Practice & Education

Baseline Survey of the Neuroradiology Work Environment in the United States with Reported Trends in Clinical Work, Nonclinical Work, Perceptions of Trainees, and Burnout Metrics

Fellows’ Journal Club

A voluntary survey was sent to practicing and out-of-training members of the ASNR. Four hundred thirty-two respondents across a broad range of experience reported: 93% with workdays extending at least 1 hour past expected; 71.9% reading more cases per hour compared with previous years; 79.5% sometimes-to-always interpreting cases faster than comfortable for optimal interpretation; and 67.8% sometimes or more often with inadequate time to discuss abnormal results. Burnout symptoms ranged between 49% and 75%. The trends and the correlations should be concerning to the leaders of radiology and warrant further monitoring.

Opportunity to Attend a Hands-On Clinical fMRI and Diffusion Tractography Course

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May 3-5, 2017

24 CME and 3 SAM credits

Course Director: Andrei I. Holodny, MD

Conference Location:

Weill Greenberg Center
Weill Medical College of Cornell University
1305 York Avenue (at 70th Street)
New York, NY 10065

Course Overview:

During most MRI procedures, there is no need for interaction between the administrator of the test and the patient. The situation is quite the opposite in functional MRI (fMRI), where the neurological status of the patient must be assessed; an appropriate paradigm must be selected based on the neurological assessment and prior MRI examinations. Further, the paradigm must be delivered to and successfully performed by the patient while in the MRI machine. In addition, there is a rather complicated analysis of the fMRI and diffusion tractography data, which must be performed and assessed. How to properly perform these tasks is often not addressed during residency and fellowship training or in annual scientific society meetings.

Target Audience:

Clinicians involved in fMRI, including neuroradiologists, neurosurgeons and neurologists.

Educational Objectives:

  • Understand the fundamental principles behind fMRI and diffusion tractography
  • Choose the optimal fMRI paradigms appropriate for the patient and clinical situation
  • Deliver fMRI paradigms correctly and monitor the patient for adequate compliance
  • Hands on experience so that the attendee will be able to analyze fMRI and diffusion tractography
  • Understand how data is delivered to a neurosurgical navigational system and used by the neurosurgeon
  • Avoid pitfalls in the interpretation of clinical fMRI and diffusion tractography
  • Optimize fMRI billing and coding

Accreditation Statement:

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the International Institute for Continuing Medical Education, Inc. and fMRI Consultants LLC. The International Institute for Continuing Medical Education Inc. is accredited by the ACCME …

Will Radiologists Demonstrate Their Value?

The original version of this post originally appeared on The CancerGeek Blog – Challenging the Status Quo in Healthcare and Industry.

how-can-radiologists-demonstrate-value

Earlier this week during the American Journal of Neuroradiology (#AJNR) tweetchat, the above questions was posed:

How can radiologists demonstrate value to referring physicians, patients, and their own trainees?

I caught the question and chimed in with the following thoughts:

  • Provide concise simple explanations with associated key images to help referring physicians with their discussions
  • Radiologists evangelizing the importance of ACR Imaging 3.0 (“Patient Engagement”)
  • “Artifact” for patients to take with them immediately after their imaging exam (sheet of paper, image, summary, number for follow up questions)
  • Dial a Radiologist
  • Partner with a Radiologist
  • Lead, participate, co-moderate an internal meeting consisting of multidisciplinary team members
  • @FalgunChokshiMD stated, “Increasing patient portals need adaptive changes…”

In my opinion I believe there are plenty of opportunities for Radiologists to demonstrate their value.

I believe we are asking the wrong question. We should not be focusing on the “can.”

We should be asking:

Will Radiologists Demonstrate Their Value?

It is time Radiologists step out of the dark and into the light.

A picture may be worth a thousand words, but a handshake and a hello makes a connection that can leaves a lasting impression.

Own your story.

As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek

~CancerGeek

A Proposal to Move the Fellowship Match to the R4 Year

My recent neuroradiology fellowship interview trail was truly enjoyable — a chance to meet neuroradiologists I admire, reunite with old friends, and deepen my appreciation for the neuroradiology division at my current institution. Despite this pleasant experience, I feel the fourth (R4) year of residency would be better suited for fellowship interviews and the match.

Prior to restructuring the ABR board examination, it seemed logical to position fellowship interviews in the third year of residency. There was enough time to establish the next step in a resident’s life before becoming lost in the oral exam “board frenzy”.1-3 Now, our third year residents take on the new ABR Core Exam, AIRP, meetings, projects, and clinical rotations/call in addition to the “fellowship frenzy”.4 And let’s not forget life outside of work. That’s a tall order for one academic year.

Moving fellowship interviews and the match to the fourth year would address problems not only related to applicants’ busy third year schedules, but also issues in the fourth year stemming from the new timeline of the ABR exams. Programs across the country are now stocked with a surplus of bright fourth year residents who have passed the boards and matched to fellowships. While these senior residents maintain an internal drive for success, the ambition and hunger seem to have dampened in some. Delaying the fellowship match may prolong residents’ eagerness about the field and desire to maintain a competitive edge.

The current timeline has its advantages. I am thrilled about the match results. Now I can take advantage of my last year with my residency institution and connect with my fellowship institution. Additionally, my husband and I have time to plan ahead for my fellowship year. However, a full year of advance notice is a luxury, not a necessity.

We have …

Diagnostic Errors in Neurological Emergencies – The Radiologists’ Role

Recently an interesting retrospective study evaluating missed neurological emergencies was published in the journal ‘Diagnosis’.  Physicians from the emergency department of large tertiary care center reviewed cases involving a missed or delayed diagnosis of a neurologic emergency in which a diagnostic error in the ED management was identified. Out of 1168 cases reviewed, 42 were found to have a missed acute neurologic diagnosis, 29 of which were attributed to error. These 29 cases were individually reviewed by the three emergency physician investigators. Of these, approximately 24% were attributed to a radiology resident misread.

The diagnosis most commonly missed was posterior fossa strokes. At their institution, preliminary reports are issued overnight and clinical decisions and disposition of these patients are often made prior to the final read. The authors suggest that ED physicians should consider requiring real-time attending radiologist reads on all ED neuroimaging to reduce the rate of preliminary misreads. There appears to be a growing trend among academic centers to increase resident supervision by attending physicians overnight in order to reduce the number of misreads by inexperienced radiology residents, though this is not the standard of care in the US. From a patient safety perspective, this data certainly supports that notion. At the institution where I am training, there is ED coverage by an attending physician approximately 21-22 hours/day.

Interestingly, they found no difference in error rates between the first and second halves of the academic year. This is incongruent with other studies that have demonstrated an increased amount of medical errors in teaching hospitals when new interns begin, commonly known as the “July Effect”. Radiology residents, however, are not allowed to take call independently until after 6 months of training, which could in theory result in a “January Effect”. It would be interesting to know if there …

Interobserver Agreement in the Interpretation of Outpatient Head CT Scans in an Academic Neuroradiology Practice

Fellows’ Journal Club

January 2015

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Repeatability of outpatient head CT interpretations performed in an academic practice was assessed in 119 randomly selected studies. These were blindly read twice by 8 neuroradiologists. Differences in location and severity of findings occurred in 9.2% of cases and contradictory findings in 15.1%. Thus, discrepancies in double-blind interpretations were more common than reported in peer-review quality assurance programs.

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Communication: Meeting Patients Face-to-Face

This post originally appeared on The Voice of Radiology Blog, run by the American College of Radiology.

At my institution, we have been putting radiology reports into our online patient portal for about two years and we are preparing to make images available with those reports in the portal. We make our pager numbers available in the report and have been taking phone calls from patients since reports started going into the patient portal.  With these changes, we have experienced more patients requesting consultations with the interpreting radiologist.

In a recent New York Times article, Drs. Jennifer Kemp and Geraldine McGinty highlight their experiences with direct communication of results to patients by radiologists. The day following publication of this article was a busy one for me with a full exam schedule and a few administrative meetings.  So when our patient experience representative paged me, I responded with some trepidation. She told me she had a patient requesting a radiologist consult with questions about her brain MRI that her neurologist was unable to answer. We arranged to meet that afternoon in one of the patient consultation rooms to review the images.

The patient was extremely well informed. She had done extensive research about the brain imaging sequences and had examples of normal and abnormal cases on her smart phone to illustrate her concerns. She actually knew as much about the imaging technique as some of my junior residents!

At the end of the conversation, my patient told me she had been asking to have someone review her brain imaging at outside facilities for several months without success and that she was grateful that someone had finally taken the time to review her images with her.  It was a pleasure to speak with her and ease her concerns about the exam …

Education

As a program director I would be interested in a category on education. Hopefully others are as well. Some suggested discussion topics:

It would be great if the ASNR opened up on-line content to residents.

ASNR should consider offering member in training to residents.

Programs are required to have a core curriculum of about 10 lectures. What should be the role of ASNR to help its members acheive this goal.?…

Why Can’t ASNR Come Up with Better CME’s?

Great journals and case of the day…

but, compared to Radiographics or ACR’s Case of the Day… would love to see the Neuro cases of the week or some other case base format provided for online CME… esp with higher end neurocases… (eg showing cases with CTP and MRS etc…

I know the cases are out there and the manpower im sure is there…

C’mon AJNR/ASNR… give us all a little bone…. 🙂

amkrad1…