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Wilhelm Roentgen's discovery of the x-ray in late 1895 was relatively quickly shared with the New Orleans community through reports published in 1896 in local newspapers and medical journals. Radiology became popularized through public demonstrations organized by local proponents and was open to both the lay and medical communities. The first clinical x-ray equipment in New Orleans was installed at Charity Hospital in 1896 within the Department of Surgery, and the first examination was performed on December 23, 1896. Initially, those particularly interested in the x-ray phenomenon were photographers and physicists interested in electricity. X-rays were a curiosity, and entrepreneurs set up studios for x-ray photographs and advertised in local newspapers. Early clinical uses were the localization of foreign bodies, particularly bullets, and the evaluation of bones for fractures and other abnormalities. The fluoroscope was quickly adopted by roentgenologists as a faster and easier method for obtaining medical diagnosis but with the disadvantage of the absence of a permanent record. By the early 1910s, the use of x-rays in clinical medicine had been firmly adopted.

This section focuses on the professional workforce comprised of the primary medical specialties that utilize ionizing radiation in their practices. Those discussed include the specialties of radiology and radiation oncology, as well as the subspecialties of radiology, namely diagnostic radiology, interventional radiology, nuclear radiology, and nuclear medicine. These professionals provide essential health care services, for example, the interpretation of imaging studies, the provision of interventional procedures, radionuclide therapeutic treatments, and radiation therapy. In addition, they may be called on to function as part of a radiologic emergency response team to care for potentially exposed persons following radiation events, for example, detonation of a nuclear weapon, nuclear power plant accidents, and transportation incidents. For these reasons, maintenance of an adequate workforce in each of these professions is essential to meeting the nation's future needs. Currently, there is a shortage for all physicians in the medical radiology workforce.

To assess the radiology department chairs' opinions concerning current status and plans for teaching ultrasound to medical students, the American College Taskforce on Radiology Ultrasound Education, commissioned by the American College of Radiology, distributed a survey to 142 radiology chairs and a medical school dean subgroup.The response rate was 30% (42/142), and 76% indicated ultrasound was currently part of the medical student curriculum. In preclinical years, radiology involvement was only 6.4%. During clinical years, radiology led ultrasound education with 51.7% in general and 82.9% in elective rotations. Regarding actual content, top 4 results were evenly distributed between learning hands-on scanning (81.1%), diagnostic use of ultrasound (75.7%), anatomy/pathology (75.7%), and ultrasound guidance for procedures (54.0%). Educational leaders in preclinical courses were emergency medicine (72.7%) followed by radiology (45.4%) physicians. During clinical years, leaders were radiology (52.6%) and emergency medicine (47.4%) physicians. Most chairs stated that knowledge of diagnostic ultrasound should be mandatory (76.2%), stressing the importance of teaching the diagnostic capabilities and uses of ultrasound as the primary goal (78.8%). Perceived barriers to implementation were evenly distributed between lack of space in the curriculum (55.6%), lack of faculty (48.2%), lack of resources (44.4%), and lack of institutional support (40.7%). The American College Taskforce on Radiology Ultrasound Education survey shows that radiology's role in ultrasound undergraduate education occurs almost exclusively during clinical years, and the chairs voice a desire to improve upon this role. Barriers include both intradepartmental (faculty and resources) and institutional (curricular) factors.

Objectives The growing body of evidence suggesting that lifestyle changes and aggressive medical management reduce the risk of strokes in patients with carotid stenosis has fostered interest in noninvasive screening. The objective of this study was to develop recommendations for follow-up carotid ultrasound surveillance of patients with Methods This retrospective observational cohort study includes 2956 patients seen between August 1998 and March 2015 in 4440 visits. Data analysis was restricted to 7710 carotid ultrasounds. Primary outcome was progression of carotid stenosis as defined by the “bulb” method: baseline stenosis of 0%–39% progressed to 40%–59% on subsequent examination, baseline stenosis of 0%–39% progressed to ≥60%, or baseline of 40%–59% progressed to ≥60%. Progression was estimated using Cox proportional hazard ratios and the Kaplan-Meier method. Results More than 10% of patients progressed in the 40%–59% baseline group within 12 months compared to 78 months for the 0%–39% baseline group. Patients who progressed had a higher proportion of peripheral vascular disease, and current/former smoking compared to those who did not. While there were statistically significant correlations between medication classes and comorbidities, none of the medications studied appeared to slow carotid stenosis progression. Conclusions In our experience, for patients with a 0%–39% carotid stenosis, follow-up examination should be performed at 6-year intervals. For patients with 40%–59% carotid stenosis, follow-up should be obtained annually to identify those who progress to a level requiring intervention. Future studies should examine whether study findings can be replicated using other approaches for determining carotid stenosis.

More than 25% of the present radiology workforce, or nearly 8300 radiologists, are actively practicing late-career radiologists. While these individuals could decide to retire from active practice, their continued presence in the workforce helps to maintain adequate and appropriate patient imaging services. To ensure their continued participation, issues important to all late-career radiologists need to be appreciated, discussed, and addressed. These issues include call-duty requirements, compensation, physical and cognitive health, and organized phase-out programs. The gamut of these issues is addressed in this review article. ©RSNA, 2018.

Increasingly, radiologists' workplaces revolve around PACS and digital imaging. Use of these technologies can lead to repetitive strain injuries, many of which can be exacerbated by specific features of a radiology practice environment. Ergonomic approaches, such as proper reading room structure, lighting, temperature, noise, and equipment setup, can help decrease the frequency and severity of repetitive strain injuries and improve radiologist productivity. However, ergonomic approaches are complex, include all aspects of the radiology practice environment, and are best implemented along with proper training of the practicing radiologists. The ergonomic approaches considered most important by members of the ACR Commission on Human Resources are presented in this report, and this information may serve as an aid in departmental planning.

Objectives-The purpose of this study was to determine the incidences and rates of progression of varying degrees of carotid stenosis that do not require intervention according to the Asymptomatic Carotid Atherosclerosis Study, the European Carotid Surgery Trial, and the North American Symptomatic Carotid Endarterectomy Trial, and from this information, to provide evidence-based recommendations for follow-up imaging.

Workplace bullying is common in health care and has recently been reported in both radiology and radiation oncology. The purpose of this article is to increase awareness of bullying and its potential consequences in radiology and radiation oncology. Bullying behavior may involve abuse, humiliation, intimidation, or insults; is usually repetitive; and causes distress in victims. Workplace bullying is more common in health care than in other industries. Surveys of radiation therapists in the United States, student radiographers in England, and physicians-in-training showed that substantial proportions of respondents had been subjected to workplace bullying. No studies were found that addressed workplace bullying specifically in diagnostic radiology or radiation oncology residents. Potential consequences of workplace bullying in health care include anxiety, depression, and health problems in victims; harm to patients as a result of victims' reduced ability to concentrate; and reduced morale and high turnover in the workplace. The Joint Commission has established leadership standards addressing inappropriate behavior, including bullying, in the workplace. The ACR Commission on Human Resources recommends that organizations take steps to prevent bullying. Those steps include education, including education to ensure that the line between the Socratic method and bullying is not crossed, and the establishment of policies to facilitate reporting of bullying and support victims of bullying.

The transition of leadership within radiology practices is often not a planned replacement process with formal development of potential future leaders. To ensure their ongoing success, however, practices need to develop comprehensive succession plans that include a robust developmental program for potential leaders consisting of mentoring, coaching, structured socialization, 360-degree feedback, developmental stretch assignments, job rotation, and formal education. Succession planning and leadership development will be necessary in the future for a practice to be successful in its business relationships and to be financially viable.

Objectives We sought to assess midterm sonographic findings in patients after stenting for hepatic artery stenosis. Methods Thirty-nine hepatic artery stent procedures were performed for hepatic artery stenosis after liver transplantation between September 2009 and December 2013. Thirty cases were technically successful and met the minimum follow-up time (76 days, defined by earliest diagnosed stenosis). Routine ultrasound surveillance was obtained on all patients, and statistical analysis of the findings in the patency and restenosis groups was performed. Results Of the 30 cases, restenosis occurred 9 times in 6 patients. Mean follow-up was 677 days. Mean time to restenosis was 267 days. Five cases (56%) were identified within the first 6 months after stent placement. Four cases (44%) were recognized in the second year after stent placement. Prior to the sonographic diagnosis of restenosis, the mean resistive indices of the main (.64 versus .57, P

Clinical depression affects physicians, including radiologists. Medical professionals, including radiologists, may be more comfortable treating a patient than being one, and psychiatric issues may be regarded as taboo for discussion, so the issue of clinical depression in the specialty and subspecialty has not received widespread attention. Specifically, a review of the national and international literature in PubMed, Scopus, and Google reveals few publications dedicated to the issue of clinical depression in radiology; although statistically, they must exist. The purpose of this report is to define the terms and describe the manifestations and scope of the issues related to clinical depression, with special attention given to risk factors unique to radiologists, such as working in low ambient light or near different fields of magnetic strength. By the end of the article, it is the authors' hope that the reading radiologist will be aware of, and open to, the possibility of clinical depression in a colleague or within his or herself because clinical depression is common and it is important to get help.

Radiologists may choose or need to leave radiology as a career. The purpose of this article is to discuss options available to radiologists beyond their clinical careers.

Burnout is a concern for radiologists. The burnout rate is greater among diagnostic radiologists than the mean for all physicians, while radiation oncologists have a slightly lower burnout rate. Burnout can result in unprofessional behavior, thoughts of suicide, premature retirement, and errors in patient care. Strategies to reduce burnout include addressing the sources of job dissatisfaction, instilling lifestyle balance, finding reasons to work other than money, improving money management, developing a support group, and seeking help when needed.

The objective of our study was to assess utilization of the Family and Medical Leave Act (FMLA) in radiology practices in 2016 and compare with 2015 utilization.The Practice of Radiology Environment Database was used to identify practice leaders, and these leaders were asked to complete the annual American College of Radiology Commission on Human Resources workforce survey. The 2017 survey, which asked about 2016 experiences, again included questions about the number of radiologists in each practice who took FMLA, reasons why, and how absences were covered.Twenty-six percent (477/1811) of practice leaders responded to the survey. Of these respondents, 73% (346/477) answered FMLA questions, and 23% (80/346) of those answered affirmatively that a radiologist in their practice had taken FMLA leave in 2016 (previously 15% in 2015; p = 0.15). The reasons for FMLA leave included taking care of a newborn or adopted child (57%, previously 49%; p = 0.26), personal serious health condition (35%, previously 42%; p = 0.31), caring for an immediate family member (8%, unchanged), and engaging in active military duty (1%, unchanged). Although more women (72%) than men (32%) took FMLA leave for the first reason (p0.01), more men (63%) than women (18%) took FMLA leave for the second (p0.01), and there was no significant difference between women (10%) and men (5%) taking leave to care for an immediate family member (p = 0.18). Most practices (80%) again made no workforce changes to cover absences due to FMLA leave (previously 82%).Utilization of FMLA leave in radiology practices in 2016 was similar to that in 2015 and represents the beginning of longitudinal accrual of data on this important topic for both male and female radiologists.

Background The ACR Commission on Human Resources and Commission on General, Small and Rural Practice collaborated on developing a question regarding hiring preferences to include in the annual Commission on Human Resources Workforce Survey in order to understand hiring preferences. Methods Group leads were asked to rank five types of prospective radiologists from most desirable to least desirable for hire on the basis of the needs of their practices: single-specialty radiologists, focusing on only one subspecialty; single-specialty radiologists with general capabilities; multispecialty radiologists; general radiologists; and radiologists who did two fellowships in the same specialty. Results The most desired hiring preference was for a single-specialty radiologist with general capabilities. Sixty-eight percent of the practice leaders identified a single-specialty radiologist with general capabilities as the most desirable type of individual to hire, compared with 21% who chose multispecialty radiologists, 13% who chose single-specialty radiologists and general radiologists, and 5% who expressed a preference for radiologists who did two fellowships in the same specialty. Conclusions The most desirable candidates for hire appear to be those who are fellowship trained as subspecialists but who are also capable of reading in other clinical areas or modalities. This preference is true for most private practices, multispecialty practices, and hospital-owned practices. In contrast to those practices, chairs and leaders of academic medical center practices prefer to hire single-specialty radiologists slightly more than single-specialty radiologists with general capabilities.

The ACR Commission on Human Resources continues to conduct its annual electronic survey to better understand the present workforce scenario for radiologists.The Practice of Radiology Environment Database was used to identify group leads, who were asked to complete an electronic survey developed by the Commission on Human Resources. The survey asked group leaders to report the number of radiologists they currently employ or supervise, the number hired in 2014, and the numbers they plan to hire in 2015 and 2018. The leaders were asked to report the subspecialty area used as the main reason for hiring each physician, as well as the ages and genders of their current workforce.Thirty-two percent of group leaders responded to the survey, corresponding to 12,079 radiologists or 39% of all practicing radiologists. Twenty-one percent of the workforce is female and 79% is male. Ten percent of radiologists older than 65 years are women, while 32% younger than 35 are women. Twelve percent of radiologists work part-time, corresponding to a breakdown of 10% of men and 24% of women working part-time. The current workforce is 13% general radiologists and 87% subspecialists. In 2015, a projected 1,131 to 1,484 jobs will be available for radiologists.Job opportunities for radiologists seem to be increasing compared with 2013 and are relatively similar to 2014. Radiologists continue to subspecialize in greater numbers, but only 39% of radiologists practice more than 50% of the time in their subspecialties.

Midcareer job transitions are occurring for many reasons other than individual radiologists' professional performance quality, affability, and desire for geographic change. New causes seem to be related to the present health care environment. All radiologists should be aware of this disruptive change to the profession and of the resources available to help job seekers find new positions.

Successful retirement planning requires a determination of which activities and relationships may replace those associated with the current full-employment position. Next, there must be acceptance of leaving the profession behind. Finally, the individual must determine the specific decisions and actions that must be made to transition to successful retirement in the future. To be successful, the entire process should occur over a period of several years. Alternatively, bridge employment may play a significant role in the transition from full-employment to full-time retirement.

Radiologists are faced with ever-increasing challenges in the needs of the practice, in both private and academic settings. Targeted information about protecting and maintaining the physical, mental, and emotional health of the radiologist is highly limited. Impairment is a functional classification that implies that the individual affected by a disease is unable to perform specific activities. Radiologists can suffer from the same illnesses as any human being, which include substance abuse and addiction, as well as chronic infectious diseases such as human immunodeficiency virus, hepatitis B and C, and tuberculosis. This article is intended to educate radiologists and leaders about various forms of physician impairment. It provides discussion of the challenges related to such impairment and provides tools and resources to address the impaired radiologist.

Practice leaders surveyed in the 2017 ACR Human Resources Commission workforce survey reported that 25% of the radiologists or radiation oncologists they supervised had neck pain, 32% had low back pain, and 16% were dealing with a repetitive stress injury. The prevalence rates of these musculoskeletal ailments among radiologists and radiation oncologists were consistent with those reported in the literature in other populations. However, these prevalence rates may be underestimated because practice leaders, not the radiologists themselves, were surveyed, and the leaders may not be aware of all injuries.

The 2017 ACR Workforce Survey included questions for group leaders about management trends and areas in which they need more help from the ACR. Respondents identified point of care ultrasound as the area in which they need the most help. Most respondents gave positive or neutral answers regarding their role in the management of radiology allied health professionals and radiology information technology, and most believed their role and influence in decision making in the organization were not decreasing.

The ACR Commission on Human Resources conducts an annual workforce survey to determine the makeup of the radiology workforce and to identify potential plans for hiring new staff in an attempt to understand our profession better.The Practice of Radiology Environment Database group leaders were asked to complete an electronic survey regarding the makeup of their present workforce by subspecialty, as well as the numbers and types of subspecialists hired in 2016 and the numbers and types of subspecialists expected to be hired in 2017 and 2020. They were also asked about midlevel practitioners.Twenty-six percent of practice leaders (477) representing 11,056 radiologists, 33% of all practicing radiologists in the United States, responded to the survey. The workforce distribution by practice type and radiologists' ages has been relatively stable since 2012. Six percent of the practicing workforce is over the age of 65 years. Sixteen percent of radiologists work part-time, and 21.5% of radiologists are female. The survey results indicate that 1,569 to 2,037 radiologists were hired in 2016. In 2017, 1,826 to 2,370 new job opportunities are anticipated, a 14.1% increase compared with 2016. For 2017, the subspecialists most recruited will be neuroradiologists, general interventionalists, after-hours radiologists, and body imagers. Approximately 2,156 midlevel practitioners are presently working and supervised by radiologists.The 2017 ACR workforce study shows an optimistic picture and outlook for those seeking jobs as practicing radiologists in 2017. For practice leaders, the market will be much more competitive than it has been in past years.

The ACR Commission on Human Resources conducts an annual electronic survey during the first quarter of the year to better understand the present workforce situation for radiologists.We used the Practice of Radiology Environment Database (PRED) to identify 2,067 practice leaders and asked them to complete an electronic survey developed by the Commission on Human Resources. The survey asked group leaders or their designates to report the number of radiologists they currently employ or supervise, the number hired in 2012, and the number they plan to hire in 2013 and 2016. The leaders were also asked to report the subspecialty area that was used as the main reason for hiring that physician.Of the 2,067 practice leaders surveyed, 22% responded, a figure corresponding to 23% of all practicing radiologists in the United States. These results showed that 54% of radiologists are in private practice and 46% are employed by various other entities. The current workforce consists of 21% general radiologists and 79% subspecialists. The largest areas of subspecialty include general interventionalists, neuroradiologists, and body imagers. In 2012, 1,407 radiologists were hired. The greatest number of radiologists hired involved general interventional radiologists, followed by general radiologists, body imagers, and those specializing in musculoskeletal radiology, neuroradiology, and breast imaging. In 2013, 1,526 job opportunities were projected and in 2016, 1,434 job opportunities. In 2013, the most sought-after individuals will be general radiologists, general interventionalists, breast imagers, neuroradiologists, musculoskeletal radiologists, and body imagers.Based on the data collected from the responding practices, the demand for hiring radiologists in 2013 will be similar to 2012. Each of the 1,200 residents who complete their training programs each year should have a position available, but the job may not necessarily be in the subspecialty, geographic area, or type of practice that the individual desires.

Radiologists today are faced with the challenges of maintaining and balancing individual and family health needs and the demands of the workplace. To provide the highest quality and safest care of our patients, a corresponding ethos of support for a healthy workforce is required. There is a paucity of targeted information describing protections for and maintenance of the health of the practicing radiologist, in both private and academic settings. However, a review of existing family and medical leave policies may be helpful to practice leaders and practicing radiologists as a platform for the development of strategic workforce plans. This writing, by members of the ACR Commission on Human Resources, addresses the following areas: (1) medical leave, (2) maternity and/or paternity leave, and (3) disability.

Merely suggesting that radiologists answer the call to bolster and secure the future of their own specialty has not resulted in increased activism. Therefore, the ACR Commission on Human Resources has developed a definition for the concept of citizenship in radiology and explicit descriptions of the activities associated with it. Furthermore, the authors introduce a methodology for the measurement and valuation of individual radiologists' contributions to group practices and to the specialty as a whole. These measures can in turn be used to promote, acknowledge, recognize, and incentivize citizenship activity among radiologists at the local, regional, and national levels.

BackgroundHepatic artery stenosis (HAS) after orthotopic liver transplantation is a significant risk factor for subsequent hepatic artery thrombosis (HAT). HAT is associated with a 30%-50% risk of liver failure culminating in retransplantation or death. Traditional treatment of hepatic artery complications has been surgical, with hepatic artery revision or retransplantation. Endovascular therapy of HAS, described primarily in the interventional radiology literature, may provide a less-invasive treatment option.MethodsThis was a retrospective review of all endovascular interventions performed for HAS after orthotopic liver transplantation over a 31-month period (August 2009 to January 2012). Patients with duplex ultrasound imaging evidence of severe main HAS (peak systolic velocity of >400 cm/s, resistive index of

Retirement and issues associated with the initiation of retirement have undergone extensive change in the past decade. Multiple factors, including economic conditions, have resulted in a delay in the initiation of retirement. Delayed retirement of senior radiologists is a factor contributing to a diminished job market for entering radiology graduates. These senior radiologists have extensive experience in operational issues and understanding complex relationships with other health professionals, hospitals, and often medical schools. In addition, although they may not be as facile with MRI or PET/CT, senior radiologists have a tremendous command of traditional imaging, which is lacking in recently trained radiologists. The authors examine many of the issues related to delayed retirement and propose some possible solutions.

OBJECTIVE. The risk of injury associated with long-term occupational exposure to ionizing radiation is low for radiologists. The purpose of this article is to systematically review and inform radiologists about radiation-related effects to which they are potentially susceptible. CONCLUSION. Formal education and training on radiation safety and management, careful attention to good radiation protection habits, and continued emphasis on radiation management and the as low as reasonably achievable principle are recommended for all radiologists.

Purpose Despite federal and state laws mandating lactation facilities for eligible employers, no reliable data exist regarding the availability of lactation facilities in the radiology workforce. To fill this void, the ACR Commission on Human Resources added new questions to its annual electronic survey to better understand this aspect of the workforce situation for radiologists. Methods As done annually, the Practice of Radiology Environment Database was utilized to identify leaders of radiology practices, who were asked to complete an electronic survey developed by the ACR Commission on Human Resources. Among other questions, leaders were asked, "Does your radiology or radiation oncology practice have a dedicated lactation facility?" Results Overall, 579 of 1,815 (32%) practice group leaders responded to the survey. Of 579, 394 responded to lactation question. Of 394, 51 (13%) reported affirmatively that they do have dedicated lactation facilities, and 343 of 394 (87%) responded that they do not have dedicated lactation facilities. Conclusion The vast majority of radiology and radiation oncology practices in the United States do not have dedicated lactation facilities; given the numerous benefits to breastfeeding mothers and babies, this impacts not only women but also men given that they too would like to have healthy colleagues with minimal absenteeism.

The number of 4th-year medical student applications to the field of diagnostic radiology has decreased from 2009 to 2015. The purpose of this study was to learn how radiology departments are recruiting medical students.An anonymous online survey hyperlink was distributed to the members of the Society of Chairs of Academic Radiology Departments regarding both innovative and proven recruitment strategies. The results were synthesized with a recently published survey of medical students about factors influencing them to go into radiology.Forty of 126 radiology departments completed the survey. Most felt that radiology exposure and curricula require alteration given recent downward trends in medical student applications. A majority (79%) had changed their outreach to medical students in response to these trends. The responding department chairs felt that interactive learning while on rotation was the most important strategy for recruitment. The presence of a diversity program, dedicated medical school educator, or rotating daily assignment for students did not affect the likelihood of filling residency spots in the main match.Many radiology departments are changing their outreach to medical students to improve recruitment. Effective strategies to focus on include early active outreach by involving students in the radiology department, thereby framing radiologists as clinicians.

Purpose To assess gender utilization of the Family and Medical Leave Act (FMLA) in radiology practices across the United States. Methods The Practice of Radiology Environment Database was utilized to identify U.S. practice leaders, who were asked to complete an electronic survey developed by the ACR Human Resources (HR) Commission. In 2016, new survey questions asked about number of radiologists in each practice who took FMLA, the reasons why, the average number of weeks taken, and how such absences were covered. Results Thirty-two percent (579/1815) of practice group leaders responded to the survey and of these, 73% (432/579) answered FMLA questions, with 15% of those (64/432) answering affirmatively that a radiologist in their practice had taken FMLA leave. Reasons for this in 2015 included to care for a newborn/adopted child (49%), because of a personal serious health condition (42%), to care for an immediate family member (8%), or for active military duty (1%). Women took a greater number of weeks of FMLA leave than men for all reasons (care of newborn/adopted child: 10.7 versus 4.7; personal serious health condition: 10.3 versus 8.0; care of immediate family member: 9.7 versus 8.7) except for military duty (24 weeks taken, all by men). At least 69% of leave time was paid, irrespective of reason for leave or gender of person taking it. Most practices (82%) made no workforce changes to cover FMLA leave. Conclusions Both genders of radiologists needed absences from work for FMLA-sanctioned reasons.