Nathan Coleman, PGY-II, R-I

Attendees of the ACR 2016 National Meeting were offered two dramatically different views of the future of Radiology. The first came from the keynote speech given by Dr. Ezekiel Emanuel, an oncologist and faculty member at the University of Pennsylvania School of Medicine and the Warton School (as well as the brother of Chicago mayor Rahm Emanuel). Incidentally, he played a significant role in the development of the Affordable Care Act, has published numerous books on healthcare ethics and policy, and previously was the Chief of the Department of Bioethics at the Clinical Center of the NIH. 
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Dr. Emanuel’s talk focused on the changing nature of healthcare and how it, inevitably, in his opinion, would shift away from inpatient care and subsequently, medical imaging. In light of the $3.24 trillion the United States spends on health care annually, change is certainly to be expected, but Dr. Emanuel’s vision of that change was grim, particularly for radiology. In addition to his predicted coming decrease in medical imaging, Dr. Emanuel sees the advancement of Artificial Intelligence and “Deep Learning” pattern recognition programs as direct threats to radiologists, rather than tools to be wielded by the Radiologic community. Interestingly, there was little discussion of the role pharmaceutical companies, bloated hospital administrations, and private insurance companies have in driving up healthcare costs. While the talking points were unsurprisingly controversial, they stimulated numerous conversations in meeting rooms, hotel lobbies, and around dinner tables throughout the rest of the week. 

A more optimistic, but equally motivating, address was given by Andrew DeLoa for the annual Moreton Lecture. Mr. DeLao, widely known by his Twitter handle, @CancerGeek, has a long history in healthcare business, clinic and hospital development, health administration, and patient advocacy. He focused on Radiology’s role in “telling patient’s stories” due to the vital role it plays in nearly every aspect of a patient’s medical journey. Because of the interconnectedness Radiology has in the medical world, it has an opportunity to play a significant part in what Mr. DeLao calls the “Connection Economy.” By dedicating time towards gaining the trust of a patient and allowing the exchange of ideas between patient and physician, the connection economy is a way to create real value in health care. However, the connection economy doesn’t just involve patient-physician interaction. Mr. DeLao touched on the five “p’s” of the network that helps create the connection economy: politicians, payers, pharma, patients, and providers, and encouraged attendees to act as an active “node” in their network to create value and, most importantly, positive patient experiences. He highlighted ways to increase transparency and build patient trust, even without direct patient contact, by including summary reports of imaging for patients with key images, a picture of the radiologist, and contact info all attached to help patients understand the process they are actually undergoing when they have medical imaging.
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While the Keynote Address and Moreton Lecture had starkly different tones, they both were effective highlights for important transitions in Radiology over the next several years. Clearly, the landscape of medicine is changing, and we will have to change with it. It is vital that we assert ourselves as key “nodes” in the connection economy of 21st century healthcare and play an active role in telling our patient’s stories as they progress through their individual medical journeys.  It is also apparent that if we as Radiologists do not actively demonstrate our value by improving outcomes and enhancing the patient experience, we will be gradually pushed aside in the name of expediency. 

By Tiffany Sae Kho, PGY-II, R-I
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​I had the opportunity to attend the American College of Radiology 2016 annual meeting in Washington D.C. May 14th-19th as a first year Indiana University radiology resident thanks to the Indiana Radiological Society. There were in total ten residents from Indiana University that were able to attend the meeting. I had a fantastic experience and would just like to share some highlights of our week.
 
The resident and fellow section started over the weekend with a number of sessions that were geared specifically for radiologists in training. Dr. Frank Lexa, who was also spoke at the spring meeting of the Indiana Radiologic Society, presented "How to Nail a Job Interview- Secrets from Wharton." The lecture covered important questions to ask an interviewer, questions to never ask an interviewer, and questions we should never be asked as interviewees.  Our own Dr. Richard Gunderman gave a lecture on Bill Cook, the humble entrepreneur and philanthropist who helped found interventional radiology. Our fourth year chief resident Will Kerridge participated in a heated debate on Eliminating the Intern year from Radiology Training. 

There was a leadership session on team building from a military, large corporation, and large academic practice standpoint. We had a chance to listen to Colonel James E Harris, a former west point graduate; Robert Cancalosi, director of GE global customer leadership education; and Dr. Richard Baron, former chair of the department of radiology at University of Chicago and University of Pittsburgh. We learned about Project Aristotle, Google’s data analysis of 150 teams in attempts to determine what constitutes a great team. They found that in great teams members spoke in roughly same proportion, there was an overall high average social sensitivity, and teams had strong psychological safety.  We were able to reflect how we could apply these ideas to our IU resident leadership meetings as well as personally.
 
We learned about the current evolving state of radiology. President Dr. David Kushner gave a clear, thought-provoking presentation on the changes for radiology in the future and the shift to patient/family centered care. This was followed by the Keynote address given by Dr. Ezekiel Emanuel, who admittedly said he doesn’t have many friends in radiology. He spoke his forecast for medicine in the future and predicted decreased uses of the hospital, more care in patient’s homes, and most controversially, spoke about machine learning being a real threat to radiology. He emphasized that this threat was inevitable, and stated “Machines are able to improve their predictive accuracy, shorter time for reading and interpretation, and isn’t affected by fatigue or emotions.” As physicians in training, Dr. Emanuel’s opinions gave us a lot to think about and talk about later that evening at dinner.

​Contrary to the Keynote address, the next day the Moreton Lecture was highly motivational and entitled “Step Out of the Dark and Into the Light” by Andrew De Lao (better known as @cancergeek). Andrew has an extensive background in health care, cancer services, radiology/oncology, and has helped developed hospitals and cancer centers. His key message was radiologists should not let other people tell our stories because it devalues our impact and the importance of radiology. He focused on shifting from the experience economy to the connection economy, and at the very top of this pyramid would be meeting a radiologist as an ideal patient experience. The n of 1 can make a difference in the patient’s ideal experience with 4 T’s: time, trust, transparency, and transitioning with our patients in the journey of health care.
 
Of course, we learned about a little about radiology politics and participated in Capitol Hill day. RADPAC is constantly lobbying in D.C. for the political interests of radiology. They had two recent victories with HR 2029 with reducing the professional component multiple procedure payment from 25%-5%, and in placing a 2-year moratorium on the currently flawed screening for mammography issued by USPSTF.  
 
On Capitol Hill we had a chance to meet Senator Joe Donnelly, Congressman Andre Carson, the legislative assistant of Senator Dan Coats, and the legislative assistant of Congresswoman Susan Brooks. Topics discussed were HR 1151s/1151 the USPSTF transparency and accountability act. This proved a valuable experience, illuminating the importance of lobbying for our profession.
 
Last, but certainly not least, this week was a great opportunity to network with residents from other institutions. We had a chance to mingle with other residents from across the country during the weekly sessions as well as after the day was finished! I had a great time getting to bond with my fellow amazing co-residents from IU as well. We all plan to encourage resident participation in IRS and will share our positive experiences with the residents who were unable to attend. ​

By John P. Tobben, PGY-II, R-I

As radiologists, we work mostly behind the scenes, aiding in diagnosis and helping guide care through our unique knowledge of anatomy, pathophysiology, and imaging technology. Despite ​important efforts to get out of the reading room and put a face to radiology such as the ACR's Imaging 3.0 initiative, radiology will never be a "glamour" specialty. Television medical dramas such as House and Grey's Anatomy routinely give short shrift to radiology's role in the process of diagnosis and treatment. While most of us are content with this arrangement, the lack of public visibility for the field can prove problematic when it comes to healthcare policy. Radiologists do not conform the the tradition archetype of "doctor" the way that surgeons and internal medicine physicians might -- a fact that is likely as true for politicians shaping healthcare policy as it is for the person at home watching ER. Yet as a specialty we do have one valuable tool for putting a face to the name of radiology in the political arena -- lobbying.​

​Lobbying sometimes gets a bad reputation -- being perceived as an avenue for powerful entities to manipulate legislation to their advantage. Yet in at its core lobbying is a crucial aspect of representative democracy -- especially to a field such as radiology which may not exist at the front of the public's consciousness. The lobbying efforts of the ACR and the Radiology Advocacy Network recently struck a huge victory in lowering the professional component multiple payment reduction (PC MPPR) from 25% to 5%. At the ACR's annual meeting, attendees of the conference have the opportunity to be involved in lobbying for radiology via "Hill Day."

The event, which typically marks the culmination of the week-long meeting, provides an opportunity for radiologists (both practicing and in-training) to meet their congressmen/congresswomen. At this year's meeting, members of the Indiana Radiological Society again participated in Hill Day. A group which included residents and staff physicians from Indiana University as well as private practice radiologists from around the state met with representative, senators, and their aides to discuss specific pieces of legislation identified by ACR leadership as essential to the future of radiology.

​The major initiatives of this year's Hill Day were concerned with recommendations and reimbursement for screening examinations. The first, The USPSTF Transparency and Accountability Act (H.R. 1151/S. 1151) aims to make the US Preventative Task Force more transparent in its methodology and rationale for implementing specific recommendations. The task force's 2009 and 2016 mammography recommendations -- which have since been discredited -- were highlighted as notable pitfalls of the task force's current approach. We emphasized that this proposed legislation aimed not to dissolve the USPSTF -- which plays a vital role in our nation's healthcare system -- but rather to improve it and thus ensure a science driven, publicly accountable process for generating recommendations.

The latter piece of legislation, The CT Colonography Screening for Colorectal Cancer Act (H.R. 4632/S. 4632) aims to ensure that medicare will cover CT Colonography as a method of colon cancer screening. Screening rates for colon cancer are just below 60% in most parts of the country. CT Colongraphy offers a valuable alternative screening method for those for which traditional colonoscopy is impractical or impossible -- such as those unable arrange transportation to and from a procedure requiring sedation (or if you'rePresident of the United States). Again, it was emphasized that the aim of this legislation was not to replace traditional colonoscopy as a screening method, but to ensure that CT Colonography was available as a medicare approved screening method with aim to improve the overall nationwide compliance with colon cancer screening.

Overall, the event was a valuable opportunity to take an active role in radiology advocacy and get face time with the congressmen and congresswomen who will help shape the future of healthcare. In these face to face meetings radiologists have the opportunity to educate our elected representatives with knowledge, facts, and personal accounts that enable sound decisions and policy. 

Getting involved serves the interest of both our patients and specialty.