Author: Logan Young

  • Barriers & Facilitators—Lung Cancer Screening Equity in Individual, Provider, and Community Practice

    Barriers & Facilitators—Lung Cancer Screening Equity in Individual, Provider, and Community Practice

    Claudia M. Muns

    University of Puerto Rico School of Medicine

    lejandra Cardona

    Department of Internal Medicine, San Juan City Hospital, Puerto Rico

    Efrén J. Flores

    Department of Radiology, Massachusetts General Hospital

    Despite the advancements in diagnosis and treatment, lung cancer (LC) remains the leading cause of cancer-specific mortality with an estimated 235,760 new cases and 131,880 deaths in 2021 [1]. Although LC affects all races and ethnicities, disparities in LC outcomes and mortalities exist. Barriers related to medical and sociodemographic factors, including language, access to smoking cessation resources, LC stigma, and health literacy, among other social determinants of health, are factors that play a role in the existing disparities in the LC care continuum [2, 3]. Lung cancer screening (LCS) can serve as a pillar to bridge disparities in LC outcomes through primary risk reduction with smoking cessation and secondary risk reduction with LCS [4]. However, despite the proven benefits of LCS in reducing LC mortality, only a fraction of the eligible population has been screened, and the proportion of individuals eligible for LCS among underserved populations is likely to be lower [5]. The ongoing COVID-19 pandemic, which has exacerbated health disparities among racial/ethnic minority communities and other underserved communities, has resulted in diversion of medical resources to address immediate needs [5, 6]. The effects of postponing nonurgent medical care, including LCS, because of the pandemic are unknown. Without targeted outreach, the low participation rates and delays in LCS will widen existing disparities in LC outcomes among underserved communities [6].

    The recent update in the U.S. Preventive Services Task Force (USPSTF) LCS eligibility guidelines lowers the required smoking history to 20 pack-years and age to 50 years [7]. This provides an opportunity to improve overall LCS participation rates among diverse patient populations through tailored approaches that consider barriers related to social determinants of health. Therefore, it is vital that we take steps to understand barriers to LCS and develop targeted multilevel outreach interventions to increase LCS participation rates. The purpose of this InPractice piece is to use a modified social-ecologic model of barriers to LCS (Fig. 1) to discuss multilevel interventions and advance equity in LCS uptake among diverse patient populations by increasing awareness, opportunities, and participation in LCS (Table 1). This framework can be adapted to advance equity in LCS among radiology practices in different settings.

    Fig. 1—Drawing shows social-ecologic barriers to lung cancer screening (LCS) that many patients encounter before undergoing LCS at individual, provider, community, and health system levels. EMR = electronic medical record, USPSTF = U.S. Preventive Services Task Force.

    Table 1—Summary of Multilevel Barriers to and Facilitators of LCS Awareness, Opportunities, and Participation

    Barriers to and Facilitators of Lung Cancer Screening Awareness

    Barriers

    At the individual level, some of the barriers to awareness include unfamiliarity with LCS as a health preventive service tool (Fig. 2), unawareness of the new USPSTF and Centers for Medicare & Medicaid Services (CMS) recommendations for LCS, unfamiliarity with insurance coverage and costs, uncertainty about available accredited LCS programs, lack of culturally appropriate information, and lack of information at an appropriate health literacy level [8–10]. 

    Fig. 2—Awareness barriers to lung cancer screening (LCS). 57-year-old man with limited English-language proficiency who was referred for LCS. He was initially referred for LCS 2 years earlier, at age 55 years old, but he missed that appointment because he did not have additional information resources in other languages about steps to undergo LCS. During annual physical examination 2 years after that initial referral, patient was referred again to LCS. CT images show left upper lobe mass with hilar lymphadenopathy (arrow, Left), surrounding lymphangitic carcinomatosis (Middle), and bony metastasis in sternum (arrow, Right).

    At the provider level, unfamiliarity with the new USPSTF and CMS recommendations and identifying patients who are eligible under the new guidelines for LCS are substantial barriers reported in the literature [9–11]. Other barriers at the provider level include unfamiliarity regarding where to refer patients; unfamiliarity with insurance coverage; lack of knowledge about available resources for management of abnormal LCS findings and follow-up of incidental findings; and skepticism about the benefits of LCS, given that clinical trials recruited predominantly White non-Hispanic patients with a higher socioeconomic status than that of the general U.S. population [10]. 

    At the community and health care system level, suboptimal quality of institutional information about LCS (i.e., information not tailored for the surrounding communities) and a lack of institutional social media presence or engagement through social media campaigns to disseminate information about LCS are barriers to LCS [12, 13]. Furthermore, electronic medical records (EMRs) that are not optimized to automatically notify providers of eligible patients have been reported as a barrier [10].

    Facilitators

    At the individual level, facilitators for LCS are creating patient-centered, culturally tailored educational content to increase interventions to raise awareness and increase health literacy about the new guidelines and fostering non-stigmatizing language and guidelines from national organizations such as the International Association for the Study of Lung Cancer (IASLC) [4, 10, 12, 14]. An effort must be made to inform patients about the importance of early LC detection through LCS, the availability of insurance coverage, and the location of nearby LCS centers using websites such as the “Lung Cancer Screening Locator Tool” [10, 15]. Community health fairs, conventional media, social media, educational brochures, and mailed invitations are examples of how LCS educational information can be disseminated in multiple settings [10]. The educational material can be tailored to focus on hope based on the advancements in LC treatment by including patient testimonials about their experiences with LCS and by tailoring the education to fit the needs and capacities of diverse populations [10, 16]. Online content can provide information and details about LCS programs in multiple languages at the recommended health literacy levels [13]. The Internet and the use of social media can play a key role in the dissemination of information regarding LCS [17]. Prior studies have shown that digital awareness strategies leveraging social media were effective in increasing LCS engagement [17].

    At the provider level, unfamiliarity with expanded eligibility criteria and where to refer patients for LCS can be addressed through educational webinars, institutional online resources, and provider-specific educational material that offers continuing medical education credits [18–21]. All these resources will address unfamiliarity with eligibility criteria, skepticism about the benefits of LCS, lack of awareness about LCS insurance coverage, and concerns related to the management of LCS findings [9, 10]. 

    At the community and health care system level, an important facilitator to LCS is updating EMR systems to identify patients who are eligible for LCS under the new guidelines. This information can be incorporated into EMR systems with alerts for eligible high-risk patients, autopopulated referral tools, and lists of certified LCS centers that will help identify eligible patients and promote uptake among diverse patient populations [10, 22]. Online content can facilitate LCS by providing information about LCS programs that is tailored for the local communities served by radiology practices and health care institutions [10, 12]. Furthermore, implementing institutional social media campaigns that emphasize the expanded new eligibility criteria will help overcome knowledge gaps and barriers to awareness [23].

    Barriers to and Facilitators of Lung Cancer Screening Opportunities

    Barriers

    At the individual level, some of the barriers include decreased opportunities to provide accurate smoking history in the EMR, cost concerns related to insurance coverage of LCS and subsequent followups (Fig. 3), challenges to understanding LCS results when examinations show abnormal findings, fragmentation of care for management of abnormal LCS results and incidental findings, and difficulties navigating the complexities of health care systems [4, 8, 10]. Cost transparency and cost concerns are areas of active research, because cost influences how patients access and use health services [2]. For example, a recently published study evaluated the out-of-pocket cost of invasive procedures after LCS and showed that the rates of invasive procedures in commercially insured populations exceed those of invasive procedures in clinical trial participants [2].

    Fig. 3—Insurance barriers to lung cancer screening (LCS) opportunities. Left, CT image of 58-year-old man who initially underwent LCS in 2019 shows right upper lobe lung nodule (arrow) that was interpreted as Lung-RADS 3, and 6-month follow-up was recommended. Before follow-up, patient lost his job and employee-sponsored insurance due to COVID-19 pandemic. LCS follow-up was delayed because patient did not have insurance. Right, Follow-up CT image obtained 2 years later shows interval growth of right upper lobe nodule (arrow), which was biopsy-proven carcinoid.

    At the provider level, some of the barriers include difficulty identifying patients who meet eligibility criteria, understanding the influence of comorbidities on the LCS eligibility criteria, and lack of assistance with following up on results [4, 10]. Additional barriers at this level include inconsistent documentation of smoking history, insufficient time to conduct shared decision-making because of other medical responsibilities, difficulty accessing multilingual decision-making aids, and anticipation of patient emotions about participating in LCS [4, 9, 10].

    At the community and health care system level, some of the barriers are lack of health insurance coverage for LCS under the new USPSTF guidelines and barriers to telemedicine and broadband Internet access for conducting shared decision-making telehealth encounters. Uncertainty in defining the population-level health data of patients who meet eligibility criteria and would benefit from LCS, the absence of American College of Radiology (ACR)–accredited radiology practices performing LCS in communities, and a lack of community-based strategies to increase participation among underserved communities are additional barriers at this level [4, 5, 8, 10].

    Facilitators

    At the individual level, facilitators of opportunities for LCS include increasing the opportunities to provide an accurate smoking history through educational campaigns and additional opportunities in other health encounters to capture LCS eligibility information [24]. For identifying LCS-eligible patients, leveraging teachable moment and care coordination strategies during existing routine appointments can be effective. A previous study showed that among women undergoing screening mammography who were given a brief survey to assess LCS eligibility, only a small fraction of LCS-eligible women had undergone LCS [25]. 

    Facilitating care coordination and overcoming transportation barriers can provide additional opportunities for patients to undergo LCS [4, 26]. For example, same-day screening appointments at the time of other medical appointments have been shown to be beneficial to patients who have trouble with transportation, taking time off from work, and finding assistance with dependent care, and this strategy could be expanded to be offered to patients eligible for LCS [27]. Concerns about the costs of LCS can be alleviated by providing information about expected costs related to LCS and by offering information about diverse financial support options provided by institutions. People who are uninsured or have concerns about out-of-pocket expenses related to LCS can be referred to community health care workers and patient navigators who can assist patients in identifying grant funding and institutional financial assistance programs to cover LCS among patients who do not have insurance or have a low income [22, 28]. Health care workers can also assist patients in navigating the complexities of the health care system and clarify additional questions related to their LCS results [22].

    At the provider level, LCS can be leveraged as an opportunity to advance early LC detection and tobacco cessation. Primary care providers can benefit from training on shared decision-making encounters for the initial enrollment in LCS to gain further knowledge and expertise about tobacco cessation; the safety of tobacco cessation medications; and additional benefits of LCS with low-dose CT, such as coronary artery calcium scoring and evaluation of emphysema, among others [16, 29]. Prior studies have shown that additional findings such as interstitial lung disease, severe coronary artery disease, thyroid cancer, and renal masses can have clinical implications among patients undergoing LCS [29, 30]. Other facilitators are explaining the LCS results to the patient by identifying and addressing most concerning factors to them and incorporating an assessment in the decision-making process with a patient-centered approach [31]. In addition, creating EMR-based dashboards and alert systems that assist primary care practices in identifying patients who are eligible for LCS, particularly under the updated USPSTF guidelines, will provide additional opportunities for patients and providers to engage in conversations about participating in LCS [10]. Other facilitators can be addressing the importance of consistent documentation of smoking history, multilingual decision aids, and educational workshops or seminars to optimally manage incidental findings and address patient concerns related to undergoing LCS [24].

    At the community and health care system level, facilitators of opportunities include the development of system-level policies that combine the updated USPSTF guidelines for LCS and consider social risk factors affecting patients and their communities to promote equitable LCS use and advocacy efforts that increase telehealth and patient portal access by increasing broadband Internet access points and digital patient navigators among underserved communities [5, 7, 10, 12, 17]. Including social risk factors in the calculation used for new LC risk models and LCS eligibility criteria can potentially benefit racial and ethnic minority groups and other underserved patient populations [4]. Increasing access to information about local accredited LCS centers and optimizing EMR systems to identify population-level health data of eligible patients under the new guidelines are additional facilitators to aid in removing these barriers [10, 15, 22].

    Barriers to and Facilitators of Lung Cancer Screening Participation

    Barriers

    At the individual level, barriers to participation include conflicting personal and health schedules, such as medical appointment times that conflict with working hours, dependent care schedules, understanding the importance of adherence to annual LCS and recommended follow-up (Fig. 4) for the detection of early LC, anxiety and stigma about LC diagnosis, concerns about radiation exposure, and access to primary care services to get LCS referrals [4, 9, 10, 26].

    Fig. 4—Knowledge barriers to participation in recommended lung cancer screening (LCS) follow-up. Top Left, CT image of 74-year-old patient who presented for initial LCS in 2018 shows right upper lobe nodule (arrow) that was interpreted as Lung-RADS 2. Top Right, Patient missed annual LCS appointment 1 year after Top Right and returned for LCS 2 years after Top Right. CT image shows interval increase in size of right upper lobe nodule (arrow), which was interpreted as Lung-RADS 4X. Bottom, PET/CT image, also obtained 2 years after Top Right, shows intense uptake within right upper lobe nodule (arrow), which was biopsy-proven lung adenocarcinoma.

    At the provider level, barriers to participation include a lack of locally accessible LCS centers or LCS centers outside the health care system that do not offer a streamlined referral and follow-up process, lack of public transportation access to get to appointments, and lack of systemwide patient navigators or health care workers who can aid primary care providers in ensuring patients undergo LCS and help track adherence to recommended follow up of results [4, 10, 26].

    At the community and health care system level, barriers include EMR-based LCS appointment reminders that are not available in multiple languages or that are available only through patient portals, decreased availability of system-based dashboards that will alert patients and providers about adherence to follow-up of abnormal LCS examinations, lack of accessible smoking cessation services for patients who smoke, and lack of access to multidisciplinary lung nodule clinics to assist patients in management of abnormal LCS findings [4, 10, 32].

    Facilitators

    At the individual level, facilitators of participation for LCS include providing schedule flexibility by offering off-hours appointments during weekends and evenings or collaborating with community organizations to offer resources and promote screening during social events in the communities [28, 33]. Providing transportation to LCS appointments, such as ride sharing or cab vouchers, or providing access to mobile LCS units can assist patients in overcoming transportation barriers that could lead to missed LCS appointments [10]. To improve participation, providers can collaborate with radiology practices in communicating the importance of LCS and can promote follow-up through reminders sent to patients, which have been shown to increase LCS adherence [34]. The ACR National Lung Cancer Roundtable (NLCRT) launched a campaign to decrease the stigma associated with a LC diagnosis and decrease concerns about radiation exposure [35–37]. Increasing access to LCS clinics that offer an integrated approach to LCS in collaboration with primary care practitioners can assist in overcoming barriers related to a lack of access to primary care practitioners [38, 39]. 

    At the provider level, facilitators include increasing the availability of community health care workers and patient navigators who can aid primary care practices to assist patients in participating in LCS [40]. 

    Patient navigators can assist primary care providers in conducting shared decision-making, identifying and confirming LCS eligibility of patients, and assisting patients in clarifying additional steps or concerns needed to engage in LCS [40]. Collaboration between radiology and primary care practices can lead to offering integrated LCS programs that have streamlined referral pathways for LCS independent of practice location [38, 39]. In addition, LCS radiology programs that collaborate with primary care providers and community organizations to offer LCS, smoking cessation services, and screening for other cancers can be opportunities to increase participation in LCS and meet other population health preventive service goals [41, 42].

    At the community and health care system level, facilitators of opportunities include EMR-based LCS appointment reminders available in multiple languages and through additional services other than patient portals, updating population-level health dashboard alerts of patients who are eligible or overdue for LCS under the new USPSTF guidelines, and creating system-based alerts to notify providers about newly eligible patients [10, 34]. Studies that have evaluated LCS adherence rates, patient characteristics associated with adherence, and diagnostic testing rates after screening revealed that underrepresented racial/ethnic minority populations and individuals who currently smoke are less likely to remain in the program [32]. Patients who undergo LCS and are currently smoking can benefit from the integration of smoking cessation counseling services into part of their LCS encounters, and participation in LCS increases adherence to a smoking cessation program [43]. Interventions that combine promoting participation in LCS and connecting patients who are current smokers with an evidence-based intervention composed of a web-based program and text messaging, are examples of a coordinated approach that increases participation in both LCS and smoking cessation [43, 44]. Finally, for assisting patients who have abnormal LCS results, improving telehealth access, increasing the capacity of smoking cessation services, and implementing a tailored approach with multidisciplinary lung nodule clinics for the management of abnormal LCS results and EMR dashboards that automatically track adherence to follow-up and outcomes can provide a system-based care coordination that will aid these patients in accessing LC care [38, 45–47].

    To advance equitable participation in LCS and achieve the population health goal of improving LC outcomes for all patients through early detection, it is paramount that multilevel interventions are tailored to fit the needs and capacities of diverse patient populations served by all types of community practices. To achieve this goal, transdisciplinary system-based programs and interventions are key to address systemic barriers, improve access and uptake of LCS, and improve LC outcomes primarily among underserved patient populations. As radiologists and promoters of the health and well-being of our patients, partnering with patients, community organizations, and other medical specialties to assist patients in overcoming multilevel barriers to LCS will allow us to design sustainable programs to promote awareness of, opportunities for, and participation in LCS for all patients.

    References

    1. NIH website. SEER Program. Cancer stat facts: lung and bronchus cancer. seer.cancer.gov/statfacts/html/lungb.html. Published 2021. Accessed November 12, 2023
    2. Febbo J, Little B, Fischl-Lanzoni N, et al. Analysis of out-of-pocket cost of lung cancer screening for uninsured patients among ACR-accredited imaging centers. J Am Coll Radiol 2020; 17:1108–1115
    3. Wang GX, Pizzi BT, Miles RC, et al. Implementation and utilization of a “pink card” walk-in screening mammography program integrated with physician visits. J Am Coll Radiol 2020; 17:1602–1608
    4. Flores EJ, Irwin KE, Park ER, Carlos RC. Increasing lung screening in the Latino community. J Am Coll Radiol 2021; 18:633–636
    5. Doubeni CA, Simon M, Krist AH. Addressing systemic racism through clinical preventive service recommendations from the US Preventive Services Task Force. JAMA 2021; 325:627–628
    6. Van Haren RM, Delman AM, Turner KM, et al. Impact of the COVID-19 pandemic on lung cancer screening program and subsequent lung cancer. J Am Coll Surg 2021; 232:600–605
    7. U.S. Preventive Services Task Force. Final recommendation statement: lung cancer—screening. www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening. Published March 9, 2021. Accessed November 12, 2023
    8. Ford JG, Howerton MW, Lai GY, et al. Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer 2008; 112:228–242
    9. Trauth JM, Jernigan JC, Siminoff LA, Musa D, Neal-Ferguson D, Weissfeld J. Factors affecting older African American women’s decisions to join the PLCO Cancer Screening Trial. J Clin Oncol 2005; 23:8730–8738
    10. Wang GX, Baggett TP, Pandharipande PV, et al. Barriers to lung cancer screening engagement from the patient and provider perspective. Radiology 2019; 290:278–287
    11. Wang GX, Neil JM, Fintelmann FJ, Little BP, Narayan AK, Flores EJ. Guideline-discordant lung cancer screening: emerging demand and provided indications. J Am Coll Radiol 2021; 18:395–405
    12. Coughlin JM, Zang Y, Terranella S, et al. Understanding barriers to lung cancer screening in primary care. J Thorac Dis 2020; 12:2536–2544
    13. Gagne SM, Fintelmann FJ, Flores EJ, et al. Evaluation of the informational content and readability of US lung cancer screening program websites. JAMA Netw Open 2020; 3:e1920431
    14. International Association for the Study of Lung Cancer (IASLC) website. IASLC language guide. www.iaslc.org/IASLCLanguageGuide. Published May 2021. Accessed November 12, 2023
    15. American College of Radiology (ACR) website. Lung cancer screening locator tool: screening location finder. www.acr.org/Clinical-Resources/Lung-Cancer-Screening-Resources/LCS-Locator-Tool. Published 2021. Accessed November 12, 2023
    16. Flores EJ, Neil JM, Tiersma KM, et al. Feasibility and acceptability of a collaborative lung cancer screening educational intervention tailored for individuals with serious mental illness. J Am Coll Radiol 2021; 18:1624–1634
    17. Jessup DL, Glover Iv M, Daye D, et al. Implementation of digital awareness strategies to engage patients and providers in a lung cancer screening program: retrospective study. J Med Internet Res 2018; 20:e52
    18. American College of Radiology (ACR) website. Lung cancer screening resources. www.acr.org/Clinical-Resources/Lung-Cancer-Screening-Resources. Accessed October 7, 2021. Accessed November 12, 2023
    19. American College of Radiology (ACR) website. Lung CT Screening Reporting & Data System (Lung-RADS). www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Lung-Rads. Published 2021. Accessed November 12, 2023
    20. LuCa National Training Network website. Enhancing provider education on lung cancer care. lucatraining.org. Published 2021. Accessed November 12, 2023
    21. American College of Radiology (ACR) website. National lung cancer roundtable lung cancer screening webinar series. pages.acr.org/2021-NLCRT-Webinar-Series.html. Published 2021. Accessed November 12, 2023
    22. Percac-Lima S, Ashburner JM, Rigotti NA, et al. Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. Cancer Med 2018; 7:894–902 
    23. Wang GX, Narayan AK, Park ER, Lehman CD, Gorenstein JT, Flores EJ. Screening mammography visits as opportunities to engage smokers with tobacco cessation services and lung cancer screening. J Am Coll Radiol 2020; 17:606–612
    24. Cardarelli R, Roper KL, Cardarelli K, et al. Identifying community perspectives for a lung cancer screening awareness campaign in Appalachia Kentucky: the Terminate Lung Cancer (TLC) study. J Cancer Educ 2017; 32:125–134
    25. Lopez DB, Flores EJ, Miles RC, et al. Assessing eligibility for lung cancer screening among women undergoing screening mammography: cross-sectional survey results from the National Health Interview Survey. J Am Coll Radiol 2019; 16:1433–1439
    26. Bieniasz ME, Underwood D, Bailey J, Ruffin MT 4th. Women’s feedback on a chemopreventive trial for cervical dysplasia. Appl Nurs Res 2003; 16:22–28
    27. Healio website. ‘I’ve never been treated so well’: same-day cancer screening program helps reduce barriers. www.healio.com/news/hematology-oncology/20210907/ive-never-been-treated-so-well-sameday-cancer-screening-program-helps-reduce-barriers. Published September 7, 2021. Accessed November 12, 2023
    28. CancerCare website. Financial assistance program. www.cancercare.org/financial. Published 2021. Accessed November 12, 2023 
    29. Fan L, Fan K. Lung cancer screening CT-based coronary artery calcification in predicting cardiovascular events: a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e10461
    30. Hatabu H, Hunninghake GM, Richeldi L, et al. Interstitial lung abnormalities detected incidentally on CT: a Position Paper from the Fleischner Society. Lancet Respir Med 2020; 8:726–737
    31. Schapira MM, Aggarwal C, Akers S, et al. How patients view lung cancer screening. the role of uncertainty in medical decision making. Ann Am Thorac Soc 2016; 13:1969–1976
    32. Barbosa EJM Jr, Yang R, Hershman M. Real-world lung cancer CT screening performance, smoking behavior, and adherence to recommendations: Lung-RADS category and smoking status predict adherence. AJR 2021; 216:919–926
    33. CDC website. Offering flexible hours and locations. www.cdc.gov/cancer/nbccedp/success/hours-locations.htm. Published 2021. Accessed November 12, 2023
    34. Hirsch EA, New ML, Brown SP, Baron AE, Malkoski SP. Patient reminders and longitudinal adherence to lung cancer screening in an academic setting. Ann Am Thorac Soc 2019; 16:1329–1332
    35. American Thoracic Society (ATS) website. American Thoracic Society and American Lung Association implementation guide for lung cancer screening. www.lungcancerscreeningguide.org. Accessed November 12, 2023
    36. International Association for the Study of Lung Cancer (IASLC) website. Feldman J, Faris NR, Warren GW. Ending stigma in lung cancer: the IASLC participates in a collaborative summit held by the National Lung Cancer Roundtable. www.iaslc.org/iaslc-news/ilcn/ending-stigma-lung-cancer-iaslc-participates-collaborative-summit-held-national. Published October 15, 2020. Accessed November 12, 2023
    37. Christiani DC. Radiation risk from lung cancer screening. Chest 2014; 145:439–440
    38. Okpala P. Increasing access to primary health care through distributed leadership. Int J Healthc Manag 2021; 14:914–919
    39. Joseph AM, Rothman AJ, Almirall D, et al. Lung cancer screening and smoking cessation clinical trials: SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med 2018; 197:172–182
    40. Denver Health website. Module 3: healthcare team—community health workers and patient navigators. https://www.denverhealth.org/patients-visitors/community-voices-patient-navigators. Published 2011. Accessed November 12, 2023
    41. Headrick JR, Morin O, Miller AD, Hill L, Smith J. Mobile lung screening: should we all get on the bus? Ann Thorac Surg 2020; 110:1147–1152
    42. Atrium Health website. Levine Cancer Institute launches nation’s first mobile lung CT unit to improve care for region’s underserved and rural patient. atriumhealth.org/about-us/newsroom/news/2017/03/levine-cancer-institute-launches-nations-first-mobile-lung-ct-unit-to-improve-care-for-regions-unde. Published March 20, 2017. Accessed November 12, 2023
    43. Lococo F, Cardillo G, Veronesi G. Does a lung cancer screening program promote smoking cessation? Thorax 2017; 72:870–871
    44. Graham AL, Burke MV, Jacobs MA, et al. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial. Trials 2017; 18:568
    45. Massachusetts General Hospital website. Pulmonary nodule clinic. www.massgeneral.org/cancer-center/treatments-and-services/pulmonary-nodule-clinic. Published 2021. Accessed November 12, 2023
    46. MD Anderson Cancer Center website. Lung cancer screening clinic. www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/cancer-prevention-center/lung-screening-clinic.html. Published 2021. Accessed November 12, 2023
    47. American College of Radiology (ACR) website. ACR designated lung cancer screening center. www.acraccreditation.org/centers-of-excellence/lung-cancer-screening-center. Published 2021. Accessed November 12, 2023
  • Good News, Bad News: 12 Years of Lung Cancer Screening Coverage in U.S. Newspapers

    Good News, Bad News: 12 Years of Lung Cancer Screening Coverage in U.S. Newspapers

    Brent P. Little

    Mayo Clinic, Jacksonville

    What does the general public hear about lung cancer screening (LCS) from newspapers here in the United States of America? And why does what the public hears about LCS in the papers matter? Mass media is an important source of medical information for the public at large. Print sources, radio, television, online, and social media platforms all influence public knowledge of medical topics, but especially so for older adult populations, print media remains a truly trusted resource [1].

    Public perception of LCS is particularly critical, since eligible individuals may not be aware of LCS opportunities, as well as the benefits and risks of screening with low-dose CT (LDCT). In-office discussion is often limited by time constraints; in a JAMA study from 2018, practitioners spent, on average, less than 1 minute discussing LCS [2]. According to findings from the U.S. National Lung Screening Trial, LCS with LDCT was associated with a 20% reduction in lung cancer-specific mortality [3], yet despite so many additional trials providing further support, LCS uptake continues to represent too small a fraction of the eligible population. Could the composition of coverage concerning LCS help to shape public understanding and influence the opinions of those eligible for LDCT screening? 

    For AJR, my colleagues and I analyzed 12 years’ worth of LCS coverage in U.S. newspapers to assess the volume, tenor, and scope of that coverage [4]. The good news? Most of the coverage, itself, was good. And in could-be-better news, although many articles mentioned at least one benefit of LDCT LCS, additional important benefits were uncommonly included. The worst news, though? Critical logistics were seldom mentioned, and radiologists were infrequently interviewed.

    From 2010 to 2022, a total of 859 articles mentioning LCS were included across a range of local, regional, and national newspaper sources. Weekly circulation sizes ranged from a low of 713 readers for one local paper to 1.2 million for the New York Times and 1.5 million for the Wall Street Journal. Annual article volume ranged from a high of 130 in 2014 (15% of the total) to a low of 33 (4% of the total) in 2020. Unfortunately for data, 2022 proved to be an incomplete year (Fig. 1).

    Fig. 1—Line graph depicting number of U.S. newspaper articles covering LCS by year of publication, 2010–2022. Key developments in lung cancer screening are annotated by year. Study period included only first 3 months of 2022, resulting in lower number of articles for that year. LCS = lung cancer screening. NLST = National Lung Screening Trial, USPSTF = U.S. Preventive Services Task Force, LDCT = low-dose CT, AAFP = American Academy of Family Physicians.

    The nadir of LCS coverage in 2020 coincided with the onset of the novel coronavirus disease (COVID-19) pandemic. Understandably, COVID-19 dominated the news that year, comprising about 25% of frontpage news articles for 2020 [5].

    Of all articles, 25% were published during the month of November, Lung Cancer Awareness Month. It is gratifying to see LCS information so well disseminated during this month of greater public awareness, but such clustering reminds us: more sustained coverage throughout the year might be beneficial.

    For a majority of articles, 76%, sentiment towards LCS was positive; moreover, negative sentiment comprised just 3% of the total. However, a higher proportion of negative sentiment (8%) came from articles on the highest quartile of weekly circulation (i.e., the most widely read newspapers).

    Full articles appeared most commonly (65%), but short news briefs—often a small paragraph within a collection of multiple news items—accounted for a large proportion of the total article number (31%). Typically, these news briefs were limited in scope (e.g., an announcement for a screening program). 

    Most articles (64%) mentioned at least one benefit of LCS: early detection and mortality reduction (49%). (Meanwhile, other benefits, such as the ease of LDCT or low radiation dosage, were rarely stated.) And we found it was a minority of articles (23%) that mentioned at least one potential risk.

    Logistical aspects of LCS were infrequently stated, including updated recommendations for an annual CT examination until eligibility criteria are no longer satisfied (27%) and participation in a smoking cessation program (28%).  

    Although many eligible individuals had questions regarding the potential cost or insurance coverage of LDCT LCS, we found it was a minority of articles (33%) that broached these subjects.

    Importantly, despite playing a leading role in LCS programs, radiologists were mentioned or interviewed in a minority of articles (9%). Low media representation may be a missed opportunity to illustrate the importance of radiologists—and the field of imaging—to early cancer detection and management.

    References

    1. Forman-Katz N, Matsa KE. News Platform Fact Sheet. Pew Research Center website. www.pewresearch.org/journalism/fact-sheet/news-platform-fact-sheet. Published September 20, 2022. Accessed October 19, 2023
    2. Brenner AT, Malo TL, Margolis M et al. Evaluating shared decision making for lung cancer screening. JAMA Intern Med 2018; 178:1311–1316
    3. National Lung Screening Trial. U.S. Department of Health and Human Services’ National Institute of Health, National Cancer Institute website. www.cancer.gov/types/lung/research/nlst. Accessed October 19, 2023
    4. Zippi ZD, Cortopassi IO, Johnson EM et al. U.S. newspaper coverage of lung cancer screening from 2010 to 2022. AJR 2023; 221
    5. Krawczyk K, Chelkowski T, Laydon DJ. Quantifying online news media coverage of the COVID-19 pandemic: text mining study and resource. J Med Internet Res 2021; 23:e28253
  • Roentgen Fund Names Francis Baffour, Hyun Soo Ko 2024 Radiology Journalism Fellows

    Roentgen Fund Names Francis Baffour, Hyun Soo Ko 2024 Radiology Journalism Fellows

    The American Roentgen Ray Society (ARRS) is pleased to announce Francis Baffour of Mayo Clinic in Rochester, MN, as the 2024 Melvin M. Figley Fellow in Radiology Journalism. ARRS also recognizes Hyun Soo Ko of the Peter MacCallum Cancer Centre and Epworth Medical Imaging in Melbourne, Australia, as the 2024 Lee F. Rogers International Fellow in Radiology Journalism.

    Supported by The Roentgen Fund® and named for two distinguished Editors Emeriti of ARRS’ own American Journal of Roentgenology (AJR), the Melvin Figley and Lee Rogers Fellowships offer practicing radiologists an unparalleled opportunity to learn the tenets of medical publishing via “the yellow journal”—the world’s longest continuously published radiology journal. Through hands-on experience with ARRS staff and AJR personnel—as well as personal apprenticeship with AJR’s 13th Editor of Chief, Andrew B. Rosenkrantz—Drs. Baffour and Ko will receive expert instruction in scientific writing and communication, manuscript preparation and editing, peer review processes, journalism ethics, and both print production and digital publication.  

    Founded in 1907, AJR is one of the specialty’s leading peer-reviewed journals, publishing clinically oriented content across all imaging subspecialties and modalities relevant to radiologists’ daily practice. Overall, “the yellow journal” garnered 35,480 citations in 2022, ranking AJR fourth among all radiology journals.

    Since 1990, The Roentgen Fund has granted millions of dollars to hundreds of imaging professionals for both research pursuits and professional development. Today, through six vital scholarship and fellowship programs, the generosity of The Roentgen Fund’s donors is channeled to every corner of the globe—establishing dual foundations in innovation and leadership for a true diversity of radiology’s next generation. 

    Francis Baffour practices as a diagnostic radiologist with expertise in advanced MRI and CT techniques for musculoskeletal imaging. His clinical and research interests align with his goal of identifying novel applications for advanced imaging technologies, then rapidly translating these discoveries into practical patient care. As associate medical director of the CT Clinical Innovation Center in Mayo Clinic Rochester’s department of radiology, he supports the mission of facilitating high-impact imaging innovations with direct effect on patients, such as radiation dose reduction techniques, novel CT technologies, and quantitative assessment of disease activity. Dr. Baffour earned his M.D. from the Albert Einstein College of Medicine in New York City and a B.A. in biochemistry from Vassar College in Poughkeepsie, NY. 

    A German and Australian board-certified radiologist with over 20 years of international experience, currently, Hyun Soo Ko practices at Peter MacCallum Cancer Centre and Epworth Medical Imaging in Melbourne, Australia, holding affiliations with the University of Melbourne and University of Bonn in Germany. Her expertise is diverse, with specialized fellowships in breast imaging (Melbourne), imaging research (Toronto), and pediatric radiology (Heidelberg, Germany). Dedicated to advancing translational medicine, her research focuses on AI and radiomics to discover predictive imaging biomarkers. She is an active member of the Royal Australian and New Zealand College of Radiologists (RANZCR) Advisory Committee on Artificial Intelligence and the German Roentgen Society (DRG) Working Party Methodology and Research. As a clinician researcher, Dr. Ko remains committed to mentoring and supporting emerging radiologists, firmly believing multidisciplinarity and inclusiveness are key elements for equitable progress and impact.

    From May 5–9, 2024, Drs. Baffour and Ko will attend the 2024 ARRS Annual Meeting in Boston, MA, where they will co-present the AJR Year in Review Sunday Session and participate in the Editor’s Forum.

    More about the Figley and Rogers Fellowships

    Melvin M. Figley (1920-2010) assumed the editorial mantle of AJR with the January 1976 issue. Hiring a full-time professional staff and, for the first time, a managing editor, he appointed associate editors to facilitate the peer review process. Publication accelerated, and the quality of illustrations improved, leading to the AJR Pictorial Essay. Dr. Figley was also central to the partnership between ARRS and the American Society of Neuroradiology, including the founding of the American Journal of Neuroradiology in 1980. After more than a decade of dedicated service to “the yellow journal,” Dr. Figley retired in 1985.

    Lee F. Rogers, the distinguished musculoskeletal radiologist and longtime chair of imaging at Northwestern University Medical School, was named AJR’s chief editorial officer in 1996. Highlights from Rogers’ tenure at the journal included more contemporary design, introducing of a medicolegal column, authored by Dr. Leonard Berlin, and his popular editor’s notebook. Both the quality and the variety of papers published in AJR remained quite high, as the information revolution propelled “the yellow journal” into new formats, such as CD-ROM, and frontiers, like the internet.

    Five prior Melvin M. Figley Fellows of The Roentgen Fund® will also present during the 124th ARRS Annual Meeting in Boston, MA:

    • Brett W. Carter | 2016 FIGLEY FELLOW
      • Categorical Course: High-Resolution Chest CT
    • Tara M. Catanzano | 2005 FIGLEY FELLOW
      • Wellness Summit: Defining a Well Day at Work
    • Perry J. Pickhardt | 2002 FIGLEY FELLOW
      • Challenging Abdominal Cases
    • Andrew B. Rosenkrantz | 2014 FIGLEY FELLOW
      • AJR: Publishing in the Yellow Journal
    • Jadranka Stojanovska | 2015 FIGLEY FELLOW
      • Cardiac Imaging in the Acute Setting

  • The Teamwork Imperative—Part III

    The Teamwork Imperative—Part III

    Erik K. Paulson

    2023-24 ARRS President

    In radiology, whether you work in a large or small private practice, remotely by yourself, an academic department in a medical center, or part of a mega radiology practice, there has been a palpable shortage of radiologists. This shortage is fueled by a trend toward exclusive subspecialization with declining numbers of radiologists who can handle general work, ever-increasing expectations for service to our patients, referring doctors, hospitals, and health care systems. We have been stretched thinner. There is a desire by radiologists to have more flexible work hours or, simply stated, to work less hours overall compared to years past. There is a concern about what role artificial intelligence and machine learning will play; will we be displaced? Reimbursement has been decreasing relative to inflation and compared with other specialties. As a result of these realities and others, there is clear evidence of burnout among radiologists, similar to health care workers in other specialties. On top of that, sometimes, we find that the leaders in our organizations may be distant, or too corporate, or suffer from “toxic positivity,” which may be worse than “toxic negativity.”

    There has been a steady headwind for years, but it now feels like a gale force wind. And a lot of this feels out of our control. So, goodness, how do we manage all of this? Hold on, let’s take a breath. One strategy that we can embrace and control is to develop a culture of teams within our workplaces. In fact, I have titled this series “The Teamwork Imperative” because we must establish teamwork as a core value within the radiology workforce. I believe that if we foster a culture of teams, we can mitigate and shield ourselves from some of these headwinds.

    Let me be clear. Here, when I say teams, I am specifically not referring to the “macro teams” that many of us find ourselves in. For example, at Duke Health, it is said that the 30,000-plus employees are my “teammates.” That very well may be true. But no, I am referring to your local and focal team. I am referring to the individuals that you rely on daily or weekly to deliver your work product. It’s the folks you huddle with. And the teams develop where you huddle. If you are in training, I am referring to your team of co-residents, your chief residents, maybe your program director or program coordinator who you lean on. If you are in a private practice, I am referring to those that you share physical space with, or perhaps switch call with, or the individuals you show difficult cases to, or the referring docs you have developed close relationships with, and who rely on you to deliver care. In an academic environment like mine, it might be the members of your subspecialty division. If done well, the division pulls together as a team to deliver care, service, teaching, and research.

    Those divisions that have a culture of team are far more effective than those who are unable to act as a team. If you are lucky enough to have these local and focal teams (and these often form and evolve organically), many challenges at work open up and become more manageable and attainable. The clouds begin to lift. Specifically, your deliverables, whatever they may be, are far more easily and effectively achieved if you have your team and approach your work from the perspective of that team.

    Work becomes more efficient and fulfilling and, frankly, more fun. The work becomes more manageable, with more aspects under your control. You become more engaged. And that then becomes an antidote to burnout. Teams, therefore, contribute to retention.

    Coaches discuss this all the time. I’ll borrow here from Mike Krzyzewski, the legendary Duke University men’s basketball coach. “Coach K” famously talked about the five keys to an effective team, likening them to the fingers on a hand. Each finger is individual and can stand alone, but when the five fingers of communication, trust, responsibility, caring, and productivity come together into a fist, the fist proves to be much stronger than the sum of the individual fingers. 

    Communication

    Yes, of course, communication is about sharing news back and forth, accurately and honestly, but more importantly, communication is to be able to probe, to be able to respectfully question, and to be able to expect honest answers from your teammates. Sometimes, the questions aren’t easy, and the answers may not be easy either. To foster an effective team requires the ability and the safety of pointing out the opportunities—those ones are easy. More importantly, it is to have safety in pointing out deficiencies—those are more difficult. It is critical for teammates to be able to receive and internalize the information coming from within the group, whether it is a kudo, an observation, or a deficiency or a criticism. 

    You have to talk to each other. Actually talk. And in a world of remote work and texting, we don’t talk enough. Maybe the talking occurs in a partner meeting, defined clinical case conference, resident meeting, or division or department meeting. Maybe it is your team taking a coffee break or going for a midday walk to achieve “step” goals. Hopefully, the team dynamics are such that one can tap a teammate on the shoulder and engage in an effective and safe conversation. 

    Communication needs to be practiced. That is why I think standing, regular, in-person meetings, even if the agenda is light, are very important. The opportunity to come together regularly promotes the importance and expectation of communication. And it is habit forming. You get better at it.

    Trust

    Trust means telling the truth, and telling it sooner rather than later; knowing that within a team, that can be hard. It can be hard because so many of us struggle with confrontation and conflict and try to avoid them. But consider it this way, from the perspective of the iconic University of Tennessee women’s basketball coach, Pat Summitt. She said, “The absolute heart of loyalty is to value those people who tell you the truth, not just those people who tell you what you want to hear. In fact, you should value them the most, because they have paid you the compliment of leveling with you, assuming you can handle it.” 

    Honest and fair difficult conversations almost always produce results. If you can get through the first thirty seconds of a difficult conversation, often the clouds lift and a very productive conversation follows. For me, I need to write down the key first few sentences for that opening thirty seconds and the rest flows. If difficult conversations don’t produce results, you have learned something.

    Collective Responsibility

    A coach might say, “We win together, we lose together, there is no “blame game.” In the workplace of radiology, the collective responsibility is the pulling together to deliver on our various missions. Everyone does not play the same role. One partner may be a fast and efficient reader, that’s great. Her partner is slower because he spends a lot more time consulting and discussing with referring docs. Both these individuals are important to the team. Or in an academic environment, one may be more focused and skilled clinically, another may be more focused on teaching. In a team where there is collective responsibility, they complement one another and each can be proud of each other’s successes. Indeed, the light of their success shines on the other teammates, on the entire team.

    Caring

    This is also about humanity and human connections and colleagueship. Caring in a team reflects time spent with each other and sharing aspects of ourselves, in this case the women of Duke Radiology. The caring strengthens the interconnective web between team members, in this case at our annual Fall Gathering. It makes the team softer in a positive way, and more personable, yet, at the same time stronger. 

    Here is where I worry about remote work. I get it. The pandemic has shown that we can do radiology effectively, even remotely. People like it and expect it. And we have learned that we can teach remotely. Sort of. But it seems far more difficult to foster a genuine, caring environment when work is dispersed in many geographic locales and individuals work essentially independently, free of meaningful, direct interactions with other teammates, other humans. To me the same applies to Zoom meetings. All the nuanced talk and greetings pre- and post-meeting are lost. The body language is lost. The sense of community is lost, or at least different. And I think the effectiveness of the meeting suffers. Indeed, on a Zoom meeting, you can’t even have real eye contact. I worry that with remote work, the culture of our teams maybe eroded. We do need to incorporate the best aspects of some remote work, but incorporate it in a fashion that fosters caring.

    Pride/Productivity

    Coach K says, “Everything we do has our own personal signature on it…and if we all sign off on everything we do, then we have a chance to be great.”

    And your teammates all do have the chance to add their personal touch and signature. Collectively then, we have the opportunity to harness the best of what we can be, and to be great, even with all that is facing us and challenging us in our current and future work environments. “And it is going to be hard; we all wait in life for things to get easier…when we are well staffed, when I pass the Boards, when I make partner, when the kids are older, when the pandemic is over … it will never get easier. What happens is, you handle hard better.” As pointed out by Kara Lawson, Duke women’s basketball coach. 

    Each of these domains, communication, trust, collective responsibility, caring, and pride; the five individual fingers are important. But when the five fingers are formed into a fist, a true team, the collective strength is much greater than the sum of the individual parts. When these five areas can be applied to our teams in radiology, we can become more effective and efficient. As individuals alone, we are relatively weak. Together as a team, we are stronger. And this is something within our control.  

    To me, there is an imperative to create, sustain, and grow teams in our workplace.

    Colleagues, I personally invite you to join us for ARRS 2024, either in Boston or online. This exceptional event brings together top radiologists from around the world to share new knowledge shaping our field. 

    Our Annual Meeting is renowned for its cutting-edge education, providing clinical information you can put into practice right away. We are excited to share the latest advancements in radiology, along with comprehensive review lectures to stay sharp on core topics. 

    Whether you attend in person and immerse yourself in the vibrant atmosphere of Boston, or choose our convenient online option, ARRS 2024 promises to be a remarkable experience. Your participation and engagement will help us connect, learn, and advance radiology together.

  • A Five-Star Hospitality Approach to Enhancing the Patient Experience in Breast Imaging

    A Five-Star Hospitality Approach to Enhancing the Patient Experience in Breast Imaging

    Claudia Cotes

    Assistant Professor, Department of Diagnostic and Interventional Imaging
    McGovern Medical School, UT Health Houston

    It is my pleasure to discuss a topic that holds a very special place in my heart—the patient experience in breast imaging. What makes this topic truly captivating is that it touches upon several areas that are significant to me: patient-centered care, team leadership, and wellness. But there is an interesting twist, and I would like to share that as well, because it’s a kind of secret passion that I’ve had for years. And that is my love for spas, just the unforgettable experience you can get during one of the most memorable stays in a hotel. 

    Now, you might be wondering how on earth these interests come together. How can these unrelated topics merge to create a health care experience that is as luxurious and comforting as a world-class spa getaway, while also providing exceptional patient care?

    We’ve all been on the other side of the examination table. We can relate to that mixture of emotions when walking into a doctor’s office. Just think about it for a moment. What stands out in your memory from those visits? Was it the mountains of paperwork you had to fill out, the warmth of the receptionist’s smile, the chill in the examination room? Maybe it was the time you spent waiting or the multiple ongoing discussions with your insurance company. Hopefully, and more importantly, perhaps it was the actual conversation you had with your doctor. Did you feel rushed, or were you heard and understood with all your questions addressed? Too often in our fast-paced working world of technicians and radiologists trying to meet numbers and targets, we may forget that the patient is the very reason we’re in this profession. 

    Really think about it. The news of a potential cancer is something threatening, and it is understandable that patients are stressed and anxious from the moment they walk into our office. Why not try to make the best possible experience when patients need it the most, for when they’re the most stressed and worried in their lives? 

    This is where my love for hotels comes in. When I was a girl, I loved a TV show about a lady who would receive the best stays and treatments at five-star hotels in incredible places around the world. She would then share her experiences with viewers. I used to think that, one day, I could do what this lady did. Of course, I didn’t end up being like her, but as a breast imager and as a patient now, I have always liked to compare the health care industry with the hospitality business. Although going to the doctor is not all leisure or pleasure, it is part of our wellbeing, and we’re all going to need it at some point.

    So, how do five-star hotels approach guest satisfaction and train their staff for this amazing service? These hotels are renowned for their exceptional customer service experience, and they invest heavily in preparing their staff. Please allow me to share a few of these key elements that I think we could borrow from their playbook. Thankfully, some of them we are already incorporating as radiologists.

    Let’s start with a customer-centric philosophy. Just as in five-star hotels, we should prioritize patient satisfaction above everything else. Every interaction with a patient should reflect our commitment to their wellbeing. This is exactly what the American College of Radiology’s Imaging 3.0 initiative is all about. 

    Then, we have role-specific training. As hotels do, health care should provide training that is tailored for specific positions, whether it’s radiologists, technicians, or administrative staff. Everyone should receive training that is aligned with their responsibilities. Those of us who are in academic institutions, for example, should model and objectively evaluate the interactions between our trainees and our patients to identify potential areas for improvement. 

    I want to continue with empathy and emotional intelligence. This might be a hard one, but we can train our health care professionals to empathize with patients’ needs and emotions. Recognizing and responding to patients’ moods can lead to a more compassionate and effective health care experience. 

    Next, we have language and communication, which is very important. In our diverse world, especially in the United States, language training is crucial for health care professionals. Being able to communicate effectively with patients from various backgrounds is going to enhance trust and understanding. 

    I’ll continue with problem-solving and decision-making. Similar to how hotel staff practice handling several guest scenarios, our health care professionals can benefit from training that sharpens problem-solving and decision-making skills, ensuring they can address patient concerns effectively and promptly. 

    Ongoing training. I think we’re good at this one. Learning in health care should not be a one-time event. Continuing education and professional development opportunities are not only going to keep our staff updated, but will also keep them committed to the patient experience.

    Finally, we have guest feedback. Like hotels—now with Yelp and Google reviews—we should actively seek patient feedback. Comments, both positive or negative, are going to be valuable for improvement. 

    Let’s connect all of this back to breast imaging. In diverse cities (for example, Houston, TX), diversity among our medical professionals and staff becomes essential. Having tools for communication, like translators, is helpful. More notably, having health care professionals who speak a patient’s language and share their culture creates an immediate sense of connection and trust, just as in five-star hotels.

    We know that trust is the foundation of an excellent patient-radiologist relationship, ensuring they return to us for essential care; however, establishing that trust is not the radiologist’s job alone. Since we are often the last ones to see a patient, our front desk and technician staff set the tone for what the patient’s visit will look like. We all need to be on the same page, so periodic meetings and reminders about our goals in terms of patient experience are necessary.

    Most importantly, we must not forget about our own wellbeing as health care professionals. And this is where administrators come in. Burnout, unfortunately, is a critical concern for radiologists. It affects our ability to provide the best care possible. We must set clear and appropriate boundaries in scheduling to prevent our staff from becoming overwhelmed and exhausted. 

    I know there are times when we must go above and beyond, but this should not be the baseline. If we have burned out staff, we cannot deliver the exceptional patient care and experiences we are aspiring to provide. I do feel like our role as breast imagers extends beyond our technical expertise and medical knowledge. We should create an environment where our patients feel valued, heard, and cared for. Borrowing some of these insights from the world of five-star hospitality, promoting diversity, and ensuring staff wellbeing, we can sincerely elevate the patient experience. Remember, it’s not only about what we see on the screen or the images we interpret, but how we make our patients feel through their health journey. We want this experience to be what they remember from their visit.

  • Empowering Families: Using Financial Freedom to Take Paternity Leave

    Empowering Families: Using Financial Freedom to Take Paternity Leave

    I am the lucky father of three girls. Before the birth of my youngest daughter, my hospital emailed to let me know that I was entitled to 3 weeks of paid parental leave. I was ecstatic. However, as I looked into it further, I found out that I was actually entitled to 12 weeks off! There was one small catch: 3 weeks were paid leave, and 9 weeks were unpaid leave. Not only was it unpaid time off, but I would have to pay the hospital for continuing some of my benefits during that time. My initial instinct was that I should just take the 3 weeks.

    As the date of my daughter’s birth approached, I started to rethink my priorities. For me, time with my family was more important at my early- to mid-career stage than the 9 weeks of salary. Also, my wife and I had saved an emergency fund of 6 months of expenses that we could easily access. What better way to spend that money than to have bonding time with my new daughter and help my older daughters make the transition to being older sisters to our new arrival.

    Understanding the benefits and laws surrounding paternity leave in the United States, particularly the Family and Medical Leave Act (FMLA), is crucial. Moreover, having financial literacy and an emergency fund can make this transformative experience not just feasible, but enriching for families. In this blog post, I will explore the advantages of paternity leave, delve into the FMLA laws, and discuss how financial literacy plays a vital role in embracing this invaluable time off.

    https://www.radfyi.org/2023/10/16/whats-your-number/

    Paternity Leave Benefits

    Bonding Time

    Paternity leave allowed me to establish a strong emotional bond with my newborn daughter. Those initial months were invaluable for building connections that will last a lifetime. For my family with multiple children, the initial weeks involved a large change in family dynamics. Since my wonderful wife was very occupied with our newborn, I played a large role in helping my older daughters adjust to having a new member in the family, helping them embrace their new roles as older siblings, teachers, and helpers.

    Support for Partners

    My wife had some physical and emotional challenges after childbirth. During my paternity leave, I was able to support her and share many of the responsibilities that she was accustomed to doing. This allowed her to concentrate on our youngest daughter, helping the wellbeing of both my wife and my youngest daughter.

    Time with Family

    In our practice, it is very difficult to get a long period of contiguous time off. However, paternity leave offers this. During my leave, we were able to rent an Airbnb in Canada for 6 weeks. This allowed us to be very close to my dad and sister, which allowed for so much bonding time between my family and my daughters. It was the best part of the leave time. As members of a sandwich generation, my wife and I are caring for our children and our parents at the same time. It was great to be able to bring them together and spend an extended period of time together. A fantastic blog post titled “The Tail End” by Tim Urban and the Wait but Why team does a great job of explaining why such time is so precious! I highly recommend reading it.

    The Tail End

    Understanding FMLA Laws

    The FMLA, enacted in 1993, enables eligible employees to take up to 12 weeks of unpaid, job-protected leave for specified family and medical reasons, including the birth or adoption of a child. Understanding these laws is crucial for fathers planning to take paternity leave.

    Eligibility

    FMLA applies to public agencies, public and private hospitals, and companies with 50 or more employees. To be eligible, an employee must have worked for the employer for at least 12 months and have completed at least 1,250 hours of service during the 12-month period preceding the leave.

    Job Protection

    One of the significant benefits of FMLA is the job protection it offers. Employees are entitled to return to their original or equivalent positions after the leave period, ensuring job security.

    Health Insurance Continuation

    During FMLA leave, employers must maintain the employee’s health benefits as if they were still working. During my leave, my hospital paid the employer contribution to the health plan premiums, and I was responsible for paying the employee portion of those premiums, as well as deductible and out-of-pocket costs.

    Financial Independence and Emergency Fund

    While the FMLA provides job protection, it is unpaid leave, which can pose financial challenges for unprepared families. Having an emergency fund can bridge this gap.

    Peace of Mind

    An emergency fund provides peace of mind, knowing that there’s a financial cushion to support the family during the paternity leave period.

    Focus on Family

    Financial stability allows fathers to focus entirely on their families—without the stress of immediate financial obligations. It empowers them to be present, both physically and emotionally, during this crucial time.

    Future Planning

    Financial independence encourages families to plan for the future. It ensures that the leave period doesn’t impact long-term financial goals, providing a sense of security for the entire family.

    I am very lucky to work with amazing, supportive colleagues. When I proposed taking paternity leave, even though no one had done it before, I was met with support from my department, hospital, and colleagues. Another unique benefit to my leave? I was able to take it intermittently during the first year of my daughter’s life. This flexibility allowed me to work when we had visiting family in town, who could help, then take leave when it was just my wife and me. However, the present FMLA law does not require such accommodation, so this is likely employer-dependent. Now, I talk to all fathers who are expecting new babies about establishing an emergency fund, pointing out the benefits of more paternal leave. Anecdotally, this seems to be gaining traction among physicians. I know two recent father doctors who are taking their full allotment of paternity leave, as well as another father who is strongly considering taking some unpaid leave.

    I believe that paternity leave (supported by laws like FMLA) is not just a break from work; it’s an investment in your family and the future. Understanding these laws and ensuring financial stability through an emergency fund can transform this period into a beautiful and enriching experience for fathers, mothers, and children alike. By embracing paternity leave and advocating for supportive policies, we contribute to the creation of healthier, happier families and a more balanced society.

    Sherwin Chan, MD, PhD

    Professor of Radiology, University of Missouri at Kansas City

    Vice Chair of Research, Children’s Mercy Kansas City

  • What’s Your Number?

    What’s Your Number?

    Planning for retirement is daunting. Something that many of us end up putting off in place of doing something else, anything else. We tell ourselves it is 10, 20, 30, or even 40 years in the future. Why is it that many of us, myself included, will spend more time researching a new TV purchase or our next vacation destination than planning for retirement? I’m here to tell you that it is better to start planning for your retirement now. We can strive for improvement, as I firmly believe that a doctor who is financially literate also becomes a more effective health care provider. When you have a solid grasp of your finances, you gain the capacity to make more informed decisions, not only for the benefit of your practice but also for the wellbeing of our patients.

    Determining Your Retirement Number

    Many of us delay retirement planning because it appears to be an intimidating endeavor. However, it doesn’t have to be. One of the initial steps is to determine your financial independence target, recognizing that this number is likely to evolve over the course of your career. Your number represents the amount of investable retirement assets required to maintain your desired standard of living throughout retirement. When you search for “how much do you need to retire,” you’ll encounter a wide range of responses, some of which may be inaccurate. Is it $1 million, $5 million, or even $10 million for a doctor to retire? Should it be 70% of your pre-retirement income, or perhaps 10–12 times your pre-retirement income? Regrettably, many of these responses fail to address the fundamental factor: how much you spend each year ultimately determines the amount needed for your retirement.

    Safe-Withdrawal Rate and the 4% Rule

    In order to comfortably retire, you will need about 25 times your annual spending to fund a 30-year retirement. To put another way, an investor who maintains a portfolio consisting of 75% stocks and 25% bonds can safely withdraw 4% of their portfolio’s value annually, adjusted for inflation, to support a typical 30-year retirement without the risk of depleting their funds. This is known as your safe-withdrawal rate and what has been known to many as the 4% rule of thumb. Now, this 4% withdraw rate and spending allocation must encompass all expenses, including taxes, health care costs, and financial advisory fees. If you spend $120,000 per year, you will need about $3 million in invested assets. For every $40,000 a year spending, you will need another $1 million in your retirement portfolio. This is based off “the Trinity study,” where Cooley et al. looked at historic safe withdrawal rate based on varying percentages of a stock/bond portfolio. This American Association of Individual Investors feature helped determine what percentage of money you could safely withdraw each year, indexed to inflation, and still have a reasonable chance of having money left after a 30-year retirement. In the majority of instances, individuals employing a 4% withdrawal rate during retirement will find themselves with a larger sum of money by the end of their retirement period compared to their initial retirement savings, frequently exceeding twice the amount they began with.

    Informally referred to as “the Trinity study,” as all three authors were professors at Trinity University in San Antonio, TX, Cooley et al. updated their original 1998 paper in 2011 to include data from the Great Recession of 2008. The authors looked at historic, rolling 30-year periods from 1926–2009 to help determine what withdrawal rate, indexed to inflation, would sustain different retirement lengths using different portfolios that were invested in a mixture of stocks and bonds. This study challenged the long-held belief that if a stock portfolio maintained an average annual return of 9–12%, it would be safe to withdraw 7–9% annually in retirement, ensuring the portfolio’s sustainability indefinitely. The primary factor rendering this strategy unfeasible during various periods is the risk associated with the sequence of returns.

    Sequence of Returns Risk

    The sequence of returns risk relates to the idea that the performance of your portfolio early in retirement matters more than the performance late in retirement. The term “sequence” pertains to the adverse effects of experiencing low or negative investment returns during the early years of retirement, which can significantly influence the longevity of your retirement portfolio.

    Consider, for instance, two retired investors who both achieved an average annual return of 7.75% throughout a 20-year retirement period, all while making annual withdrawals of $70,000 from their initial million-dollar portfolio (Fig. 1).

    Fig. 1—Both investors initiated their retirement with a $1 million portfolio balance and achieved an average annual return of 7.75% over a 20-year period, while withdrawing $70,000 annually. Investor 1 (orange) experienced a 35% decline in their portfolio balance in the 15th year of retirement, while Investor 2 (gray) encountered the same 35% drop in the first year of their retirement. The sequence of portfolio returns during the early stages of retirement significantly impacts the probability of the portfolio lasting throughout the entire retirement period, necessitating a much lower withdrawal rate when compared to the average portfolio return.

    In the case of the first individual, they consistently enjoyed returns of 10% per year, but in the 15th year, they experienced a significant negative return of -35%, resulting in an average return of 7.75% over 20 years. The second individual, on the other hand, also averaged a 7.75% annual return, but their portfolio started with a 35% drop in the first year, then averaged a 10% annual return for the subsequent years. It’s important to note that both individuals maintained an average return of 7.75% while withdrawing the same amount annually. However, the outcome differed significantly: the first individual concluded their 20-year retirement with nearly $400,000 more than their initial investment, whereas the second individual exhausted their funds in the 20th year. This highlights the critical importance of setting a withdrawal rate lower than your rate of return in retirement, as the sequence of returns can have a substantial impact on the outcome.

    Accumulating 25 times your annual spending in investable assets serves as a general guideline for achieving a successful retirement. However, in practice, many retirees adapt their discretionary spending based on their portfolio’s performance. During prosperous years, they can afford to spend more than the 4% benchmark, while in challenging years, they have the flexibility to reduce discretionary expenses and withdraw less than 4%. Nevertheless, it all commences with gaining a preliminary understanding of your annual spending, as this forms the foundation for determining the retirement nest egg required.

    So, I ask again, what’s your number?

    Christopher M. Walker, MD

    Glen and Karen Cox Endowed Professor of Radiology

    University of Kansas Medical Center

    The Glen and Karen Cox Endowed Professor of Radiology and a practicing cardiothoracic radiologist at the University of Kansas Medical Center, Christopher M. Walker, MD, is not a certified financial planner, accountant, or attorney. This information is presented for your entertainment only and does not constitute formal and personalized financial, accounting, or legal advice. Your personal situation may be different, so please consult your own tax attorney or fee-only financial planner for advice pertaining to your situation.

  • Improving Imaging of Gender-Diverse Patients

    Improving Imaging of Gender-Diverse Patients

    ARRS is collaborating with the Radiology Health Equity Coalition (RHEC) to curate and disseminate trusted resources and best practices for improving access and utilization of preventive and diagnostic imaging.

    Gender-affirming care is a rapidly evolving, highly politicized component of health care, affecting patients of all ages. Over the last decade, transgender and gender-diverse patients have been better recognized as a gender minority, approximated to represent up to 2% of the general population.

    A frequently stigmatized group, the health care needs of these populations are often ignored or even condemned, leading to high rates of adverse health outcomes. Therefore, it is critical for physicians and hospital systems alike to be educated in the medical and the psychosocial aspects of gender-affirming care, so to ensure competent and compassionate care that optimizes patient health, autonomy, and wellbeing.

    Presented live as a Featured Sunday Session during the 123rd ARRS Annual Meeting, “Improving Care of Gender-Diverse Patients in Radiology Departments” featured expert lectures on basic gender literacy, as well as pertinent clinical, surgical, and imaging aspects of gender-affirming care.

    Participants were presented with—and provided continuing access to—a gender diversity toolkit, care of the two course directors for “Improving Care of Gender-Diverse Patients in Radiology Departments” at the ARRS Annual Meeting:

    Sarah Menashe, MD

    Assistant Professor, Pediatric Radiology

    University of Washington School of Medicine

    Seattle Children’s Hospital  

    Jason Wright, MD

    University of Washington School of Medicine

    Seattle Children’s Hospital    

    Additionally, all viewers of this #FOAMrad resource from ARRS will enjoy a step-by-step guide and repository of resources enabling individuals and departments to improve their provision of gender-affirming care in both the adult and pediatric settings.

    Gender-diverse patients deserve uniform access to culturally competent, affirmative care in an environment that is free from harassment, discrimination, and bias. Apropos, this Featured Sunday Session during the 2023 ARRS Annual Meeting sought to educate medical imagers who want to improve their understanding and delivery of gender-affirming care.

    • What Do You Say? Literacy in Sex- and Gender-Affirming Care”—Vaz Zavaletta, MD, PhD
    • Overview of Sex- and Gender-Affirming Surgery—Frances Grimstad, MD, MS
    • Perioperative Imaging of Sex- and Gender-Diverse Patients—Michelle LaRosa, MD
    • Tools for Success: Practical Toolkit for Providing Gender-Affirming Care—Sarah Menashe, MD, and Jason Wright, MD
    Gender Affirmation Imaging Revisited

  • The Teamwork Imperative

    The Teamwork Imperative

    Over the last few years, we in radiology have faced incredible and unprecedented challenges in our day-to-day work, and this is true regardless of our specific work environments. Why? The pandemic, which has touched everyone and has had a profound impact on the workplace in general. It has changed how we work, approach work, and shaped our opinions of work. And it is not just the pandemic. It is political polarization, social unrest, changes in home life and education, the remote work life. The pandemic and its effects led to a great resignation, and as a result, many of our sites are now understaffed. It has been reported that one in five doctors plan to leave their current practice in two years; two in five nurses plan to leave their practice in two years; one in three doctors expect to work less next year.

    Health care workers have far greater demands now than in the pre-pandemic times. The delivery of health care has changed dramatically and quickly over the last few years. There is unprecedented “consumerism” in medicine now with a mandate to improve and rethink patient access, to provide more and better mental health services to our populations, and to have transparent pricing. Many health systems are facing financial challenges.

    In radiology, whether you work in a large or small private practice, remotely by yourself, an academic department in a medical center, or part of a mega-radiology practice, there has been a palpable shortage of radiologists. This shortage is fueled by a trend toward exclusive subspecialization with declining numbers of radiologists who can handle general work, ever-increasing expectations for service to our patients, referring docs, hospitals and health care systems. There is a desire by radiologists to have more flexible work hours or, simply stated, to work less hours overall compared to previous years. There is a concern about what role artificial intelligence and machine learning will play. Will we be displaced? And reimbursement has been decreasing relative to inflation and compared with other specialties. As a result of these realities and others, there is clear evidence of burnout among radiologists, similar to health care workers in other specialties. In addition, sometimes we find that the leaders in our organizations may be distant, or too corporate, or suffer from “toxic positivity,” which may be worse than “toxic negativity.”

    There has been a steady headwind for years, but it now feels like a gale-force wind. And a lot of this feels out of our control.

    One strategy to manage the headwinds and one that we can embrace and control is to develop a culture of teams within our workplaces. Establish teams as a core value within your workplace. If we have a culture of teams, we can mitigate and shield ourselves from some of these headwinds.

    When I refer to teams, I am specifically not referring to the “macro teams” that many of us find ourselves in. For example, at Duke Health, my hospital system, it is said that the 30,000-plus employees are my “teammates.” That very well may be true. But no, I am referring to your local and focal team. I am referring to the individuals that you rely on daily or weekly to deliver your work product. It’s the folks you huddle with. And the teams develop where you huddle. If you are in training, I am referring to your team of co-residents, your chief residents, maybe your program director or coordinator who you lean on. If you are in a private practice, I am referring to those that you share physical space with, or perhaps switch call with, or the individuals you show difficult cases to, or the referring docs you have developed close relationships with, and who rely on you to deliver care.In an academic environment, it might be the members of your subspecialty division. If done well, the division pulls together as a team to deliver care, service, teaching, and research. Those divisions that have a culture of team are far more effective than those who are unable to act as a team. It’s The Teamwork Imperative.

    If you are lucky enough to have these local and focal teams (and these often form and evolve organically), many challenges at work open up and become more manageable and attainable. The clouds begin to lift. Specifically, your deliverables, whatever they may be, are far more easily and effectively achieved if you have your team, and approach your work from the perspective of a team. Work becomes more efficient, fulfilling, and, frankly, more fun. The work becomes more manageable—with more aspects in your control. You become more engaged. And that then becomes an antidote to burnout. Teams, therefore, contribute to retention.

    Communication in the workplace is critical to developing teams. Of course, communication is about sharing news back and forth, accurately and honestly, but more importantly, communication is to be able to probe, to be able to respectfully question, and to be able to expect honest answers from your teammates. Sometimes, the questions aren’t easy, and the answers may not be easy either. To foster an effective team requires the ability and the safety of pointing out the opportunities—those ones are easy.More important, it is to have safety in pointing out deficiencies—those are more difficult. It is critical for teammates to be able to receive and internalize the information coming from within the group, whether it is a kudo or whether it is an observation, or whether it is a deficiency or a criticism.

    You have to talk to each other. Actually talk. And in a world of remote work and texting, we don’t talk enough. Maybe the talking occurs in a partner meeting, in a defined clinical case conference, or in a resident, division, or department meeting. Maybe it is your team taking a coffee break or going for a midday walk to achieve “steps” goals. Hopefully, the team dynamics are such that one can tap a teammate on the shoulder and engage in an effective and safe conversation.

    Communication needs to be practiced. That is why standing, regular, in-person meetings, even if the agenda is light, are very important. The opportunity to come together regularly promotes the importance and expectation of communication. It is habit forming. You get better at it.

    The communication must be honest with an expectation for mutual trust. Trust means telling the truth, and telling it sooner rather than later; knowing that within a team, that can be hard.It can be hard because so many of us struggle with confrontation and conflict and try to avoid them.

    Honest and fair difficult conversations almost always produce results. If you can get through the first 30 seconds of a difficult conversation, often the clouds lift and a very productive conversation follows. For me, I need to write down the key first few sentences for that opening 30 seconds and the rest flows. If difficult conversations don’t produce results, you have learned something.

    Communicating in person is far more effective than in an email or text. Personal communication often fosters human connections and colleagueship. Time spent with each other, sharing aspects of ourselves, results in caring. The time may be as simple as grabbing a cup of coffee together or asking someone about their weekend. Caring strengthens the interconnective web between team members, making the team softer in a positive way, and more personable, yet, at the same time stronger.

    And this is whyI worry about remote work. I understand well thatthe pandemic has shown that we can do radiology effectively, even remotely. People like it and expect it. And we have learned that we can teach remotely. But it seems far more difficult to foster a genuine, caring environment when work is dispersed in many geographic locales and individuals work essentially independently, free of meaningful, direct interactions with other teammates, other humans.To me, the same applies to Zoom meetings. All the nuanced talk and greetings pre- and post-meeting are lost. The body language is lost. The sense of community is lost, or at least different. And I think the effectiveness of the meeting suffers. Indeed, on a Zoom meeting, you can’t even have real eye contact. I worry that with remote work, the culture of our teams may be eroded.

    So, work to develop teams in your workplace. Together, as a team, we are stronger. And this is something within our control. There is an imperative to create, sustain, and grow teams in our radiology workplace.

    Erik K. Paulson, MD

    Chair, Radiology

    Duke University

  • Words & Sounds of Wellness: Dr. Sherry Wang

    Words & Sounds of Wellness: Dr. Sherry Wang

    Sherry Wang, MBBS, FRANZCR

    @drsherrywang

    I am an abdominal radiologist in the abdominal and ultrasound divisions at Mayo Clinic Rochester. Being a radiologist, I have found much of my source of unwellness and burnout tend to be psychological, rather than physical. There is a lot of mental burden, and it is no surprise that radiology is the most mentally demanding physician specialty with increasing workload contributing to burnout.  

    Music is something I have always enjoyed, and I’ve curated a “Wellness Playlist”—songs for those mentally tougher days in the reading room. Music has been found to improve mood and decrease anxiety and cortisol levels, even improving depression. Physiologically, music can decrease blood pressure, heart rate, and respiratory rate. In particular, listening to peaceful and low tempo music has been found to decrease heart rate. There are times in the reading room where I find it useful to have relaxing music to help decrease anxiety and irritation, as well as calm down. However, there are days where I want and need to get pumped up to help tackle a rougher day, just like getting pumped up at the gym for a workout. In fact, motivational music has been shown to combat cognitive and physical performance decline caused by exercise fatigue in sports. The other factor in this study by Bentouati et al. that showed to combat cognitive and physical decline was a 30-minute nap. This also showcases the importance and power of sleep, which we are all very aware of in mitigating burnout and unwellness. Since we are on the topic of sleep, listening to relaxing music has been found to be as effective as diazepam in reducing anxiety, and thus beneficial for aiding sleep. Music can lower our blood pressure, heart rate, and respiratory rate to help us fall asleep and achieve quality sleep, further boosting our wellness.  

    In “Words of Wellness” on www.radfyi.org/, members of the ARRS Wellness Subcommittee share what “wellness” and “wellbeing” mean in their own clinical practices, research focuses, and everyday lives.

    Top 3 Songs from Dr. Wang’s Motivational Playlist for Wellness:

    1. “Rise Up” by Andra Day

    “I’ll rise unafraid.”  

    2. “Fight Song” by Rachel Platten

    “This is my fight song
    Take back my life song
    Prove I’m alright song
    My power’s turned on
    Starting right now I’ll be strong
    I’ll play my fight song
    And I don’t really care if nobody else believes
    ‘Cause I’ve still got a lot of fight left in me”  

    3. “Hero” by Mariah Carey

    “So when you feel like hope is gone
    Look inside you and be strong
    And you’ll finally see the truth
    That a hero lies in you”

    You may also be interested in
    https://www.radfyi.org/2023/02/15/words-of-wellness-katia-dodelzon/
  • The Workplace Revolution

    The Workplace Revolution

    HELP, I am getting old! I can look back at my time in the workplace and remember how different things used to be. And while changes in the workplace have mostly been gradual over decades, the COVID-19 pandemic appears to have had a catalytic effect.

    I do, however, much prefer my new workplace environment over the past, and I am painfully aware that—for many readers—my current workplace is still a workplace of the “future.”

    Here’s where I am at:

    I have flexibility of my work hours in that we have shifts spanning different hours throughout the day, currently 7 am to 10 pm. While I cannot just choose on a daily basis which shift I am working, or even drop in whenever I feel like it, I much enjoy the ability to choose shifts that best accommodate my personal life. Also, I now have the flexibility of working from home. Although I cannot choose on any given day whether I work from home or not, certain shifts (day, evening, and weekend) allow me to do so, if that is my preferred way to work. On those days, my husband (who is a 100% remote worker) and I share the apartment as officemates. Fun!

    https://www.radfyi.org/2023/01/06/bye-bye-work-life-balance-welcome-work-life-integration/

    Technology enables me to be more efficient; for example, manage emails anywhere and anytime from my smart devices and easily collaborate on shared files, while protecting my organization’s need for data security. Fancy applications, like video conferencing, surveying, and data visualization, are easily accessible to me through my organization. A nerd’s dream come true…

    My work environment is defined by democracy, information sharing, learning, and collaboration. Our section makes decisions jointly, and each voice is heard. We transitioned from random score-based peer review to peer learning. And performance assessment is no longer based on knowledge agreement or RVUs, but focuses on engagement, such as participation in peer learning and educational feedback to technologists. We share information daily in an online chat that includes all radiologists and trainees on service at any location within our system. Each day, we collaborate: sharing interesting cases online, consulting each other for second opinions, taking turns in providing a teaching session.

    Our work and our career paths are becoming more customized. I am interested in Quality and Safety, and I am being given the opportunity to pursue this as my professional career. Others can nurture interests in education, research, or information technology to become leaders in those areas.

    https://www.radfyi.org/2022/09/26/leadership-styles-radiology-teams/

    These are amazing improvements taking place in our work environments. Since 2015 or so, we are said to be living through the Fourth Industrial Revolution, which is defined by cyber systems, machine learning and artificial intelligence, cloud technology, social media, a focus on human-machine interactions, deployment of nanoparticles, and a shift towards sustainability. Self-actualization is a big part of the Fourth Industrial Revolution, resulting in wokeness with regards to diversity, equity, and inclusion.

    Technology developments are the major drivers of the previous Industrial Revolutions, hence the name “Industrial.” But isn’t technology developed by humans? And aren’t these humans driven by simply wanting to make our lives better? In some way, each Industrial Revolution has propelled society further up Maslow’s pyramid of needs. Mostly in developed countries, we have surpassed the stage where our livelihoods serve physiological needs, such as food and shelter; we have gained safety and security through advances in technology and science; we opened new pathways to filling social needs, such as a sense of belonging and social networking, and we are now able to achieve self-actualization for ourselves and others.

    https://www.radfyi.org/2023/06/12/radiology-sustainability-lets-start-here/

    This is too rosy a picture for you? You are right. Each Industrial Revolution has also had negative effects, such as unsafe working conditions in early factories, unhealthy living conditions in overcrowded cities, a greater divide between the wealthy and poor, fake news, and now a threat that AI will overpower humanity.

    So, why did I write all of this? I had a thought that the change we are living is an opportunity and responsibility, maybe even an obligation. We are given the tools to decrease radiologist burnout—let’s use them! We are given the opportunity to improve patient care through machine learning and AI—let’s go for that! We can practice radiology with a more sustainable footprint—let’s rise to this challenge. We can afford equity—let’s invest in that.  

    The third Industrial Revolution was named the “Digital” Revolution. Let’s make sure that history will give a positive name to our fourth Industrial Revolution.

    Nadja Kadom, MD

    Director for Quality, Department of Radiology, Children’s Healthcare of Atlanta
    Interim Director for Quality, Department of Radiology and Imaging Sciences, Emory Healthcare
    Professor, Emory University School of Medicine

  • Saturday Scans Strengthen Lung Cancer Screening

    Saturday Scans Strengthen Lung Cancer Screening

    ARRS and 11 other medical imaging organizations are collaborating on the Radiology Health Equity Coalition (RHEC) to curate and disseminate trusted resources and best practices for improving access and utilization of preventative and diagnostic imaging.  

    A decade has passed since the United States Preventive Services Task Force’s first recommendation of low-dose CT (LDCT) for lung cancer screening (LCS). And yet, national LCS rates still remain worrying low: fewer than 1 in 10 Americans eligible for LDCT actually undergo annual screening. Compared with more established screening examinations for other cancers—about 67% for mammographic screening, 69% for colorectal screening, and 74% for cervical screening—LCS’ less than 10% looks even lower.

    The President’s Cancer Panel points to LCS as the single most effective strategy for reducing mortality from the disease, as well as for helping to close the healthy equity gap with improved access to care. Of course, for rural and racial/ethnic minority cohorts, access to and utilization of LCS has proven particularly tough. Not only are rural and minority populations more likely to live more than half an hour away from a designated screening center, all too often, these patients are also underinsured and suffer from lower levels of health literacy.

    That said, low usage rates for LCS do present a unique opportunity for radiologists and allied medical professionals at every step of the imaging encounter to work together with patient and caregiver advocates, community health organizations, cancer centers, and insurers to enhance accessibility for lifesaving and effective LDCT.  

    Screening on Saturday?  

    Although advances in modalities and innovations of technique have leveled the field, perhaps the most persistent barrier to screening is scheduling. What is the patient’s availability? When is the appointment?

    Worldwide, lung cancer continues to claim the highest mortality rate, with socioeconomically disadvantaged populations having the highest incidence rates. Despite having nearly identical medical leave needs, workers taking home less than $15 an hour have the least access to paid leave and eligibility for Family Medical Leave Act protections. More commonly, low-wage workers face adverse working conditions and financial consequences from taking whatever leave they do have. Nevertheless, most proper screening centers operate on a typical Monday through Friday schedule. Said operating hours afford little opportunity for patients with the greatest need to schedule and attend necessary screening appointments.

    https://www.radfyi.org/2021/05/28/practical-guide-to-health-equity-in-clinical-practice/

    On Saturday, November 11, 2023, ARRS and partner societies of the Radiology Health Equity Coalition (RHEC) will collaborate with the American Cancer Society’s National Lung Cancer Roundtable for the second annual National Lung Cancer Screening Day. A key date during Lung Cancer Awareness Month, National LCS Day encourages facilities to keep open their doors on the second Saturday in November, specifically for LDCT lung screening. In addition to raising awareness for early detection of lung cancer at large, Saturday screening allows those individuals who have already been referred for LDCT to get scanned—without having to take a day off of work, themselves.

    Curious if your practice or department is able to support this year’s National LCS Day on the 11th of November? There are some questions you will need to answer, first and foremost:  

    • Talk to your supervisor or chairperson. Discuss among colleagues. You’ll need approval and allocation for the additional screening, including a CT technologist for each LCS unit.
      • Perhaps there’s only a timeframe you’re able to offer LCS: morning only, afternoon only, late morning/early afternoon?
    • Inform scheduling staff your facility will be opening on November 11, so they can offer patients that Saturday option
      • Confirm with IT that scheduling system is open for booking appointments
    • Marketing & Communications
      • Ask your marketing department to promote the event: press release, social media, etc.

    Should your practice or department find all the necessary resources to scan on Saturday, here are some day-of tips to consider that will help you have a successful screening:  

    • Again, ensure your National LCS Day event is staffed accordingly
      • CT Tech—double-check!
      • Registration
      • Maintenance and housekeeping
      • Security
    • Refreshments (if allowed)
      • Coffee and donuts for Saturday morning
      • Snacks and drinks for Saturday afternoon
    • Marketing & Communications
      • Invite PR representative to take pictures and interview patients on Saturday

    National LCS Day is intended to serve as a catalyst for year-round screening awareness efforts, of course. Rather than waiting until the second Saturday in November to work screening into their routine, patients and clinicians alike are encouraged to make accessible LCS a year-round priority.

    Finally, acknowledging that National LCS Day falls on the Veterans Day holiday, RHEC is pleased to be working alongside the U.S. Department of Veterans Affairs to increase outreach and awareness to our military population, in turn saving more lives.

    https://www.radfyi.org/2022/05/25/practical-diversity-equity-and-inclusion/