Detecting bad actors in value-based payment models.

Unlabelled: The U.S. federal government is spending billions of dollars to test a multitude of new approaches to pay for healthcare.

Nipple-sparing mastectomy in women at high risk of developing breast cancer.

Nipple-sparing mastectomy is a valuable addition to the options available for women at high risk of developing breast cancer. In this review, we summarize current knowledge about the high-risk genes, , and and the associated guidelines with regard to risk-reducing surgery. We consider other genetic risks and high-risk lesions.

The performance of outside readings by radiology practices.

Objective: The purpose of our study was to determine how many radiology practices perform outside readings, what characteristics affect the prevalence and volume of outside readings, and how practices are paid for outside readings.

Materials And Methods: We analyzed data from the American College of Radiology's 2007 Survey of Radiologists, a stratified random sample e-mail and telephone survey. A total of 480 survey responses were evaluated; responses were weighted to make them representative of all U.

Frequency of use of imaging tests in the diagnosis of pulmonary embolism: effects of physician specialty, patient characteristics, and region.

Objective: The purpose of this study was to ascertain whether clinical practice in diagnosing pulmonary embolism is consistent with recommendations in the literature and to explore variations in practice across site of care (e.g., emergency department), physician and patient characteristics, and geographic location.

Radiology practices' use of external off-hours teleradiology services in 2007 and changes since 2003.

Objective: Our objective is to report patterns of utilization of external off-hours teleradiology services (EOTSs) in 2007 and changes since 2003.

Materials And Methods: We analyzed non-individually identified data from the American College of Radiology's 2007 Survey of Member Radiologists and its 2003 Survey of Radiologists. Responses were weighted to be nationally representative of individual radiologists and radiology practices.

Trends in work hours and vacation time among radiologists in the United States.

Objective: The purpose of this study was to describe recent trends in weekly work hours and annual vacation days among full-time radiologists in the United States with separate data for academic radiologists, radiologists in multispecialty groups, and radiologists in private practice.

Materials And Methods: We tabulated non-individually identified responses from the American College of Radiology 1995, 2003, and 2007 surveys of radiologists. These stratified random sample surveys had, respectively, 2,025, 1,924, and 487 responses and response rates of 75%, 63%, and 20%.

Diagnostic radiologists' subspecialization and the new final board examination.

Objective: Recognizing that subspecialization can consist of concentration in multiple fields as well as in a single main field, we conducted this study to profile in detail the subspecialization of diagnostic radiologists in the United States in ways that illuminate issues related to the American Board of Radiology plan for a new final examination.

Materials And Methods: We tabulated nonindividually identified data from the American College of Radiology 2003 Survey of Radiologists, a stratified random-sample mail survey with 1,924 responses and a 63% response rate. Respondents were guaranteed confidentiality.

Radiologists' clinical practice of neuroimaging.

Purpose: Because of the importance of neuroimaging as a radiology subspecialty, the aim of this study was to provide a detailed portrait of the demographics, clinical activities, and practices of radiologists heavily involved in neuroimaging.

Methods: The authors analyzed data from the ACR's 2003 Survey of Radiologists, a large, stratified random-sample survey in which respondents were guaranteed confidentiality. The survey achieved a 63% response rate, and responses were weighted to make them representative of all radiologists in the United States.

Balloon endometrial ablation under hysteroscopic control of septate uterus complicated by postcesarean scar defect.

Use of second-generation endometrial ablation devices has largely supplanted hysteroscopic resection and rollerball ablation for treatment of menorrhagia. Pathology of the uterus may be diagnosed immediately before endometrial ablation procedure using these newer instruments, making the chosen device inappropriate and requiring a change in planned procedure. Preprocedural assessment with 1 or a combination of transvaginal ultrasound (TVS), saline-infusion sonography, and hysteroscopy is necessary to identify suitability for preferred technique.

Satisfaction of radiologists in the United States: a comparison between 2003 and 1995.

Purpose: To prospectively ascertain what characteristics of radiologists, their practices, and their work environment affect professional satisfaction and to describe recent changes in satisfaction.

Materials And Methods: Survey respondents were guaranteed confidentiality. Those who consented to participate were informed of the nature of the study.

Radiation oncologists in the United States.

Purpose: To provide an extensive and detailed portrait of radiation oncologists, their professional activities, and the practices in which they work.

Methods And Materials: We analyzed non-individually identified data from the American College of Radiology's 2003 Survey of Radiation Oncologists, a stratified random sample survey that guaranteed respondents' confidentiality and achieved a 68% response rate, with a total of 472 responses. Responses were weighted to make them representative of all radiation oncologists in the United States.

Disagreement in interpretation: a method for the development of benchmarks for quality assurance in imaging.

Purpose: To calculate disagreement rates by radiologist and modality to develop a benchmark for use in the quality assessment of imaging interpretation.

Methods: Data were obtained from double readings of 2% of daily cases performed for quality assurance (QA) between 1997 and 2001 by radiologists at a group practice in Dallas, Texas. Differences across radiologists in disagreement rates, with adjustments for case mix, were examined for statistical significance using simple comparisons of means and multivariate logistic regression.

RADPEER quality assurance program: a multifacility study of interpretive disagreement rates.

Purpose: To develop and test a radiology peer review system that adds minimally to workload, is confidential, uniform across practices, and provides useful information to meet the mandate for "evaluation of performance in practice" that is forthcoming from the American Board of Medical Specialties as one of the four elements of maintenance of certification.

Method: RADPEER has radiologists who review previous images as part of a new interpretation record their ratings of the previous interpretations on a 4-point scale. Reviewing radiologists' ratings of 3 and 4 (disagreements in nondifficult cases) are reviewed by a peer review committee in each practice to judge whether they are misinterpretations by the original radiologists.

Women Radiologists in the United States: results from the American College of Radiology's 2003 Survey.

Purpose: To retrospectively evaluate data from the 2003 American College of Radiology (ACR) survey of diagnostic radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work.

Materials And Methods: The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself.

A portrait of breast imaging specialists and of the interpretation of mammography in the United States.

Objective: Because of the importance of breast imaging as a radiology subspecialty and concerns about malpractice, the purpose of our study is to provide a detailed portrait of breast imaging specialists, their professional activities and practices, and information on all radiologists who interpret mammograms.

Materials And Methods: We analyzed data from the American College of Radiology's 2003 Survey of Radiologists, a large, stratified random sample survey that achieved a 63% response. Responses were weighted to make them representative of all radiologists in the United States.

A portrait of interventional radiologists in the United States.

Objective: In recognition of the emergence of interventional radiology as an important "new component of...

Relative procedure intensity with self-referral and radiologist referral: extremity radiography.

Purpose: To compare the relative use of bilateral versus unilateral extremity radiographic examinations when patients are referred to radiologists for imaging (radiologist referred) versus when studies are performed in the referring physician's office (self-referred).

Materials And Methods: We reviewed 1 year of claims data for extremity radiographic examinations performed by a referring physician or referred to a radiology facility and claims data for related patient office visits. Data were analyzed for orthopedics, podiatry, and rheumatology, and data were divided by the practice pattern of the referring physician into pure self-referring, pure radiologist-referring, and mixed-referring categories.

Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer.

Purpose: To prospectively assess accuracy of mammography, clinical examination, ultrasonography (US), and magnetic resonance (MR) imaging in preoperative assessment of local extent of breast cancer.

Materials And Methods: Institutional review board approval and informed patient consent were obtained. Results of bilateral mammography, US, and contrast-enhanced MR imaging were analyzed from 111 consecutive women with known or suspected invasive breast cancer.

Does training in the Breast Imaging Reporting and Data System (BI-RADS) improve biopsy recommendations or feature analysis agreement with experienced breast imagers at mammography?

Purpose: To determine whether training in the Breast Imaging Reporting and Data System (BI-RADS) improves observer performance and agreement with the consensus of experienced breast imagers with regard to mammographic feature analysis and final assessment.

Materials And Methods: A test set of mammograms was developed, with 54 proven lesions consisting of 28 masses (nine [32%] malignancies) and 26 microcalcifications (10 [38%] malignancies). Three experienced breast imagers reviewed cases independently and by means of consensus.

Comparison of heel ultrasound and finger DXA to central DXA in the detection of osteoporosis. Implications for patient management.

The goal of the study was to investigate the potential discordance in patient management when a clinician assumes that a peripheral device is a diagnostic surrogate for central DXA in the detection and treatment of osteoporosis. Over a period of 2 mo, asymptomatic women seeking conventional central DXA evaluation for osteoporosis at a diagnostic imaging center were also evaluated with heel ultrasound and finger DXA peripheral imaging devices. T-Scores of -2.

Data from a professional society placement service as a measure of the employment market for physicians.

Purpose: To determine whether data from a professional society placement service--the Professional Bureau of the American College of Radiology--are a valid measure of the employment market.

Materials And Methods: For the United States from 1990 to 1998, the authors compared three placement service measures-the annual number of job listings, job seekers, and listings per seeker-with two presumably valid measures of the employment market-annual total jobs available (which was ascertained from surveys of hiring) and radiologist median income relative to the all-physician median. For the comparisons, both graphic displays of the data and correlation were used.