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Continuous axenic culture of Pneumocystis carinii has been achieved. A culture vessel is used that allows for frequent medium exchange without disturbance of organisms that grow attached to a collagen-coated porous membrane. The growth medium is based on Minimal Essential Medium with Earle's salt supplemented with S-adenosyl-L-methionine, putrescine, ferric pyrophosphate, N-acetyl glucosamine, putrescine, p.aminobenzoic acid, L-cysteine and L-glutamine, and horse serum. Incubation is in room air at 31 [degrees] C. The pH of the medium begins at 8.8 and rises to [approximately equal to]9 as the cells grow. Doubling times calculated from growth curves obtained from cultures inoculated at moderate densities ranged from 35 to 65 hours. With a low-density inoculum, the doubling time is reduced to 19 hours. The morphology of cultured organisms in stained smears and in transmission electron micrographs is that of P. carinii, and P. carinii-specific mAbs label the cultured material. Cultured organisms are infective for immunosuppressed rats and can be stored frozen and used to reinitiate culture.

PURPOSE: The aim of this study was to assess potential physician work efficiencies when more than one diagnostic imaging study is interpreted by the same provider during the same session. METHODS: Medicare Physician Fee Schedule data from the American Medical Association Resource-Based Relative Value Scale Data Manager for 2011 were analyzed to quantify relative contributions of preservice, intraservice, and postservice physician work to the total work of rendering diagnostic imaging services. An expert panel review identified potential duplications in preservice and postservice work when multiple examinations are performed on the same patient during the same session. Maximum potential percentage work duplication for various diagnostic imaging modalities was calculated and compared to US Government Accountability Office estimates. RESULTS: The relative contributions of preservice and postservice work to total work varied by modality, ranging from 20% [computed tomography (CT)] to 33% (ultrasound). The maximum percentage of potentially duplicated preservice and postservice activity ranged from 19% (nuclear medicine) to 24% (ultrasound). Maximum mean potentially duplicated work relative value units ranged from 0.0212 for radiography to 0.0953 for magnetic resonance imaging (MRI). Maximum percentage work reduction ranged from 4.32% for CT to 8.15% for ultrasound. This corresponds to maximum professional Physician Fee Schedule reductions of only 2.96% (CT) to 5.45% (ultrasound), approximating an order of magnitude less than the Government Accountability Office's recommendations. CONCLUSION: Although potential efficiencies in physician work occur when multiple services are provided to the same patient during the same session, these are highly variable and considerably less than previously estimated. [ABSTRACT FROM AUTHOR]

Despite the surge in artificial intelligence (AI) development for health care applications, particularly for medical imaging applications, there has been limited adoption of such AI tools into clinical practice. During a 1-day workshop in November 2022, co-organized by the ACR and the RSNA, participants outlined experiences and problems with implementing AI in clinical practice, defined the needs of various stakeholders in the AI ecosystem, and elicited potential solutions and strategies related to the safety, effectiveness, reliability, and transparency of AI algorithms. Participants included radiologists from academic and community radiology practices, informatics leaders responsible for AI implementation, regulatory agency employees, and specialty society representatives. The major themes that emerged fell into two categories: (1) AI product development and (2) implementation of AI-based applications in clinical practice. In particular, participants highlighted key aspects of AI product development to include clear clinical task definitions; well-curated data from diverse geographic, economic, and health care settings; standards and mechanisms to monitor model reliability; and transparency regarding model performance, both in controlled and real-world settings. For implementation, participants emphasized the need for strong institutional governance; systematic evaluation, selection, and validation methods conducted by local teams; seamless integration into the clinical workflow; performance monitoring and support by local teams; performance monitoring by external entities; and alignment of incentives through credentialing and reimbursement. Participants predicted that clinical implementation of AI in radiology will continue to be limited until the safety, effectiveness, reliability, and transparency of such tools are more fully addressed., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Advances in machine learning in medical imaging are occurring at a rapid pace in research laboratories both at academic institutions and in industry. Important artificial intelligence (AI) tools for diagnostic imaging include algorithms for disease detection and classification, image optimization, radiation reduction, and workflow enhancement. Although advances in foundational research are occurring rapidly, translation to routine clinical practice has been slower. In August 2018, the National Institutes of Health assembled multiple relevant stakeholders at a public meeting to discuss the current state of knowledge, infrastructure gaps, and challenges to wider implementation. The conclusions of that meeting are summarized in two publications that identify and prioritize initiatives to accelerate foundational and translational research in AI for medical imaging. This publication summarizes key priorities for translational research developed at the workshop including: (1) creating structured AI use cases, defining and highlighting clinical challenges potentially solvable by AI; (2) establishing methods to encourage data sharing for training and testing AI algorithms to promote generalizability to widespread clinical practice and mitigate unintended bias; (3) establishing tools for validation and performance monitoring of AI algorithms to facilitate regulatory approval; and (4) developing standards and common data elements for seamless integration of AI tools into existing clinical workflows. An important goal of the resulting road map is to grow an ecosystem, facilitated by professional societies, industry, and government agencies, that will allow robust collaborations between practicing clinicians and AI researchers to advance foundational and translational research relevant to medical imaging., (Copyright © 2019 American College of Radiology. All rights reserved.)

Purpose: We assessed the changing use of prebiopsy prostate magnetic resonance imaging in Medicare beneficiaries., Materials and Methods: Men who underwent prostate biopsy were identified in 5% Medicare RIFs (Research Identifiable Files) from October 2010 through September 2015. We evaluated the rate of prebiopsy prostate magnetic resonance imaging, defined as any pelvic MRI 6 months or less before biopsy with a prostate indication diagnosis code. Temporal changes were determined as well as variation by geography and among populations., Results: In male Medicare beneficiaries the prebiopsy magnetic resonance imaging use rate increased from 0.1% in 2010 to 0.7% in 2011, to 1.2% in 2012, to 2.9% in 2013, to 4.7% in 2014 and to 10.3% in 2015. In 2015 the prebiopsy prostate magnetic resonance imaging rate varied significantly by patient age, including 5.7% for greater than 80 years vs 8.4% to 9.3% for other age ranges (p = 0.040) as well as by race, including 5.8% in African American vs 10.1% in Caucasian men (p = 0.009) and geographic region, including 6.3% in the Midwest to 12.5% in the Northeast (p <0.001). The rate was highest in Wyoming at 25.0%, New York at 23.7% and Minnesota at 20.5% but it was less than 1% in 10 states., Conclusions: Historical Medicare claims provide novel insights into the dramatically increasing adoption of magnetic resonance imaging prior to prostate biopsy. Following earlier minimal use the performance increased sharply beginning in 2013, exceeding 10% in 2015. However, substantial racial and geographic variation exists in adoption. Continued educational, research and policy efforts are warranted to optimize the role of prebiopsy magnetic resonance imaging and minimize sociodemographic and geographic disparities., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to assess the potential impact of ACR evidence-based advocacy on radiologist professional reimbursement from individual-provider CMS multiple-procedure payment reduction (MPPR) initiatives., Methods: CMS Physician and Other Supplier Public Use Files and 5% research-identifiable file carrier claims files from 2012 through 2014 were used to identify individual-provider MPPR-eligible services for radiologists (group practice linking unavailability in either dataset precluded quantification of different provider discounting) and then compare actual payments to Medicare Physician Fee Schedule national professional reimbursement rates to identify MPPR-discounted services. Payments attributed to MPPR-affected services and average radiologist annual MPPR discounts were calculated to estimate incremental individual radiologist payment restoration as a result of evidence-based advocacy., Results: Between 2012 and 2014, a mean of 803 to 836 advanced imaging services per radiologist were potentially affected by individual-provider MPPR discounting. Approximately 23% of these services were discounted by individual-provider MPPR, resulting in approximately $2,524 to $2,893 lost per radiologist per year. The MPPR rollback from 25% to 5% is thus estimated to return $55 million to $64 million to radiologists each year for the individual component of MPPR alone., Conclusions: Individual-provider MPPR discounting resulted, on average, in more than $2,500 in lost payments per radiologist per year. Its rollback, associated with ACR evidence-based advocacy efforts, is estimated to return well over $50 million in Medicare professional payments to radiologists each year for individual-component MPPR discounting alone., (Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

In early 2015, Sylvia Burwell, Secretary of the Department of Health and Human Services, described the federal administration's goals for delivery of health care in the United States. Prominently featured was a conversion from volume to value through the incorporation of Alternative Payment Models. The Department of Health and Human Services laid the framework, but recognized significant knowledge gaps in how providers and institutions would develop Alternative Payment Models. To that end, the Health Care Payment Learning and Action Network was conceived. On March 25, 2015, the Health Care Payment Learning and Action Network held its first meeting, which included a broad swath of industry participants. This collaboration was considered mission critical to achieving success in the goals of advancing Alternative Payment Models. This article highlights the Health Care Payment Learning and Action Network and the framework it is proposing for Alternative Payment Models that would have meaningful implications for radiologists., (Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs. Early models with relevance to radiologists include Bundled Payment for Care Improvement (involving 48 possible clinical conditions), Comprehensive Care for Joint Replacement (involving knee and hip replacement), and the Oncology Care Model (involving chemotherapy). In July 2016, CMS expanded the range of EPMs through three new models with mandatory hospital participation addressing inpatient and 90-day postdischarge care for acute myocardial infarction, coronary artery bypass graft, and surgical hip and femur fracture treatment. Moreover, some of the EPMs include tracks that allow participating entities to qualify as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act (MACRA), reaping the associated reporting and payment benefits. Even though none of the available EPMs are radiology specific, the models will nevertheless likely influence reimbursements for some radiologists. Thus, radiologists should partner with hospitals and other specialties in care coordination through these episode-based initiatives, thereby having opportunities to apply their imaging expertise to help lower spending while improving quality and overall levels of health., (Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026. Existing APMs are most relevant to primary care physicians, and opportunities for radiologists to participate in Advanced APMs fulfilling Qualified Participant requirements are limited. Physician-Focused Payment Models (PFPMs), as described in MACRA, are APMs that target physicians' Medicare payments based on quality and cost of physician services. PFPMs must address a new issue or specialty compared with existing APMs and will thus foster a more diverse range of APMs encompassing a wider range of specialties. The PFPM Technical Advisory Committee is a new independent agency that will review proposals for new PFPMs and provide recommendations to CMS regarding their approval. The PFPM Technical Advisory Committee comprises largely primary care physicians and health policy experts and is not required to consult clinical experts when reviewing new specialist-proposed PFPMs. As PFPMs provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, radiologists should embrace this new model and actively partner with other stakeholders in developing radiology-relevant PFPMs., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objective: To study differences in imaging utilization downstream to initial emergency department (ED) ultrasound examinations interpreted by radiologists versus nonradiologists., Methods: Using 5% Medicare Research Identifiable Files from 2009 to 2014, we identified episodes where the place of service was "emergency room hospital" and the patient also underwent an ultrasound examination. We determined whether the initial ultrasound was interpreted by a radiologist or nonradiologist and then summed all additional imaging events occurring within 7, 14, and 30 days of each initial ED ultrasound. For each year and each study window, we calculated the mean number of downstream imaging procedures by specialty group., Results: Of 200,357 ED ultrasound events, 163,569 (81.6%) were interpreted by radiologists and 36,788 (18.4%) by nonradiologists. Across all study years, ED patients undergoing ultrasound examinations interpreted by nonradiologists underwent 1.08, 1.22, and 1.34 additional diagnostic imaging studies at 7, 14, and 30 days, respectively (P < .01) compared with when the initial ultrasound examination was interpreted by a radiologist. From 2010 to 2014, the volume of downstream imaging for both radiologists and nonradiologists significantly decreased, with each year resulting in 0.08 fewer imaging examinations (P < .001) 14 days after the ED ultrasound event. Despite that decline, differences in downstream imaging between radiologists and nonradiologists persisted over time., Conclusion: Downstream imaging after an initial ED ultrasound is significantly reduced when the ultrasound examination is interpreted by a radiologist rather than a nonradiologist., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 advances the goal of tying Medicare payments to quality and value. In April 2016, CMS published an initial proposed rule for MACRA, renaming it the Quality Payment Program (QPP). Under QPP, clinicians receive payments through either advanced alternative payment models or the Merit-Based Incentive Payment System (MIPS), a consolidation of existing federal performance programs that applies positive or negative adjustments to fee-for-service payments. Most physicians will participate in MIPS. This review highlights implications of the QPP and MIPS for radiologists. Although MIPS incorporates radiology-specific quality measures, radiologists will also be required to participate in other practice improvement activities, including patient engagement. Recognizing physicians' unique practice patterns, MIPS will provide special considerations in performance evaluation for physicians with limited face-to-face patient interaction. Although such considerations will affect radiologists' likelihood of success under QPP, many practitioners will be ineligible for the considerations under currently proposed criteria. Reporting using qualified clinical data registries will benefit radiologists' performance by allowing expanded arrays of MIPS and non-MIPS specialty-specific measures. A group practice reporting option will substantially reduce administrative burden but introduce new challenges by requiring uniform determination of patient-facing status and performance measurement for all of the group's physicians (diagnostic radiologists, interventional radiologists, and nonradiologists) under the same taxpayer identification number. Given that the initial MIPS performance period begins in 2017, radiologists must begin preparing for QPP and taking actions to ensure their future success under this new quality-based payment system., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Purpose: In implementing the Merit-Based Incentive Payment System (MIPS), CMS will provide special considerations to physicians with infrequent face-to-face patient encounters by reweighting MIPS performance categories to account for the unique circumstances facing these providers. The aim of this study was to determine the impact of varying criteria on the fraction of radiologists who are likely to receive special considerations for performance assessment under MIPS., Methods: Data from the 2014 Medicare Physician and Other Supplier file for 28,710 diagnostic radiologists were used to determine the fraction of radiologists meeting various proposed criteria for receiving special considerations. For each definition, the fraction of patient-facing encounters among all billed codes was determined for those radiologists not receiving special considerations., Results: When using the criterion proposed by CMS that physicians will receive special considerations if billing ≤25 evaluation and management services or surgical codes, 72.0% of diagnostic radiologists would receive special considerations, though such encounters would represent only 2.1% of billed codes among remaining diagnostic radiologists without special considerations. If CMS were to apply an alternative criterion of billing ≤100 evaluation and management codes exclusively, 98.8% of diagnostic radiologists would receive special considerations. At this threshold, patient-facing encounters would represent approximately 10% of billed codes among remaining radiologists without special considerations., Conclusions: The current CMS proposed criterion for special considerations would result in a considerable fraction of radiologists being evaluated on the basis of measures that are not reflective of their practice and beyond their direct control. Alternative criteria could help ensure that radiologists are provided a fair opportunity for success in performance review under the MIPS., (Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The results of a survey sent to practice leaders in the ACR Practice of Radiology Environment Database show that the majority of responding groups will continue to hire recently trained residents and fellows even though they have been unable to take the final ABR diagnostic radiology certifying examination. However, a significant minority of private practice groups will not hire these individuals. The majority of private practices expect the timing change for the ABR certifying examinations to affect their groups' function. In contrast, the majority of academic medical school practices expect little or no impact. Residents and fellows should not expect work time off or protected time to study for the certifying examination or for their maintenance of certification examinations in the future., (Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The 2014 ACR Forum focused on the noneconomic implications of the Affordable Care Act on the field of radiology, with specific attention to the importance of the patient experience, the role of radiology in public and population health, and radiology's role in the effort to lower overall health care costs. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to best prepare the radiology community for the rapidly evolving health care landscape., (Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Imaging 3.0 is a blueprint for the future of radiology modeled after the description of Web 3.0 as "more connected, more open, and more intelligent." Imaging 3.0 involves radiologists' using their expertise to manage all aspects of imaging care to improve patient safety and outcomes and to deliver high-value care. IT tools are critical elements and drivers of success as radiologists embrace the concepts of Imaging 3.0. Organized radiology, specifically the ACR, is the natural convener and resource for the development of this Imaging 3.0 toolkit. The ACR's new Imaging 3.0 Informatics Committee is actively working to develop the informatics tools radiologists need to improve efficiency, deliver more value, and provide quantitative ways to demonstrate their value in new health care delivery and payment systems. This article takes each step of the process of delivering high-value Imaging 3.0 care and outlines the tools available as well as additional resources available to support practicing radiologists. From the moment when imaging is considered through the delivery of a meaningful and actionable report that is communicated to the referring clinician and, when appropriate, to the patient, Imaging 3.0 IT tools will enable radiologists to position themselves as vital constituents in cost-effective, high-value health care., (Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.)