Paul H. Ellenbogen

Imaging 3.0: What Is It?

You haveprobablyheardthat theACR is beginning to widely disseminate a new strategic initiative that we are calling Imaging 3.0. This is the product of intense collaboration and thought over many months by a workgroup including members of the ACR Board of Chancellors, severalACRcommissions (especially the Economics Commission and Government Relations Commission),aswellasACRstaffmembers, including those at the Harvey L. Neiman Health Policy Institute. Bibb Allen Jr, MD, the current vice chair of the Board of Chancellors, deserves the highest praise for suggesting this concept and helping its creation along. Many others have been key, but to name a few, I credit Geraldine McGinty, MD, and Rich Duszak Jr, MD. I offer my apologies in advance to all the others who have played a significant role. So what is Imaging 3.0? What happened to Imaging 1.0 and 2.0? Well, Imaging 3.0 is actually a lot of things and is therefore somewhat difficult to describe briefly. To summarize as best I can, Imaging 3.0 is a call to action for radiologists, policymakers, payers, referring physicians, and patients to provide optimal imaging care from the moment a clinician considers orderinganimagingstudyor treatment until that referring physician receives and understands an actionable report with evidence-based recommendations. The goal is easy to put into words: to deliver all the imaging care that is beneficial and necessary and none that is not. Imaging3.0isablueprint.Alongthe way, we intend to offer a toolbox, to include such things as appropriateness criteria and clinical decision support, facility accreditation, board certification and maintenance of certification,

Lipomatous tumors of the kidney and adrenal: apparent echographic specificity.

Several fatty tumors of the kidney and adrenal gland were evaluated by gray scale ultrasound. An extremely dense echogenic pattern was common to all lesions. There were three solitary angiomyolipomata (renal hamartoma), a presumed diffuse hamartomatous involvement of the kidney in a patient with tuberous sclerosis, and one myelolipoma of the adrenal gland. This marked echogenicity is thought to be a feature of fatty tumors and enables relatively specific preoperative diagnosis of these lesions, all of which are benign. With regard to renal angiomyolipoma, this assessment may allow conservative treatment and preservation of functioning renal tissue.

How accurate is ultrasonography in detecting hydronephrosis in azotemic patients

Screening for hydronephrosis continues to be an essential part of the evaluation of patients with azotemia of unknown cause. To determine whether sonography is as reliable as nephrotomography for screening purposes, we carried out a prospective, comparative study. Sixty-two patients were evaluated. Mean serum creatinine was 4.3 mg/dl. Of 116 kidneys, 45 were obstructed according to urographic criteria and 42 of these were correctly called hydronephrotic by sonography. The 3 false negative sonographic studies occurred in 2 patients. All 3 kidneys contained radiopaque calculi visible on the plain abdominal film. Of the 71 nonobstructed kidneys, 5 were mistakenly called hydronephrotic by ultrasound, giving a false positive rate of 7%. We believe it is appropriate to use gray-scale ultrasound as a screening test for urinary obstruction in azotemic patients providing the plain abdominal radiograph shows no calcifications.

Impact of Generational Differences on the Future of Radiology: Proceedings of the 11th Annual ACR Forum

The 2011 ACR Forum focused on the impact of generational differences on the future of radiology, seeking to inform ACR leadership and members on how best to address the influence of the new integrated workforce on the specialty of radiology and on individual practices.

The Radiologist Assistant: Best New Thing Since Sliced Bread or Trojan Horse?

Starting in 1912, Otto Frederick Rohwedder’s original experiments met with opposition from bakers, who thought that sliced bread would quickly go stale. His initial prototype design held the bread firmly together with metal pins and was unsuccessful. Sixteen years later innovator Rohwedder had perfected a piece of equipment that not only cut bread into slices but also wrapped it in waxed paper. The first loaf of sliced bread was sold on July 7, 1928 (possibly at a bakery in Battle Creek, Michigan). By 1933, American bakeries were turning out more sliced bread than unsliced. A spring-loaded pop-up toaster designed by Charles Strife suddenly made sense. The Chillicothe, Missouri Constitution-Tribune of July 7, 1928, carried a story of the new machine’s first use at M.F. Bench’s Chillicothe Baking Company, 100 Elm Street, in Chillicothe, Missouri. According to the story, Mr Bench assisted Rohwedder in fine-tuning the new bread-slicing machine. So—sliced bread may have been born in Chillicothe, Missouri. Obviously, [the phrase] “the best thing since sliced bread” cannot be older than 1928, but there is no record of its use before 1969. But what was the best thing before sliced bread? That’s the real puzzle. (1)

The "P Word"

You hear it in the reading rooms or in the lunchroom. It is becoming more frequently used at society meetings. In fact, we hear and read so much about it that it’s now often used in both public and mixed company. You hear it used in a toprated academic department or in an ambitious private practice. Sometimes, it will creep into a not-soprestigious department or group. It wasn’t that way 20 years ago. I am referring to the word productivity. My premise in this column is that e need to be less productive. A beter goal is for a group or department o be more efficient. Digital rather han analog techniques, PACS intead of film viewers, and voice recogition are all good examples of imroved efficiency, which is good for atients and radiology. However, inreasing productivity is the exact oposite of what we need to do to susain our profession in the long run. ver time, we, as individual physiians, cannot continue to read or perorm more and more cases. We canot treat more and more patients. here is a physical and mental limit o what a person can do. You cannot xtend the day beyond 24 hours or he week beyond 7 days. The strategy f increasing productivity and thus ncreasing relative value units (RVUs)/ ull-time equivalents and therefore aintaining or increasing personal ncome as fee for service is cut back n extent and in rates is unsustainble. Increasing productivity is a hort-term fix and a prescription or disaster. As the race to increase roductivity goes faster and faster, ur service to our patients and our eferring physician colleagues must nevitably suffer. Mistakes must in-

The future of imaging biomarkers in radiologic practice: proceedings of the thirteenth annual ACR Forum.

The 2013 ACR Forum focused on the emerging field of imaging biomarkers and how best to integrate imaging biomarkers into clinical practice, promote research into imaging biomarkers, and leverage advances in bioinformatics. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to ensure that radiologists secure a preeminent role in the new era of precision and personalized medicine.

Radiology in 2022: Challenges and Opportunities in the Coming Decade—Proceedings of the 12th Annual ACR Forum

The 2012 ACR Forum focused on the anticipated challenges and opportunities facing radiology in the next 10 years, centered on the themes of health care reform, future payment models, research and innovation, patient-centered radiology, and information management. The recommendations generated from the forum seek to inform ACR leadership on the best strategies to pursue to ensure the continued success of the profession in the coming decade.

Challenges Facing the Mature Radiologist: A Guide

Radiologists who are chronologically advanced (or mature, as the authors prefer to call them) are faced with many special issues, obstacles, and opportunities. These are in many ways unique and different from the circumstances involving those who are recently out of training or in midcareer. The authors discuss some of these circumstances. They look at the challenges facing mature radiologists through the prism of considerable personal experience, and they hope to offer some insight and suggestions as to how one might respond to these issues.

Managing Hospital-Radiologist Relationships: Proceedings of the Tenth Annual ACR Forum

The annual ACR Forum brings together a multidisciplinary group to discuss a topic of present and future importance to radiologists. The 2010 gathering was dedicated to radiologist-hospital relationships. This article summarizes the conversations and details the advice of attendees to the ACR as to what actions might best benefit radiologists and the specialty.