Tag: Neiman HPI

Interventional Radiology’s Practice Evolution

Posted on by Brian Casey

Interventional radiology has proven benefits for patient care, enabling life-saving procedures to be performed less invasively than open surgery. But interventional radiology procedures are being concentrated among fewer radiologists, based on findings from a new study in JVIR by researchers from the ACR’s Neiman HPI group. 

From its origins in pioneering work conducted in the 1960s by Charles Dotter, MD, in image-guided minimally invasive procedures, interventional radiology has evolved into a field with one foot in diagnostic radiology and another in therapy.

  • The field achieved a major milestone in 2012, when it was recognized as an independent, primary medical specialty, and shortly thereafter an integrated IR/DR pathway was adopted that gives trainees additional dedicated interventional training. 
  • This replaced the previous practice of just tacking an extra interventional fellowship on to a diagnostic radiology program.

Has the new training structure changed who’s performing interventional procedures in the U.S.? Neiman HPI researchers examined this issue by analyzing Medicare claims from 2008 to 2023 for 46k radiologists. 

  • They focused on the volume of interventional procedures being performed by radiologists, and any shifts in volume that could have resulted from changes in the training program.

Over the study period, researchers found…

  • The percentage of all radiologists who performed at least some interventional work fell (from 67% to 50%).
  • But the percentage of super-specialists – those who spent more than 90% of their time doing interventional work – more than doubled (from 4.1% to 8.8%).
  • Among radiologists who primarily performed interventional work, more were younger compared to older (25% vs. 12%).
  • And super-specialists tended to be younger as well (9.2% vs. 6.8%). 

The changes are most likely due to the new IR/DR training pathway. But they also raise new questions, such as whether interventional radiology should completely separate from diagnostic radiology in both training and practice settings.  

  • The authors weren’t ready to go that far, noting that the integrated IR/DR pathway was designed to ensure dual competency in both image interpretation and procedures, and such flexibility is still valuable in today’s healthcare environment. 

The Takeaway

The new findings on the concentration of interventional radiology practice generally reflect the trend toward increased specialization that’s being seen in both radiology and healthcare. Patients are benefiting, as their procedures are more likely to be performed by specialists who not only received more training but also have more experience than in the past.

When Radiologists Quit

Posted on by Brian Casey

The chance that a radiologist would quit their job for a new one doubled over a recent 10-year period. And a new JACR study identifies the exact point in terms of case workload when radiologists are most likely to leave.

The burnout epidemic among healthcare professionals has been closely tied to workload, which has been rising steadily due to growing patient volumes and ongoing staff shortages.

  • In radiology, the problem has been exacerbated as radiologists are reading more images (from more complex cases) while the number of new radiologists being trained in residency programs remains static.

In the new paper, researchers from the ACR’s Neiman HPI investigated changes in radiologist turnover from 2013 to 2022 and how they compared with workload as measured by work relative value units, the most standard measure of physician productivity. 

  • They analyzed data on services provided by 39.4k unique radiologists representing 280.7k radiologist-years over the study period, then correlated that with data on how often radiologists changed practices.

Researchers found…

  • The radiologist turnover rate increased 61% (from 5.3% to 8.5%).
  • Odds of radiologist turnover were nearly 2X in 2022 versus 2013 (OR = 1.96).
  • And were 6% higher for female radiologists and 12% higher for metropolitan versus nonmetropolitan radiologists.
  • While academic radiologists had 9% lower turnover odds than nonacademic imagers.

But what about the connection between workload and turnover? This is where the study gets interesting, as the researchers found a U-shaped relationship between the two.

At low wRVU levels, turnover tended to drop as workload went up, perhaps as radiologists found more job satisfaction (and maybe higher pay) with more work to do.

But this changed once wRVUs hit a threshold, and turnover began rising as well, apparently as radiologists found themselves overworked. This inflection point differed for different types of radiologists…

  • Occurring at 12.9k wRVUs for all radiologists.
  • But at 13.4k wRVUs for private-practice radiologists.
  • And only 8.8k wRVUs for academic radiologists.

The 34% lower wRVU threshold for academic radiologists could be because many have prioritized research and teaching, and see a growing clinical care workload as a distraction without commensurate compensation. 

The Takeaway

The new study offers a fascinating look at the forces driving when and why radiologists quit, and provides a new benchmark showing precisely where the breaking point is for most radiologists. Let’s hope this data is put to good use.  

Risks of Rising Contrast Use

Posted on by Brian Casey

The use of contrast media in medical imaging procedures has been rising steadily in recent years, a trend that creates environmental risks. So says a new study in JAMA Network Open that documents growth in contrast use over the past 13 years. 

Contrast is an essential part of many imaging exams, helping radiologists better visualize pathology that might be harder to see on unenhanced scans.

  • But contrast use also comes with a wide array of risks, from patient reactions that on rare occasions can be fatal to environmental buildup of contrast that’s excreted from patients after exams and makes its way into local waterways – including drinking water.

This latter phenomenon is what’s explored in the new paper, authored by researchers from the ACR’s Harvey L. Neiman Health Policy Institute. 

  • They analyzed Medicare claims from 2011 to 2024 for 169M contrast-enhanced imaging exams that involved the use of 13.5B milliliters of contrast for both CT and MRI studies. 

HPI’s analysis found…

  • Iodinated CT contrast use grew 5.2% and gadolinium MRI was up 3.5% from 2014 to 2019.
  • Contrast use fell 9.6% for CT and 15.6% for MRI during the COVID-19 pandemic in 2020, but then rebounded afterward.
  • A small number of exams accounted for most of the CT contrast usage, such as CT abdomen and pelvis (4.4B mL) and CT chest (2.7B mL).
  • MRI numbers were far lower, such as for brain MRI scans (221M mL) and abdominal MRI studies (70M).

So what can radiology do? Simply reducing contrast use for environmental reasons isn’t much of a solution, as it has implications not only for patient care but also for medical malpractice risk. 

  • But ongoing efforts to reduce inappropriate imaging would have a follow-on effect of also lowering contrast use, as would protocols to reduce contrast use for patient safety reasons (the introduction of high-relaxivity gadolinium-based agents that cut MRI contrast dose by 50% is a great example).

The authors also cite the development of AI-based techniques that could create contrast-like exams from existing non-contrast data, offering AI developers another possible segment to target. 

The Takeaway

The new study offers an interesting twist in the debate over contrast reduction, pointing out that efforts to reduce unnecessary contrast use promise to benefit not only patients but also the planet.

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