LIogahotvtictoWvpogt

cddwcimcwcpoapssqftcl

lpsbtn

ARL VAN MOORE, MDACR CHAIR’S MEMO

© 2009

ooking to the Future

ivb

lhdbrfwtos2eoswfgtlTaa

dcpgrtitwoatca

odwioiqpdttnmnot

ReighfifctswBasw

have had several friends ask mever the past few weeks, “What isoing to be your agenda while youre chairman?” They are asking anonest question out of interest andut of concern for our specialty. Inhis world of video clips and abbre-iated sound bites, I suspect that atimes, they expect a voice clip say-ng “a chicken in every pot” or “aar in every garage.” We all haveime pressure. Increasingly, every-ne is looking for the short answer.e all look for something we can

isualize in terms of “here is theroblem, and here is how to fix it,”r we state a grand and laudableoal to which we can all aspire forhe future.

With all of the issues facing medi-ine and our specialty, a sound bite isifficult to formulate and would noto them justice. We face a world inhich the medical landscape is

hanging constantly. Change is inev-table, and it will be continuous. In

athematical terms, for our world,hange is the only constant. For ourorld, with our ability to communi-

ate at the blink of an eye—e-mail inersonal digital assistants attached tour hips, for example—and with im-ging technology changing at a fasterace, the rate of change of the land-cape is increasing. Do we have thekills and tools needed to adapt at thisuickening pace? Is our specialty’s in-rastructure, especially our organiza-ional infrastructure, such that wean adapt to and, more important,ead the changing world around us?

Well, after some thought, I be-ieve that my goal is relatively sim-le. My goal is to work to best po-ition our specialty, as representedy all 30,000-plus of us, to ensurehat we have the skills and tools we

eed to be able to adapt to this rap- s

006 American College of Radiology1-2182/06/$32.00 ● DOI 10.1016/j.jacr.2006.04.001

dly changing medical practice en-ironment over the next 2 years andeyond.That said, what are the chal-

enges ahead of our specialty? Youave seen some of these challengeselineated and addressed by pastoard chairs and other leaders inadiology. Although we can planor many of these challenges, othersill be placed on our plate, and

hose agenda items will be beyondur control. The last-minute revi-ion and sudden passage of the005 Deficit Reduction Act is anxample. With the specific detailsf the act focusing on imaging con-tructed by a very small groupithin Congress without input

rom constituents, stakeholder or-anizations, or organized medicine,he act was passed and signed intoaw in a very short period of time.his will take time to respond to

nd is being forced onto ourgenda. With our limited re-

Arl Van Moore, Jr, MD, FACRBOC Chair

ources, this will to a certain extent o

istract us from dealing with otherritical issues we believe to be im-ortant, such as quality, metrics,lobalization, radiation safety, theapid changes driven by imagingechnology, the shift from macro-maging to molecular imaging, ac-ions by payers to commoditizehat we do, and the infrastructuref organized radiology, to mentionfew. So here are some thoughts

hat hopefully will provide some fo-us to some of the important issueshead of us.

Quality Is Our Image® has beenur motto for some time. Yet whato we mean when we say thoseords? How do we explain “quality

n radiology” to those outside ofur field or to those we consider layndividuals? We clearly believe inuality, but we need clarity in ouricture so that others will better un-erstand what we mean. What ac-ions do we need to take to providehat clarity? An important compo-ent question is, How do we com-unicate our vision to those who

eed to hear it? I believe that we areff to a great start, but more needso be done.

One outcome from the Deficiteduction Act has been that influ-ntial members of Congress havensisted that pay-for-performanceuidelines be developed. Industryas been strongly advocating per-ormance guidelines for a while, us-ng organizations such as the Leap-rog Group to advocate for thesehanges. These actions lay before ushe problem of how to better mea-ure performance in radiology. Weant “radiology by radiologists.”ut what new metrics do we have asspecialty that can better demon-

trate that outcomes are betterhen appropriately trained radiol-

gists render interpretations of

385

ivadtsgatHvosseutihaw

lfatattlttihrietpcttitWetpcsip

ibiceafmcpttbstcgodoadl

smssifmsasoc

ititTirplpcat

tvti

dtoooestepfwtAcinaatacmffw

rnltmnhflmipltqanhip

386 ACR Chair’s Memo

maging studies? Do we need to de-elop more robust quality assur-nce programs? What additionalata collection methods do we needo apply to show that when imagingtudies are interpreted by radiolo-ists, outcomes are improved, therere fewer delayed diagnoses, andhere are fewer missed diagnoses?ow can we ensure that those indi-

iduals who are not trained radiol-gists are held to the same hightandards to which we hold our-elves and that a level playing fieldxists for imaging? How can we ed-cate our patients and the payers onhese issues so that when they seekmaging care, they will demand theighest quality of imaging carevailable to them? As you can see,e have a lot of work to do here.Globalization has been a chal-

enge for many industries and pro-essions in the past decade or twond, for some, even longer. The au-omobile industry is an example ofn industry challenged for someime. More recently, we have seenhe effects of globalization chal-enge the software industry, theechnical assistance industry, andhe building and building designndustry, to name a few. Escalatingealth care costs and especially theate of climb of those costs are forc-ng others to examine ways of low-ring costs and slowing the rate ofhat rise. Increasingly, there will beressures to globalize the healthare industry, if only to find a wayo reduce costs. As we all know, inhe evolving world of digital imag-ng, our specialty is going to be onhe front line of these pressures.

hat steps do we need to take tonsure that patients are not lost inhis equation? How will we com-ete in a world of global medicalare? Are these changes occurringo rapidly that our government andts regulatory processes cannot keep

ace with these changes? c

Radiation safety for our patientss an issue that remains on the fronturner. Radiation dose is receivingncreased attention with the in-reasing dependence on imaging,specially CT scanning, to diagnosend subsequently monitor the ef-ects of various therapeutic regi-ens. There are those who advo-

ate CT screening in asymptomaticatients, but what are the effects ofhe additional radiation those pa-ients receive? Does CT screeningenefit the population in certain in-tances? With new 64-slice and bet-er technology in the CT scannersurrently marketed, catheter an-iography is no longer a necessity tobtain coronary arteriograms. Howo we protect our patients from theverutilization of this technologynd minimize the effects of the ra-iation burden to the overall popu-

ation for our patients’ welfare?Increasingly, imaging research is

hifting from the macro level to theolecular level. So, how do we as a

pecialty make the transition as theseophisticated imaging modalities aremplemented? Are we on the fore-ront in the research and develop-ent of these modalities, or are we

tarting to play catch-up? How do wechieve and maintain a leadership po-ition here, and once we do, is ourrganizational infrastructure suffi-ient to achieve this goal?

In his first “ACR Chair’s Memo”n JACR, Jim Borgstede addressedhe issue of commoditization. Thisssue remains as real today as whenhat column appeared 2 years ago.here are many external pressures,

ncluding globalization and the spi-aling costs of imaging, that areushing us down a path that could

ead to the fruits of our specialty’sractice of medicine becoming aommodity. Without active man-gement on our part, it will be easyo passively follow that path. Our

hallenge will be how to manage a

his process from a political point ofiew and how to position radiologyo ensure the best chance for successn these endeavors.

One issue that has been ad-ressed by several former chairs ishe infrastructure of organized radi-logy. Does the current structure ofrganized radiology position radi-logy well to respond quickly andffectively to all of the external pres-ures that we face as a specialty? Ifhe infrastructure is deemed to beffective, what can we do to im-rove it? More important, if our in-rastructure is antiquated, what cane do to effect change? Do we have

oo many societies in radiology?re these multiple organizationshasing after an increasingly lim-ted resource, the lifeblood of orga-ized medicine, the dues dollar,nd the contribution dollar? Therere many challenges here. Althoughhis is not something we think of onday-to-day basis, how we as a spe-ialty deal with them in the futureay well be the most important

actor contributing to the success orailure of our specialty in dealingith all of the other issues we face.Are these the only issues facing

adiology and medicine? Of courseot. We face many other chal-

enges. The issues that I haveouched on above are a few of theore important ones but clearly are

ot all. The good thing is that Iave another 23 chair’s memos toesh out many of these issues andore. Will there be unanticipated

ssues that will be placed on ourlate? Sure there will. My chal-

enge—indeed, our challenge—iso best position our specialty touickly, efficiently, and effectivelyddress these events and problems,o matter how they present. Theorizon of the landscape before us

s changing faster than ever. Theroblems ahead are more complex

nd difficult than we have faced in

tpsaa

tpm

tsfy

A

ACR Chair’s Memo 387

he past, and in my view, we areast the point of easy and simpleolutions. I am confident that were up to meeting these challenges

nd more. t

So, what is my goal? Althoughhere will be many issues, past andresent, that will need resolution,y overarching goal is to use the

ime I have as board chair to posi- c

ion radiology to be one of the mostuccessful, if not the most success-ul, specialty in medicine. Withour help, I believe that we can ac-

omplish this.

rl Van Moore, Jr, MD, Charlotte Radiology PA, 1701 East Boulevard, Charlotte, NC 28203; e-mail: vanmoore@aol.com.