Challenges faced by women in radiology during the pandemic - A summary of the AAWR Women's Caucus at the ACR 2020 annual meeting

The COVID-19 pandemic has dramatically altered the professional and personal lives of radiologists and radiation oncologists. This article summarizes the 2020 American Association for Women in Radiology (AAWR) Women's Caucus at the American College of Radiology (ACR) Annual Meeting. The caucus focused on the major challenges that women in radiology have faced during the pandemic.     

Authentic gold: Celebrating the life and career of Cheri L. Canon,MD, FACR,FAAWR

Since 1927, the American College of Radiology (ACR) has awarded Gold Medals to up to four individuals each year in recognition of their distinguished and extraordinary service to the ACR or to the discipline of radiology (American College of Radiology, n.d. [1]). As of 2019, only 10 of 194 Gold Medalists have been women. In May 2021, Dr. Cheri L. Canon will become the eleventh woman in ACR history to receive this prestigious award. Contemporaneously, in November 2020, she received the highest honor bestowed by the American Association for Women in Radiology (AAWR), the Marie Sklodowska-Curie Award, presented annually to an individual who has made outstanding contributions to the advancement of women in radiology or radiation oncology (American Association for Women in Radiology, n.d. [2]). Herein we celebrate Dr. Canon's remarkable life and impressive career achievements, and learn important lessons from her shared wisdom.     

Dr. Kay Vydareny: Fifth female ACR Gold Medal winner

Each year, the American College of Radiology (ACR) has awarded its highest honor, the ACR Gold Medal, to an individual for distinguished, extraordinary service to the ACR or to the discipline of radiology. While this prestigious award was established almost a century ago, only ten women have received the honor throughout its history. This article seeks to highlight the life and achievements of one of these women, Dr. Kay Vydareny. Despite encountering barriers facing women in the medical field during medical school and residency in the 1960–70s, Dr. Vydareny went on to embark on a remarkable, enduring career. Early in her career, she began to build a professional network of fellow women colleagues through the American Association of Women Radiologists (AAWR), eventually serving as AAWR President in 1984. In addition to the AAWR, she served in leadership roles in many professional radiological organizations including the ACR. She was elected the first female speaker of the ACR Council Steering Committee in 1993, served on the Board of Chancellors from 1995 to 2002, and was President in 2001. At the same time, she maintained a passion for medical education. In honor of her distinguished and extraordinary service to radiology full of many groundbreaking firsts, she was awarded the ACR Gold Medal in 2005. She was only the fifth woman ever to receive this award. Throughout her outstanding career, Dr. Vydareny has continually been a dedicated and thoughtful educator, mentor, and leader who has made a lasting impact on the field of radiology.     

Pregnancy and maternity leave: AAWR survey results

In 1987 to obtain information regarding pregnancy and maternity leave policies in academic and private radiology departments, the American Association of Women Radiologists (AAWR) surveyed academic and private diagnostic radiology departments and academic radiation oncology departments in the United States and Canada. One hundred thirty-one diagnostic radiology departments and 30 radiation therapy departments responded to the questionnaire. Despite the increasing number of women entering the field of radiology, many departments do not have formal policies. Of those that do, there was a wide range of responses regarding details of maternity leave and duties during pregnancy. The AAWR recommends that every department develop a written pregnancy and maternity leave policy, which should be available to all current and prospective employees.     

Proposed program guidelines for pregnant radiology residents: a project supported by the American Association for Women Radiologists and the Association of Program Directors in Radiology

RATIONALE AND OBJECTIVES: Written institutional policies governing radiation exposure and work responsibilities for pregnant radiology residents are not uniform and often are nonexistent. Standardized program guidelines would allow residents and program directors alike to prepare for a resident pregnancy with objectivity and consistency. MATERIALS AND METHODS: The American Association for Women Radiologists (AAWR) launched a task force to revisit guidelines for the protection of pregnant residents from radiation exposure during training. We conducted two surveys of the Association of Program Directors in Radiology (APDR) membership. Survey 1 was designed to learn about existing program and institutional policies and to assess the need for and interest in standardized guidelines that would address radiation exposure and work responsibilities for pregnant radiology residents. Based on those responses, we drafted a set of program guidelines incorporating policies contributed by responding program directors. Our follow-up APDR survey, survey 2, was conducted to determine opinions and acceptance of the drafted program guidelines. Each survey was analyzed by using a proportion of means test. RESULTS: Fifty-five of 156 program director APDR members (35%) responded to survey 1. Only half the respondents had formal written policies at their respective institutions. Review of submitted policies showed widely divergent opinions about appropriate policies for pregnant radiology residents. Most (34/52; 75%) supported the development of standardized guidelines. In survey 2, 38/73 responding APDR members (53%) offered their opinions and comments on our drafted guidelines. Approximately 90% agreement was catalogued on 13 of 18 items (72%); a majority (>60%) agreed on all points, even the most controversial points concerning fluoroscopy. CONCLUSION: A minority of radiology residency programs have written policies addressing pregnancy during training. With expressed support from a majority of responding program directors, we have developed and present here proposed program guidelines for pregnant radiology residents to serve as a framework for radiology residents and program directors alike.     

Process modification and emergency department radiology service

Our purpose was to demonstrate the impact of changes in technology, staffing, and departmental processes on service levels in emergency department (ED) radiology. We also attempted to determine if report turnaround time affects ED patient throughput. Radiology performance was evaluated before and after the modifications of processes integral to the interpretation of ED imaging. Picture archiving and communication system, voice recognition (VR), staffing, physical site, work flow, and administrative modifications were undertaken over ∼2 years. The average time interval from the exam completion to report signature was 5,184 min (standard deviation (SD) of 1,858 min before the implementation of VR and other modifications of ED radiology processes). In post initial modifications, it was 150 min (SD, 169 min) and 157 min (SD, 215 min) in post additional modifications. The percentage of the signed written reports available in less than or equal to 60 min was 0%, 27%, and 40%, respectively. Ongoing improvements are needed to increase the service levels for ED radiology. Further improvement will require collaboration and adjustment with the ongoing assessment of metrics.     

Methods and resources for physics education in radiology residency programs: survey results

Over the past 2 years, ongoing efforts have been made to reevaluate and restructure the way physics education is provided to radiology residents. Program directors and faculty from North American radiology residency programs were surveyed about how physics is being taught and what resources are currently being used for their residents. Substantial needs were identified for additional educational resources in physics, better integration of physics into clinical training, and a standardized physics curriculum closely linked to the initial certification examination of the American Board of Radiology.     

The Residency Review Committee for Radiology: its organization, function, and performance in diagnostic radiology

The accreditation process for training in radiology is managed by the Residency Review Committee for Radiology under a prescribed system. That system and the actions taken by the Committee in recent years are described. Most applications for new or continuing programs in 1975-1981 were approved. An analysis of the adverse actions of the Committee indicates the most common deficiencies were inadequate clinical experience in subspecialty areas, inadequate formal teaching, and understaffing of the clinical program. Certain trends in radiology are apparent. The numbers of programs in diagnostic and therapeutic radiology have not changed significantly over the past 5 years, whereas opportunities for training in nuclear radiology have increased greatly. The number of trainees in diagnostic radiology has increased 13% during this period; the number in radiation therapy remains unchanged. The number of women trainees in diagnostic radiology has increased from 15% to 22%, and the number of foreign graduate trainees has decreased from 19% to 11%.     

Research misconduct

Good research practice is important to the scientific community. An awareness of what constitutes poor practice is important. Various types of research misconduct are defined in this article. The extent of research misconduct in the field of radiology has been assessed by contacting five English language radiology journals. Redundant or duplicate publication has been reported infrequently, Radiology (1), American Journal of Roentgenology (3), Clinical Radiology (3), British Journal of Radiology (2) and European Radiology (1). The issue of how the radiology community might tackle research misconduct is discussed with reference to guidance from the Medical Research Council, the Wellcome Trust and the Committee of Publication Ethics.     

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures

Purpose  

To determine the value of a breast ultrasound (US) examination in addition to mammography in cases of American College of Radiology (ACR) tissue pattern III and IV in symptomatic women and women at risk.     

Relative attractiveness of diagnostic radiology: assessment with data from the National Residency Matching Program and comparison with the strength of the job market

PURPOSE: To quantify medical students' preferences for various specialties and to compare shifts in specialty preference with overall employment market prospects. MATERIALS AND METHODS: By using National Residency Matching Program data, a previously validated help-wanted index (HWI), and American Medical Association (AMA) salary data, the authors quantified medical students' preferences for various specialties and examined the association of shifts in specialty preference with overall trends as seen in the strength of the diagnostic radiology match and its relationship with the job market. The authors established a proxy for the relative attractiveness (RA) of diagnostic radiology (relative to all specialties) in the match, which was calculated by subtracting the percentage fill rate for all specialties from that for radiology. The RA values were plotted for 1990-2000 and compared with trends in the HWI, American College of Radiology data, and AMA salary data. RESULTS: The RA of diagnostic radiology varied greatly during the past 10 years, with a low in 1996 and a return to its high in recent years. There is a relationship between the RA and economic vitality of diagnostic radiology, with the RA lagging behind the HWI and AMA salary data by 2 years. CONCLUSION: Medical students appear to have an in-depth understanding of the economic forces at play in the health care job market and incorporate this information into their choice of a specialty.     

Longitudinal Resilience and Burnout in Radiology Residents

PurposeThe aims of this study were to determine resilience levels of radiology residents at the start of radiology residency, investigate changes in resilience and burnout during residency, and assess the relationship between resilience and burnout among radiology residents.MethodsDiagnostic radiology residents were invited to participate in online surveys from 2016 to 2019. Resilience was assessed using the Connor–Davidson Resilience Scale. Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey. For each data set, genders’ scores were compared using either analysis of variance or Kruskal–Wallis tests. Pearson correlation coefficients were calculated to explore the correlations between resilience and burnout.ResultsWomen and men had no statistically significant difference among baseline resilience scores (P = .78). However, there was a statistically significant overall decrease in resilience scores among women (P = .002). Baseline Maslach Burnout Inventory–Human Services Survey scores indicated that residents began residency without frequent symptoms of burnout. There was no statistically significant temporal change across subjects among burnout scores in any scale (P ≥ .09 for all) or between women and men (P ≥ .37 for all interactions). However, among women, there was a statistically significant difference in depersonalization scores during training (P = .009). Additionally, higher resilience scores were associated with a greater sense of personal achievement (r = .52) and less emotional exhaustion (r = −.56) and depersonalization (r = −.59).ConclusionsThe results of this study demonstrate that gender differences in resilience and burnout occur during radiology residency and that resilience has a protective effect against experiencing symptoms of burnout. Radiology residency programs should consider building longitudinal resilience for all trainees, especially women.     

Entrepreneurial Women in Radiology: Role Models of Success

Radiology is undeniably male dominated. Alongside surgery and orthopedic surgery, academic radiology ranks near the bottom in having the lowest proportion of full-time female faculty members. Despite many efforts to recruit talented women, the pipeline entering the radiologic disciplines continues to flow at a trickle. One factor is the relative lack of role models for female medical students. Entrepreneurial women in radiology can lead the field with their innovation and creativity, courage, and commitment. In this article, the authors highlight two entrepreneurial female radiologists who shared their success stories at the American Association for Women Radiologists’ session at the 2015 ACR annual meeting. Their successes underscore the potential for such women to serve as role models to female medical students and even college undergraduates. Despite the gender gap in radiology, the field has yielded some exceptional women who can take on challenges, overcome barriers and assume risks, create strategies and processes to operationalize their visions, secure funding, and expand their enterprises to make sustainable impacts both at home and abroad. As we move toward more patient- and family-centered care models and become increasingly visible to diverse populations, there is no better time for female leaders in radiology to inspire the next generation to join our essential and rewarding specialty.     

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From the Reading Room to Operating Room: Retrospective Data and Pictorial Review After 806 SCOUT Placements

ObjectiveNon-wire localization techniques are becoming more common. SCOUT surgical guidance system has been shown to increase flexibility in scheduling patients for surgery. The objective of this article is to provide institutional experiences with pictorial review after placement of 806 SCOUT devices.Materials and methodsRadiology procedure reports of SCOUT device placements from January 11, 2018 to May 19, 2020 were reviewed to assess demographics of patient population, imaging method of placement, size of reflector delivery system used, placement approach, and time spent in the radiology suite or Turn Around Time (TAT). TAT was compared to that of wire placement using a Two-tailed Mann-Whitney U Test. Reports were assessed for those with absent signal at time of placement. In cases where signal was absent, migration was found, or complications noted, further case review was performed using the Electronic Medical Record to assess whether the devices were successfully retrieved.ResultsThere were 806 total SCOUT placements identified from radiology procedure reports in patients aged 12-92 with 64.3% (518/806) placed using ultrasound-guidance and 35.7% (288/806) by mammographic-guidance. The most common delivery device was a 7.5 cm needle. Only 0.9% (7/806) of SCOUT reflectors were >1cm from target, all of which were successfully excised. After radiology placement, signal was not heard in 1.4% (9/806) of cases and individual case review revealed that all were successfully excised. In 2019, TATs of SCOUT procedures were significantly lower than TATs from wire localizations (P = 0.00024).ConclusionsSCOUT localization for breast surgery can provide solutions to problems encountered by patients and providers. A year after implementation, SCOUT use was found to result in shorter TATs in radiology. In addition, 100% of devices that were either migrated or inaudible at the time of radiology placement were successfully excised.     

Career Research Performance Among Radiology Early Career Grant Recipients Compared With National Institutes of Health K Award Recipients

ObjectiveTo compare academic and demographic metrics among recipients of three major early career radiology, interventional radiology, and radiation oncology grants to National Institutes of Health (NIH) K awardees at the time the grants were awarded and then over the course of their careers.MethodsRadiologists who received the RSNA Research Scholar Grant, General Electric Radiology Research Academic Fellowship (GERRAF), American Roentgen Ray Society (ARRS) Scholar Award, or NIH Career Development (K) Award before January 1, 2015, were included. Research metrics at the time of grant award (eg, publications) and subsequent scholarly productivity (eg, academic rank, h-index, NIH funding) were recorded until April 2020. Wilcoxon ranked-sum, χ², logistic regression, and standard least-square regression were used for data analysis.ResultsThere were 279 recipients: 48 K Award, 115 RSNA Research Scholar Grant, 36 ARRS, and 80 GERRAF. At the time of grant awarding, GERRAF recipients were less likely to have an MD-PhD degree (odds ratio [OR]: 0.36; P = .002) and were more likely to be women (OR: 1.55; P = .042) than K Award recipients. Similarly, recipients of the ARRS (OR: 2.87; P = .010) and GERRAF (OR: 3.19; P = .002) were more likely to have a master’s degree. Academic rank, leadership positions, and R01 funding were significant predictors of h-index and total publications over time. Academic rank and the GERRAF were significant predictors of subsequent NIH funding duration but there were no significant predictors of NIH funding amount.ConclusionsEarly career radiology awards, specifically the GERRAF, provide support for female and non-PhD investigators and result in comparable academic performance metrics to NIH K Award recipients.     

Lifting the fog of confusion about breast cancer screening guidelines: Surprise - it's about the money!

Large amounts of misinformation denigrating the benefits of breast cancer screening have been published over the past 50 years and continue to be published. Each effort to reduce breast cancer screening has been refuted, scientifically, but the efforts continue. The motivation has been unclear until the recent guidelines issued by the American Society of Breast Surgeons who support annual screening starting at the age of 40 contrasted with the American College of Physicians who advocated delaying screening until the age of 50 and then biennially. An analysis of the facts can only lead to the conclusion that delayed screening has been chosen to save money rather than lives.     

The State of Radiologic Teaching Practice in Preclinical Medical Education: Survey of American Medical,Osteopathic, and Podiatric Schools

PurposeThis study describes the state of preclinical radiology curricula in North American allopathic, osteopathic, and podiatric medical schools.MethodsAn online survey of teaching methods, radiology topics, and future plans was developed. The Associations of American Medical Colleges, Colleges of Osteopathic Medicine, and Colleges of Podiatric Medicine listing for all US, Canadian, and Puerto Rican schools was used for contact information for directors of anatomy and/or radiology courses. Letters were sent via e-mail to 198 schools, with a link to the anonymous survey.ResultsOf 198 schools, 98 completed the survey (48%). Radiology curricula were integrated with other topics (91%), and taught by anatomists (42%) and radiologists (43%). The majority of time was spent on the topic of anatomy correlation (35%). Time spent teaching general radiology topics in the curriculum, such as physics (3%), modality differences (6%), radiation safety (2%), and contrast use (2%) was limited. Most schools had plans to implement an innovative teaching method in the near future (62%). The major challenges included limits on: time in the curriculum (73%); resources (32%); and radiology faculty participation (30%). A total of 82% reported that their curriculum did not model the suggestions made by the Alliance of Medical Student Educators in Radiology.ConclusionsThis survey describes the current state of preclinical radiology teaching: curricula were nonstandard, integrated into other courses, and predominantly used for anatomy correlation. Other important contextual principles of the practice of radiology were seldom taught.     

Characteristics of musculoskeletal radiology job postings to guide radiology trainees

ObjectiveTo review current musculoskeletal (MSK) job market postings to define the listed requirements for practice in order to provide insight to guide residents pursuing fellowship training in MSK radiology to best meet the needs of potential future employers.MethodsUtilizing the ACR (American College of Radiology) Career Center, a review of the ACR job postings began 6/1/2018 focusing on jobs labeled as musculoskeletal (MSK) subspecialty. E-mail notifications from the career center were reviewed, and jobs were tracked prospectively for 1 year. Data was collected regarding the number of positions, the location, the practice type, and required skills both within musculoskeletal radiology and within the remainder of the radiology subspecialties.Results456 postings met the inclusion criteria. Approximately 19% were for a dedicated MSK radiologist, 25% sought a combination of MSK and a general skill set, and 56% were specifically for a general radiologist position. Approximately 29% of jobs require some combination of mammography and/or light interventional radiology (IR).DiscussionOur results indicate that majority of job postings for musculoskeletal radiology require a practice that is not specifically limited to MSK, mirroring trends in other radiology subspecialties. Radiology trainees and program directors should be aware of the needs being demanded by the job market to help guide trainees to individualize their training to best meet the needs of their future employment.