Marcia Frellick

Advances in surgical technology and demand for real-time multispecialty expertise are often putting radiologists and surgeons side-by-side in the operating room and changing the way they interact.

When the relationship works well, respect is mutual and each clinician is able to take full advantage of the other’s expertise. When it doesn’t, tensions arise and frustrations build.

The relationship is particularly important in reconstructive surgery, Oren Tepper, MD, plastic and reconstructive surgeon at Montefiore Medical Center in the Bronx, New York, said.

“There’s definitely more of the back-and-forth collaboration between surgeons and radiologists that people hadn’t seen before,” he said. “There’s an increasing desire and a need to sit and go over the films together.”

At Montefiore, Tepper works with radiologists on skull and facial reconstructions and traumatic deformities. Together they map out blood vessels via magnetic resonance angiograms to locate the best places to take tissue from and the best location for attaching.

Years ago, if a patient came in with severe facial trauma and multiple bones had to be put back in place, he or she would have been taken to the radiology suite for scans and then back to the OR. Now surgeons and radiologists can look at the images together in the OR, Tepper said.

“More than ever there’s a need to have radiology input in real time,” he says. “It’s not unusual for us to have a head-and- neck radiologist come to the operating room and review a CT scan while the patient is on the operating room table.”


Respecting the other’s need for efficiency helps strengthen the relationship between radiologists and surgeons at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, said Robert Kane, radiologist and co-chief of ultrasound.

“We schedule our cases as much as possible and we have a 10- to 15-minute response time,” Kane said. “Surgeons will send a call down to us that they’ll be ready to scan in 10 to 15 minutes and our part of the bargain is we’ll be up there ready to go… So neither of us stand around waiting for something to happen.”

A. James Moser, MD, FACS, executive director for the Institute for Hepatobiliary and Pancreatic Surgery at Beth Israel works with a team including Kane on image-guided surgery. He gave an example of how the relationship plays out during pancreas surgery where many of the lesions are small and you can’t feel them in a minimally invasive operation because you don’t have the tactile feedback.

The team looks at an image that Kane produces in the console so they have both a 3-D image of the operative field and an ultrasound in the same image.

“So the interface of somebody with Kane’s skillset is extremely important,” he said. “The surgeon’s view of the operating field changes dramatically when it’s being done in a minimally invasive fashion.”


The nature of how surgeons and radiologists visualize images can potentially lead to frustrations in communication

As chairman and CEO of EchoPixel, a San Jose, California-based, company that develops medical imaging solutions, Ron Schilling, PhD, works with both surgeons and radiologists.

He says when tensions develop between the two groups, it usually comes down to two things: language and money.

Regarding language, the trouble comes when radiologists, who see images two-dimensionally, try to explain their findings to surgeons, whose view is 3-D.

EchoPixel and other companies have developed software that translates data acquired through CT or MR or other modalities and produces an image in the dimension that is most meaningful to the physician requesting it. Any doctor can access the patient data and have an anatomically meaningful view.

But without a common language, the gap between the ways images are viewed can lead to built-in tensions when radiologists and surgeons discuss images, Schilling said.

 “At the Mayo Clinic, you will not find tensions like this…but in a lot of other places I can see when those tensions arise, especially when the radiologist is throwing their material over the wall and the surgeon gets it, but it doesn’t relate to the surgeon the way it should…. as we go forward with Obamacare, it’s going to demand that there’s an excellent interaction among all docs.”

The other factor that builds tensions centers on reimbursement, he said. He gave the example of a cardiologist who recommends an angiogram, using a catheter to determine whether there is disease in the arteries. The radiologist may recommend a minimally invasive CT angiography or MR angiography for the patient, which is much less expensive. 

The cardiologist may be less likely to recommend the less expensive procedure, “Because that’s taking money out of the cardiologist’s pocket,” he said.

At the root of a good surgeon-radiologist relationship is an appreciation for what the other does, Schilling said.


In that spirit, at Emory Healthcare Network in Atlanta, Georgia, where radiologists make up 125 of the 1,800 physicians on staff, radiologists and surgeons are part of a weekly oncology conference which also includes specialists such as radiation therapists and pathologists. Together they discuss roughly 25 cases each week.

 “Because we bend over backwards to support [surgeons], they are very supportive of us,” says Emory radiologist William Torres, MD, FACR. “The radiologists who do biopsies, drains and ablations often go to the operating room and work with the surgeons to do these procedures. In some places that’s not true and the ablations in the operating room are done by the surgeons themselves, but at least in our institution, we have a very collaborative way of doing things.”

The relationship is particularly important with the complexity and volume of MRI, especially body MRI, at Emory. “We do as many as any place else in the world,” Torres said. Surgeons need radiologists’ expertise to see the whole picture, he said.

The sheer volume and the number of sequences – often 20 for each body MRI – has made the radiologist-surgeon relationship even more critical in oncologic surgery, gynecologic surgery, transplants and general surgery, he said.

Having PACS has made it less common for surgeons to come to the reading room to view images, so in-person collaboration has become both choice and necessity, Torres said.

 “If a radiologist wants to sit in a dark room and read, they are not going to have the same kind of relationship as we do…you want to make yourself useful and relevant and the only way you do that is by working with the surgeons and find out what they need and be able to provide it to them.”

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Technology has put radiologists and surgeons side-by-side when it comes to patient care, but the relationship can be tricky if not navigated properly.

 Radiologists and Surgeons: Can’t We All Just Get Along?

Currently, the root cause analysis procedure is only standard following a sentinel event. But some professionals argue that limiting the practice to sentinel events results in missed opportunities for improvement.

The Joint Commission works with accredited organizations to thoroughly review all factors that may have played a part in the event from human error to communication gaps to mechanical failures. While such an analysis is unquestionably important with events causing death or serious injury, radiologists say, there is also need for analysis with a much broader scope of errors or inefficiencies.

“If only serious adverse events are analyzed, there will be very few opportunities for learning and improving,” Jonathan B. Kruskal, MD, PhD, professor of radiology, Harvard Medical School, and chairman of the department of radiology at Beth Israel Deaconess Medical Center in Boston told 

“Too often I attend [morbidity and mortality] meetings where adverse events are described, or cases shown, and the discussion simply moves to the next case with no consideration of what went wrong, how to fix it, how to prevent it from happening again, and how to share the lessons learned,” he said.

Radiologists can learn from near misses, which are often harder to identify and are not often reported, Kruskal said.

The challenge is that radiologists are not well-trained to do RCAs and therefore do them ineffectively or not at all, Kruskal said. While radiologists have become good at diagnosing why the PACS didn’t work, for instance, being open to analyzing clinical errors has been a tougher sell. “This is why we are trying to train more of our colleagues.”

The educational goal is to share different methods for conducting an RCA, show how contributing factors are categorized and can then be considered, how the focus should be on process and not just the human factors that led to an adverse outcome, and how mitigating strategies can be identified and implemented.

The biggest task is orchestrating a cultural shift so physicians want to do these analyses, because they know the outcome will help them do something better.

“Instead of hiding our mistakes, the ideal culture encourages self-reporting such that cases can be pooled and analyzed to identify improvement opportunities,” Kruskal said.

One way to institutionalize RCAs to increase awareness and so clinicians expect to conduct them would be to alternate by month an RCA meeting with a morbidity and mortality meeting, Sumir Patel, MD, chief resident, radiology, Medical College of Georgia at Georgia Regents University in Augusta, said.

At these meetings, it’s important to involve all levels of employees, not just high-level executives. “You want to be able to get the information from the boots on the ground,” Patel said.

Radiologists can use RCA to solve day-to-day problems such as work flow issues, Patel said.

Suppose you have a work list and you see certain studies that have not yet been completed by your radiology technologist, even though you can see the images on the screen. You have clinicians calling for results, but you don’t know whether the examinations have been completed.

That situation would benefit from an RCA to examine and streamline the current process so everyone is clear when the complete results are available.

Another example is if people are referring you for interventional procedures but clinicians don’t know the best way to contact you. You can use RCA to look at the issues complicating the referral stream, Patel said.

These issues may seem minor, but examining all of the factors at play, categorizing the errors, correcting the errors or inefficiencies and disseminating that information to an entire organization takes a structured analysis.

RCAs go beyond routine examinations of errors or inefficiencies. They are formalized with follow-up structures with checklists and plans of action. 

, for instance, asks clinicians to examine 24 questions including what controllable environmental factors were at play; how equipment performance affected the outcome; what other areas of the organization could encounter the same problem; and how actual staffing compared with ideal levels.   

“If you’re just brainstorming…you might be limited in scope. You might be satisfied with the one example that you found,” Patel said.

RCAs can also turn up latent errors you didn’t know existed. Addressing those errors proactively can help avoid producing sentinel errors down the road, he said.

Sometimes radiologists aren’t part of hospital RCAs – either because radiologists don’t make it a priority or they aren’t included by others – and they need to be key players, Patel said.

“As radiologists have a seat at the table, they’re not going to be the dinner on the table,” he said.

Root cause analysis isn’t reaching its potential in the radiology community. 

Widening the Scope of Root Cause Analysis

In his position as chairman of the radiology department at the University of Washington, Norman Beauchamp, MD, MHS, gets to be both talent scout and someone who can enable careers.

At a recent RSNA 2013 session in Chicago, he offered a few tips for fellows and residents to help them “become someone you absolutely wouldn’t want to lose.”

1. Choose an environment for success. Before you even start your job, interact with your boss and make sure he or she is someone you can trust, respect and communicate with. Determine in negotiations whether they are interested in your success.

2. Be driven to be positive, professional and personable. “Don’t act as if it’s a job; act as if you’re an owner.”

3. Keep learning. Study people who are doing the job right. Who seems indispensable?

4. Get a mentor. The best mentors need to be recruited. Sometimes the best mentors are the busiest and you may need to ask persistently.

5. Have a vision and a plan. “Never, ever go to a meeting with someone you report to without an agenda.” Include in the agenda your top three goals, what you’re working on, what you need help with.

6. Don’t be a complainer. Present problems as opportunities and tell the boss how you’ve tried to solve it. “Solvers are absolutely indispensable.”

7. Be a leader. Step in when others are unwilling to do so. Help others believe in themselves.[[{"type":"media","view_mode":"media_crop","fid":"12399","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9836482713146","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1517","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 5px;","title":"Norman Beauchamp, MD, MHS","typeof":"foaf:Image"}}]]

8. Create something. “I tell our residents, I tell our fellows that the first question I will ask them if they are interviewing for a job is ‘Tell me what you did to make the department better that wasn’t your job.’” Build a website, form a professional group, stage a fund-raiser or charity run, organize a volunteer day, suggest curriculum changes.

9. Maintain an unwavering belief in yourself. If you don’t believe in yourself, how will others?

10. Build a team. Surround yourself with excellence. Your productivity will skyrocket. Be generous in giving credit to all who did the work that resulted in success.

11. Manage your time. Don’t reverse delegate. If a member of your team isn’t executing, talk with them but don’t do the work for them.

12. Understand the rules. Make sure you know what it takes to get promoted. Ask every year when you meet with your boss, “Am I on track for promotion?”

Norman Beauchamp, MD, MHS, offers his tips for how residents and fellows can really become a valued member of the radiology group.

12 Ways Radiology Residents, Fellows Can Be Indispensible

CHICAGO - How can radiologists improve their partnerships with referring physicians? At a recent RSNA 2013 session, the referrers gave their perspective.

When asked about challenges in ordering studies, “23 percent of referring physicians stated that ordering the correct studies is often or always a problem … and 10 percent say they often need to contact the radiologist because of too much information in the report,” according to a study cited by panel moderator Judy Yee, MD, FACR of the University of California-San Francisco.

Sally Reynolds, MD, is the medical director of the emergency department at Lurie Children’s Hospital in Chicago. She gave examples of how she depends on radiologists.

One thing that has changed in her practice is that she’s seeing many more adults. At Lurie Children’s the cardiac department now takes care of patients until they’re 35. The urology department takes care of some patients into their 30s.

“It’s impressive the number of people I see now that I was never really well-trained to see at that age. So what I’m really looking for is for all radiologists, and anyone I consult, to help me think broadly about the patient, to make sure I haven’t missed something,” Reynolds said.

One example of when a radiologist can be a vital contributor is in determining whether the object a child has swallowed is a battery or a coin.

“We had a bad experience, where the kid said he ate the nickel, we thought he ate the nickel, the radiology resident said it was a nickel - and it was a battery. And he has a reconstructed trachea now. Every hour makes a big difference in the outcome,” she said.

Also, when a report says “need for further studies,” Reynolds said she would like the radiologist to include whether that study needs to be immediate or next week.

She urged radiologists to let physicians know if they’ve ordered the wrong test. “As we try to decrease radiation, the last thing I want to do is zap the wrong thing or order the wrong test,” she said.

Finally, because the number of ICD codes has multiplied, she needs radiologists to be very specific, for instance, about fractures including type, percent angulation and displacement.

Stephan Wyers, MD, a general surgeon at University of Chicago, said it helps for radiologists and referring physicians to have a healthy appreciation for other person’s perspective - what the other’s work day is like, when you know you’re interrupting them, what irritates them.

“The communication piece has to be easy, open and frank. We’re all trying to take care of the same patient but we may see it from different sides,” Wyers said.

His preferences for what he’d like to see in a report:

Use of a standard language, such as BI-RADS for breast images

Elimination of dated language such as “phlegmon” or “pancreatic abscess.”

Highlighted images. If there’s a key image, pull it out, put arrows right on a lesion.

Strong opinions in narrative form, no waffling. Avoid descriptors such as “ill-defined” or “hazy.”

Information on any previous imaging and how it compares.

“I’m not so interested in the technical details of how the study was done - sequence of the MRI, how much contrast was used,” he said.

Both speakers agreed that one of the most frustrating phrases to see on a report is “clinical correlation needed.”

“This phrase is so ubiquitous it makes me wonder whether they take the radiology residents aside and say, ‘Look, no matter what you do, say this in the report,’” Wyers said.

CHICAGO - Referring physicians offer some insight into what they want from their radiology colleagues, from better collaboration to clearer reports.

What Referring Physicians Want from Radiologists

CHICAGO - What’s the job outlook for radiologists? It depends on which of the many cues you’re considering.

First there are the negative signs, including sluggish recovery from the recession, which has kept many senior radiologists from retiring, healthcare reform’s push for less imaging, decreases in reimbursement, increased use of advanced practice providers, patient fear of radiation and research cuts in the form of sequestration. Carolyn Meltzer, MD, chair of radiology and imaging sciences at Emory University in Atlanta, detailed the outlook at a session at RSNA 2013.

Some signs point to a need for more radiologists: More baby boomers are becoming heavy users of healthcare, millions of uninsured are entering the market, and patients are becoming more engaged in their care and demanding more scans.

But most agree, the trajectory for actual numbers of radiologists needed is trending flat for the next several years.

Edward Bluth, MD, radiologist at Ochsner Medical Center in New Orleans and chairman of the Commission on Human Resources for ACR, summarized findings from the ACR 2013 workforce survey at the session.

The largest number of radiologists are in the South; the smallest number are in New England.

About 50 percent are in private practice, down slightly from last year’s survey.

7 percent of practicing radiologists are older than 65.

20 to21 percent are general radiologists, down slightly from the previous year.

The largest group of radiologists hired in 2013 are expected to be general radiologists (16 percent) followed by general interventionalists (14 percent).

The largest number of jobs in 2016 are projected to be in the South; the fewest will be in the Northeast.

The largest numbers of jobs in 2016 will be in private practice, followed by academic universities.

In 2012, 1,400 radiologists were hired; in 2013, projections point to 1,500. For perspective, 1,200 residents finish each year.

The numbers going up in 2013 are general radiologists and breast imagers; the numbers going down are in body imaging and pediatrics.

The study concluded that all residents are expected to find jobs, but they may not be in the geographic area they prefer and they may not land in the specialty they prefer.

Still, there is room for change in the predictions, Bluth said. “Remember, workforce needs will change depending on retirement, individual finances and health issues of practicing radiologists. … Also there are 2,100 practicing radiologists over the age of 65.”

The flat projected growth “assumes all the economic conditions remain the same. We don’t really understand the influence totally that Obamacare will give us and Accountable Care Organizations,” he said.

Journal of the American College of Radiology

CHICAGO - Some signs point to dismal job prospects while others look more promising. Most agree the radiology workforce will stay flat for the next few years.

Radiology Workforce to Stay Steady Through 2016

CHICAGO - If you have a RIS and a PACS, congratulate yourself, but not too much. So does everyone else.

The real questions you should be asking, said Paul Nagy, PhD, director of quality in the department of radiology at Johns Hopkins University in Baltimore, are how old are those systems and what could you be doing to take advantage of available developments in technology?

Speaking at RSNA 2013, Nagy listed reasons you may need new systems, including advances that have been made in workflow management, search capabilities, analytics, report generation, dashboarding and the introduction of EHRs. Even five years ago, “your computer was 10 times slower. They had 10 times less storage on them,” Nagy said.

Nagy gave a five-point checklist to judge how your practice rates on the technology achievement spectrum:

Do you have a tech-savvy radiologist in leadership? It’s not enough that physicians have some technology skills. You need a radiologist who understands it thoroughly to bridge the gap between clinical and IT, Nagy said.

Do you have a qualified IT staff? You wouldn’t hire an uncertified technologist or an uncertified nurse, so why would you hire an uncertified PACS administrator, for instance? Certification ensures that they can be your partners in care.

Do you know your chief information officer (CIO)? “They can make so many changes without being aware of how it impacts radiology and you’ll only catch it when you have a disaster in your scheduling or registration,” Nagy said. Knowing who they are and developing a relationship will help avoid surprises when changes are implemented.

Do you have a good relationship with IT vendors - or is it hostile? Is your vendor there to help you solve clinical problems? That’s important in getting the best value out of your investment.

All five areas are important in making sure your practice is staying current and operating at maximum efficiency, he said.

Matthew Morgan, MD, assistant professor and chief of imaging informatics at University of Utah Health Sciences, noted that as fee-for-service models move to value-based models, imaging is going from profit center to cost center. So the pressure is on to do more with less.

Business intelligence, using data to make sure you’re staying on track, will help radiologists be proactive in this changing climate.

Building an informatics infrastructure starts with building a team. Start with an executive-level chair or vice-chair who has a vision for informatics and an appreciation for its urgency, he said.

You also need an IT director with CIIP (Certified Imaging Informatics Professional) and someone working in the trenches within PACS or RIS. Critical roles on the team are project sponsor, project manager and technical expert.

Make sure the team knows the goals and the rules. You need a strategy and a way to keep score. Managing data will help you support decisions such as whether you should hire another mammographer or uncover workflow bottlenecks.

Once you have a team, you need to inventory the data, understanding the complexity of the many systems and sometimes brittle interfaces.

Then aggregate the data to create a data warehouse easily accessed.

You can build such a system yourself, buy it from vendors, or use a hybrid approach, Morgan said.

Whatever you choose, he said, “you need people at your institution who both appreciate the value and need for this and are willing to take the time and work on this.”

CHICAGO - Is your practice competitive in its use of informatics and business intelligence? Here’s how to assess your place on the technology spectrum.

Is Your Radiology Practice Tech-Savvy Enough?

CHICAGO - All three radiologists who spoke at an RSNA 2013 session on meaningful use of electronic health records agreed the incentives program is a good idea, but only two were successful in implementing the first phase.

The three-phase program is now moving into Stage 2. The program rewards practices only when they go beyond purchasing and implementing EHRs and using them at a prescribed level.

Keith Hentel, MD, MS, is chief of the division of emergency/musculoskeletal radiology at Weill Cornell Medical Center at New York-Presbyterian. His practice pursued meaningful use but failed, he said.

Among his practice’s challenges were:                                               

Original confusion on the role of radiologists in meaningful use.

The great divide: “Our practice only registers our patients in the EHR because it’s our billing system. … We don’t spend a lot of time with the electronic health record.”

Existing systems didn’t qualify: You have to use certified healthcare technology to achieve MU. “If we were going to be meaningful users, we would have to get radiologists to function in the electronic health record.”

Up-front costs to overhaul the system seemed to overshadow the benefit.

Other projects and programs took priority.

Lack of meaning: “If you look at the core measures, many don’t pertain to radiologists. … To put a lot of effort into a project that doesn’t have meaning to us was a tough sell,” he said.

As the program phases in, Hentel said he has seen many solutions for some of the challenges. He also sees that penalties that will kick in for not having meaningful use starting in 2015 may be “just the tip of the iceberg,” of punitive measures. He said despite the challenges, he wants to try again, and he expects his division to become meaningful users in the near future.

Curtis Langlotz, MD, PhD, professor and vice chair for informatics in the Department of Radiology at the University of Pennsylvania, said some of the friction comes because “most radiologists are eligible but the objectives are not tailored toward radiologists. The reason for that is that if you look at the physicians out there, the vast majority of them are in office-based practices where they have visits and outpatients. That’s not the way we generally practice.”

He said a couple of factors were important in their path to meaningful use. One was that “90 percent of patients we see in radiology are referred from within Penn medicine. So these are patients whose medical records are already being kept in our Epic outpatient ambulatory record. That is a critical success factor for us.”

The second is in how they defined “seen by” and “office visit” - a distinction which varies by hospital.  “Our definition did not include that a radiologist was interpreting an exam on a patient so that did not constitute an office visit. That’s what we decided. As far as ‘seen by,’ Penn decided that ‘Yes, if I interpret a radiographic diagnostic imaging exam on a patient, that constitutes that that patient was seen by me.’” The definitions are important in measures used to qualify for MU.

Ramin Khorasani, MD, MPH, described some factors that led to pursuing and achieving meaningful use at Brigham and Women’s Hospital in Boston where he is vice chair of radiology. One factor was the consideration of the penalty for not achieving meaningful use which, by 2015, could be up to a 5 percent cut off Medicare reimbursements.

“Five percent of collections on Medicare population for our services is a major, major consideration,” Khorasani said.

The organization as a whole also believed “that meaningful use is directionally correct and we felt that because we believe ourselves to be one of the leaders in health IT, we felt compelled to participate.”

It was also important to note, he said that “our professional organizations led by the ACR fought very hard to include radiologists as meaningful users. Initially radiologists were not included in the bill.”

In August, 2011, only one of the 98 Brigham radiologists was a meaningful user. Now 92 have achieved it, Khorasani said. There will be a great incentive for the others to meet the mark as well, because Brigham will soon impose a pay cut individually for radiologists who don’t meet MU requirements, he said.

CHICAGO - Here’s why achieving meaningful use of electronic health records worked for some hospital departments, but not for others.

Should Hospital-based Radiologists Pursue Meaningful Use?

CHICAGO - By now, you’ve likely heard the phrase “working in the cloud.” But what does that mean to radiologists?

Fred Prior, PhD, professor of radiology at Washington University in St. Louis, explained the concept at an RSNA 2013 session.

Think of it both as a set of services delivered over the internet as well as hardware and systems that provide those services which you don’t necessarily own. The services are provided through remote data centers that you will never see.

Many of the services are free, but for those that aren’t, you pay for what you will use. “For example I can temporarily use 1,000 machines from the Amazon cloud, use them for 10 minutes and give them back. I don’t have to actually buy 1,000 computers,” Prior said.

One service model is when the software runs on a software provider’s infrastructure and you don’t know anything about it, you don’t manage it, but you simply “lease” it for a reasonable fee, he said.

Prior says he uses the software tools in the private cloud so they can support a lot of applications on the same hardware. Private clouds can be shared by a group of organizations. Public clouds can be used by any individuals either free or on a pay-as-you-go system.

Lower IT costs: You can make better use of a small number of physical resources. If you’re having someone else manage your computing hardware in their data center with their IT staff, it could go a long way in reducing costs.

Automate storage management: You adjust the storage as you need it as opposed to paying for permanent storage.

Improve scalability: You can access 100 servers in seconds.

Enjoy easy access: They are very easy to access, some with the push of a button.

There are cloud versions for services including PACS, RIS, and EHR. Cloud computing evolved from the application service providers in the early 2000s that sold deep storage and enterprise archiving, Prior said. In the ‘60s and ’70s, a large insurance company might have a huge mainframe and use only a small portion of it and they offered “time sharing,” to help cover the costs. What makes cloud computing different is that now we’re all wired and we’re used to being able to stream information to our devices. As the amount of data that needs storage multiplies, physicians are seeking better and cheaper ways to manage it.

You have to ask these questions, Prior said:

Does your network support cloud-based imaging services? Moving images from a PACS requires substantial bandwidth. “When you sit down at a PACS system and you say ‘display a case,’ you expect something will be on that screen in under two seconds,” Prior said. “Even our institution [Washington University] that has very high bandwidth connections … we don’t have enough bandwidth to move data rapidly in and out of our institution.” That’s because the network is internally focused rather than designed to move information externally. Know how yours is set up.

Can you protect patient privacy and security at the HIPPA level on a cloud? If a medical institution puts data on a cloud, it has to be encrypted and it has to comply with HIPAA. The cloud provider should be in the same compliance. “If we do violate patient privacy the penalty is up to $25 million per incident… Make sure your risk is shared with your service provider,” he said. Check 

 to see detailed requirements. There are secure clouds. Even the Defense Department uses one, Prior said.

Will this save you money? Some financial advantages include no major capital investment and you can manage obsolescence. If you buy a physical computer, it is quickly obsolete. If you give that problem to someone else, it saves you money. Software licensing may or may not save you money because you still have to license the cloud software and it depends whether it’s a usage-based software or how it’s set up.

The biggest savings may come in system administration. You still have to have an IT staff, but it can likely be smaller. Financial literature suggests that it may be a cost-effective storage model if you need 10 terabytes of space and use it for up to nine years, Prior said. That formula however, is not specific to radiology practices.

“It basically comes down to - it may make sense for a smaller institution, but for a very large institution like ours, it makes more sense to keep it internally,” Prior said.

One other challenge to think about, he said: “If you trust all of your data to a cloud service provider, and you are legally required to maintain that data for 30 years, what happens if the provider goes out of business? How do you get it back and what are you going to do with it?”

CHICAGO - Cloud-based imaging sharing and storage can save money on IT, but radiology groups have to make sure their infrastructure will support it.

Cloud Computing: Is It Right for Your Radiology Practice?

CHICAGO - In a year of transition for the healthcare system, the American Board of Radiology is responding with transformations that include changes to the core exam and maintenance of certification.

Dennis Balfe, MD, board member from St. Louis, reported that the new core exam (the first of a two-part process of certification) was given to 1,206 people from Sept. 30 to Oct. 4. The last oral exams were given in June of this year.

Surveys went out to those who took the new test, and comments included:

51 percent said the exam was more difficult than expected and that it was harder than the online practice plan.

Almost everyone said there was plenty of time to finish the test.

Cardiac, neuro, and musculoskeletal were perceived to be the most difficult organ-based categories.

Scoring is still unofficial, Balfe said, but pass rate was very close to expected from traditional performances.

Milton Guiberteau, MD, president-elect of ABR from Houston, explained the transition to continuous certification, which began in January of this year. Before that time, radiologists had transitioned from being certified once with no other responsibilities to the ABR to a system under which recertification happened every 10 years. That’s still the case, but different people have been on different cycles.

“Our purpose here with continuous certification is to get everyone in MOC on the same page in terms of requirements,” Guiberteau said.

Why the change? This allows for a more continuous process. It provides an annual credential of your performance for external requirements and an up-to-date reporting of your MOC status, he said.

“Continuous certification is not a new MOC or an MOC replacement. It does not change the four-part MOC structure you’re familiar with,” he added.

Guiberteau answered some of the questions ABR most often gets:

How does continuous certification affect my existing certificate that has an end date?

“If you have an end date, you will receive a new certificate if you are meeting the requirements of MOC at the end of the current end date of that certificate. The new certificate will be valid contingent on your ability” to meet MOC requirements.

If you don’t have an end date and you present it to someone, how do they know it’s valid?

This is accomplished through public reporting of MOC status online, which the ABR began in March 2013.

What happens if you don’t meet the requirements of MOC?

You have one year to make up the deficiencies. During that time you will be listed as certified but not meeting the MOC requirements. If you do not meet them after a year, you will be listed as not certified.         

CHICAGO - The American Board of Radiology has made major changes to the core exam and maintenance of certification. Here’s what you need to know.

ABR Explains Changes to Certification Process

CHICAGO - As desktop computer models are giving way to mobile versions, physicians are searching for the best solutions to increase efficiency and better serve patients at the point of care.

One of the first choices is which platform to use. The three main platforms are Android, iOS and Windows.

"You're not just choosing a phone, you're choosing an ecosystem that you are going to be invested in for a very long time," said Michael D'Alessandro, MD, radiology professor at University of Iowa College of Medicine, speaking this week at RSNA 2013.

In a nutshell, D'Alessandro described the options this way:

CHICAGO - From determining the platform and device to adding apps, there are quite a few considerations when going mobile.