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Rationale and Objectives: The number of international medical graduates (IMGs) entering radiology residencies and neuroradiology fellowships averaged 9.7% and 20.9% from 2021 to 2023, respectively. We aimed to determine whether IMG graduates are populating leadership roles at a proportionate rate in diagnostic radiology (DR) and neuroradiology., Materials and Methods: We surveyed 191 DR program directors, 94 neuroradiology program directors (PDs), 192 chairs of radiology, and 91 directors of neuroradiology inquiring about their original citizenship and medical school (American Medical Graduates [AMG] vs IMG). We reviewed institutional websites to obtain missing data and recorded H indices for each person using Scopus., Results: We confirmed the original citizenship and medical school location in 61-75% and 93-98% of each leadership group. We found that 16.2% of DR program directors, 43.7% of neuroradiology PDs, 28.5% of Chairs, and 40.6% of neuroradiology directors were not originally US citizens. The IMG rate was 18/188 (9.6%), 20/90 (22.2%), 26/186 (14.0%), and 19/85 (22.4%) for the same groups respectively. The most common country of origin and medical school cited was India for all leadership groups. IMGs had a median H index of 14 while AMG 10, significantly different (p = 0.021) CONCLUSION: Compared to the rate of diagnostic and neuroradiology trainees entering from 2021 to 2023, IMGs are proportionately represented at the leadership positions studied. The H index of the IMGs was higher than AMG. We conclude that IMGs have made substantial and proportionate inroads in radiology and neuroradiology leadership., Competing Interests: Declaration of Competing Interest Dr. Yousem reports royalties from Elsevier, personal fees from Medicolegal consultant, speaking and consulting fees from MRIOnline.com/Medality, outside the submitted work. The remaining authors declare that they have no conflict of interest., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: Radiology faculty across various specialties have been reported to receive an average of 20.7 invitations to submit manuscripts to bogus journals and 4.1 invitations to speak at unsuitable events over a two-week span. Radiology trainees also receive a fair number of unsolicited invitations from unknown senders to submit manuscripts and speak at meetings. Trainees can be more vulnerable to predatory invitations due to potential naivety. We aimed to determine the prevalence of these spam invitations received by radiology trainees., Material and Methods: The designed survey for evaluating the experience of radiology trainees regarding phishing scams of predatory publications and conferences was sent to radiology residency and neuroradiology fellowship program leadership to redistribute amongst their trainees, and was advertised on social media platforms. The survey was first sent out on September 28, 2023, and was closed two weeks later October 12, 2023. Spearman's correlation, univariable and multivariable linear regression analyses were performed., Results: Our study included 151 respondents who completed the survey. Of the survey respondents, 53 % reported receiving unsolicited emails from predatory publications (mean = 6.76 ± 7.29), and 32 % reported receiving emails from fraudulent conferences (mean = 5.61 ± 5.77). Significant positive correlation was observed between number of unsolicited email invitations with number of PubMed indexed publications, number as corresponding author, number in open access journals and number of abstract presentations., Conclusions: Trainees in radiology receive many unsolicited invitations to publish papers as well as to present at meetings that are not accredited. This could lead to wasted time and financial resources for unsuspecting trainees., Competing Interests: Declaration of competing interest All authors declare no conflict of interest with respect to this work. Dr. Yousem reports royalties from Elsevier, personal fees from Medicolegal consultant, speaking and consulting fees from MRIOnline.com, outside the submitted work. Dr. Lakhani receives grant support from American Society of Neuroradiology and Physician Scientist Training Program at Johns Hopkins University, outside the submitted work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Rationale and Objectives: Literature shows that discrimination has been pervasive in the field of medicine. The aim of this study was to collect experiences related to discrimination among US radiology residents, including type and source, as well as the residents' perception on lectures about discrimination and harassment. We also explored the barriers to reporting, and suggested strategies to overcome them., Material and Methods: Following Institutional Review Board (IRB) approval, an online survey was sent to program directors and coordinators across the US, who were asked to forward the link to their radiology residents. A reminder email was sent over a period of 4 months. The participants were reassured the survey was confidential and anonymous., Results: Among the respondents, the most reported types of discrimination were based in gender, race and nationality, the majority of which not being reported. The most common perpetrators were attending radiologists, co-residents, technologists, and patients. The main barriers for reporting were fear of retaliation, confidentiality concerns, and skepticism about a positive outcome., Conclusion: Our study examines some experiences of discrimination shared by residents during their training, with gender and race being the most common causes. This sheds light into a hidden and unspoken issue and highlights the need for more active discussions in radiology on microaggressions and implicit bias. Our data can guide future studies as well as residency programs to build effective strategies to address discrimination, aiming for sustainable changes., Competing Interests: Declaration of competing interest All authors declare no conflict of interest with respect to this work. Dr. Yousem reports royalties from Elsevier, personal fees from Medicolegal consultant, speaking and consulting fees from MRIOnline.com, outside the submitted work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Financial security and retirement planning are essential for all medical professionals including radiology residents. Given the available discretionary income during residency it is crucial to have insights into investment. We aimed to assess the prevalence of retirement plans offered to radiology residents, the available choices, and their degree of participation., Methods: Two surveys were created using Qualtrics platform, one targeting program directors and another one oriented to radiology residents with items focused on demographic, financial status, offered plans, and participation. Analysis was performed using chi square whenever appropriate using Qualtrics platform. P values less than 0.05 were considered statistically significant., Results: 199 radiology residents (72.6% attending university-based programs) responded to the survey. 83.7% participated in retirement plans; university-based programs had the highest rate of offering plans; 82.8% vs 70% and 53.8% for university, community and hybrid programs respectively. The most frequently offered retirement plan was a 403(b). Most of the residents (94.3%) started investment in the retirement program as early as PGY1 and PGY2. A considerable proportion of programs lacked formal training on retirement plans; however, residents emphasized the significance of financial education during their residency., Conclusion: Radiology residents are more likely to participate in a retirement plan if it is offered by their program. Providing proper guidance by incorporating financial education into radiology residency curricula can optimize residents' decision making and economical planning, leading to a more secure financial future., Competing Interests: Declaration of competing interests The authors have no competing interests to declare. The authors declare no conflict of interest. Unrelated, Dr. Yousem reports royalties from Elsevier, personal fees from Medicolegal consultant, speaking and consulting fees from MRIOnline.com, outside the submitted work. Dr. Bar-Or reports that he receives royalties on book sales and is sometimes paid to teach financial literacy., (Copyright © 2024. Published by Elsevier Inc.)

The supplemental ERAS application that includes three components: past experiences, geographic preferences, and program signals was introduced in 2022 to complement the standard ERAS CV material. The goal was to help programs identify optimal candidates to interview and to improve the chances of applicants being invited for interviews at programs that align with their goals and interests. Based on limited data, Program signal is the most emphasized component by the programs. Applicants should realize that programs have used signals to determine who to interview (aligned with AAMC guidance), and to determine the program's candidate rank list (contrary to AAMC guidance). We have herein suggested options for leveraging benefits from the ERAS supplemental application which has now been incorporated into the full ERAS application., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

BACKGROUND. International medical graduates (IMGs) are a source of physicians who could help alleviate radiologist workforce shortages in the United States. However, IMGs may face barriers in obtaining appropriate visas (e.g., H-1B or O-1 visas) to allow faculty employment. OBJECTIVE. The purpose of this study was to assess the policies and experiences of U.S. academic radiology departments in offering visas to IMGs applying for faculty positions. METHODS. A web-based survey on policies and experiences in offering visas to IMG faculty candidates was distributed to chairs of U.S. radiology departments with a diagnostic radiology training program recognized by the National Resident Matching Program. Individual survey questions were optional. The initial survey and subsequent reminders were sent from October 7, 2022, through November 7, 2022. RESULTS. The survey response rate was 81% (143/177). A total of 24% (28/115), 38% (44/115), 17% (20/115), and 20% (23/115) of departments offered H-1B visas to IMG faculty frequently, sometimes, rarely, and never, respectively; 3% (3/113), 27% (31/113), 22% (25/113), and 48% (54/113) of departments offered O-1 visas frequently, sometimes, rarely, and never, respectively. However, 41% (46/113) and 5% (6/113) of departments had default policies of offering H-1B and O-1 visas for IMG faculty candidates, respectively. The most common reasons given for why departments did not offer visas included, for both H-1B and O-1 visas, the time-consuming process, lack of reliability of candidates' starting time, and the expense of the visa application; for O-1 visas, the reasons given also included lack of expertise. A total of 15% (16/108) of departments set their own visa policies, 75% (81/108) followed institutional policies, and 10% (11/108) followed policies set by other entities (e.g., state government). CONCLUSION. Although to at least some extent most U.S. academic radiology departments offer H-1B and O-1 visas for IMGs seeking faculty positions, use of such visas typically is not the departments' default policy. A variety of barriers contributed to visas not being offered. The departments' visa policies were primarily determined at the institutional level. CLINICAL IMPACT. The identified barriers faced by U.S. academic radiology departments in offering visas to IMG faculty candidates impact the role of IMGs in helping to address radiologist workforce shortages.

Rationale and Objectives: The number of international medical graduates (IMG) in radiology residencies has varied from year to year even as the number of candidates continues to grow. It is unclear from which countries the IMGs are arriving and what visas are being used to accommodate them., Materials and Methods: We sent a survey to 195 program directors (PD) in diagnostic radiology (DR) inquiring about the number and nationality of IMG residents in their program, their attitudes about IMG candidates, the performance of their IMG trainees, and the visas that are offered., Results: We received responses from 121 of 195 (62.1%) DR programs (121/149 =81.2% of actionable emails). 80/121 (66.1%) had at least one IMG in their DR residency program and the countries of origin included India (36), Iran (30), Saudi Arabia (24), Egypt (16), Canada (14), Brazil (14), and Pakistan (9), as the most common. While most programs (76/104, 73.1%) offered J1 visas, 23/99 (23.2%) provided H-1B visas to trainees. IMG DR residents overall performed as well as American graduates, with an equal number of PDs saying IMGs performed better and worse than American graduates. PDs' issues with IMGs centered on visas: (1) expense, (2) lack of familiarity, (3) Educational Commission for Foreign Medical Graduates regulations, and (4) time commitment in submitting paperwork., Conclusion: Most radiology IMG residents originate from India and Middle Eastern countries. Once enrolled, IMG residents perform similarly to US graduates. However, adding IMG candidates to the training program requires overcoming bureaucratic and monetary hurdles around visas., Summary Sentence: Most DR international medical graduate residents are from India or the Middle East. Although their performance is the same as American graduates in general, PDs note the monetary and bureaucratic hassles accompanying their recruitment., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David M. Yousem reports a relationship with Elsevier that includes: consulting or advisory. David M. Yousem reports a relationship with Medality that includes: board membership, consulting or advisory, and speaking and lecture fees. David M. Yousem reports a relationship with Medicolegal Expert Witness that includes: paid expert testimony., (Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

This study examines the patterns of faculty solicitations by open-access (OA) publishers in radiology. The purpose of the research is to determine the factors that predict the likelihood of receiving such solicitations. We recruited 6 faculty members from 7 subspecialties in radiology to collect emails from OA journals for 2 weeks. We assessed the number of publications by each faculty member in 2022 and 2023, the previous 5 years, and entire career in PubMed. For each email, the solicitation was categorized for article submission, article review, and editorial board membership. An invitation to submit a manuscript was the most common type of solicitation received, followed by editorial boards and reviewer invites. Faculty with more than 10 indexed articles in PubMed since January 2022 were significantly more likely to receive article solicitations than those with 10 or fewer publications. Additionally, scholars with more than 40 articles since 2018 were significantly more likely to receive more than 10 article solicitations. Full professors were significantly more likely to receive solicitations to serve on editorial boards. A multivariate linear regression model predicted that publications since 2022 had the highest predictive value for the number of article solicitations and total solicitations. This study provides insight into the patterns of mass communication and various solicitations by OA publishers in radiology. The study highlights the importance of publication productivity as a predictor of article and total email solicitations and of professorial rank for editorial board invitations., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: When deciding among imaging equipment vendors, one may use a vendor's prevalence in peer-reviewed publications as a measure of their research and development. We sought to determine which vendors, countries, and journals were dominant in hepatic imaging literature of 2018 with respect to magnetic resonance (MR), computed tomography (CT), and ultrasound (US)., Methods: We recorded and analyzed the modality (MR, CT, US), journal, vendor, and authors' country for all original hepatic imaging articles published in 2018 in 29 imaging journals., Results: Of 197 MR articles, investigators used Siemens in 98 (50%), General Electric (GE) in 65 (33%), and Philips in 63 (32%). Of 115 CT articles, investigators mentioned Siemens in 55 (48%), GE in 45 (39%), Philips in 25 (22%) and other vendors in 27 (24%). Of 68 ultrasound articles, Siemens dominated with 27 (40%), versus GE with 19 (28%), Philips with 11 (16%), and other vendors with 42 (62%). We found a significant difference in vendor usage for MR, CT, and all modalities (p < .01). The plurality of articles was written in the United States (73 [23%]) with South Korea (56 [17%]) and China (56 [17%]) following. European Radiology published the most hepatic articles. For American journals, we found a significant difference in MR (p = .02) and CT (p < .01) vendor usage, whereas non-American journals nearly reached significance in MR (p = .06) and CT (p = .06) vendor usage., Conclusion: Siemens was the most cited vendor in hepatic imaging literature for all modalities. American institutions and non-American journals published the most hepatic imaging articles., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Rationale and Objectives: Women remain underrepresented in leadership positions in radiology. We sought to determine if 1) women are equitably represented in the senior author positions in radiology journals and 2) if women's contributions to the radiology literature and their individual productivity are proportional to their representation at senior academic rank., Materials and Methods: The gender of 3,702 first and last authors listed for manuscripts published in nine high-impact American radiology journals was assessed between 2002-2017. For the same years, the gender composition of academic faculty and ranks based on AAMC data was queried. Statistical tests were employed to detect discrepancies and changes over time., Results: First authorship by women grew from 26.9% to 37.4% and from 15.7% to 23.9% as senior author between 2002-2017 (P<.0001). Although the index of manuscript productivity rate was nearly equal for men and women over the 16-year study period, women remained under-represented in senior radiology faculty rank over the same period., Conclusions: Although women have proportionally increased their contribution to the radiology literature over the years, commensurate increased representation of women in senior authorship and faculty positions was not observed. Despite increased involvement of women in research over time, they remain disproportionately at junior faculty positions., (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: To explore the current status and determine the uniformity of parental leave policies among US radiology residency programs., Methods: An electronic survey was developed and sent to 222 radiology residency program directors (PDs) in June 2019 to assess their policies and attitudes toward parental leave. The survey was administered via the Internet Qualtrics Research Suite (Qualtrics, Provo, Utah) format with four reminders sent over the course of 2 months before closing the data collection., Results: In all, 74 PDs responded to the survey. Of those, 88% claimed to have a maternal leave policy (88% explicitly written and 77% paid); 80% had a paternal leave policy (88% explicitly written and 75% paid). The average length of maternal and paternal leaves was 7.4 ± 3.9 and 3.7 ± 3.7 weeks, respectively. Parental leaves were allocated at least every other year in over 70% of programs. Approximately 60% of the PDs required residents to make up call rotations for parental leaves. About 92% of responsive programs adjusted angiography and fluoroscopy rotations for trainees throughout the pregnancy or according to the trainee's request. Policies did not generally address issues of breastfeeding and nontraditional parenthood., Conclusion: The proportion of radiology programs with explicit maternal leave policies remained constant compared with previous surveys during the last two decades. However, there was a dramatic rise in the adoption of paternal leave policies. Overall, there was a lack of national uniformity in radiology residency programs' policies concerning parental leave, leaving open the possibility of national guidance in addressing the issue., (Copyright © 2020 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among radiology residency programs, the state of parental leave in radiology fellowships has not been addressed to date. Our aim was to determine the state of parental leave policies in American neuroradiology fellowship programs., Materials and Methods: An Internet survey was sent to the directors of neuroradiology fellowship programs listed on the Accreditation Council for Graduate Medical Education Web site ( n  = 87) in January 2020. The questionnaire assessed the policies of the fellowship programs and Program Directors' attitudes toward maternal and paternal leave. Four reminders were sent during the 3 weeks before closing data collection., Results: The response rate was 76% (66/87). Ninety-four percent (62/66) of program directors claimed to have a maternal leave policy, of which 51/62 (82%) were written and 53/62 (85%) were paid. Additionally, 77% (51/66) had a policy for paternal leave, of which 80% (41/51) were written and 76% (39/51) were paid. The average length of paid leave was 6.7 ± 3.25 weeks for new mothers and 2.9 ± 2 weeks for new fathers. Unpaid leave was mostly based on the Family and Medical Leave Act. Fellows were responsible for making up call duties during the parental leave in 47% of the programs. Radiation exposure was restricted in 89% of the programs during pregnancy. Policies addressed breast feeding and untraditional parenthood in just 41% of the responding programs. Most program directors supported the development of a unified national policy on maternal (83%) and paternal (79%) leave., Conclusions: Most neuroradiology fellowship programs have explicit maternal and paternal leave policies that grant paid leave to trainees. Some also offer unpaid leave, mostly through Family and Medical Leave Act guidelines. A uniform policy derived from the Accreditation Council for Graduate Medical Education and/or American Board of Radiology would be useful and overwhelmingly accepted., (© 2020 by American Journal of Neuroradiology.)

The electronic medical record (EMR) can reveal preferences of clinicians regarding imaging services. We sought to evaluate viewing habits for reports and images of musculoskeletal (MSK) studies by ordering clinicians. We hypothesized that MSK reports are important to clinical management, especially for advanced imaging modalities. We tracked the image and report access of all MSK studies ordered in September 2016 over 8 months using logs of the EMR (Epic Systems, Verona, WI), and by an independent analysis of the institutional PACS (Picture Archiving and Communication Systems) (Carestream Health, Rochester, NY). The time stamps were extracted for when images and reports were viewed. We categorized MSK studies by modality and provider department. We also compared the rates of viewing reports and images among different modalities and departments using the chi-square test. Of the 8143 viewed MSK studies, 7842 (96.3%) reports (with/without images) and 3916 (48.1%) imaging data (with/without reports) were viewed. Viewing reports alone occurred in 4227 (51.9%) studies. CT and MRI reports alone views occurred more often in comparison to radiographs ([482/706; 68.3%] for CT and [981/1713; 57.3%] for MRI vs. [2764/5724; 48.3%] for radiography, p < 0.001). Orthopedists ordered the highest number of MSK studies and viewed reports 99.2% (3216/3242) of the time, including a 54.6% (1770/3242) rate of viewing reports alone and a 44.6% (1446/3242) rate of viewing both reports and images. They viewed images without reports in 0.8% (27/3242) of cases. MSK reports were viewed significantly more frequently than the images across all modalities and all relevant specialties.

OBJECTIVE. Policies regarding how to handle the review of imaging studies performed at another institution (second opinion consultations) have not been uniform in academic radiology. Departments must decide whether to simply store outside studies in the PACS, report the studies officially, bill third-party payers, repeat such studies, or take a combination of these steps. The purpose of this study was to determine the current state of practice in dealing with second opinion consultations in academic radiology departments. SUBJECTS AND METHODS. A survey was conducted of the members of the Society of Chairs of Academic Radiology Departments (SCARD) and the Association of Administration in Academic Radiology (AAARAD) for their practices with respect to outside studies. RESULTS. Completed surveys were received from 91 of 160 (56.9%) SCARD and 35 of 106 (33.0%) AAARAD members. Of the 91 SCARD respondents, 70 (76.9%) added outside studies to their PACS, and 34 (37.4%) required formal internal reports on all outside studies. By contrast, 74 (81.3%) allowed at least some outside studies into their PACS without requiring an internal report. Many respondents interpreted outside studies only if specifically requested. Most (67/91 [73.6%]) billed insurers but not patients (61/91 [67.0%]) for the second opinion consultations. Fifteen (16.5%) preferred repeating studies rather than including outside studies in the PACS. With minimal exceptions, the AAARAD results paralleled the SCARD results. CONCLUSION. The survey showed that common practices in academic radiology are to add outside studies to the institutional PACS without mandating an internal report and to bill insurers but not patients for second opinion consultations.

Objective: Increasingly, medical journals are recognizing "equally credited authors" (ECA) in the primary and senior authorship of articles. The aim of this study was to assess the policies of co-first authorship, co-senior authorship, and designation of a corresponding author in the radiology literature., Methods: We identified 29 radiology journals based on impact factor ranking. Journal offices were contacted by phone and e-mail to ascertain their practices on first and senior authorship ECA designations. We surveyed the March, June, and December 2018 issues of each journal (when available) to assess the utilization of the co-designations in articles., Results: Twenty-five of 29 journals responded to our survey (response rate: 86.2%). Of 25 journals, 20 (80%) allowed co-first authorship. Among these, 4 of 25 journals (16%) allowed more than two co-first authors. Among the 25 responses, 14 journals (56%) allowed co-senior authorship. Among the 24 journals who responded to this specific question, 23 (96%) approved designation of a corresponding author, different from the first or senior author. The review of March, June, December 2018 editions found co-first authorship and co-senior authorship ECA rates of 8.6% (range 0.0%-22.7%) and 1.8% (range 0.0%-13.3%), respectively. A corresponding author other than first or senior author was noted in 13.3% (range 0.0%-34.7%)., Discussion: There has been widespread acceptance of the concept of ECA in the policies of the top cited imaging journals particularly for first authors (80%). However, the utilization of these designations is uncommon for first authorship (8.6%) and rare (1.8%) for senior authorship based on our 2018 sampling., (Copyright © 2019 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: The validity of radiology peer review requires an unbiased assessment of studies in an environment that values the process. We assessed radiologists' behavior reviewing colleagues' reports. We hypothesized that when a radiologist receives a discrepant peer review, he is more likely to submit a discrepant review about another radiologist., Materials and Methods: We analyzed the anonymous peer review submissions of 13 neuroradiologists in semimonthly blocks of time from 2016 to 2018. We defined a discrepant review as any one of the following: 1) detection miss, clinically significant; 2) detection miss, clinically not significant; 3) interpretation miss, clinically significant; or 4) interpretation miss, clinically not significant. We used random-effects Poisson regression analysis to determine whether a neuroradiologist was more likely to submit a discrepant report during the semimonthly block in which he or she received one versus the semimonthly block thereafter., Results: Four hundred sixty-eight discrepant peer review reports were submitted; 161 were submitted in the same semimonthly block of receipt of a discrepant report and 325 were not. Receiving a discrepant report had a positive effect on submitting discrepant reports: an expected relative increase of 14% (95% CI, 8%-21%). Notably, receiving a clinically not significant discrepant report (coefficient = 0.13; 95% CI, 0.05-0.22) significantly and positively correlated with submitting a discrepant report within the same time block, but this was not true of clinically significant reports., Conclusions: The receipt of a clinically not significant discrepant report leads to a greater likelihood of submitting a discrepant report. The motivation for such an increase should be explored for potential bias., (© 2019 by American Journal of Neuroradiology.)

Purpose: Women in radiology are known to be underrepresented in academic leadership positions. We sought to determine if women are appropriately represented on editorial boards and editor-in-chief positions compared with their authorship contributions., Materials and Methods: We assessed the first and senior authorship male versus female gender breakdown of manuscripts published in nine high-impact American radiology journals 1 month per year from 2002 to 2017. We looked at the gender of the first authors, senior authors, editorial board members, and editors-in-chief of these journals to see if there was a gender discrepancy., Results: We assessed 3,702 first authors, 3,702 senior authors, and 9,400 editorial board members. Women were underrepresented on the editorial boards compared with their first-authored manuscript contribution in our sample of articles from every journal for every year and were underrepresented compared with their senior-authored manuscript contributions in 119 of 139 (85.6%) journal-years. The percentage of women as first authors (mean = 29.3 ± 9.9), senior authors (mean = 20.7 ± 8.1), and editorial board members (mean = 13.4 ± 6.5) showed major differences (P < .001). This gap did not significantly narrow over the 16 years of study. Notably, there was no woman as editor-in-chief for any of the journal-years., Conclusion: There is a gender gap in the composition of editorial boards in radiology compared with authorship contributions by women. Given the implications of editorial board assignment and editorship on women's academic advancement, journals may wish to consider strategies that will narrow the gap., (Copyright © 2018. Published by Elsevier Inc.)

Background and Purpose: Many articles that are relevant to patient care but published in radiology journals may escape notice by clinicians. We sought to determine how often the 20 most prolific American Journal of Neuroradiology ( AJNR ) authors from 2013 to 2017 published in clinical journals and the extent to which their articles were disseminated into the clinical literature., Materials and Methods: We counted all authors' first- or senior-authored articles in the AJNR from 2013 to 2017 to identify the 20 most prolific authors in AJNR . We searched for these 20 authors' total articles from 2013 to 2017 to determine which were published in radiology or clinical journals and the number of citations received from radiology and clinical journals. Authors were sorted into quartiles according to these metrics, and other descriptive statistics were performed., Results: The top 20 AJNR authors contributed to 1463 articles during 5 years, including 711 (48.6%) in radiology and 752 (51.4%) in clinical journals. These articles were cited 15,857 times, including 4659 (29.3%) by articles in radiology journals. The more prolific authors published in clinical journals more often (Spearman ρ = 0.65, P = .002) and were cited more (ρ = 0.42, P = .07). Articles published in clinical journals were cited more often (mean, 12.3 clinical, 9.3 radiology general versus 8.7 in AJNR ), and whether published in radiology or clinical journals, they were cited more frequently by clinical journals., Conclusions: Regardless of where it is published, radiology research is disseminating into the clinical realm. Radiology articles published in clinical journals are cited more often than those published in radiology journals., (© 2018 by American Journal of Neuroradiology.)

There are numerous misconceptions about serving as a medical malpractice expert witness. By maintaining an objective perspective based in the unbiased interpretation of the images provided (for both sides of the conflict), one can best serve society as a whole. Most cases for which a neuroradiology expert is recruited are the following: 1) not with the radiologist as a defendant, 2) resolved without court testimony, and 3) short-lived if frivolous. One can learn much about medicine, our nonradiology colleagues, and the litigation process by participating as an expert witness., (© 2018 by American Journal of Neuroradiology.)

Purpose: Cost-effectiveness analyses (CEAs) have become more prevalent in radiology. However, the lack of standard methodology may lead to conflicting conclusions on the cost-effectiveness of an imaging modality and hinder CEA-based policy recommendations. This study reviews recent CEAs to identify areas of methodological variation, explore their impact on interpretation, and discuss optimal strategies for performing CEAs in radiology., Methods: We performed a systematic review for cost-utility analyses in radiology from 2013 to 2017. Cost and quality-of-life methods were analyzed and compared using the Consolidated Health Economic Evaluation Reporting Standards checklist., Results: Eighty cost-utility studies met our inclusion criteria. A payer perspective was the most common (70%) and hospital perspective the least common (5%). Fourteen studies (17.5%) did not report perspective, and 12 (15%) reported a perspective inconsistent with their performed analysis. Cost inclusion varied greatly between studies; adverse effects of imaging (20.5%) and hospitalization (34.6%) were the least frequently included direct costs. Studies that measured their own utilities most commonly used the EuroQol-5D and Short Form-6D questionnaires; however, most studies (80%) cited utilities from previous literature. Seventy-two studies (90%) used willingness-to-pay thresholds, and 30 used cost-effectiveness acceptability curves (41.7%)., Conclusion: We observed statistically significant methodological variation indicating the need for a standardized, accurate means of performing and presenting CEAs within radiology. We make several recommendations to address key problems regarding study perspective, cost inclusion, and use of willingness-to-pay thresholds. Further work is required to ensure comparability and transparency between studies such that policymakers are properly informed when utilizing CEA results., (Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study is to assess medical ethics knowledge among trainees and practicing radiologists through an online survey that included questions about the American College of Radiology Code of Ethics and the American Medical Association Code of Medical Ethics., Conclusion: Most survey respondents reported that they had never read the American Medical Association Code of Medical Ethics or the American College of Radiology Code of Ethics (77.2% and 67.4% of respondents, respectively). With regard to ethics education during medical school and residency, 57.3% and 70.0% of respondents, respectively, found such education to be insufficient. Medical ethics training should be highlighted during residency, at specialty society meetings, and in journals and online resources for radiologists.

Purpose: To gauge the prevalence of sexual harassment (SH) and to understand the issues regarding its disclosure among radiologists., Methods: A questionnaire on ethics and SH was sent by e-mail to 1,569 radiologists and radiology trainees in an institutional database maintained for continuing medical education purposes on three separate occasions between September 17 and October 31, 2016. The link to the survey was also posted on social media sites via the authors' divisional and institutional accounts on Facebook, Twitter, Instagram, and Aunt Minnie, as well as on ACR and RSNA web blogs., Results: Overall, 9.75% (39 of 400) respondents stated they had suffered SH, with more female (22 of 90 = 24.4%) than male victims (11 of 249 = 4.4%) (P < .001). Only 29.4% of SH victims said they would likely report SH (P < .001). Women (46 of 90 = 51.1%) said they were less likely to report SH than men (150 of 242 = 62.0%) (P = .03), and American medical school graduates (119 of 220 = 54.1%) were less likely than graduates from outside the United States (37 of 48 = 77.1%). Of 401 respondents to questions on SH, 28.7% (n = 115), including more women (38 of 91 = 41.8%) than men (61 of 249 = 24.5%) (P = .002), said they had witnessed SH., Conclusions: By percentage responding, female radiologists are more frequently victims and witnesses of sexual harassment but are less likely to report such cases. Steps need to be taken to eliminate a culture that leads radiologists to tolerate SH without addressing it., (Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

We sought to establish a guide for identifying fellowship competency in performing fluoroscopically guided lumbar punctures. With a linear mixed-effects model, we compared the fluoroscopy time between the first and last 3 months of neuroradiology training. During 7 years, 55 fellows performed 1142 and 861 lumbar punctures in the first and last quarters of training. A target fluoroscopy time of 0.26 minutes, the upper 95% confidence interval, can serve as a fellowship benchmark for successfully achieving competence in fluoroscopically guided lumbar punctures., (© 2017 by American Journal of Neuroradiology.)

Rationale and Objectives: We sought to determine (1) whether United States Medical Licensing Examination (USMLE) scores predict academic productivity in neuroradiology fellows as measured by publications and citations, and (2) what factors predict such productivity., Materials and Methods: We reviewed the USMLE scores, gender, medical school location attended, publication record before and during fellowship, fellowship evaluation ratings and subsequent practice site (private vs academic) of neuroradiology fellows from 2004 to 2014 to determine relationships with publications and citations after fellowship. Spearman's correlation and Poisson regression analyses were performed to assess the association between these factors and quantity of publications and citations per year after fellowship., Results: USMLE scores and fellowship evaluation scores correlated inversely with radiology publications and citations. There were strong correlations between publication records before or during fellowship and after fellowship. Fellows from international medical schools, with PhD degrees, and those fellows proceeding to academic practice had more publications before or during and after neuroradiology fellowship., Conclusions: The best predictors of whether a graduating neuroradiology fellow will publish and have high citation rates is prior publication record, a PhD degree, and staying in academics. USMLE scores and evaluations during the fellowship were inversely correlated with publication measures of academic productivity., (Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose: Many neuroradiology programs use United States Medical Licensing Examination (USMLE) scores to assess fellowship candidates. The authors hypothesized that because they are taken several years before fellowship, USMLE scores would correlate poorly with success in fellowship training as measured by faculty evaluations., Methods: USMLE scores from 10 years of neuroradiology fellows (n = 73) were compared with their cumulative mean E*Value scores from their fellowship years and their best-to-worst rankings within their fellowship years. If available, subspecialty certification scores were also factored as an outcome. Linear correlation and regression analyses were performed adjusting for gender, medical school site, and practice setting after fellowship., Results: USMLE Step 1, 2, and 3 scores were available for 69, 64, and 56 fellows, respectively. Fellowship E*Value scores and rankings showed statistically significant (P < .05) correlations with all USMLE scores, but most strongly for Step 1 scores and E*Value grade (r = 0.443) and rank (r = 0.370). The mean USMLE Step 1 score of the top-ranked fellows (234.5) was significantly higher than that of the bottom-ranked fellows (217.7). The correlations of E*Value score and rank with USMLE Step 1 and 2 scores remained after adjusting for gender and American versus foreign medical school, but the medical school site attended also was an independent predictor of fellowship evaluations. Subspecialty certification scores did not show correlations but were underpowered (n = 28)., Conclusions: USMLE Step 1 and 2 scores correlated significantly with success in neuroradiology fellowship, measured by faculty assessments of the six core competencies. Using the scores as a means of assessing candidates for positions is justified., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: No previous study compares neuroradiology training programs and teaching schedules across the globe, to our knowledge. This study was conducted to better understand international program requisites., Materials and Methods: Data from 43 countries were collected by an e-mail-based questionnaire (response rate, 84.0%). Radiologists across the world were surveyed regarding the neuroradiology training schemes in their institutions. Answers were verified by officers of the national neuroradiology societies., Results: While many countries do not provide fellowship training in neuroradiology (n = 16), others have formal postresidency curricula (n = 27). Many programs have few fellows and didactic sessions, but the 1- or 2-year duration of fellowship training is relatively consistent (n = 23/27, 85%)., Conclusions: There is a wide variety of fellowship offerings, lessons provided, and ratios of teachers to learners in neuroradiology training programs globally., (© 2015 by American Journal of Neuroradiology.)

Background and Purpose: Timely reporting of critical findings in radiology has been identified by The Joint Commission as one of the National Patient Safety Goals. Our aim was to determine the magnitude of delays between identifying a neuroradiologic critical finding and verbally notifying the caregiver in an effort to improve clinical outcomes., Materials and Methods: We surveyed the time of critical finding discovery, attempted notification, and direct communication between neuroradiologists and caregivers for weekday, evening, overnight, and weekend shifts during an 8-week period. The data were collected by trained observers and/or trainees and included 13 neuroradiology attendings plus fellows and residents. Critical findings were based on a previously approved 17-item list. Summary and comparative t test statistics were calculated, and sources of delays were identified., Results: Ninety-one critical findings were recorded. The mean time from study acquisition to critical finding discovery was 62.2 minutes, from critical finding discovery to call made 3.7 minutes, and from call made to direct communication, 5.2 minutes. The overall time from critical finding discovery to caregiver notification was within 10 minutes in 72.5% (66/91) and 15 minutes in 93.4% (85/91) of cases. There were no significant differences across shifts except for daytime versus overnight and weekend shifts, when means were 2.4, 5.6, and 8.7 minutes, respectively (P < .01). If >1 physician was called, the mean notification time increased from 3.5 to 10.1 minutes (P < .01). Sources of delays included inaccurate contact information, physician unavailability (shift change/office closed), patient transfer to a different service, or lack of responsiveness from caregivers., Conclusions: Direct communication with the responsible referring physician occurred consistently within 10-15 minutes after observation of a critical finding. These delays are less than the average interval from study acquisition to critical finding discovery (mean, 62.2 minutes)., (© 2014 by American Journal of Neuroradiology.)

Purpose: The aim of this study was to determine the level of support for the proposal to restrict ACGME-accredited fellowships to candidates who completed residencies accredited by the ACGME or the Royal College of Physicians and Surgeons of Canada. Perceptions of foreign-trained international medical graduates during and after fellowships were also assessed., Methods: An e-mail survey was sent to the members of the organizations that represent academic chairpersons (the Society of Chairs of Academic Radiology Departments) and radiology residency and fellowship program directors (the Association of Program Directors in Radiology) and to the program directors of the largest American radiology subspecialty society (the American Society of Neuroradiology). Results were analyzed separately for each of the 3 societies interviewed and then as a composite report for all 3 societies., Results: Approximately 60% of the respondents said that they have offered at least one fellowship or faculty position to foreign-trained applicants in the past 5 years. More than 70% of the respondents said that these doctors performed equally to or better than American-trained ones both clinically and academically. The majority of members of all 3 societies responding opposed enactment of the rule, with the American Society of Neuroradiology being the most disapproving. The main concerns of those supporting the new rule were the inhomogeneous and sometimes unknown levels of training of the foreign-trained doctors and the need to favor American graduates. Those opposed were mostly worried about diminishing the quality of fellowship candidates, programs being unable to fill their positions, and a decrease in academic-oriented people., Conclusions: Most respondents opposed the proposed rule. The majority were supportive of foreign-trained physicians continuing their training in the United States., (Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Radiology benefits managers (RBMs) and computerized decision support offer different advantages and disadvantages in the efforts to provide appropriate use of radiology resources. RBMs are effective in their hard-stop ability to reject inappropriate studies, incur a significant cost, and interpose an intermediary between patient and physician. Decision support is a more friendly educational product, but has not been implemented for all clinical indications and its efficacy is still being studied., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: An increasing portion of imaging studies are performed by nonradiologists, especially for modalities with the highest relative value units. The aim of this study was to examine the trends in neuroradiologic interpretation among radiologists, neurologists, neurosurgeons, and other specialists within the Medicare population., Methods: The number of neuroradiologic studies interpreted by radiologists, neurologists, neurosurgeons, and other specialists in the inpatient, hospital outpatient, and private office settings was determined from the CMS Physician/Supplier Procedure Summary Master Files for 1996 to 2010. Studies billed through professional and global charges were aggregated. Utilization rates and utilization rate compound annual growth rates were computed by specialty and by imaging study., Results: In 1996, radiologists interpreted 4,802,490 (93.7%) CMS neuroradiologic procedures, neurologists 77,312 (1.5%), neurosurgeons 9,825 (0.19%), and other specialists 234,423 (4.6%). In 2010, radiologists interpreted 11,476,376 (93.5%) procedures, neurologists 101,172 (0.8%), neurosurgeons 20,697 (0.17%), and other specialists 680,786 (5.5%). Neurology and neurosurgery lost market share at all sites. Radiology's share increased in the inpatient (from 94.8% to 98.7%) and hospital outpatient (from 95% to 98.7%) settings but decreased in the private office setting (from 88.2% to 73.1%). Lost market share was captured by the other CMS specialty categories, including independent diagnostic testing facilities and multidisciplinary groups, many of which included radiologists., Conclusions: There was marked growth (140%) in neuroradiologic studies between 1996 and 2010 in the Medicare patient population. Radiologists' share of the total neuroradiologic interpretations remained unchanged and constituted 93.5% in 2010. Radiology's market share has shown growth in the inpatient and hospital outpatient sectors but not the private office sector, where independent diagnostic testing facilities, multidisciplinary groups, and other specialists have seen increases., (Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: Recent literature shows an increasing portion of imaging studies being conducted and interpreted by nonradiologists, especially across the modalities with the highest RVUs. We examined the trends in the Medicare technical charges for private office neuroradiology studies submitted by subspecialists to identify utilization trends among MR and CT scanner owners or lessees over the last decade., Materials and Methods: The number of neuroradiology studies performed on MR and CT machines owned or leased in private offices was determined from the CMS PSPSMF for 1998-2008. Studies billed through technical and global charges were aggregated. Utilization rates and utilization rate CAGRs were computed by specialty and by imaging study., Results: Between 1998 and 2008, MR studies grew by a factor of 2.5 and CT studies grew by 2.1. In 2008, radiologists charged the technical/global fee in 1,386,669 (56.6%), neurologists in 82,360 (3.4%), neurosurgeons in 29,218 (1.2%), multi/IDTF in 617,933 (25.2%), and other specialists in 334,843 (13.7%) of neuroradiology cases. Changes from the 1998 base rate to the 2008 rate per 1000 Medicare beneficiaries were 24.1 to 39.7 for radiologists, 1.03 to 2.4 for neurologists, 0.15 to 0.84 for neurosurgeons, 2.2 to 17.7 for multi/IDTF, and 1.3 to 9.6 for other specialists. All specialties, except for multi/IDTF, showed greater MR utilization increases than CT. Neurology (CAGR of 10.6%), neurosurgery (22.1%), multi/IDTF (23.2%), and other specialists' (24.6%) MR growth outpaced that of radiology's (5.3%)., Conclusions: All nonradiologists showed greater overall utilization growth in private office neuroradiology than did radiology. Also, nonradiologists generally showed greater utilization increases in MR than CT. Radiologists' private office neuroradiology technical fee share shrank from 83.6% to 56.6% between 1998 and 2008.

Background and Purpose: The maintenance of certification (MOC) process has begun in radiology, and many physicians will be affected by it. We sought to assess the compliance with and knowledge of the MOC steps by American Society of Neuroradiology (ASNR) members., Materials and Methods: An on-line survey was distributed via e-mail to the members of the ASNR for whom e-mail addresses were available. The survey addressed 3 components of the MOC currently implemented: 1) MOC cognitive examinations, 2) self-assessment modules (SAMs), and 3) continuing medical education (CME) credits., Results: The response rate was 1020/2662 (38.3%). Of those responding, 11% stated that they either do not support the MOC examination (8%) or were unaware of it (3%), 21.4% of respondents have completed an SAM module, but >30% were unaware that they had to complete SAMs or did not know where they were offered. Many members will receive most of their 25 required CME hours for 2007 from sources besides the ASNR annual meeting. Of the small proportion of respondents who made comments (247/1020, 24.2%), those about the MOC process were favorable in 6.1% (15/247), unfavorable in 46.6% (115/247), and neutral in 47.4% (117/247)., Conclusion: The MOC process remains poorly understood, with limited compliance. The radiology societies should spend additional effort publicizing the requirements and offering support and products aimed at allowing their members to achieve compliance in a reasonable cost-effective fashion.

Background and Purpose: The selection of neuroradiology fellows who will start on July 1, 2005, marked the fourth year in which program directors in neuroradiology used the National Resident Matching Program (NRMP) as the selection modality. The aim of this study was to investigate fellowship candidates' views regarding the match process., Methods: A Web survey was distributed electronically to all candidates applying for neuroradiology fellowship positions offered for the July 1, 2005, start date, with questions about the match. One hundred thirteen neuroradiology fellowship candidates responded to the survey, representing 73.9% of the surveyed fellowship pool. Candidates were also allowed to enter their comments regarding the match process via the Web survey., Results: Of the 113 neuroradiology fellowship candidates responding, 75.7% felt that the NRMP system was fair, 86.0% were satisfied with the outcome, 88.8% had matched with one of their top three choices, 54.5% recommended continuing the neuroradiology fellowship match, and 15.5% stated that they experienced violations of the match rules. The main perceived advantages of the match from the candidates' perspectives were the ability to see many programs and explore multiple options, the perception of fairness, and the efficiency of using the match program. The main disadvantages were the cost of applications and traveling, the number of days required to interview, and the perception that the match program favors internal candidates., Conclusion: The majority of fellowship candidates felt that the match system for selection is a fair process and were satisfied with the outcome. However, the perceived disadvantages produced tepid (54.5%) support for the continuation of the match. Program directors in neuroradiology and other radiologic subspecialties should consider the data provided in this article in deciding the future selection process.

Background and Purpose: When the fellowship match for trainees entering neuroradiology programs was first proposed in 2001, the program directors in neuroradiology agreed to a 3-year trial utilizing the National Residency Match Program (NRMP) for selecting fellows. A decision as to whether to continue with the neuroradiology fellowship match was to be assessed at the 3-year mark in 2004., Methods: A Web survey designed through the offices of the ASNR was distributed to neuroradiology fellowship program directors after the results of the most recent fellowship match were tabulated in June 2003. The questionnaire included items about the current sentiment about the fellowship selection process., Results: Most (52 of 61 = 85%) neuroradiology program directors favored continuing the match system for selecting fellows. Most believed that the match 1) had little impact on their success in recruiting fellows (43 of 62 = 69%), 2) was fairly administered (100%), and 3) was appropriately timed from February to June in the third year of residency (56 of 65 = 86%). The number of candidates entering the neuroradiology match increased from 71 in 2001 to 124 in 2003., Conclusion: Support for continuing a match system for selecting fellows remains high (85%) among neuroradiology program directors. The system is considered fair and does not harm many programs. The recruitment of fellows to neuroradiology via the match has increased over the 3 years of its existence.