRI and prostate-specific antigen (PSA) testing could prevent prostate biopsy in more than 88 percent of patients without prostate cancer.

In the study of 881 patients who had a pre-biopsy MRI and PSA testing due to suspicion for prostate cancer, 220 patients were diagnosed with prostate cancer and 162 patients had clinically significant cancer. For clinically significant cancer (CSC), the researchers found the combination of pre-biopsy MRI and PSA testing had a significantly higher positive predictive value (PPV) (0.567) than a PSA level greater than or equal to 4 ng/mL alone (0.0219).

While the study authors noted a greater than 25 percent decrease in the sensitivity rate for the tandem of MRI and PSA (0.679 in comparison to 0.938 for PSA alone), they also found the combination had more than triple the specificity rate for CSC (0.833) in comparison to sole reliance on a PSA level greater than or equal to 4 ng/mL (0.248).

“The results meant that more than 88% of patients without prostate cancer could avoid prostate biopsy using the PSA and MRI strategy,” wrote lead study author Moon Hyung Choi, M.D., Ph.D., who is affiliated with the Department of Radiology at the College of Medicine at the Catholic University of Korea, and colleagues. “ROC (receiver operating characteristic) curves of the PSA alone and the (PSA and MRI combination) also showed the difference between the two.”

However, Choi and colleagues did caution against relying solely on MRI results when determining whether a prostate biopsy is necessary. When they employed cutoff values of PI-RADS greater than or equal to 3 and a PSA level greater than or equal to 3 ng/mL, the study authors found that MRI missed 36 percent of all cancers and 30 percent of CSCs.

“Therefore, care should be taken to determine whether to perform biopsy based solely on MRI results,” added Choi and colleagues. “Even in patients with negative MRI, it is necessary to consider additional clinical information to decide on prostate biopsy and to follow-up carefully.”

Yet the researchers did find that as the PSA cutoff level increased, there were corresponding increases in PPVs and decreases in negative predictive values (NPVs) for PSA and MRI.

“For example, even when we considered patients with PSA 

10 ng/mL as positive, only 44% of the patients had prostate cancer, which meant that the PPV of PSA was 0.44. In those patients, the PPV of MRI was much higher (0.86) as MRI could classify the patients according to the likelihood of prostate cancer,” pointed out Choi and colleagues.

In regard to study limitations, the authors noted the emphasis on per patient analyses as opposed to per lesion analyses. Acknowledging the shortcomings of the retrospective study design, the researchers cited a lack of consistency with radiology reports due to the varied experience of those assessing the prostate MRI scans, and a lack of access to PI-RADS reports for some of the study patients. Despite 3T MRI having advantages over 1.5T MRI, Choi and colleagues pointed out that 1.5T MRI scanners were utilized for nearly 70 percent of the MRI exams in the study.

Emerging research suggests that combining pre-biopsy magnetic resonance imaging (MRI) with prostate-specific antigen (PSA) testing more than triples the specificity rate for detecting clinically significant prostate cancer in comparison to sole reliance on a PSA level greater than or equal to 4 ng/mL.

Study Shows Adjunctive Benefit of Pre-Biopsy MRI for Diagnosing Prostate Cancer

The Food and Drug Administration (FDA) has granted 510(k) clearance to version 2.1 of the ClearPoint Neuro Navigation software, which can be utilized in conjunction with magnetic resonance imaging (MRI) for stereotactic guidance during neurosurgical procedures.

Reserved for use with 1.5 and 3.0 Tesla MRI scanners, 

the latest version of the ClearPoint Neuro Navigation software

 features trajectory planning tools, improved detail of imaging data sets and other technical improvements to enhance neurosurgical workflows, according to the company.

ClearPoint Neuro said the software, which facilitates the use and placement of instruments and devices in neurosurgical procedures, can be utilized for biopsy procedures as well as catheter and electrode insertion, including lead placement for deep brain stimulation.

“In addition to offering new image visualization capabilities and performance improvements, this version offers a rich set of functionalities which will strengthen an already comprehensive set of trajectory planning and guidance tools within the software,” noted Tim Orr, a vice president of software engineering at ClearPoint Neuro. “Over the years of developing an image-guided platform for neurosurgical procedures, we have paid very close attention to the differing workflows that clinicians have used within our system and have incorporated several important features in this version which we believe will better optimize their interoperative clinical workflows.”

ClearPoint Neuro noted the new version of the Neuro Navigation software, currently in limited market release, will initially be available for those who participate in the company’s Pathfinder program. This program cultivates the discovery of innovations in patient care, according to ClearPoint Neuro.

Version 2.1 of the ClearPoint Neuro Navigation software reportedly offers enhanced imaging and new trajectory planning tools for neurosurgical procedures.

New Version of Adjunctive MRI Neuroimaging Software Gets FDA Nod

Emerging research out of Japan suggests that women and those who have had the Moderna COVID-19 vaccine may be more predisposed to have the vaccine-related side effect of axillary lymphadenopathy.

In a study of 433 people who had second doses of either the Moderna COVID-19 vaccine (43) or the Pfizer-BioNtech COVID-19 vaccine (390), researchers reviewed pre- and post-vaccination chest magnetic resonance imaging (MRI). The mean age of the study population was 65 years of age, and the cohort was comprised of 300 men and 133 women, according to the study, which was recently published in 

The study authors found that 40 percent of those who had the Moderna vaccine (17 of 43 study participants) developed axillary lymphadenopathy in comparison to 19 percent of study participants who had the Pfizer-BioNtech vaccine. Those who developed axillary lymphadenopathy were five years younger on average (61 years of age) in comparison to those without the side effect (66 years of age), according to the research. The researchers also found that 29 percent of women participants (39 of 133 women) developed axillary lymphadenopathy in comparison to 17 percent of men in the study cohort (51 of 300 men).

“This female predominance may indicate that females are more hypersensitive to COVID-19 vaccines just as females are more likely to develop delayed localized cutaneous reactions to the Moderna vaccine … and hypersensitivity to other vaccines,” wrote study co-author Osamu Abe, M.D., Ph.D., who is affiliated with the Division of Diagnostic Radiology at the University of Tokyo Hospital in Japan, and colleagues.

Sixty-five percent of patients with post-vaccine axillary lymphadenopathy developed the side effect within two weeks after second dose administration of COVID-19 vaccination, according to the study. Researchers noted the prevalence declined to 40 percent 15 to 28 days after the second vaccination dose and to less than 10 percent more than 56 days after the second vaccination dose.

While noting an overall 21 percent incidence of COVID-19 vaccine-related axillary lymphadenopathy in this study population, Abe and colleagues also pointed out the gradual downward trend in prevalence of the side effect within two months after the second vaccination dose. Accordingly, they advised postponing non-urgent chest imaging in this population.

“In particular at 1-14 days after vaccination, a high prevalence of lymphadenopathy may cause many false positives for malignancy and heighten anxiety of examinees,” noted Abe and colleagues. “Recommendations and guidelines should be revised for more appropriate duration of postponement and follow-up strategies based on accumulated knowledge including our results.”

In regard to study limitations, the authors note the study was conducted at one institution in Japan. They also pointed out that the study cohort was an older population (mean age of 65) due to prioritization of vaccine administration for senior citizens in Japan and that the majority of the participants were of Asian ethnicity.

In a new study looking at the development of axillary lymphadenopathy after a second dose of COVID-19 vaccination, researchers found that those who had the Moderna COVID-19 vaccine were 21 percent more likely to have the post-vaccine side effect in comparison to those who had the Pfizer-BioNtech COVID-19 vaccine. 

Post-Vaccine Axillary Lymphadenopathy: What a New Chest MRI Study Reveals

Eric Postal, MD, is a diagnostic radiologist with the University of Pittsburgh Medical Center. 

A prospective teleradiologist recently posted on one of the social media outlets I prowl. Still in residency, he wanted to know what sort of fellowship, if any, would be valuable in that line of work since, as he put it, there aren’t any programs for telerad.

That last bit gave me a chuckle. Considering the lengths to which many academic types will go to carve out personal niches, why hasn’t anybody put forth a formal telerad fellowship? Surely, some entity would consider it worth the bragging rights if only to be the first one.

I could envision it. To properly train people for working in telerad, you would force them to work overnights, seven days on/seven days off, and constantly tell them to read more cases, faster, and with greater accuracy. Of course, they would need to “practice” the tele lifestyle by never actually physically showing up in your facility.

One of the funny things I have noticed over time is that if I think about how ridiculous/stupid/laughable an idea is, I can wind up taking it more seriously. It reminds me of a psychological experiment in which subjects were given the task of representing the opposite of their usual political views for a few weeks. Afterward, a surprising number of them reported that their views shifted as result of the play-acting.

(Editor’s note: For related articles, see “

Teleradiologist Overcalls and Hedging: We Are What You Make Us

Issues and Answers with Outsourced Teleradiology Night Coverage.

The more I thought about how absurd a telerad fellowship would be, the more I came to realize it could actually be a valuable experience, perhaps more so than some other radiology fellowships I have seen out there.

I won’t poke at any particular subspecialty or institution. Let’s just say that a lot of fellowships seem to be a matter of doing more of the work already done during four years of residency. Granted, additional experience is valuable, especially if the subspecialists in your fellowship are better than their counterparts wherever you did your residency program, but how often does a fellow really do or learn something that had not been doable/learnable during his earlier training?

By contrast, the telerad fellowship I imagined would have trainees doing things truly new to them in addition to getting well prepped for a subsequent career of remote radwork. The more I thought about it, the more convinced I became that it’s a matter of when, not if, such a program gets brought into being.

To really be worthwhile, the fellowship would have to be offered by an outfit that already had a robust telerad practice in place. This might be obvious to some. If you were considering subspecialty training in pediatrics or oncology, you might lean toward programs offered by Boston Children’s Hospital or Memorial Sloan-Kettering Cancer Center rather than taking your chances with Random Community Hospital in Anytown, USA.

It goes beyond that though. A lot of the issues and special challenges faced in telerad are often off the radar and even complete unknowns in traditional onsite practices. Literally everyone I’ve known who has gone into telerad, myself included, faced substantial learning curves for things that were foreign concepts when working onsite. Someone claiming to offer telerad fellowship training outside of an established telerad milieu would be at best misguided and arguably fraudulent.

One of the key elements of a telerad fellowship would be the teaching of its logistical aspects. That might get left to administrators and ancillary staff in a traditional, onsite practice. If things are less than streamlined and efficient, they might be annoying, but it is far from a deal killer.

A telerad group that wants to stay afloat can’t be so cavalier. If you misjudge your rad-to-work ratio one time too many, the places you are covering may lose faith in your ability to manage their volumes and kick you to the curb. Err in the opposite direction — too many rads routinely emptying the worklists and having nothing to do — and your workforce might get angry about not being able to hit their productivity targets.

Fellows would learn all about this stuff, and other things that a successful teleradiology service needs to get right in getting/keeping contracts for coverage. Vital concepts may include typical referrer expectations for turnaround times (TATs); how to predict case volumes at various times of the day/week/year, and accurately staff for the same; and addressing the vagaries of credentialing when you are covering multiple different facilities. In other words, there are “business aspects of radiology” that get mentioned but are rarely comprehensively covered during residency training.

Running a telerad group isn’t all about appeasing and managing expectations of the referrers. There is also plenty to be learned about recruiting, retaining, and otherwise managing the radiologists and ancillary staff on your team. Fellows would learn about relative value units (RVUs) as well as the pros and cons of various models for compensation (salaried, per-click, hybrid). One would also learn about the differences between 1099 and W-2, and how only some telerad situations allow a real choice between them.

Formal sessions to discuss these issues with the telerad group’s leadership could be augmented by routine communications as “learning opportunities” occurred. For instance, one could send an email to the fellows when an unexpected spike in case volume one night was either successfully handled by contingency plans established by the practice, or when such a spike created trouble due to a lack of safety net coverage.

That is far from all I’ve got for my teleradiology fellowship. Tune in next week for more.

Navigating key logistical aspects, maintaining coverage contracts, and understanding the pros and cons of different reimbursement models are just a few of the topics that could make a teleradiology fellowship worthwhile.