AP R I L 2004 ■ VO LU M E 14, NUMBER 4

Financial Debts Mount for Today’s Medical Students

Also Inside:■ Report Urges Coordinated Effort on Use of Diagnostic Imaging Technology■ Radiologist Shortage Easing, Physician Shortage Growing■ Functional MRI Tests Working Memory in Brain-Injured Children ■ Residents, General Radiologists Need More Mammography Training■ Trauma Imaging Faces Regional, Cultural Challenges

Advance Registration for RSNA 2004

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RSNA NewsApril 2004 • Volume 14, Number 4

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AP R I L 2004

1 People in the News2 Announcements

Feature Articles 4 Report Urges Coordinated Effort on Use of

Diagnostic Imaging Technology6 Radiologist Shortage Easing, Physician Shortage

Growing8 Trauma Imaging Faces Regional, Cultural

Challenges10 Functional MRI Tests Working Memory in Brain-

Injured Children 11 Residents, General Radiologists Need More

Mammography Training 13 Financial Debts Mount for Today’s Medical Students

Funding Radiology’s Future20 R&E Foundation Donors

15 RSNA: Working for You16 Radiology in Public Focus17 Journal Highlights18 Program and Grant Announcements19 Product News22 Meeting Watch24 Exhibitor News25 www.rsna.org

E D I T O RSusan D. Wall, M.D.

D E P U T Y E D I T O RBruce L. McClennan, M.D.

C O N T R I B U T I N G E D I T O RRobert E. Campbell, M.D.

M A N A G I N G E D I T O RNatalie Olinger Boden

E X E C U T I V E E D I T O RJoseph Taylor

E D I T O R I A L A D V I S O R SDave Fellers, C.A.E.

Executive Director

Roberta E. Arnold, M.A., M.H.P.E.Assistant Executive DirectorPublications and Communications

E D I T O R I A L B O A R DSusan D. Wall, M.D.

Chair

Bruce L. McClennan, M.D.Vice-Chair

Lawrence W. Bassett, M.D.Richard H. Cohan, M.D.David S. Hartman, M.D.Richard T. Hoppe, M.D.William T.C. Yuh, M.D., M.S.E.E.Hedvig Hricak, M.D., Ph.D.

Board Liaison

C O N T R I B U T I N G W R I T E R SBruce K. DixonJoan DrummondMarilyn Idelman SoglinMary Novak

G R A P H I C D E S I G N E RAdam Indyk

W E B M A S T E R SJames GeorgiKen Schulze

2 0 0 4 R S N A B O A R D O F D I R E C T O R SRobert R. Hattery, M.D.

Chairman

R. Gilbert Jost, M.D.Liaison for Annual Meeting and Technology

Theresa C. McLoud, M.D.Liaison for Education

Gary J. Becker, M.D.Liaison for Science

Hedvig Hricak, M.D., Ph.D.Liaison for Publications and Communications

Burton P. Drayer, M.D.Liaison-designate for Annual Meeting andTechnology

Brian C. Lentle, M.D.President

David H. Hussey, M.D.President-elect

NEW

1R S N A N E W SR S N A N E W S . O R G

PEOPLEINTHENEWS

British Institute of RadiologyHonors HricakRSNA Board Liaison for Publications and CommunicationsHedvig Hricak, M.D., Ph.D., will receive honorary mem-bership in the British Institute of Radiology—the oldestradiologic society in the world. The ceremony will be heldin May at the BIR President’s Conference in London. Atthe meeting, Dr. Hricak will also lecture during a multidis-ciplinary symposium on prostate cancer.

Hedvig Hricak, M.D.,Ph.D.

Stewart R. Reuter,M.D., J.D.

Erdem Yavuz, M.D.,M.S.

Franklin J. Miller Jr.,M.D.

Constantin Cope, M.D.

Send your submissions for People in the News to rsnanews@rsna.org, (630) 571-7837 fax, or RSNA News, 820 Jorie Blvd., OakBrook, IL 60523. Please include your full name and telephone number. You may also include a non-returnable color photo, 3x5 or

larger, or electronic photo in high-resolution (300 dpi or higher) TIFF or JPEG format (not embedded in a document). RSNA News maintains the right toaccept information for print based on membership status, newsworthiness and available print space.

Stewart R. Reuter, M.D., J.D., andFranklin J. Miller Jr., M.D., are the2004 gold medalists of the Society ofInterventional Radiology (SIR). Theyreceived their awards in March duringthe SIR annual meeting in Phoenix.

Dr. Reuter is the professor emeritusof radiology at the University of TexasHealth Science Center at San Antonio.

Dr. Miller is the director of the Heredi-tary Hemorrhagic Telangiectasia Clinicat the University of Utah Medical Centerin Salt Lake City.

Constantin Cope, M.D., receivedthe 2004 Cardiovascular and Interven-tional Radiology Research and EducationFoundation (CIRREF) Leaders in Inno-vation Award.

SIR Gold Medals

Medical Student Honored at NationalResearch ForumErdem Yavuz, M.D., M.S., who’s pursuing a Ph.D. inbiomedical engineering at the University of Miami, is thewinner of the Award for Research in Biomedical Imagingand Bioengineering, presented by the Eastern-Atlantic Student Research Forum.

Dr. Yavuz presented research on adaptation of cochlearcompound action potentials using very high stimulus rates.

Among the prizes were one-year subscriptions to Radiology and RadioGraphics.

AMA Honors Sood, UrsoTwo radiologists are among the 2004recipients of the American MedicalAssociation’s (AMA) Leadership Awardpresented by the AMA Foundation.

Ajay Sood, M.D., chief resident inthe Department of Radiology at CooperHospital, University of Medicine andDentistry of New Jersey in Camden, is aresident recipient. James Urso, M.D.,an interventional radiol-ogist in Richmond, Va.,is a young physicianrecipient.

The program hon-ors leaders amongAmerica’s medical students, residents andfellows, and youngphysicians who havedemonstrated strongnon-clinical leadershipskills in medicine orcommunity affairs. Theawards were presentedas a part of the AMA’sNational AdvocacyConference in March.

Dr. Sood receivedthe RSNA RoentgenResident/FellowResearch Award in2002 and 2003. He is the founding chairof the Resident and Fellow Section ofthe Radiological Society of New Jersey,and is also a resident delegate to theCommission on Government and PublicRelations of the American College ofRadiology (ACR).

Dr. Urso is a past-president of theACR Residents Section and an AMAdelegate from the Pennsylvania Resi-dents Section.

Ajay Sood, M.D.

James Urso, M.D.

2 R S N A N E W S A P R I L 2 0 0 4

ANNOUNCEMENTS

RSNA Hosts BIROW 2

Approximately 140 radiologists, physicists, bio-engineers and radiologic scientists gathered in

Bethesda, Md., in February for the second annualBiomedical Imag-ing ResearchOpportunitiesWorkshop (BIROW2). The workshopsare designed tobring these disci-plines together toidentify challengesand opportunities inselect areas ofimaging research.BIROW 2 focused

on optical imaging, computerized image analysis,imaging gene expression and image-guided vas-cular intervention. Representatives from govern-

ment agencies that fund imaging research alsoparticipated in the discussions.

Participants worked together to craft a whitepaper that will be published simultaneously in thejournals of each of the majorsponsoring organizations. Lastyear’s white paper is availableat www.birow.org.

RSNA was the lead spon-sor of BIROW 2, along withAmerican Association ofPhysicists in Medicine, Bio-medical Engineering Society,Academy of Radiology Research and AmericanInstitute for Medical and Biomedical Engineer-ing. The workshops are also supported by 20other participating organizations and receivedpartial funding from NIBIB and the WhittakerFoundation.

NCRP Hosts Session on Radiologic TerrorismThe 2004 annual meeting of theNational Council on Radiation Protec-tion and Measurements (NCRP), to beheld this month in Arlington, Va., willfocus on advances in counteractingthe threat to human life created byacts of radiologic terrorism.

Major advances in several aspectsof preparing for acts of radiologic ter-rorism will be described, includingnew radiation detection technologies,current and future biological dosime-try, recent advances in the develop-ment of chemical protectants and ther-apeutic agents for mitigating radiationhealth effects.

For more information, go towww.ncrp.com/Prog2004.html.

Update on the NIH RoadmapNational Institutes of Health (NIH) Director Elias A. Zer-houni, M.D., and other key NIH leaders participated in abriefing and Webcast in late February to provide updatesand future opportunities in the NIH Roadmap for MedicalResearch. NIH Roadmap initiatives are designed to speedthe movement of research discoveries from the bench intopractice for the benefit of the public.

Materials, speaker presentations and a synopsis of thebriefing are available on the NIH Roadmap Web site atnihroadmap.nih.gov.

NIBIB Requests Comments on Strategic PlanThe National Institute of Biomedical Imaging and Bioengineering(NIBIB) is soliciting broad publicinput as it builds its strategic plan.For more information and a list ofsome of the issues on which NIBIBwants feedback, go to www.nibib1.nih.gov/about/SP/strategicplan.htm.

Elias A. Zerhouni, M.D.

G. Scott Gazelle, M.D., Ph.D. (left), and RSNABoard Liaison for Science Gary J. Becker, M.D.,attended BIROW 2 in Bethesda, Md.

3R S N A N E W SR S N A N E W S . O R G

ANNOUNCEMENTS

Code of Ethics for MedicalDevice IndustryThe Advanced Medical Technology Asso-ciation (AdvaMed) has released an indus-try “Code of Ethics for Interactions withHealth Care Professionals.” AdvaMed rep-resents nearly 90 percent of the diagnosticand medical device industry.

Jeff Ezell, director of media relationsfor AdvaMed, says the code will changethe way sales and marketing professionalsinteract with physicians. “AdvaMed mem-bers adopted this new code of ethics inresponse to the rapidly changing health-care fraud enforcement environment. Ourmembers are concerned about this situa-tion because it presents risks to the indus-try itself, and to physicians and otherhealthcare industry professionals, who areso critical to the delivery of life-savingand life-enhancing therapies,” he says.

Restrictions on entertainment, meals,meeting locations, donations and gifts areincluded, but collaborations betweenindustry and physicians, such as consult-ing and research, are still allowed.

For more information, or to view theentire code, go to www.advamed.org/pub-licdocs/coe.html.

Medical Device Budget May Rise in FY’05President Bush is requesting a $216.7 mil-lion budget for the Food and Drug Admin-istration’s medical device program for fis-cal year 2005. That’s an increase of $25.6million over the current fiscal year’s level.

The proposed budget increase wouldbe augmented by $33.9 million in userfees—a projected increase of $2.3 million.

“This increase will ensure that theFDA succeeds in meeting the ambitiousperformance goalsnegotiated with themedical device indus-try for prompt review of safe and effectivemedical devices so that patients can enjoythe benefits of those products sooner,” theFDA writes.

For more information, go towww.fda.gov/bbs/topics/NEWS/2004/NEW01012.html

NIBIB and CDRH Establish Joint Laboratory

The National Institute of Biomed-ical Imaging and Bioengineering

(NIBIB) and the FDA’s Center forDevices and Radiological Health(CDRH) have signed an interagencyagreement establishing a joint Labo-ratory for the Assessment of MedicalImaging Systems (LAMIS).

The purpose of the joint effort isto assess and optimize high-resolu-tion, multi-dimensional medicalimaging systems.

“The jointagreement withCDRH is anexciting oppor-tunity forNIBIB, and willprovide us withanother avenue for exploring innova-tive and high-quality technologiesand interdisciplinary research thatwill lead to improved healthcare,”

said NIBIB Director RodericI. Pettigrew, M.D., Ph.D. “TheCDRH medical imaging pro-

gram is stellar and we are proud tocollaborate with an organization ofthis caliber.”

MR Data Available from Cardiovascular Health StudyThe National Heart, Lungand Blood Institute is invit-ing radiologists and neurora-diologists to take advantageof the MR data availablethrough its CardiovascularHealth Study (CHS).

CHS is a longitudinalstudy of risk factors fordevelopment and progres-sion of coronary heart dis-ease and stroke in peopleaged 65 years and older. TheCHS database includes nearly 6,000serial MR studies from nearly 4,000participants.

These scans provide a robustdatabase for the assessment of neu-rovascular risk factors, the influenceof imaging findings on subsequentcerebrovascular or cardiovascularevents, or the onset of dementia.They also provide an excellent

means for evaluating longitudinallythe effects of aging on the brain.

To inquire about the steps neededto access the electronic database,contact David M. Yousem, M.D.,M.B.A., at dyousem1@jhu.edu. Formore information on CHS, go tohttp://128.208.129.3/CHS/.

4 R S N A N E W S A P R I L 2 0 0 4

The growth of diagnostic imaginghas been one of the most visibleand costly technological advances

over the last 25 years. Using it wiselyand maximizing the benefits of diag-nostic imaging technology requires acoordinated effort from all segments ofthe healthcare system, according to anew report from the Blue Cross andBlue Shield Association (BCBSA).

“The point we’re trying to make inthis paper is, on the one hand, wereally value the clinical advances thathave come with diagnostic imaging,”says Barbara Rothenberg, Ph.D., seniorconsultant for BCBSA. “At the sametime, there is evidence to suggest thatdiagnostic imaging is not always usedwisely.”

Utilization of radiology services fordiagnosis and treatment increases byabout nine percent a year, according toone estimate cited inthe report. In addition,strategy and technol-ogy consultant BoozAllen Hamilton esti-mates that in 2000,expenditures for med-ical technologyequaled $150–$200billion. Diagnosticimaging, the largestcategory of expendi-tures, was valued at$65–$75 billion.

Dr. Rothenbergadds that, “According to the Verispan2003 Diagnostic Imaging Center Mar-ket Report, diagnostic imaging centersin 1999 generated about $60 billion inrevenue, or five percent of total health-care spending.” Data for 1999 is the

latest available.The BCBSA report points out that

advances in medical technology maydrive up the cost of healthcare by offer-ing safer and less invasive proceduresthat can greatly increase the number ofpatients who want to use them.

“There’s no question that patientexpectation has a lot to do with theescalation in costs of healthcare,”says William T. Thorwarth Jr., M.D.,president of the American College ofRadiology (ACR), chairman of theACR Commission on Economics andchair of the RSNA Medical LegalCommittee. “I think that the directmarketing to patients by the pharma-ceutical industry and by some of theimaging industry, frankly, creates anexpectation.”

He adds that a large portion of thegrowth of imaging costs is related to

self-referral byphysicians whoput imagingequipment intheir offices.“The growth rateof that segmentof imaging costsis far outpacingthe growth ofimaging per-formed on areferral basis byradiologists,” Dr.Thorwarth says.

“Payers need to demand that anyphysician performing imaging exams isappropriately qualified, uses qualityequipment and employs certified tech-nologists.”

The BCBSA report points to the

increasing popularity of imaging exam-inations, such as whole body CT scansfor which patients pay out of pocket.

A statement adopted by ACR inMay 2003 says there is not sufficientevidence demonstrating that the use ofwhole body CT is efficacious in pro-longing life or improving health. Thestatement also says, “The ACR is con-cerned that this procedure will lead tothe discovery of numerous findingsthat will not ultimately affect patients’health, but may cause patient anxietyand may result in unnecessary follow-up examinations, treatments and signif-icant wasted expense.”

“It’s important that the public bevery wary of those examinations ratherthan thinking they’re only some sort ofglorified physical examination,” Dr.Thorwarth says. “When those kinds ofexams hit the lay press and some of theTV talk shows, it creates a less-than-informed interest in the public to pur-sue these. As a result, it drives upcosts.”

Report Urges Coordinated Efforton Use of Diagnostic ImagingTechnology

[Radiologists] should work

cooperatively with their referring

physician population—both

from a standpoint of educating

the physicians on appropriate

use, and consulting with them

on individual patients to guide

them to the appropriate test.

William T. Thorwarth Jr., M.D.

William T. Thorwarth Jr., M.D.

RSNA:HOTTOPIC

5R S N A N E W SR S N A N E W S . O R G

With the growth rate of the medicalimaging industry not likely to slow,BCBSA offers four recommendationsfor maximizing the benefits of diagnos-tic radiology:

1 It is essential to ensure access todiagnostic imaging when it is clini-cally indicated. At the same time, consumers need to understand thatthe newest, most expensive technol-ogy is not always necessary and inmany cases will not improve the qual-ity or results of their care.

“Probably the best person to givethem that message is their own physi-cian, who they can trust and whoknows the specifics of their clinical sit-uation,” Dr. Rothenberg says.

2 Physicians need to reaffirm theircommitment to evidence-based medi-cine and evaluate whether an addi-tional diagnostic test will changetheir treatment plans before orderingthe test.

Dr. Rothenberg says guidelines cre-ated by physician societies can help getout the latest information in a field thatis changing very rapidly, “If, for exam-ple, you’re a primary care provider andyou see some unusual case that youonly see a few times a year, it may bedifficult to keep up with all the infor-mation on what’s the best approach.”

Dr. Thorwarth says ACR has devel-oped appropriateness criteria. “Multi-specialty panels have taken a large num-ber of common clinical presentations,like low back pain or a urinary tractinfection, and developed recommenda-tions for tests that are particularly effec-tive, and tests that are less than effec-tive,” he says. “These are available inprint form, in electronic form suitablefor a PDA.”

3 Hospitals and other providers shouldrefrain from engaging in a “medicalarms race,” where every facilitywants to have every technology, evenif doing so will create substantialexcess capacity.

ACR has not taken a position onthis issue because of the great variabil-

ity among locales. “Certain states stillhave state-evaluated certificate of needprocesses and try to promote commu-nity health planning and appropriateinstallation of new technologies by thatmethod,” Dr. Thorwarth says. “Andmany states have, in essence, an openmarket model saying that the market-place will drive an appropriate, optimalnumber of scanners or outpatient facilities.”

He suggests that facilities can bene-fit from planning and cooperation, real-izing that there will be competitionamong facilities, but at the same time,not over-expanding.

4 Health plans can leverage informa-tion on how and where costs and utilization are rising and share it inpartnership with providers to ensureaccess to services while reducingunnecessary utilization.

Dr. Rothenberg says it is importantto look at the whole picture. “We’re notfocusing just on diagnostic imaging.We’ve also done reports on the driversof healthcare costs overall. We’ve donea separate report on the impact of phar-

maceutical marketing to physicians.And we’ve even looked in our ownhouse, and looked at what our ownadministrative costs are,” she says.

“The other thing is that our plansreally are working with providers to tryto bring both our strengths to the table,to figure out ways that some of theseissues can be addressed in a construc-tive fashion,” she adds.

Dr. Thorwarth says he believes thekey for radiologists is to promotethemselves as consultants with themost expansive knowledge of the capa-bilities of imaging equipment. “Theyshould work cooperatively with theirreferring physician population—bothfrom a standpoint of educating thephysicians on appropriate use, andconsulting with them on individualpatients to guide them to the appropri-ate test,” he says. “That’s the way, Ithink, radiologists can make the mostdirect impact on the appropriate use ofimaging technology.” ■■

Expenditures for Technology in 2000 and Projected Growth 2000-2005

Source: From Medical Technology as a Driver of Healthcare Costs: Diagnostic Imaging © Blue Cross Blue Shield Association.Reprinted with permission.

$0

$20

$40

$60

$80

$100

Projected Growth 2000-2005

2000

Diagnostic Imaging Cardiovascular Diagnostic In Vitro(Lab)

Minimally InvasiveSurgery

$18-$21 Billion

$65-$75 Billion $30-$40 Billion

$30-$40 Billion

$12-$16 Billion

$30-$40 Billion

$6-$9 Billion

$6-$9 BillionBi

llion

s

On April 14, the National Electrical Manufacturers Association will launch a new Web site, Medical

Imaging.org, to portray the value of medical imaging in itsmany dimensions. An expanded story will appear in afuture edition of RSNA News.

❚

Note: To view the BCBSA report, go to online-pressroom.net/bcbsa/, then click on “HealthcareCost Research” and then “Medical Technologyas a Driver of Healthcare Costs.”

6 R S N A N E W S A P R I L 2 0 0 4

For years, radiologists have beenconcerned about the growingshortage of diagnostic radiolo-

gists. However, new research from theAmerican College of Radiology (ACR)suggests the workforce crisis may beeasing.

A study published in the February2004 issue of the American Journal ofRoentgenology (AJR) reports the short-age of candidates for faculty positionsin academic radiology programs hasdecreased.

Jonathan Sunshine, Ph.D., ACR’ssenior director for research and leadauthor of the study, says he’s not surewhy there are fewer vacancies in theradiology job market. “A lot of peopleare breathing more readily, but few feelthe problem is definitely resolved,” hesays.

Dr. Sunshine and three otherresearchers studied job advertisementsin AJR and Radiology for September–November 2003. They found a 28 per-cent decrease in the number of jobsadvertised—848 listed for that timeperiod in 2003, compared to 1,186 jobvacancies listed in 2002.

C. Douglas Maynard,M.D., study co-authorand chairman emeritus ofthe Radiology Depart-ment at Wake Forest Uni-versity School of Medi-cine in Winston-Salem,N.C., conducts an annualsurvey of academic radiology depart-ments. He found that vacancies in aca-demic radiology have gone down overthe last three years. In 2001, there were5.4 vacancies per academic department.In 2002, the number dropped to 5.1. In2003, it was down to 3.9.

Dr. Maynard, an RSNA past-presi-

dent, says he’s not ready to declare anend to the shortage: “I tend to be a littlepessimistic. I don’t know if the short-age will persist or if this is a one-timecorrection.”

No Magic BulletIn 2001, ACR established a blue ribbontaskforce to assess the radiologist short-age and to recommend steps to ease thegrowing crisis, such as increasing the

number of resi-dents and encour-aging recentlyretired radiolo-gists to return towork. At the time,the taskforceadmitted thatthere would be no

“magic bullet” to resolve the crisis.Dr. Maynard says these small steps

have helped to some extent. “Radiolo-gists aren’t retiring as quickly, moreretirees are agreeing to part-time workand radiologists have learned to bemore efficient with their workload,” heexplains. “We are losing some turf to

other specialties, but the volume ofradiology procedures is increasing. Sothe question becomes, have we used upall the little pieces?”

One of Dr. Maynard’s greatest con-cerns is for the long-term health of aca-demic radiology. “In order to keep upwith the ever-increasing number of pro-cedures, academic productivity hasgone down,” he says. “There are fewerpapers being written, fewer talks and areduction in the amount of time forteaching medical students and resi-dents. That’s okay in the short-term,but bad for radiology in the long-term.”

One of the attractions of an aca-demic position is that in exchange forlower pay, that person is supposed to beallowed to teach and to conductresearch. “But with an increasingdemand for radiology services, there isless time for teaching and research,”Dr. Sunshine explains. “As peopleleave academics, a greater burden isplaced on those who stay. It becomes avicious spiral.”

Drs. Maynard and Sunshine agreethat it is very important to continue to

Radiologist Shortage Easing,Physician Shortage Growing

C. Douglas Maynard, M.D.Jonathan Sunshine, Ph.D.

I tend to be a little pessimistic.

I don’t know if the shortage

will persist or if this is a

one-time correction.

C. Douglas Maynard, M.D.

FEATURE:WORKFORCE

7R S N A N E W SR S N A N E W S . O R G

track the market because past experi-ence has shown a number of up anddown cycles. They will now investigatepotential reasons for the current easing,such as PACS and teleradiology.

As ACR presses legislators toincrease the number of radiology slots,some radiology departments are usingcreative ways to add slots without gov-ernment funding. Dr. Sunshine says alocal radiology practice may fund thelast year of training in exchange for aresident’s promise to work for the prac-tice after his or her residency ends. Hesays there are a number of other inno-vative program possibilities to supportradiology as a valuable and interestingfield of work.

Physician Shortage AcknowledgedRadiology may have been hit first, butthe shortage of all physicians is becom-ing more widespread. In a report in theDecember 10, 2003, issue of The Jour-nal of the American Medical Associa-tion (JAMA), Richard A. Cooper, M.D.,and colleagues questioned medicalschool deans in the United States andPuerto Rico to assess the adequacy ofthe physician supply.

They found that of the 70 deansresponding from mainland schools, 62(89 percent) cited shortages of physi-cians in at least one specialty.

Dr. Cooper says for years, all thedata showed an impending shortage,but few read it right. “This is one of thegiant screw ups of healthcare planningand no one wants to take the blame.This poor forecasting and the entireprocess should be examined by medi-cine,” he says.

Dr. Cooper, director of the HealthPolicy Institute at the Medical Collegeof Wisconsin, says a telltale signappeared late last year when the Coun-cil on Graduate Medical Education(COGME) changed its position 180degrees and called for an expansion ofspaces in medical schools and slots forresidents. “One day, COGME saidthere were 100,000 too many physi-cians. The next day, COGME said there

were 100,000 too few. There was nochange in the data, just a different wayof looking at it,” he explains.

Jonathan Sunshine adds: “The typi-cal approach to planning assumed thatthe number of physicians required per100,000 Americans would remain con-stant—except for the effects of theaging population. But this is really anassumption that there will be noprogress in medicine. ‘No change’ is acompletely foolish assumption beliedby the history of healthcare for the lasthalf century or more. In reality, overthe decades, medicine makes greatadvances. In simple terms, that meansphysicians can do more for patients.This, in turn, means more physiciansare needed.”

The American Medical Associationadopted a policy statement in Decem-ber acknowledging a physician short-age in some areas of the country and insome specialties. “Previous estimatesof physician oversupply were based onassumptions regarding the impact ofmanaged care insurance plans; suchassumptions have been shown since tobe erroneous,” an AMA statement says.The AMA also issued a directive tosupport current programs to alleviateshortages in many specialties and themaldistribution of physicians in theUnited States.

Also in December, the Associationof American Medical Collegesannounced that it had established a newCenter for Workforce Studies to assess

the supply, demand, use and distribu-tion of physicians.

Dr. Cooper says more difficult dayslie ahead: “We are in the relativelyearly stages of a shortage. It’s just shal-low enough now that we feel a little bitoff. However, in 10 years, there will bea huge shortage and a little fine tuningjust won’t help.”

He says one solution is to openmore medical schools. In Texas, a newmedical school is being built but itwon’t open until 2007, Dr. Coopersays. The first students will graduate in2011 and residency training won’t becomplete until 2015.

“Radiologists won’t be as bad offas other specialties in the futurebecause radiology foresaw the problemand has been trying to fix it. Radiologywill be able to fix the problem, but thelarger solution won’t come for another15 years,” Dr. Cooper adds. ■■

Source: Data from C. Douglas Maynard’s annual survey of academic departments. These data were included in AJR 2004; 182:301-305

0

1

2

3

4

5

6

200320022001

Vacancies Per Academic Department

Notes: To view the abstract of the AJR article,“Update on the Diagnostic Radiology Short-age,” go to www.ajronline.org/cgi/content/abstract/182/2/301. To view the abstract for theJAMA report, “Perceptions of Medical SchoolDeans and State Medical Society ExecutivesAbout Physician Supply,” go to jama.ama-assn.org/cgi/content/abstract/290/22/2992.

8 R S N A N E W S A P R I L 2 0 0 4

Imaging plays an important role inemergency care around the world,but the type of imaging used varies

by region.Some of the differences in emer-

gency radiology arise from an inade-quate supply of radiologists andequipment; other differences stemfrom the political climate and diseaseprevalence.

The RSNA Committee on Interna-tional Relations and Education (CIRE)held a refresher course at RSNA 2003to provide a more complete under-standing of emergency radiology on aglobal scale. Practitioners from severalmajor geographical areas describedtrauma imaging in their respectiveregions.

“The course was well attended andpeople thanked RSNA for providingthem with an insight into how environ-mental conditions, as well as econom-ics, have an impact on trauma care,”says CIRE Chairman Barry B. Gold-berg, M.D. “For example, in theUnited States, many traumas resultfrom accidents. But in Latin America,especially in Colombia, we learnedthat shootings were responsible formost trauma cases. Other regions aredealing with war.”

Dr. Goldberg says CIRE felt thatsince emergency care is such a compli-cated issue, it would be valuable toshare insights about how emergencyimaging is handled in other parts of theworld.

EuropeMariano Scaglione, M.D., from Car-darelli Hospital in Naples, Italy,described emergency services inEurope. He explained that emergencycare is provided at three levels—basic

care hospitals, special care hospitalsand maximum care centers.

Along with the trauma surgeon andanesthesiologist, Dr.Scaglione says theradiologist is a keymember of thetrauma team and thatinterventional radiol-ogy is frequently partof the managementplan. He says a chestx-ray is always part of the basic work-up, following physical examination.

“Second-line imaging studies incases of blunt trauma include a choicebetween ultrasound and CT scanning,”Dr. Scaglione says. “In contrast toAmerica, where CT is much more pre-ferred as a screening measure, ultra-sound remains popular in Europe. Cer-tainly, CT should not be used routinelyin all trauma victims. Radiation expo-

sure, feasibility in a busy trauma centerand cost are relevant considerationswhen choosing a modality.”

He adds that aradiologist’s taskis to decide whichis most appropri-ate for a givenpatient in the cur-rent clinical status.European radiolo-gists believe

strongly that ultrasound should remainpart of the clinical algorithm fortrauma patients, according to Dr.Scaglione. “It is fast, relatively inex-pensive, can be repeated, and may becarried out at the bedside. Consideringthe growing demand for trauma care,screening ultrasound can lower thenumber of CT scans that will berequired,” he says.

Trauma Imaging FacesRegional, Cultural Challenges

Mariano Scaglione, M.D. (left), with session moderator Barry B. Goldberg, M.D.

In contrast to America, where

CT is much more preferred as a

screening measure, ultrasound

remains popular in Europe.

Mariano Scaglione, M.D.

FEATURE:MEDICINEINPRACTICE

9R S N A N E W SR S N A N E W S . O R G

AsiaSevere shortages of both manpowerand equipment prevail throughout theAsian continent. There is no such sub-specialty as emergency radiology, andmost nations in the region have nonational program to develop qualityemergency services. “The present situ-ation in Asia, with respect to emer-gency radiology as a subspecialty, iseither non-existent or currently at anearly stage of development,” says Lil-lian F.L.Y. Leong, M.D., M.B.A., chiefof service in the Department of Radiol-ogy at Queen Mary Hospital in HongKong, and an honorary clinical associ-ate professor at the University of HongKong.

Common trauma cases in Asiancountries include:• Traffic accidents, often involving

bicyclists and motorcyclists • Occupational injuries and industrial

accidents• Injuries from land mine explosions• Terrorist attacks• Natural disasters• Attempted suicide

Ultrasound is widely used in Asiaas an initial imaging method. Strokesare increasing, presumably becauseAsians are incurring more dietary andother risk factors, Dr. Leong explains.For acute stroke, she says CT or MRimaging would be the appropriate ini-tial imaging study. If severe acute res-piratory syndrome (SARS) is sus-pected, a chest x-ray should be taken,reserving CT for the managementphase, she adds.

Sub-Saharan AfricaPeter D. Corr, M.D., a professor andchief of radiology at the University ofKwaZulu Natal in Durban, SouthAfrica, says there are only 750 radiolo-gists in Sub-Saharan Africa—morethan half in South Africa. He says theregion includes some of the poorestcountries in the world and is heavilypopulated by children.

Dr. Corr says one way they aredealing with the shortage of radiolo-

gists is through teleradiology, whichmakes it possible for a radiologist any-where in the world to evaluate imagesat any time. Patients that present to theemergency department in Sub-SaharanAfrica are oftentimes suffering fromHIV/AIDS, lower respiratory infec-tions or tuberculosis. He says injuriesfrom wild animals remain a real men-ace—crocodiles being major culprits.Motor vehicle injuries connected withdrinking are another common cause oftrauma.

He says trauma centers are avail-able in some urban areas, but in ruralsites nurses and nurse assistants mainlyprovide medical care. Ultrasound iswidely used as an initial imaging pro-cedure. “One of the challenges facingthose evaluating emergency patients isthe maintenance of the imaging equip-ment,” Dr. Corr explains. “Other chal-lenges are acquiring mobile and versa-tile equipment, and training more tech-nicians—especially in ultrasound.”

Emergency Radiology at RSNA 2004Overall, Dr. Goldberg says the courseshowed that imaging is an importantearly tool in helping clinicians decide

how to best treat trauma patients. Hesays CIRE plans to host a similarcourse at RSNA 2004, titled “Radiol-ogy Triage of Trauma During War andPeace.”

“We want to provide informationabout how trauma imaging is handled,not only in developed areas, but also inemerging areas and underdevelopedareas,” he says. “This type of sympo-sium allows physicians to make moreefficient decisions and set goals forfuture patient care.”

Dr. Goldberg, who is the directorof the Division of Ultrasound and aprofessor of radiology at Thomas Jef-ferson University Medical Center andHospital in Philadelphia, is also therecipient of a “Teach the Teachers”grant from the RSNA Research & Edu-cation Foundation.

Emergency radiology will also bethe subject of the 2004 CategoricalCourse in Diagnostic Radiology. ■■

Note: This article was adapted from a feature inthe RSNA 2003 Daily Bulletin.

Lillian Leong, M.D., M.B.A., explained that severe shortages of manpower andequipment prevail throughout Asia.

10 R S N A N E W S A P R I L 2 0 0 4

Functional MRI Tests Working Memory in Brain-Injured Children

In the United States, more than200,000 children are hospitalizedeach year for head trauma. About

30,000 suffer permanent disability.Most children make the majority oftheir recovery within the first 12months.

Researchers in Houston have foundchildren with poor recovery following atraumatic brain injury (TBI) have morefocal patterns of activation using func-tional MR imaging (fMRI). Their earlyresearch was presented in a scientificpaper at RSNA 2003.

Jill V. Hunter, M.B.B.S., sectionhead for pediatric neuroradiology in theDepartment of Diagnostic Imaging atTexas Children’s Hospital in Houston,and colleagues tested four right-handedgirls and one right-handed boy, with amean age of 12.7 years, who had mod-erate to severe TBI caused three to 51.5months prior to the imaging procedure.The children were each matched forage and sex with five healthy right-handed children, with a mean age of13.2 years and with parents of similarsocioeconomic status andeducation.

The researchers usedan N-back workingmemory task with lettersto check the memories ofthe children. In that test,participants see a seriesof items, each appearingone at a time, followedby the next object in the series. Thechildren learn to press a button whenthe item shown is the same as the oneshown a certain number (N) of itemsearlier. For example, in a 1-back test, abutton has to be pressed if it matchesthe one immediately prior.

The load was increased incremen-tally from 1- to 2- to 3-back after thesuccessful completion of 75 percent orgreater responses. Dr. Hunter says the75 percent rate was used to avoid purechance. Responses were recorded elec-tronically with a left or right push but-ton control fed to the laptop computerprojecting an image. All the test sub-jects reached their maximum level ofcompetence two hours before theirfMRI. In addition, all the childrenunderwent neuropsychological, IQ, language and math testing outside ofthe time of their fMRI study.

fMRI showed that three of the TBIpatients, who could complete only the1-back task successfully, had a differentand more focal pattern of frontal acti-vation than the fourth and fifth TBIpatients and the five control patients.The fourth and fifth TBI patients andthe five control patients showed a moreneuro-anatomically distributed patternof activation, even at the 1-back level.Dr. Hunter notes that as the childrenage and the time since their injury

passes, scoresincrease and brainactivity becomesless focal and moredistributed.

“While per-forming equivalentworking memorytasks, the childrenwith poor recovery

following TBI had a more focal patternof brain activation than either normal,age-matched controls or the child whohad good recovery after TBI,” Dr.Hunter says. “These findings may haveimportant prognostic and managementimplications for children sustaining

closed head injury. Treatment optionscould include parent counseling andearlier implementation of therapy.”

Dr. Hunter, who is also an associateprofessor of radiology at Baylor Col-lege of Medicine, says she and her col-leagues will now conduct a longitudinalstudy to confirm that children withimpaired working memory followingTBI demonstrate a different pattern ofbrain activation. ■■These findings may have

important prognostic and

management implications

for children sustaining

closed head injury.

Jill V. Hunter, M.B.B.S.

Note: This article was adapted from a feature inthe RSNA 2003 Daily Bulletin.

FEATURE:SCIENCE

Jill V. Hunter, M.B.B.S.Texas Children’s Hospital, Houston

11R S N A N E W SR S N A N E W S . O R G

Anew study suggests radiology residents, and even some generalradiologists, need more training

and experience in breast imaging.Meanwhile, a second study shows thatwhile breast implants interfere withmammography, cancer outcomesremain unchanged.

More Training Needed During a scientific paper session atRSNA 2003, Gillian M. Newstead,M.D., provided an assessment of cur-rent screening mammography trainingin residency programs.

“I undertook this study as part of alarger ongoing evaluation of radiologistperformance in the breast imagingarena,” says Dr. Newstead, an associateprofessor of clinical radiology and clin-ical director of breast imaging at theUniversity of Chicago. “Now thatbreast imaging education is included inthe training, my colleagues and Iwanted to compare how residents aredoing by year of training.”

In a simulated mammographyscreening exercise, the researchers eval-uated the performance of radiology res-idents enrolled in two large universitytraining programs and compared it withthe performance of 100 general practiceradiologists and three mammographyexperts.

“The residents read 100 mammo-grams containing 50 cancers mountedon motorized viewers,” she explains.“They read them individually andrecorded their interpretations on ananswer sheet.”

The mean sensitivity of cancerdetection for first-year residents was 35percent. For second-year residents itwas 51 percent. For those in their thirdyear, it was 40 percent, and for fourth-

year residents, it was 57 percent. The overall resident performance

was lower than the general radiologistperformance (72 percent). The generalradiologist performance was also sig-nificantly lower than the expert mam-mography interpretations (82 percent).

“I wasn’t sure how the residentswere going to perform, compared withgeneral radiologists,” Dr. Newsteadsays. “I thought the senior residentsmight have done better than they did.But I think it just points to the fact thatwe need to stress training and screeningduring residency programs and havesome kind of performance measuresduring residency.”

While some have recommendedadditional requirements, the president ofthe Society of Breast Imaging saysanother approach is needed. “I am con-cerned that the regulatory requirementsin mammography already exceed thosethat are part of other subspecialty areasin radiology and medicine in general,”says D. David Dershaw, M.D., a profes-sor of radiology at Cornell UniversityMedical College and director of breastimaging at Memorial Sloan-KetteringCancer Center in New York. “Additional

requirements will further discouragephysicians from choosing breast imag-ing as a field in which to work. Becauseof the shortage of both radiologists andtechnologists, this could seriouslyimpact availability of services. There isalso little or no evidence to suggest thatincreasing the number of mammogramsthat a radiologist needs to read to partic-ipate in mammography improves thequality of film interpretation.”

Residents, General RadiologistsNeed More Mammography Training

FEATURE:SCIENCE

Gillian M. Newstead, M.D.University of Chicago

Mean Sensitivity for Cancer Detection on Mammography

0

20

40

60

80

100

ExpertInterpreter

GeneralRadiologist

Fourth-yearResidents

Third-yearResidents

Second-yearResidents

First-yearResidents

Source: Adapted from data from Gillian M. Newstead, M.D.

Continued on next page

12 R S N A N E W S A P R I L 2 0 0 4

Mammography screening is such animportant issue that the Institute ofMedicine (IOM) of the National Acade-mies, under direction from Congress,has embarked on a 15 month study ofmammography standards. The IOM willevaluate ways to improve physicians’interpretation of mammograms, withoutimpairing access. The study will alsocover audits, technical quality, supply ofpersonnel, mandates for monitoring andassessing quality and access, and stepsto make available new technology.

The IOM report is expected to finalized prior to the scheduled 2005Mammography Standards Quality Actreauthorization.

Implants Affect Mammography SensitivityA large national study published in theJanuary 28 issue of The Journal of theAmerican Medical Association (JAMA)confirms that breast implants interferewith the detection of breast cancers byscreening mammography. However, the

study also found thataugmentation doesnot increase thefalse-positive ratenor does it seem toinfluence the prog-nostic characteristicsof tumors.

The study, whichincluded data fromseven mammogra-phy registries acrossthe country, showedthat 55 percent ofcancers were missedin asymptomaticwomen with aug-mentation, compared

with 33 percent in similarly agednonaugmented women.

“We were surprised to find that therewere no differences in cancer character-istics given the large difference inscreening mammography,” says leadauthor Diana L. Miglioretti, Ph.D. “Ithink it’s very worrisome to find out thatso many cancers were missed via mam-

mography, but on the other hand, thisdidn’t seem to result in more advancedcancers at diagnosis.”

Dr. Miglioretti, affiliate assistantprofessor with the Department of Biosta-tistics at the University of Washington inSeattle and an assistant investigator withthe Center for Health Studies, HealthCooperative, says there may be severalexplanations for the similarity in cancercharacteristics between women withbreast augmentation and those without it.

“Women with breast implants mayhave the socioeconomic edge, and there-fore may be getting better healthcare,”she says. “Also, women with implantsmay have less native breast tissue andthe implants push the tissue up againstthe skin which may make it easier to feela lump. Augmented women are told tocheck their breasts often for any prob-lems with the implant, so they may bemore likely to find lumps on their own.”

Dr. Miglioretti and her colleaguesalso were surprised by the finding that,while the sensitivity of screening mam-mography was reduced, specificity wasone percentage point higher amongwomen with implants.

Co-author Robert Rosenberg, M.D.,a professor of radiology at the Univer-sity of New Mexico in Albuquerque,says even though the study demonstratesthe limitations of screening, it brings

good news, “Even though mammogra-phy sensitivity is lower in women withimplants, there is no evidence that thisresults in more advanced disease at diag-nosis.”

Both Drs. Rosenberg and Migliorettiemphasize the importance of using dis-placement views when filming aug-mented women. “That is the standard ofcare,” says Dr. Miglioretti, “but in thisstudy we don’t know if the women gotimplant displacement views. I’d bereally curious, if we could do anotherstudy, to go back and see if displacementviews were performed in all womenbecause they do improve the accuracy ofmammography.”

Dr. Rosenberg adds that these datareflect the performance of radiologists inthe community and therefore should berepresentative of general practice.“These were not data coming out ofreferral centers or specific clinics. This isthe standard mix of patients in theUnited States,” he says. The authorsexpressed their gratitude to all of theradiologists who contributed to the studyby participating in the Breast Surveil-lance Consortium. ■■

Continued from previous page

Submuscular BreastImplant(left) Right craniocaudalimplant displaced view.(right) Right craniocaudalfull view.Image courtesy of Robert Rosenberg, M.D.

Notes: To view the abstract of the JAMA study,“Effect of Breast Augmentation on the Accuracyof Mammography and Cancer Characteristics,”go to jama.ama-assn.org/cgi/content/abstract/291/4/442. A portion of this article was adaptedfrom a feature in the RSNA 2003 Daily Bulletin.

Mammography

screening is such an

important issue that the

Institute of Medicine of

the National Acade-

mies, under direction

from Congress, has

embarked on a 15

month study

of mammography

standards.

13R S N A N E W SR S N A N E W S . O R G

Financial Debts Mount forToday’s Medical Students

This year’s medical graduates willleave academia with more than anM.D. and a hearty handshake.

The majority face daunting amounts ofeducational debt—more than any gen-eration before them. The Associationof American Medical Colleges(AAMC) reports that more than half oflast year’s graduates owe more than$100,000, and 80 percent of graduateshave some degree of financial debt.

“Medical school is an investmentthat will pay for itself many, manytimes over,” says Erik Thurnher, M.D.,C.F.P., an emergency room physicianand certified financial planner forPhysicians’ Financial Advisors inNewport Beach, Calif. “It has the high-est rate of return and graduates have tothink of this long term.”

Dr. Thurnher’s clients include fel-low physicians who often are discour-aged by such an overwhelming debtload. But even duringthe penny-pinchingdays of medical schooland early residency, heencourages them tokeep an eye on theirtotal financial picture—week by week, monthby month.

He suggests creating a master fil-ing system, with a different file folderfor each loan and all of its correspon-ding paperwork. “Open every letteryou get from lenders,” he says. “WhenI was a resident I was working 15 to18 hours a day in the trauma unit. Iwas so busy that the mail piled up inmy apartment. Afterwards, I realized Ihadn’t paid my credit card bills or evenread mail from lenders. Some billswent into collection and it left a blackmark on my credit report for a while. I

tell that story to people so they realizehow important it is to stay on top ofthings.”

Dr. Thurnher also encourages resi-dents to get a calendar and mark allkey dates regarding their loans. Thatway, filing deadlines and repaymentschedules will remain fresh in theirminds even under sometimes crushingworkloads.

It’s important too to understandexactly how much you owe and howmuch interest you will pay, he sug-gests. Many Web sites provide calcula-tors to help figure the total cost ofloans. Some lenders offer online loantracking, allowing borrowers to deter-mine exactly where they stand in totalindebtedness. There’s a wealth ofinformation on loans, repayment pro-grams and interest. The Internet,library and medical school searchesproduce comprehensive debt-manage-

ment publications,full-service Websites, targeted work-shops and onlinediscussion forumsfor physicians seek-ing guidance inmanaging medicalschool debt and

starting the repayment process. Somemedical schools make debt manage-ment seminars part of their pre-gradua-

tion offerings. Any financial aid officecan point current students and gradu-ates in the right direction for advice onissues related to debt repayment.

“What they’re facing is amarathon, not a sprint,” says J.Michael Moody, M.B.A., president andco-founder of National Tax and Invest-ment Seminars, the nation’s largestsponsor of financial education pro-grams for healthcare associations.“Spend your time before you spendyour money,” Moody advises. He saysresidents should sit down and thought-fully create a financial plan, includingcurrent needs and future goals.

J. Michael Moody, M.B.A.

Start paying off credit or

consumer high-interest debt

first and move down to

low-interest student debt.

Erik Thurnher, M.D., C.F.P.

FEATURE:FORRESIDENTS

Paying to Practice2003 Medical Graduate Debt

Public Schools Private Schools All Schools

Average Debt $97,275 $129,392 $109,457

Graduates with Debt 84% 79.4% 82.1%

Average new physicians’ debt load increased 5.4% over 2002.

Source: Association of American Medical Colleges

Continued on next page

14 R S N A N E W S A P R I L 2 0 0 4

“Be specific. Write it down. Breakdown your goals,” he advises. • Short-term goals – less than a year• Intermediate goals – 2 to 8–10 years • Long-term goals – 10 years or more

Most students apply for andreceive government-backed Staffordloans, says Dr. Thurnher. They’re themost attractive because of their lowinterest rates, grace periods and defer-ments that usually cover the period ofresidency. Many students reach thefederal borrowing limits before theirschooling is complete and take outadditional, private loans, often at com-petitive but higher interest rates.

Sample repayment schedules puttogether by AAMC last year show thaton $100,000 in typical medical studentloans, monthly payments ranged from$1,274 a month to $1,740 a month,depending on interest rates. “Intimidat-ing numbers for some, but on a physi-cian’s salary, that should be doable,”says Dr. Thurnher. “Start paying offcredit or consumer high-interest debtfirst and move down to low-intereststudent debt. Pay off the highest inter-est loans first.”

“There are the fiscal imperatives,”Moody adds. “You have to meet yourloan deadlines and your other obliga-tions such as food, rent and clothing.But there is often a psychologicalimperative too. Some people find thathuge debt just burns a hole in theirsoul and they are motivated to pay itoff as soon as possible.”

Because of today’s low interestrates, Moody says this is a great time

to be paying off student debt. “Returnson traditionally conservative invest-ment tools, such as CDs and moneymarket accounts, make paying offloans more practical,” he says. How-ever, physicians who enter higher-pay-ing specialties mayhave a decision tomake about whereto put their assets—into loan repaymentor other, higher-interest yieldinginvestments.

Dr. Thurnherlikes to presentclients with options,such as putting someof their new incomein funds that havehigher rates ofreturn so clients cansee that taking alonger payoff pathcan actually earnthem money.

Borrowers who want to streamlinethe payoff process are turning to con-solidation loans, says Moody. Therules are specific and the process isdifferent for those holding federalloans and those with loans from sev-eral sources. He says borrowers cancontact either the loan servicer or thecurrent entity holding the loan. “It’simportant to read the fine print beforechanging a loan payment program,” hesays. “Be cautious of any fees chargedwith consolidation. Make sure theytake into account payments alreadymade and be sure there are no pre-pay-

ment penalties.” As any financial advisor would,

Moody reminds young physicians towalk before they run. “It’s nice todrive a BMW or buy Armani, but atage 25, do you need an expensive car?

If you meet your debt,then create savings. Ina couple of years youcan drive around in anice car that you paidfor with cash. You cantackle it all in amethodical way,” heconcludes.

The American Med-ical Association(AMA) is studying fea-sible strategies for cre-ating new and/orexpanded loan pro-grams, specifically forthe health professions.A report is expectedlater in the year.

In addition, theAMA supports further expansion ofstate loan repayment programs andthe expansion of those programs tocover physicians in non-primary carespecialties. The AMA is also urgingstate medical societies to activelysolicit funds for the establishment and expansion of medical studentscholarships. ■■

Continued from previous page

Managing your Debtand Loan Repayment ■ Understand your loan repayment

terms and conditions

■ Determine which loans to target for early repayment

■ Be aware of your repaymentoptions

■ Consolidate wisely and evaluateconsolidation/ refinancing options

■ Consider a forgiveness or repay-ment program as an option

■ Tailor your repayment strategy toyour circumstances, personal andprofessional goals

Source: Association of American Medical Colleges

The RSNA Education Cen-ter will again host two

financial seminars prior toRSNA 2004 in Chicago. Theseminars will be on Saturday,November 27 at McCormickPlace. They are “Protecting

Assets from Creditor Claims,”led by Barry Rubenstein, B.S.,J.D., L.L.M., and “EffectiveReal Estate Investment Strate-gies,” led by J. Michael Moody,M.B.A.

❚RSNA Education Center Financial Seminars

November 28 –December 3, 2004

McCormick Place,Chicago

15R S N A N E W SR S N A N E W S . O R G

RSNA:MEMBERBENEFITS

Membership Applications in Español and FrançaiseRSNA membership applications are now available inSpanish and French for distribution to potential mem-bers. An international application form is also beingdeveloped to make it easier for non-English-speakingcandidates to apply for membership.

To request a membership application in Spanish orFrench, contact the RSNA Membership and Subscrip-tion Department at (877) RSNA-MEM [776-2636](U.S. and Canada), (630) 571-7873 or membership@rsna.org.

Working For You

If you have a colleague who would like to become an RSNA member, you can download an application at www.rsna.org/about/membership/memberapps.html, or contact the RSNA Membership and Subscription Department at (877) RSNA-MEM [776-2636] (U.S. and Canada), (630) 571-7873 or membership@rsna.org.

Educating DevelopingNationsRSNA’s Committee on InternationalRelations and Education provided 59gratis subscriptions to Radiology andRadioGraphics to institutions in 30developing nations in 2003 as part ofits Educational Materials and JournalAward program. Educational materi-als were also sent to three institu-tions. Each recipient is required toevaluate the impact of the program.

WO

RK

ING

FO

R Y

OU

PR

OFI

LE

SERVICE TO MEMBERS:RSNA Link was one of the firstradiologic Web sites. Launchedat RSNA 1994, it consists ofmultiple sites today, withaccredited educational pro-grams available on demand,browser-based request forms,online membership applica-tions, and interactive meetingresources, including the scien-tific program, floor plan andexhibitor database, as well asapplications for handheld com-puters. In light of last year’sworldwide simulcast of theSunday Image InterpretationSession, who knows what thefuture holds?

I’m involved in onetime,recurrent and ongoing projectsthat support the RSNA strategicplan by means of Internet tech-nology. I help to make RSNA

resources available throughbrowsers. As Webmaster, Ihave many roles: informa-tion gathering, design, con-tent tagging, implementa-tion, quality control, main-tenance, correspondence,guidance and planning.Like the annual meeting,RSNA Link depends onteamwork. I’m one ofmany behind the scenes.WORK PHILOSOPHY:To make life easier, dothings in phases. Meetdeadlines. Balance fresh-ness with familiarity somembers will feel at home whenthey visit. Clarify expectations.We’re always trying to improvenavigation to help members findwhat they need on the site. I tryto think long term and focus onthe short term. Our biggest chal-lenge may be trying to pleasesomeone who may not exist—the average user. Some arephysicians and others arepatients, students, reporters or

technical exhibitors. Some prefertext and others, graphics. Somehave fast connections and somestill use modems. Some havehigh resolution; others, low.Some rarely surf the Web andothers use it every day. We try tofind a “happy” medium. The lat-est technology isn’t necessarilythe best. On any site, thinkbefore you click—it may saveyou time.

NAME:Ken SchulzePOSITION:WebmasterWITH RSNA SINCE:May 15, 1989

Continued on page 25

16 R S N A N E W S A P R I L 2 0 0 4

Press releases have been sent to the medical news media for the following scientificarticles appearing in the April issue of Radiology (radiology.rsnajnls.org):

Radiology in Public Focus

RSNA:JOURNALS

Breast Cancer Treated with US-guided Radiofrequency Ablation: Feasibility Study

Ultrasound-guided percutaneousradiofrequency (RF) ablation of

small invasive breast carcinomas is fea-sible and safe.

Bruno D. Fornage, M.D., and col-leagues from the University of TexasM.D. Anderson Cancer Center in Hous-ton performed RF ablation on 21malignant lesions in 20 patients imme-diately before a scheduled lumpectomyor mastectomy.

They found that in all 21 cases,complete ablation of the target lesionwas visualized at ultrasound. Therewere no adverse effects.

“A high level of three-dimensionalaccuracy is required to correctly placethe device inside the tumor volume.Thus, we believe that the best resultswill be obtained if the procedure is per-formed by an operator who is fullytrained and experienced in interven-tional breast ultrasound,” the

researchers write. “Whether RF abla-tion can be used satisfactorily as atreatment replacement for lumpectomyof small breast cancer remains to beconfirmed.”(Radiology 2004; 231:215-224)

Aortoiliac Insufficiency: Long-term Experience withStent Placement for Treatment

Aortoiliac stent placement for treat-ment of chronic lower-extremity

ischemia is a durable, low-risk revascu-larization option.

Timothy P. Murphy, M.D., fromRhode Island Hospital in Providence,and colleagues describe their long-termexperience with the procedure.

Between February 1992 and March2001, the researchers treated 505lesions—88 occlusions and 417stenoses. They report that hemody-namic success was achieved in 98 per-cent of the limbs (484/496) for which

postprocedural translesion pressure gra-dients were available.

The researchers write, “Althoughinitially introduced as a method to sal-vage failed balloon angioplasty, stentshave been proved to allow the indica-tions for percutaneous interventions tobe extended to include treatment oflesions that previously were not consid-ered suitable for balloon angioplastyand these devices are now accepted asa primary therapy.”(Radiology 2004; 231:243-249)

Intraoperative photograph shows inser-tion of the needle electrode into thelesion, with the needle electrode asparallel to the chest wall as possible.This technique is similar to the needleinsertion technique used to performcore-needle biopsy.

Drawing illustrates the RF ablationdevice correctly placed so as to producea thermal lesion volume (black outline)that is concentric to the tumor andthat encompasses the tumor and a suf-ficient margin of noncancerous tissue.© 2004 RSNA. All rights reserved. Printed with permission.

RSNA press releases are available atwww2.rsna.org/pr/pr1.cfm.

17R S N A N E W SR S N A N E W S . O R G

RSNA:JOURNALS

Multiple Myeloma: Clinical Review and Diagnostic Imaging

In the past decade, important advances in theunderstanding of multiple myeloma (MM)

and the therapeutic options available to MMpatients have resulted in improved survival.Current imaging technologies, in particular

bone marrow surveys withMR, have made it easier to

detect disease involvement, the results of treat-ment, areas of potential complications andsites of focal disease for safe bone biopsies.

In an article appearing in the April issue ofRadiology, Edgardo J.C. Angtuaco, M.D., andcolleagues from the University of Arkansas forMedical Sciences in Little Rock, review:• clinical presentation• clinical staging and prognosis• imaging studies used to detect MM• perspectives in treatment

To access this article online, go to radiology.rsnajnls.org.

Complete resolution of diffuse and focal lesions.Left: Pretreatment sagittal(top) and coronal (bottom)STIR MR images(2,000/150/20) of lumbarspine and pelvis show dif-fuse disease with focallesions (straight arrows) inpelvis. Right: Follow-upsagittal (top) and coronal(bottom) STIR MR images(2,000/150/20) of lumbarspine and pelvis show complete resolution of bothdiffuse and focal lesions.Note normal MR appearanceof diffuse hypointensitywithout focal lesions. Superior end-plate fractureat L4 (curved arrow) hasdeveloped. © 2004 RSNA. All rights reserved. Printedwith permission. (Radiology 2004; 231:11-23)

Importance and Effects of Altered Workplace Ergonomicsin Modern Day Radiology Practice

Picture archiving and communicationsystems (PACS) have revolutionized the

practice of radiology and have dramaticallyincreased workflow. But in addition toupdated technology,the radiology suitealso needs updated ergonomics to helpmaximize throughput and minimize radiol-ogist fatigue.

In an article appearing in the March-April issue of RadioGraphics, Mukesh G.Harisinghani, M.D., and colleagues fromMassachusetts General Hospital in Bostondiscuss and illustrate ergonomic deficien-cies that commonly exist in the currentPACS environment with respect to:• vision• posture• temperature• ventilation• sound• ambient lighting

They also review ergonomic challenges,discuss injury potential and propose possi-ble solutions.

To access this article online, go toradiographics.rsnajnls.org.

Slouching constitutes suboptimal and ergonomically poor posture andputs undue strain on the lower back and intervertebral disk spaces.© 2004 RSNA. All rights reserved. Printed with permission. (RadioGraphics 2004; 24:615-627)

Journal Highlights

18 R S N A N E W S A P R I L 2 0 0 4

RSNA:PROGRAM&GRANTANNOUNCEMENTS

Through a grant from the RSNAR&E Foundation, the ClevelandClinic Foundation is acceptingapplications for its 2005-2006RSNA clinical fellowship in cardio-vascular imaging. This position willbe within the one-year cardiovascu-lar tomography fellowship programcurrently in place.

The fellowship experience willemphasize integrated non-invasivecardiovascular imaging with state-of-the-art MR imaging and multide-

tector CT within a busy clinicalservice.

For more detailed information,contact Richard D.White, M.D., at (216)444-2740 or atwhiter@ccisd1.ccf.org.

Program and Grant Announcements

NEW!

Cleveland Clinic Institutional Clinical Fellowship in Cardiovascular Imaging

Register online (www.rsna.org/education/shortcourses) for thisdynamic, interactive RSNA coursedirected by Lawrence R. Muroff,M.D.

The course will be held July23-25, 2004, at the Chicago Mar-riott Downtown. It is designed forcurrent and future leaders in radiol-ogy and focuses on relevant topicsincluding financial issues, strategicplanning, billing, compliance andlegal matters. Didactic morninglectures are followed by split inter-active breakout sessions for aca-demic or private practice strategicplanning in the afternoon.Registration Fees:RSNA member: $695RSNA member-in-training: $295Non-member: $795

For more information, contactthe RSNA Education Center at(800) 381-6660 x3747 or at ed-ctr@rsna.org.

NEW!

Stanford Cardiovascular ImagingFellowship Also through a grant from the RSNA R&EFoundation, Stanford University is acceptingapplications for a one-year fellowship in non-invasive cardiovascular imaging. Fellows willreceive detailed training in the principles anduse of multidetector row CT and cardiovascu-lar MR imaging systems within the context ofa busy clinical cardiovascular imaging service.

Active participation in research isexpected and dedicated research time is a keycomponent of the fellowship.

For more detailed information, contactGeoffrey D. Rubin, M.D., at (650) 725-4325or at grubin@stanford.edu.

Nomination DeadlineJune 15 is the nomination deadline for theRSNA 2004 Outstanding Researcher andRSNA 2004 Outstanding Educator awards.For more details and application/nominationforms, go to www.rsna.org/research/foundation.

DETAILS COMING SOON!

Digital Presentation Skills for the RadiologistAugust 7 at RSNA Headquarters in Oak Brook, Ill.

■ For information about RSNA Research & Educa-tion Foundation Grant programs, contact ScottWalter at (630) 571-7816 or at swalter@rsna.org.

Leadership Strategies for Radiology Practices

19R S N A N E W SR S N A N E W S . O R G

RADIOLOGYPRODUCTS

FDA CLEARANCE

Software FacilitatesRapid Detection ofBreast Cancer After receiving FDA approval,the privately held company 3TPLLC has started distributing itspromising new software thathelps radiologists more easilyinterpret contrast-enhanced MRstudies of the breast.

Professor Hadassa Deganiof the Weizmann Institute developed the three-time point (3TP)model based on the wash-in and wash-out properties of con-trast media in tissue. Her unique, patent-protected formulameasures tissue permeability and extracellular volume fractionon a pixel-by-pixel basis at three distinct time points. The soft-ware assigns a color to each pixel.

“I look forward to continuing the research and to the inter-national collaboration in extending the 3TP methodology toother malignancies and pathological conditions,” she said.

NEW PRODUCT

New High-Resolution Vascular Imaging TechnologyToshiba America Medical Systems has introduced a newversion of 3D vascular imaging technology for itsInfinix-i series line of vascular x-ray systems. Developedin conjunction with neuroradiologists, Philippe Gailloud,M.D., and Kieran J. Murphy, M.D., from Johns HopkinsUniversity School of Medicine, previous 3D digital sub-traction angiography (3D-DSA) technology is improvedwith a new 3D fusion digital subtraction angiography(3D-FDSA) technology.

The new technology illustrates both intracranial vas-cular anomalies and detailed anatomic correlation withsurrounding bone structures.

Product News

Information for Product News came from the manufacturers. Inclusion in this publication should not be construed as a productendorsement by RSNA. To submit product news, send your information and a non-returnable color photo to RSNA News, 820 Jorie

Blvd., Oak Brook, IL 60523 or by e-mail to rsnanews@rsna.org. Information may be edited for purposes of clarity and space.

ACQUISITION

Advanced Visualization Expands Appli-cations for Image-Guided SurgeryGE Healthcare hasacquired CBYON®, Inc.’sspecialized surgical navi-gation technology andintellectual property forneurosurgery, spine, andear, nose and throat (ENT).

“By integratingCBYON’s virtualendoscopy and surgicalperspective volume render-ing features, with GE’sunique electromagnetictracking technology, wecan help treat a broaderrange of medical condi-tions and diseases lessinvasively through our image-guidance surgical product,” saidLewis Dudley, general manager of surgery at GE Healthcare.“We are also pleased to further expand our capabilities in ourneurosurgery, spine and ENT surgical offerings through thisacquisition and resultant integration of CBYON’s leading edgesurgical software applications with GE’s InstaTrak® product.”

GE’s InstaTrak® surgical navigation system allows physicians to clearly visualize the position of surgical instru-ments inside the body in real-time andwithout a large incision in the patient.

An MR breast image after 3TPprocessing. The bright redcolor mapping is indicative ofa malignant lesion.

NEW PRODUCT

New Age in Ultrasound Equipment Royal Philips Electronics has launched a new generation of“smarter” ultrasound equipment. The Philips iU22 system, with

intelligent control and advancedergonomic design, offers a widerange of high-performance featuresincluding next generation, real-time4D imaging, voice-activated controland annotation, and automated imageoptimization technologies.

“Clinicians have been looking fora revolutionary leap forward in ultra-sound performance and workflow.The new Philips iU22 system meetsthat criteria, going far beyond excel-

lent image quality,” said Barbara Franciose, CEO of ultrasoundfor Philips Medical Systems.

The Philips iU22 system is also designed to reduce therepetitive stress injuries common to sonographers.

The Philips iU22 systemdisplays a 4D ultrasoundimage of a fetus withits foot in its mouth.

20 R S N A N E W S A P R I L 2 0 0 4

RESEARCH&EDUCATION:OURFUTURE

Research & Education Foundation Donors

PLATINUM ($1,000 - $4,999)Branta Foundation

GOLD ($500 - $999)William M. Angus, M.D., Ph.D.Stephen C. Dalton, M.D.

SILVER ($200 - $499)Judith & Ronald C. Ablow, M.D.Rebecca S. Cornelius, M.D. & JamesArbaugh

Stephen T. Austin, M.D.Ada Azodo & Michael V.U. Azodo,M.D.

Michael H. Baldwin, M.D.Danielle & Viren J. Balsara, M.D.Patricia Barth, Ph.D. & Merle H.Barth, M.D.

Brent W. Beahm, M.D.Gayle & Harold F. Bennett, M.D.,Ph.D.

John M. Benson, M.D.Steven M. Bernstein, M.D.Paul A. Bilow, M.D.Rainer G. Bluemm, M.D.Aurelia & Evelio R. Bofill, M.D.Tommie & Morton A. Bosniak, M.D.Marianne & Juan Brackins-Romero,M.D.

Mara & Steven H. Brick, M.D.Mellena D. Bridges, M.D.Nancy L. Brown, M.D. & WilliamBrown

Constance Whitehead & M. PaulCapp, M.D.

Jaime J. Cebedo, M.D.Helen H.L. Chan, M.B.Ch.B.Naomi & Mark M. Chernin, M.D.John V. Cholankeril, M.D.Jeffrey E. Chung, M.D.Winston Franklin B. Clarke, M.D.Irene A. Schulman, M.D. & BarryCohen

Robert O. Cone III, M.D.Leonard P. Connolly, M.D.George W. Cox, M.D.Carole & Hugh D. Curtin, M.D.Bruno Damascelli, M.D.

THE BOARD OF TRUSTEES of the RSNA Research & Education Foundation and its recipientsof research and educational grant support gratefully acknowledge the contributions made

to the Foundation January 17–February 24, 2004.

Ghanteswara R. Dasari, M.D.Brenda Foreman & Anthony J. De Raimo, M.D.

Philip M. Ditmanson, M.D.Carol A. Dolinskas, M.D.Joel S. Dunnington, M.D.Carmen Endress, M.D.Erwin H. Engert Jr., M.D.Laura Gordon, M.D. & Frank A.Erickson, M.D.

Victoria & Eugenio Erquiaga, M.D.Joshua M. Farber, M.D.Edrick J. Ferguson, M.D.Sharon & E. Edward Franco, M.D.Indra & Mark S. Frank, M.D.Maija G. Freimanis, M.D.Alan S. Friedman, M.D.Kunihiko Fukuda, M.D.Juan Dario Gaia, M.D.Pablo A. Gamboa, M.D.Robert C. Game, M.D.Eric J. Gandras, M.D.Denis L. Gibbs, D.O.David J. Goodenough, Ph.D.Debby Hojeking & Lionel Gorbaty,M.D.

David C. Graumlich Sr., M.D.Thomas L. Greer, M.D.Jeffrey T. Hall, M.D.Lewis C. Halverson, M.D.Masumi Haraguchi, M.D.Poppy & H. Hugh Hawkins Jr., M.D.Charles I. Heller, M.D.William T. Herrington, M.D.Abi Raymer & Brooks A. Horsley,M.D.

Joseph M. Hunt, M.D.Kerrie & William T. Jacoby, M.D.Rainer B. Jakubowski, M.D.Rosemary & Diego Jaramillo, M.D.James C. Johnson, M.D.Eric D. Johnson, M.D.Ahmad Judar, M.D.Paul D. Kamin, M.D.Alan M. Kantor, M.D.Barry T. Katzen, M.D.John C. Kirby, D.O.

Mary & Edmond A. Knopp, M.D.Mary & Stanton S. Kremsky, M.D.Yen-Zen Kuo, M.D.Avelina E. Laxa, M.D.Vivian Lim, M.D.John A. Loewy, M.D.Ada & Hector Tin Ging Ma, M.D.James E. Machin, M.D.Emer & Dermot E. Malone, M.D.William W. Mayo-Smith, M.D.John G. McAfee, M.D.Richard A. McKenzie, M.D.Martha I. McQuaid, M.D.Melvin & John T. Melvin, M.D.John M. Milbourn, M.D.Charles J. Miller Jr., M.D.Antonio Nelson, M.D.Mathew L. Nickels, M.D.Kathleen T. Nixon, M.D.Zina Novak, M.D.Becky & Jason M. Ozment, M.D.Alexis Pagacz, M.D.Aloyzas K. Pakalniskis, M.D.Shirley & Bradley E. Patt, Ph.D.Harvey PickerMark G. Poag, M.D.Stuart W. Point, M.D.Patricia A. Randall, M.D.Claire & Lawrence J. Reif, M.D.Francis X. Roche, M.D.Dorothy & Albert H. Ruhe, M.D.Marty & Tony J. Ryals, M.D.Het & Stephen W. Sabo, D.O.Sadayuki Sakuma, M.D., Ph.D.Charles J. Savoca, M.D.Ernest P. Scarnati, M.D.Shelley Adamo & Matthias H.Schmidt, M.Sc., M.D.

Sharon & Michael C. Scruggs, M.D.Jonathan Seeff, M.D.Samuel N. Smiley, M.D.Marie V. Spagnoli, M.D. & HenryMaxwell

Paolo Spoletini, M.D.Seth A. Steinman, M.D.Richard G. Stiles, M.D.Suzette & Bruce J. Stringer, M.D.

Steven J. Strober, M.D.Lai-Man & Simon Tang, M.B.B.SV. Marie Tartar, M.D.Rowena G. Tena, M.D., M.P.H.Michael M. Teng, M.D.Jonathan M. Tibballs, M.D.Matthias Tischendorf, M.D.Kaori Togashi, M.D.Bonita & David A. Turner, M.D.Henry T. Uhrig, M.D.Gert Van Der Westhuizen, M.B.Ch.B.Cynthia & Kris John Van Lom, M.D.Babu R. Vemuri, M.D.Anthony C. Venbrux, M.D.Rommel G. Villacorta, M.D.Laura V.R. Weisse, M.D.John S. Wills, M.D.Huei-mei & Wen C. Yang, M.D.Alain Zilkha, M.D.Robert D. Zimmerman, M.D.

BRONZE ($1 - $199)Lotty Andrade & German G. AbdoSarras, M.D.

Richard R. Abello, M.D.Annie & Mitchell D. Achee, M.D.Susiz & Richard A. Ahlstrand, M.D.Arthur S. Albert, M.D.Kamran Ali, M.D.Katherine P. Andriole, Ph.D.Daniel H. Arndt, M.D.Kathleen & David E. Avrin, M.D.,Ph.D.

Nami R. Azar, M.D.Jelle O. Barentsz, M.D., Ph.D.Farida & Yunus K. Barodawala, M.D.Dianne & Daniel D. Beineke, M.D.Maureen & John C. Bennett, M.D.Lucille & Roger A. Berg, M.D.Marylynn & Richard M. Berger, M.D.Thomas M. Bernhardt, M.D.Anjala & Davender Bhardwaj, M.D.Gayle H. Bickers, M.D.Juanita & Harold A. Bjork, M.D.James V. Blazek, M.D.Amy & David A. Bloom, M.D.Andrew S. Blum, M.D.

RSNAPRESIDENT’S CIRCLE MEMBERS$1,500 per year

Patricia G. Becker, M.D. & Gary J.Becker, M.D.

Claudia I. Henschke, M.D., Ph.D.Beverly B. Huckman & Michael S.Huckman, M.D.

Hedvig Hricak, M.D., Ph.D. &Alexander Margulis, M.D.

Drs. Carol & Barry RumackDerace L. Schaffer, M.D.Ingrid E. & Stephen R. Thomas, Ph.D.David F.Yankelevitz, M.D.Liwei Lu & David M.Y. Yeh, M.D.

EXHIBITOR’S CIRCLE

BRONZE $1,000

ITS Group

21R S N A N E W SR S N A N E W S . O R G

RESEARCH&EDUCATION:OURFUTURE

Elissa & Edward I. Bluth, M.D.Nancy & David Brake, M.D.Micheline & Guy Brassard, M.D.Stuart E. Braverman, M.D.Virginia & Leonard J. Bristol, M.D.George J. Broder, M.D.Lynn S. Broderick, M.D.Alma Rosa Rodriguez-Garcia &Ignacio Cano-Munoz, M.D.

Huyen V. Cao, M.D.Martha A. Nowell, M.D. & Mark J.Carvlin, Ph.D.

Viplava & Krishna Chadalavada, M.D.F. Spencer Chivers, M.D.Wui K.Chong, M.D.Iris Bee-Suan Choo, M.D.Gina A. Ciavarra, M.D.Crandon F. Clark Jr., M.D.Karen S. Sheehan, M.D. & BrianCockrell

Janet & Mervyn D. Cohen, M.B.Ch.B.Calvin J. Cruz II, M.D., Ph.D.Cecelia & John De Carlo Jr., M.D.Robert G. Dixon, M.D.Debbie A. Desilet-Dobbs, M.D. &Larry Dobbs

David J. Dowsett, M.Sc., Ph.D.Kathryn A. Draves, M.D.Val D. Dunn, M.D.Steven M. Eberly, M.D.Joyce & John P. Eberts, M.D.Margaret & Jimmie L. Eller, M.D.Sandra L. Fallico, M.D.Elaine Ferreira, M.D. & Jose LuizNunes Ferreira, M.D.

Anne M. Curtis, M.D. & JamesFischer

Laurence H. Fitzgerald, M.D.Judy & Marc C. Flemming, M.D.Susan & James D. Fraser, M.D.Elaine M. Freiler, M.D.Mikihiko Fujimura, M.D.Virginia Garcia M.D.Mary S. Gardner, M.D.Simona Gaudino, M.D.Hilary W. GentileZoe Ghahremani, D.D.S. & Gary G.Ghahremani, M.D.

Raymond A. Gibney, M.D.Harold A. Goldstein, M.D.Richard L. Goldwin, M.D.Jack A. Goode, M.D.Diane & Lawrence H. Goodman, M.D.Debbie & George S. Grable, M.D.Nigel C. Graham, M.B.Ch.B.Carolyn & Joseph D. Hall, M.D.Dianne & Hirsch Handmaker, M.D.Curtis L. Harlow, M.D.Jacquelyn & Roger K. Harned, M.D.Kelly Z. Hart, M.D.Richard S. Hartman, M.D.Diane & R. S. Lyle Hillman, M.D.Elizabeth A. Hingsbergen, M.D.Chia-Sing Ho, M.D.Thomas M. Hoess, M.D.

Roy A. Holliday, M.D.Charles H. Holloway, M.D.Arnold B. Honick, M.D.Laura A. Hotchkiss, M.D. & BruceHotchkiss

Daniel F. Housholder, M.D.Marcy B. Jagust, M.D.Dragan V. Jezic, M.D.Takeshi Johkoh, M.D., Ph.D.Kishore V. Kamath, M.D.Leslie A. Kennedy, M.D.Paula C. Kezdi-Rogus, M.D.Ajit K. Khanuja, M.D.Stephane Khazoom, M.D.Surekha D. Khedekar, M.D.Ruben Kier, M.D.Madhuri Kirpekar, M.D.Laura C. Knight, M.D.Tracy & Steven B. Knight, M.D.John R. Knorr, D.O.Anne E. Kosco, M.D.Kenneth Koster, M.D.Man-Fai Kung, M.B.B.S.Lorraine L. La Roy, M.D.Robert E. Lambiase, M.D.Daniel L. Laufman, M.D.Claudia A. Lawn, M.D.Wolfgang Lederer, M.D.John C. Leonidas, M.D.Georges B. LeRoux, M.D.Christopher K.J. Lin, M.D.Ardeth & Richard D. Lindgren, M.D.Robert L. Lindsay, D.D.S., M.D.Yvonne & David N. Lisi, M.D.Eric H. Loevinger, M.D.John H. Lohnes, M.D.Eddy D. Lucas, M.D.Manuel A. Madayag, M.D.Frances S. Maeda, M.D.Laurene C. Mann, M.D.David E. March, M.D.James M. McCarthy Jr., M.D.James E. McConchie M.D.James E. McGill M.D.Allister J. McGowan M.D.Nancy & Charles W. McGuire, M.D.Joel R. Meyer, M.D.

Ari D. Mintz, M.D.Kristine M. Mosier, D.M.D., Ph.D.Margie & John R. Muhm, M.D.Thelma & Luther S. Nelson, M.D.Leslie N. Nishimi, M.D.Alejandra Michel-Guerrero, M.D. &Felipe Olezada, M.D.

Aruna & Manu N. Patel, M.D.Reid M. Perlman, M.D.Dieu H. Pham, M.D.Marcelle L. Piccolello, M.D.Mary Ellen & Donald A. Podoloff,M.D.

Eva-Marlis Lang-Poelkow, M.D. &Stefan Poelkow

Kristin & Kent W. Powley, M.D.Josephine Pressacco, M.D., Ph.D.Elizabeth Hanke & Ethan A. Prince,M.D.

Bjoern W. Raab, M.D.Bolar R. Rao, M.D.Robert Rapport, M.D.David D. Reed, M.D.Rajdai & Dirk Rehder, M.D.Steve N. Rindsberg, M.D.Janet & Grant P. Rine, Ph.D., M.D.Stephanie & Wesley B. Roney, M.D.Lauren & Richard D. Rossin, M.D.Jaap G. Roukema, M.D.Marilyn J. Goske, M.D. & RichardRudick

G. Thomas Ruebel, M.D.Klaus Ruedisser, M.D.Marwan H. Saab, M.D.Pedro Saiz, M.D.Karl J. Schnabel, M.D.Sheryl & Mark E. Schweitzer, M.D.Clark L. Searle, M.D.Peter M. Selzer, M.D.Aram Semerdjian, M.D.Gwy Suk Seo, M.D., Ph.D.Chunilal P. Shah, M.D.Diana & Alfred Shaplin, M.D.Ravinder & Jaspal Singh, M.D.Andreas F. Siraa, M.D.Connie M. Siu, M.D.Priscilla J. Slanetz, M.D., M.P.H.

Mary Ellen & Valery P. Sobczynski,M.D.

Ronald M. Sokoloff, M.D.Austin L. Spitzer, M.D.Kathy & Steven A. Strickler, M.D.Yasuo Takehara, M.D.Shoichi D. Takekawa, M.D.Karen & Robert D. Tarver, M.D.Khaled K. Toumeh, M.D.Sabah S. Tumeh, M.D.Ulf Tylen, M.D., Ph.D.Helmut G. Unger, M.D.Ester P.J. Van der Wal, M.D. & DavidHadian, M.D.

Jean A. Vezina, M.D.Maria & Henrique Vilaca-Ramos,M.D.

Kim Villarreal, M.D. & MichaelVillarreal

George H. Wakefield III, M.D.Eric A. Walker, M.D.Ruth M.L. Warren, M.D.Otto-Henning Wegener, M.D.Steven F. West, D.O.Holger H. Woerner, M.D.Ira S. Wolke, M.D., Ph.D.Wei-Jen Yao, M.D.Main Yee, M.D.Mark Ming-Yi Yeh, M.D., M.S.Jun Yoshigi, M.D.

Online donations can be made atwww.rsna.org/research/foundation/donation.

COMMEMORATIVE GIFTSStanley Baum, M.D.In honor of Peggy J. Fritzsche, M.D.

Patricia Becker, M.D. & Gary Becker, M.D.In memory of Morris Petasnick

Gregory Christoforidis, M.D.In memory of Ann Wigdahl

James M. Forde, M.D.In honor of John P. Forde

Gail C. Hansen, M.D.In honor of Juris Gaidulis

Beverly B. & Michael S. Huckman, M.D.In memory of Morris Petasnick

Edward E. Kassel, MDIn memory of Derek Harwood-Nash, M.D., D.Sc.

Douglas S. Katz, M.D.In honor of Patricia A. Randall, M.D.

Richard E. Latchaw, M.D.In memory of Ralph B. Latchaw

Felipe N. Lim, M.D.In memory of Teodoro Lim

Ernst J. Rummeny, M.D.In memory of P.E. Peters, M.D.

John L. Schultz, M.D.In memory of Isadore Meschan, M.D.

Michael G. Stebbins, M.D.In memory of Juan Delgato, M.D.

M. Linda Sutherland, M.D. & James D.Sutherland, M.D.In memory of Prof. Paul E. Fischbachand George P. Sutherland

Richard Westhaus, M.D.In honor of Josef Lissner, M.D.

22 R S N A N E W S A P R I L 2 0 0 4

News about RSNA 2004

MEETINGWATCH:RSNA2004

New Security Measures The United States has adoptednew security measures designedto protect the safety of U.S. citi-zens and international visitors atairports and seaports. The U.S.Department of Homeland Secu-rity promises that these newmeasures will be quick and effi-cient, requiring no more thanseconds in most cases. For moreinformation, go to www.dhs.gov/us-visit.

Four Ways to Register for RSNA 2004➊ InternetGo to www.rsna.org/registerUse your member ID# from theRSNA News label or meetingflyer sent to you, or search byyour last name. If you havequestions, send an e-mail torsna@itsmeetings.com.➋ Fax (24 hours)(800) 521-6017(847) 940-2386

➌ Telephone (Monday–Friday,8:00 a.m.–5:00 p.m. CT)(800) 650-7018(847) 940-2155

➍ MailITS/RSNA 2004108 Wilmot Rd., Suite 400Deerfield, IL 60015-0825 USA

Accessing a BrochureVersion one of the Advance Registration andHousing brochures will be available in electronicformat only. There are two ways to get a copy:

➊ RSNA LinkGo to www.rsna.org/register and click on thePDF file.

➋ Request a faxed copyCall the fax-on-demand server at (847) 940-2146.Enter your fax number (including 1 or 011, pluscity and country codes). Enter your telephonenumber and extension. Select a document:• Enter 1300 for the entire brochure.• Enter 1375 for the registration form only.

Course enrollment information will bemailed in late June and also will be available onRSNA Link in electronic format.

Advance Registration andHousing Opens April 26Advance registration for RSNA2004 opens April 26 for RSNAand AAPM members. Generalregistration begins May 24.

Important Dates for RSNA 2004April 15 Deadline for abstract

submission April 26 RSNA and AAPM member

registration and housingopens

May 24 General registration andhousing opens

June 21 Refresher course enroll-ment opens

Nov. 5 Final housing deadlineNov. 12 Advance conference

registration deadlineNov. 28– RSNA 90th ScientificDec. 3 Assembly and Annual

Meeting

Registration FeesBY 11/12 ONSITE

$0 $100 RSNA Member, AAPM Member$0 $0 Member Presenter$0 $0 RSNA Member-in-Training, RSNA Student Member and Technical Student$0 $0 Non-Member Refresher Course Instructor, Paper Presenter,

Poster Presenter, Education or Electronic (infoRAD) Exhibitor$110 $210 Non-Member Resident/Trainee$110 $210 Radiology Support Personnel$520 $620 Non-Member Radiologist, Physicist or Physician$520 $620 Hospital Executive, Research and Development Personnel,

Healthcare Consultant, Industry Personnel$300 $300 One-day badge registration to view only the Technical Exhibits area

For more information about registration at RSNA 2004, visit www.rsna.org, e-mailreginfo@rsna.org, or call (800) 381-6660 x7862.

Apply Early for Your Visa! Visa applications are now subject to greater scrutiny. All visa applicants are advised toapply for a visa as soon as travel to the United States is contemplated and no later thanthree to four months before November 28, 2004. This means that international dele-gates should start their visa process July–August. See the following Web sites formore information:• Do you require a visa?

travel.state.gov/vwp.html• How to apply for a visa?

travel.state.gov/visa_services.html orwww.nationalacademies.org/visasClick on Traveling to the U.S.

• Check the status of a pending visa:www.nationalacademies.org/visasFor visa application over 30 days old,click on Visa Questionnaire, completeand submit.

■ CME Update: Earn up to 80.5 category1 CME credits at RSNA 2004!

23R S N A N E W SR S N A N E W S . O R G

MEETINGWATCH:RSNA2004

2004 Preliminary Program GridSATURDAY

11/27FRIDAY

12/3THURSDAY

12/2WEDNESDAY

12/1TUESDAY

11/30MONDAY

11/29SUNDAY

11/28

Opening Session &President’s Address8:30-10:15

ProtectingAssetsfromCreditorClaims,IncludingMalpracticeClaims*10:00-12:00

RefresherCourses 8:30-10:00

Case-BasedReview 8:30-10:00

RefresherCourses 8:30-10:00

Case-BasedReview8:30-10:00

EssentialsCourse8:30-10:00

EssentialsCourse10:30-12:00

EssentialsCourse10:30-12:00

ScientificSessions 10:30-12:00

ScientificSessions 10:30-12:00

AAPM/RSNAPhysicsTutorial forResidents12:00-2:00

LunchBreak12:00-1:00

Effect.RealEstateInvest-mentStrate-gies*1:00-5:00

GrantWriting1:00-5:00

Lunch,PosterSession, &VisitExhibits12:15-2:00

Lunch, Poster Session & VisitExhibits12:00-1:30

Lunch, Poster Session & Visit Exhibits12:00-1:30

Lunch12:00-1:00

EssentialsCourse1:00-2:30

EssentialsCourse1:00-2:30

PlenarySession(RSNA/AAPMSympo-sium)**1:30-2:45

PlenarySession(AnnualOration inRadiationOncology)**1:30-2:45

Lunch12:00-1:00

Lunch, Poster Session & Visit Exhibits12:00-1:30

Lunch,PosterSession & VisitExhibits12:00-1:30

ImagingSymposium12:45-3:15

Lunch &VisitEducationExhibits12:00-12:45

RefresherCourses2:00-3:30

ScientificSessions3:00-4:00

Image InterpretationSession4:00-5:45

FocusSessions 4:30-6:00

Case-BasedReview 3:30-5:45

Case-BasedReview3:30-6:00

Case-BasedReview3:30-5:00

RefresherCourses 4:30-6:00

Oncodiag-nosis Paneland FocusSessions 4:30-6:00

ScientificSessions3:00-4:00

EssentialsCourse2:45-4:15

EssentialsCourse2:45-4:15

RefresherCourses 4:30-6:00

ScientificSessions3:00-4:00

FocusSessions3:00-4:00

PlenarySession(NewHorizons)**1:30-2:45

Case-BasedReview 1:30-3:00

PhysicsSymposium1:30-3:30

PhysicsSymposium3:45-5:45

Case-BasedReview1:30-3:00

Case-BasedReview1:30-3:00

PlenarySession(AnnualOration inDiagnosticRadiology)**1:30-2:45AAPM/

RSNAPhysicsTutorial onEquipmentSelection2:15-5:15

RefresherCourses 8:30-10:00

Case-BasedReview8:30-10:00

EssentialsCourse8:30-10:00

RefresherCourses 8:30-10:00

RefresherCourses 8:30-10:00

ScientificSessions10:45-12:15

ScientificSessions/AssociatedSciences Sympo-sium10:30-12:00

Jury Trial10:45-4:00

ScientificSessions/AssociatedSciencesSympo-sium10:30-12:00

ScientificSessions/AssociatedSciencesSympo-sium10:30-12:00

Case-BasedReview 10:30-12:00

Case-BasedReview10:30-12:00

Case-BasedReview10:30-12:00

*An additional fee is charged for these courses. ** Awards/Ceremonies to begin at opening of Plenary Session (1:30-1:45)

8:30 a.m.

9:00

9:30

10:00

10:30

11:00

11:30

12:00 p.m.

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

Technical Exhibits10:00-5:00

Technical Exhibits10:00-5:00

Technical Exhibits10:00-5:00

Technical Exhibits10:00-5:00

TechnicalExhibits10:00-2:00

24 R S N A N E W S A P R I L 2 0 0 4

June Exhibitor Planning MeetingBooth assignments will bereleased June 22 at theExhibitor Planning Meeting andLuncheon. All exhibitors forRSNA 2004 are invited toattend at Rosewood Restaurantand Banquets near Chicago’sO’Hare International Airport.

■ For more information, contact RSNA Technical Exhibits at (800) 381-6660 x7851 or e-mail:exhibits@rsna.org.

■ For up-to-date information about technical exhibits at RSNA 2004, go towww.rsna.org/rsna/te/index.html.

EXHIBITORNEWS:RSNA2004

RSNA 2004 Exhibitor News

November 28 – December 3, 2004McCormick Place, Chicago

Exhibitor ProspectusThe RSNA 2004 ExhibitorProspectus was mailed in lateMarch. To achieve maximumavailable space and assignmentpoints, send your completedapplication to RSNA Headquar-ters as soon as possible. Thefirst-round space assignmentdeadline is May 10, 2004.

Advertising at RSNA2004Many opportunities exist forexhibitors to promote theirexhibits at RSNA 2004—theworld’s largest annual medicalmeeting. For more information,see www.rsna.org/advertising/index.html or contact:■ Jim Drew

Director of Advertising(630) 571-7819jdrew@rsna.org

■ Judy KapicakSenior Advertising Manager(630) 571-7818jkapicak@rsna.org

Important Exhibitor Dates for RSNA 2004May 10 First-round space assignment

deadline

June 22 Exhibitor Planning/BoothAssignment Meeting

July 6 Technical Exhibitor Service Kitavailable online

Nov. 12 Exhibitor advance badge request deadline

Nov. 28– RSNA 90th Scientific Assembly Dec. 3 and Annual Meeting

RSNA 2003 included 668 exhibiting companies, 69 ofthem from outside of North America.

25R S N A N E W SR S N A N E W S . O R G

RSNA:ONTHEWEB

RSNA Link www.rsna.orgRadiology Onlineradiology.rsnajnls.orgRadiology Manuscript Centralradiology.manuscriptcentral.comRadioGraphics Onlineradiographics.rsnajnls.org

Education Portalwww.rsna.org/education/etoc.htmlCME Credit Repositorywww.rsna.org/cmeRSNA Medical ImagingResource Centermirc.rsna.org

RSNA Index to Imaging Literaturersnaindex.rsnajnls.orgRSNA Career Connectionscareers.rsna.orgRadiologyInfo™

RSNA-ACR public informa-tion Web sitewww.radiologyinfo.org

RSNA Online Products and Serviceswww.rsna.org/memberservicesRSNA Research & Education Foundation Make a Donationwww.rsna.org/research/foundation/donation

Community of Sciencewww.rsna.org/research/cos.htmlHistory of the RSNA Serieswww.rsna.org/about/history/index.htmlMembership Applicationswww2.rsna.org/timssnet/mbrapp/main.cfm

ec o n n e c t i o n s Your online links to RSNA

www.rsna.org

Spring heralds the arrival of two annual features on RSNA Link:• The Exhibitor Prospectus for technical exhibitors appeared on

RSNA Link in March.• Advance registration for RSNA and AAPM members opens

Monday, April 26. You can access any of the annual meeting pages through the

upper left-hand corner of the home page, www.rsna.org.Refresher Course enrollment opens June 21. Details about

RSNA 2004 will be posted on RSNA Link as they become avail-able during the year.

RSNA 2004

Later this month, the Integrating theHealthcare Enterprise (IHE) initiative willpublish an updated radiology technicalframework (rev. 6.0) for trialimplementation. In February,the framework was availablefor public comment.

IHE technical frameworksare a resource for users, developers andimplementers of healthcare imaging andinformation systems. They define specificimplementations of established standardsto achieve effective systems integration,

facilitate appropriate sharing of medicalinformation and support optimal patientcare. They are expanded annually, after a

period of public review, and main-tained regularly by the IHE Techni-cal Committees through the identi-fication and correction of errata.

In addition to radiology, techni-cal frameworks are now published in thedomains of IT infrastructure and labora-tory. A cardiology technical frameworkwill be published later this year. The docu-ments can be found at www.rsna.org/IHE.

Revised IHE Technical Framework PDFs for Journal AuthorsManuscript authors for Radiologynow receive portable documentfiles (PDFs) of their edited jour-nal manuscripts. The processbegan in late February. Radio-Graphics authors have beenreceiving PDFs for about a year.Previously, the edited manu-scripts were sent by FedEx. Theelectronic transmission of thedocuments helps to expedite thepublication process and reducecosts.

RSNA:MEMBERBENEFITS

Working For YouContinued from page 15

Medical Meetings May – June 2004

CALENDAR

APRIL 27–MAY 1Society for Pediatric Radiology (SPR), Westin Savannah Harbor, Savannah, Ga. • www.pedrad.orgAPRIL 28-MAY 1Asian Oceanian Congress of Radiology, 10th Annual Meeting,Raffles City Convention Centre, Singapore • lennytan@nus.edu.sgMAY 2–7American Roentgen Ray Society (ARRS), 104th Annual Meeting, Fontainebleau Hotel Resort and Towers, Miami Beach• www.arrs.orgMAY 8–13American College of Radiology (ACR), Annual Meeting andChapter Leader Conference, Hilton Washington, Washington,D.C. • www.acr.orgMAY 15–21International Society for Magnetic Resonance in Medicine(ISMRM), 12th Scientific Meeting and Exhibition, Kyoto International Conference Hall, Kyoto, Japan • www.ismrm.orgMAY 19–22 German Radiology Congress, Deutsche Röntgenkongress 2004,Wiesbaden, Germany • www.drg.deMAY 20–2234th Annual Conference on Chest Disease, The Fleischner Society for Thoracic Imaging and Diagnosis, Orlando, Fla. • www.fleischner.orgMAY 20-23Society of Computer Applications in Radiology, SCAR 2004,Vancouver Convention & Exhibition Centre, British Columbia • www.scarnet.orgJUNE 5-11American Society of Neuroradiology (ASNR), 42nd AnnualMeeting, Washington State Convention & Trade Center, Seattle• www.asnr.orgJUNE 6–8U.K. Radiological Congress 2004, UKRC, Manchester, U.K. • www.ukrc.org.ukJUNE 12-16American Medical Association (AMA), House of DelegatesAnnual Meeting, Hyatt Regency, Chicago • www.ama-assn.org

JUNE 15-18European Society of Gastrointestinal and Abdominal Radiology(ESGAR), 15th Annual Meeting and Postgraduate Course,Geneva, Switzerland • www.esgar.orgJUNE 19-23Society of Nuclear Medicine (SNM), Pennsylvania ConventionCenter, Philadelphia • interactive.snm.orgJUNE 20-22American Institute of Ultrasound in Medicine Annual Meeting(AIUM), Marriott’s Desert Ridge Resort & Spa, Phoenix • www.aium.orgJUNE 21–22BECON/BISTIC SYMPOSIUM: Informatics for Clinical Decision-making in the 21st Century, Natcher Auditorium, NIH Campus, Bethesda, Md. • www.becon.nih.gov/becon_symposia.htmJUNE 23-26Computer Assisted Radiology and Surgery (CARS), 18th Inter-national Congress and Exhibition, Chicago • www.cars-int.deJUNE 24-25Institute of Electrical and Electronics Engineers (IEEE), 17th IEEE Symposium on Computer-based Medical Systems(CBMS 2004), Hotel Four Points by Sheraton, Bethesda, Md. • www.cvial.ttu.edu/Conferences/cbms2004/cbms2004.htmlJUNE 25-29International Congress of Radiology (ICR), hosted by the Canadian Association of Radiologists, Palais des Congrès deMontréal, Montreal, QC, Canada • www.icr2004.comJULY 23–25Leadership Strategies for Radiology Practices, RSNA Education Center, Chicago Marriott Downtown • www.rsna.org/education/shortcourses AUGUST 7Digital Presentation Skills for the Radiologist, RSNAEducation Center, RSNA Headquarters, Oak Brook, Ill. • www.rsna.org/education/shortcourses

NOVEMBER 28–DECEMBER 3RSNA 2004, 90th Scientific Assembly and Annual Meeting,McCormick Place, Chicago • www.rsna.org

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