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SCAR Residents' |
SCAR 2002 Resident Roundtable Discussion
by and
This year’s Resident Roundtable discussion on Sunday, May 5, at the SCAR 2002 meeting in Cleveland, OH, proved more lively and informative than anticipated. In attendance were many long-time leaders in radiologic informatics, including Drs. Byrn Williamson, Arvin Robinson, Eliot Siegel, Bruce Reiner, Steven Horii, Katherine Andriole, and David Channin. Also present were two new leaders: Dr. Char Branstetter, who finished his informatics fellowship less than a year earlier at the University of Pittsburgh, PA, and Dr. Brian Bartholmai, who was just finishing his electronic imaging fellowship at the Mayo Clinic in Rochester, MN. Topics discussed at the roundtable included resident education, research grants, the curriculum of a radiologic informatics fellowship, and even the definition of the term radiologic informatics.
Dr. Jean Jeudy is a radiology resident at Long Island College Hospital and a representative of the American Association of Academic Chief Residents in Radiology (A3CR2). He presented the results of a survey conducted on informatics training at A3CR2 member institutions. These results demonstrated a dearth of such training at almost all of the institutions surveyed. The study underscored the need for development of a curriculum to introduce radiologic informatics to residents.
Dr. Williamson formally announced that SCAR will offer two research grants in the amount of $40,000 each for original research in radiologic informatics. Applications (click here: DOC | PDF for the grants can be obtained on SCAR’s website (www.scarnet.org) under the “What’s New” section and may be submitted until September 4, 2002. The grant period begins January 1, 2003, and extends for a year thereafter. See the application for more details.
Dr. Siegel pointed out the need for imaging informatics specialists who understand digital imaging, image archiving, and image analysis. Dr. Andriole envisioned an informatics fellowship that would develop next-generation technology experts with adequate research skills to evaluate new technologies and understand how to convey the needs of radiologists to industry.
It became clear during this discussion that SCAR actually has two different educational missions. One is to reach the general radiology resident who needs to be prepared to deal with the technological changes in the practice of radiology, including but not limited to PACS, CR, speech recognition, teleradiology, and the new medicolegal requirements of HIPAA. These are things that every new radiologist needs to understand in order to succeed. Dr. Channin agreed that this material might be an appropriate addition to the the American College of Radiology’s noninterpretive skills video series for radiology residents. SCAR’s other mission is to nurture the radiologic informatics experts of the future. It is to this end that SCAR is offering the new research grants and hopes to establish a curriculum for radiologic informatics fellowships. In fact, Dr. Bartholmai presented a scientific paper earlier at the SCAR meeting highlighting the curriculum of the Electronic Imaging and Technology fellowship at the Mayo Clinic.
Dr. Reiner delineated the need for residents to perceive a “return on investment” if they were to choose to pursue some expertise in informatics. Dr. Siddiqui provided some preliminary evidence that such experience does indeed confer a competitive advantage to radiology job seekers.
The meeting also provided an opportunity for participants to reflect on the terms “radiology informatics” and “computer applications,” and, by extension, the very essence of what SCAR is about. Strictly speaking, computed and digital radiography are simply new modalities and, as such, are no more within the realm of informatics than CT, MRI, or any other modality. However, as Dr. Siegel noted, no other branch of radiology has undertaken to study their effects on diagnostic accuracy and workflow, so they have, de facto, become a subject of study by informaticians. Although informatics is defined as information science, it has come to connote many more areas of technological and legal interest that have no place elsewhere. Likewise, a perusal of the topics covered at SCAR symposia and in the Journal of Digital Imaging reveals a breadth well beyond that implied by SCAR’s name.
The list of institutions offering informatics fellowships continues to grow, and the roundtable provided a convenient forum in which to assemble this updated roster, which includes contact names at the respective institutions:
For more information, see the Residents’ Corner of the SCAR website at www.scarnet.org.
Dr. Hirschorn just completed his residency at UMDNJ-New Jersey Medical School and is starting his fellowship in Radiologic Informatics/MRI at Massachusetts General Hospital/Harvard Medical School in July 2002. Dr. Siddiqui is currently finishing his third year of residency at Geisinger Medical Center.
Q&A: Radiologic Informatics Fellows
by David Hirschorn, MD, from SCAR News January 2002
What exactly is a radiologic informatics fellowship?
To find out, I interviewed three radiologists who were either currently participating in or had recently completed such training. The first was Dan Nir, MD, who completed his fellowship at the Massachusetts General Hospital under Keith Dreyer, DO, PhD, in December 2001; Char Branstetter, MD, who completed his fellowship at the University of Pittsburgh under Paul Chang, MD, in June 2001; and Brian Bartholmai, MD, who is currently a fellow in electronic imaging technology at the Mayo Clinic in Rochester, MN, under Brad Erickson, MD. Each fellow was asked three questions about his experiences and the knowledge and skills acquired in this specialized training.
Q: What did you do during your fellowship?
A: Dr. Nir: None of these fellowships has a formal curriculum as of yet. While staying clinically involved with musculoskeletal MRI, I participated in software project development, including computer program writing and testing. I also participated in the PACS planning and organizational meetings.
A: Dr. Branstetter: My informatics training was interwoven with my neuroradiology fellowship. In the beginning, I shadowed my mentor, Dr. Chang, at the various PACS meetings and conferences. Over time, I was given increasing responsibility for managing the radiology informatics division. I learned how to set up a PACS from the ground up. The facets of my training are well described by the various educational tracks of SCAR University, from digital imaging, to networking, to security, and everything in between. I acquired technical knowledge about RAID, bandwidth issues, and where bottlenecks tend to occur. However, I also learned some of the political aspects of PACS, including how many people need to be hired to run a PACS and what their job descriptions should be. I also participated in research on a system that replaces the paper-based imaging study requisition, encompassing such tasks as study protocol management and technologist feedback. I also learned about the advantages of asynchronous collaboration in a clinical setting. As much as I learned during my fellowship, the new fellows this year are learning even more informatics than I did.
A: Dr. Bartholmai: My largest project so far involved the planning, deployment, administration, and formal evaluation of a commercial PACS system here at Mayo. I helped plan everything from equipment layout to network requirements, disaster recovery planning, and image management rules and led the training of the radiologists and technologists on how to use it. In planning for the PACS demo, we took advantage of our informatics laboratory and made mockups of clinical settings to test various scenarios of utilization and workflow. I learned everything it takes to implement a PACS from the ground up. I also wrote a series of reports based on our surveys of user acceptance and worked directly with the vendor’s software developers to improve PACS efficiency and usability Other projects included evaluation of a unified departmental radiology teaching file solution, evaluation of JPEG2000 compression for CT and MRI, and participation in the creation of a very large institutional image archive for both radiology/ PACS and heterogeneous image sources from other departments. The clinical portion of my fellowship involved both cross-sectional body imaging (CT, MRI, US) as well as filmless general imaging (CR, DR). Sometimes the informatics part was intermixed with my clinical duties, but at other times I was given dedicated blocks of time for informatics when the projects required it.
Q: What skills do you feel you developed by the end of it?
A: Dr. Nir: I learned modern rapid application development tools, the basics of SQL, databases, object-oriented programming, Microsoft COM objects, and the DICOM toolkit.
A: Dr. Branstetter: I would summarize it as how to set up a PACS from the ground up and how to do informatics research.
A: Dr. Bartholmai: I gained an in-depth knowledge of PACS architecture, usability testing, and how to be an effective PACS trainer. I also learned about visual perception, the effects of image compression, and monitor and digital image quality control. I also learned important leadership skills and discovered how to contribute meaningfully to a large administrative committee organization and make actual progress.
Q: Where do you think it will take you in the future?
A: Dr. Nir: I plan to create programs to augment hospital scheduling and any other little projects where I see room to improve our practice. I may either do the project myself or just direct someone else, now that I know how to get computer software projects done. I may also serve as a liaison between the medical staff and the technical staff at the Lahey Clinic in Burlington, MA, where I will be practicing in the musculoskeletal division after my fellowship.
A: Dr. Branstetter:I decided to stay on here after my fellowship. I am now Associate Director of the Division of Informatics, Department of Radiology, University of Pittsburgh School of Medicine. I am also a member of the Neuroradiology Division, and specialize in head and neck.
A: Dr. Bartholmai: I will be staying on here at Mayo in an academic career. I will continue to have some time dedicated to digital imaging research and radiology administration. I may act as a liaison between our department and our PACS vendor and will certainly be involved in the ongoing effort to convert the large Mayo–Rochester department to an entirely filmless practice, constantly striving to improve our system. Each of these radiologists has had very different experiences, but all accumulated a broad knowledge base of strategies for creating real-world solutions. Although all began their programs with some basic technical knowledge, their fellowships presented opportunities to learn how to put that knowledge to work in a clinical setting. Their experiences sharpened their clinical, technical, and administrative skills. Two are interested in academic careers, and one plans to use his skills in private practice. As radiologic informatics fellowships grow in popularity, the evolution of their curricula and objectives should prove interesting. Reminder: At the annual meeting, radiology residents are invited to join representatives of SCAR for a discussion of topics of mutual interest at the Resident Roundtable Breakfast, 7–8 a.m., May 5. Registration for SCAR 2002 is not required for residents who attend the roundtable only, but residents are strongly encouraged to take advantage of the opportunities the annual meeting has to offer. Residents are entitled to a special reduced registration rate for the SCAR 2002 meeting. SCAR 2001 Resident Roundtable Discussion
The second annual Residents' Roundtable discussion was held at SCAR 2001 on Sunday, May 6th in Salt Lake City. A synopsis of the meeting follows, but be sure to also check out the formal announcement of the SCAR Grants and Fellowship Committee which was distributed at the meeting. Also check out the articles about the meeting which were published online on DiagnosticImaging.com and AuntMinnie.com.
Structuring a Fellowship
One distinguishing feature of this year's roundtable was that it included at least one fellow who was currently participating in a radiologic informatics fellowship. Dr. Char Branstetter was doing a combined fellowship in neuroradiology and informatics at U. of Pittsburgh with Dr. Paul Chang. One point that Dr. Branstetter re-iterated was the importance of combining informatics training with clinical training. Dr. Byrn Williamson echoed the point that to be useful in the field of informatics, one needs to be "in the trenches with everyone else, for both credibility and perspective."
Dr. Branstetter also felt that it was better to combine the two in a parallel fashion, as opposed to devoting a long block of time solely to informatics. Other programs do indeed devote whole months to informatics, while still others split up each week between the two. How to achieve the best balance is unclear at this early stage. Nonetheless, Dr. Branstetter and Dr. Steve Horii, the new editor-in-chief of the society's journal, Journal of Digital Imaging, agreed that whatever the arrangement regarding time allocated to informatics training and research, it should be spelled out clearly well in advance, to avoid being pulled excessively to cover unexpected "holes" in the clinical schedule. Part of the advantage of having the informatics portion of the fellowship specifically funded for that purpose is to avoid such situations.
Setting a Curriculum
Dr. Brian Bartholmai just began his combined fellowship in abdominal imaging and electronic imaging/teleradiology at the Mayo Clinic in Rochester, MN. He noted the need for development of a formal curriculum for an informatics fellowship.
Dr. Branstetter remarked that SCAR U itself might be a good basis for a curriculum.
Dr. Katherine Andriole of UCSF underscored that industry has a need for researchers in the field of radiologic informatics, which might help shape such a curriculum. She envisioned the creation of a new type of radiologist, one who not only performs informatics research, but has also received didactic training in the subject, has learned how to analyze the literature, and how to criticize it.
Dr. Brad Erickson of the Mayo Clinic added that other skills an informatics fellow should hope to develop are the political skills of dealing with committees while managing the change from film to filmless imaging.
With the focus on curriculum, Dr. Pomerantz remarked that there was work to be done regarding the curricula of medical students and residents as well. Indeed, little mention is made of the increasing role of informatics in medical practice in medical school and residency programs. To this Dr. Arvin Robinson, chairman of radiology at U. of Rochester, responded that efforts are already underway to change that.
Careers in Radiologic Informatics
So where does a radiologist armed with informatics training get a job? Dr. Horii pointed out that many private and academic practices are going filmless, and will need such personnel to manage the transition. Industry as well will need such radiologists to define new products. In the future, we will try to hear from radiologists who have completed their informatics fellowships, and learn what directions they have taken.
Future Directions
Dr. Kyle Smith felt that PACS and teleradiology are no longer technical issues, but rather political ones at this point. Computer aided diagnosis (CAD), he said, is the next frontier. Indeed Dr. Williamson as well noted that SCAR is well aware that PACS will not be the foremost subject in the informatics world forever, and down the line CAD will probably supersede it. Yet, Dr. Andriole cautioned that while the hardware issues of PACS have been well worked out, the software issues are far from solved. Moreover, digital radiography (DR) is very new to medicine, and will also play a large role. Dr. Horii added to the mix exploration of virtual reality technologies and perception research - what it is that enables our brains to detect lesions, the psychology as well as the physiology.
Conclusion
Needless to say, all of this has laid fertile ground for further discussion of these issues. In the near future, we hope to develop a threaded email discussion group to further explore them. As for SCAR sponsorship of a radiologic informatics fellowship and SCAR research grants, be sure to check out the formal announcement of the SCAR Grants and Fellowship Committee which was distributed at the meeting. Also check out the articles about the meeting which were published online on DiagnosticImaging.com and AuntMinnie.com.
Update on Fellowship Training
from SCAR News April 2001
At the Resident Roundtable discussion at last year's SCAR symposium, the issue of fellowship training was explored at length. Questions were raised regarding just what fellowships are available in radiology computer applications / radiologic informatics, and how they should be structured. One point that most seemed to agree upon was that the ideal fellowship should combine traditional clinical training with informatics training. To paraphrase one participant, just as a good radiologist must learn to be a good clinical doctor first, so, too, must a good radiologic informatician learn to be a good radiologist first.
These issues were further discussed during a conference call of the Grants and Fellowships Committee led by Dr. Byrn Williamson in February. Other issues discussed included the possibility of SCAR funding of research grants for both clinical and basic research.
To my knowledge, there are 4 radiologists in training who are actually completing or plan on completing some type of formal fellowship training in radiologic informatics. Dr. Dan Nir recently completed a fellowship in gastrointestinal imaging at Boston University Medical Center, and is now completing a fellowship in radiologic informatics at Massachusetts General Hospital (MGH) in Boston, MA. Dr. Matthew Benjamin is a fourth-year resident at MGH and is currently engaged in a mini-fellowship in radiologic informatics, with a focus on computer-based educational tools. Dr. Brian Bartholmai is currently a fourth-year resident at Wake Forest University Baptist Medical Center and will begin a combined fellowship in digital imaging / teleradiology and abdominal imaging at the Mayo Clinic in Rochester, MN this July. Lastly, I am currently a third-year resident at UMDNJ-New Jersey Medical School and plan to begin a combined fellowship in radiologic informatics and MRI at MGH in July, 2002.
I look forward to sharing our experiences and further exploring resident issues at the next Resident Roundtable discussion 7 am Sunday morning at SCAR2001. Hope to see you there!
SCAR 2000 Resident Roundtable Discussion
Introduction
On Tuesday morning June 6, 2000 a resident roundtable discussion was held at the SCAR 2000 meeting. Participants included past chairmen of RISC/SCAR, Drs. Robert Allman, David Avrin, Alan Rowberg and David Piraino, incoming SCAR Chairman Dr. Michael Abiri, Dr. Katherine P. Andriole, SCAR Secretary and Chair of the SCAR Research and Development Committee, and Program Committee Chairman Dr. Byrn Williamson, Jr. Other members of the Program Committee in attendance included: Drs. Nicholas Hangiandreou, Bruce Reiner, Eliot Siegel, and Steven Horii. Sridhar Seshadri, General Manager, Global Marketing Integrated Imaging Solutions, from GE Medical Systems attended the roundtable as well. Six residents attended: Dr. David Hirschorn of UMDNJ - New Jersey Medical School, Dr. Brian Bartholmai of Wake Forest University Baptist Medical Center, Dr. Toseef Khan of Temple University, Dr. Stuart Pomerantz of University of Pennsylvania, Dr. Della Kaminski of Albert Einstein Medical Center, and Dr. Indrajit Choudhuri of St. Louis University School of Medicine.
Fellowship Training
Choice of fellowship was one of the first issues discussed. Most agreed that the most useful radiologist with an understanding of computers and information technology is one who is also a good clinical radiologist,"down there in the trenches" with everyone else. There was a consensus that radiologic informatics training could be incorporated into a traditional fellowship, but disagreement as to how. Should radiologic informatics training replace a portion of a fellowship (i.e. six months of an abdominal imaging fellowship), or should it be done as a second year? It was noted that this might fit in well with neuroradiology fellowships which are already 2 years long and have research time built-in during the second year. Also discussed was whether the time devoted to radiologic informatics should be distributed over the course of the fellowship or concentrated as a separate block of time. The former would permit more opportunity for research involvement which tends to require longer term investments, but the latter, would allow the fellow to travel to other institutions to broaden his/her experience. In that vein, Mr Seshadri suggested that GE might well be interested in hosting a fellow at their Chicago suburb facility. SCAR itself is considering the possibility of sponsoring a fellowship at an appropriate institution (or institutions) to pay for the time that the fellow spends in computer applications and radiologic informatics activities.
Residency Training
All agreed that there is a need for development of a radiologic informatics curriculum for residents. To date, there is virtually no formal education about the computer systems which radiologists increasingly depend upon, yet plenty of test questions about modulation transfer functions of films. Furthermore, much of the current computer related curriculum is arcane, such as methods of calculating image sizes. A structured curriculum needs to be created to prepare radiology residents to make effective use of computer technologies, and to wisely choose among the myriad of competing products. SCAR is considering forming a committee to investigate this matter and make recommendations to the American Board of Radiology.
The meeting raised some very important issues. Much work lies ahead to follow up on them. Hopefully, this will spark efforts to create formalized fellowships that incorporate radiologic informatics, and to bring residency training up to date on computer technologies.
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