Some may call me a Luddite when it comes to technology, but they'd be wrong. I don't resist new gadgets, apps and electronics to flout change and progress. I shun them because of their learning curve. This cursed curve is like an anchor on a moving boat-it slows the path to smooth sailing until you can haul it up and put it in its place.

In some cases, the anchor wins and I jump ship altogether. I don't speed dial on my cell phone (well, until my husband noticed, sighed in pity, then hooked me up-in less than three minutes). And you can forget about texting me. If you try, chances are I won't get your message until some time in April. I can barely work the TiVo, much less figure out which remote turns on the tube. Oh, and just when I figured out how to program the VCR, they go and switch to DVDs. (Kidding! You didn't really think I figured that out, did you?)

I have many reasons for this techno trouble: lack of patience, challenged attention span, little time-and a ton of other equally lame excuses. Honestly, it's a wonder I ever traded a typewriter in for a computer years ago. But I did, and I love my shiny black laptop as much as the smell of an old book in my hands. Which brings me to my point: I can embrace technology once I scale that learning curve, and I will convert to new technologies if: 1. It is easy. 2. I may be missing out on something good. Or, 3. I have no choice.

Take Facebook (where 1 and 2 apply). My first impression of this social networking Web site where you connect with new and old friends was, "Eh. Nah." I had never even glimpsed at MySpace and thought Twitter meant something naughty. Plus, I can't even keep up with e-mail, and the thought of having more cyber commitments to a slew of multiplying friends sounded overwhelming.

Then one day my husband, who knew I'd like it, threw his hands in the air and just signed me up. In minutes, I was like a kid eating Smarties-tentative at first, lips pursed, then...addicted. The trick, my patient techno-tamer advised, was to keep posts short. The longer you fret over what to write, the less you'll want to partake.

I'm still fairly new to the Facebook scene and its myriad hidden treasures. But unlike nonintuitive technologies, I enjoy tinkering with this growing Web phenomenon. I also like hearing from old chums, swapping advice, spotting news leads and always learning something new.

Just as you can "friend" people on Facebook, you can also "fan" companies. ADVANCE for Imaging & Oncology joined awhile ago and guess who's captain? Admittedly, my navigation skills still need honing, but I enjoy the connectivity, networking and community it fosters in our field. Same goes for Twitter.

So, come sail and fly with us via these social networking venues, and let me know how you like the ride. Just don't text me about it.

Big topics at both shows centered on the economy, health care reform, the specialty's future and new technologies that are continuing to gain momentum---nanotechnologies, molecular imaging, IMRT, IGRT, VMAT, proton therapy, new advances in brachytherapy and more. In the main exhibit hall and within sessions, there was also a steady hum about comparative effectiveness (i.e., outcomes) and appropriate use of treatment options, especially IMRT, whose utilization has skyrocketed since its inception, so much so that it's now on the radar of the House Ways and Means Committee.

But despite concerns and uncertainties plaguing the field (which made for an aptly titled "Winds of Change" SROA conference theme), SROA attendees found a lighter side for winding down. Among events were the Halloween party the first night, a dinner and Spirit of Chicago cruise/president's party on Tuesday night, several networking receptions and private get-togethers among attendees, and a mentalist to entertain and boggle the mind at the Quality Luncheon on Tuesday. How he knew that Darrin Kistler, SROA president from 2006-07, read the word "pasted" from a random book is beyond me.

Moving from downtime to down on the times (humor me and roll with that transition) is the growing fear and loathing of health care reform among Americans. One take-home message on the topic is that health care is going to cost us regardless of where we're headed. "Some say [the future] will be more expensive with reform," says David S. Hefner, MPA, senior advisor for Healthcare Innovation, Association of American Medical Colleges and Council of Teaching Hospitals, "but it will be more expensive no matter what."

While last year's message among the general public was "Yes we can!" now it's "Don't euthanize grandma!" he joked during his reform talk. Fear is a powerful deterrent indeed. He also added that dialog needs to shift to payment and utilization reform, which so far has remained in the margins.

According to Paul Wallner, DO, senior vice president of 21^st Century Oncology, another take-home message is that reform probably won't affect radiation oncology on a day-to-day basis ... but that also remains to be seen.

Dr. Wallner, who gave the SROA talk, "Changes in the Economics of Radiation Oncology over the Next Five Years," shared several additional concerns facing the field:

• Radiation oncology has not been able to show significant differences in treatment with IMRT and IGRT. "We need to prove these thing work," he says, "or we're not going to get paid for them."
• The field is losing sight of the new conversion factor--$28 down from $36, which is a real hit for facilities. While some say it won't happen, Dr. Wallner says it could.
• There's a "stealth attack" in rad onc by surgeons involving the 62 modifier. This modifier raises reimbursement to 120 percent of the Medicare allowable and allows surgeons to get half. Rad onc, however says no thanks to this intrusion.
• Also a concern: Who owns your rad onc facility? Those owned by docs outside of the field can pose serious turf incursions ... and cause Dr. Wallner to define chutzpah in colorful new ways, he admitted.
• More rad onc benefits managers (ROBMs) are entering the scene, requiring modality precertifications, time/dose precertifications, technology limits and bundled payments, which could compromise care.

With these and other challenges, the call for leadership remains strong in radiation oncology. Of course, riding the winds of change isn't easy--even with your best pair of Levis on.

From tissue engineering to words so moving they required tissues, highlights of today's ASTRO meeting centered on a mix of awe-inspiring technical updates and heartfelt reminders of why docs enter the rad onc field to begin with.

In Keynote Address 1, "Advances in Drug Delivery and Tissue Engineering," the highly renowned Robert S. Langer, ScD, a David H. Koch Institute Professor at MIT, discussed treatment possibilities with new drug delivery technologies including novel polymers and intelligent microchips to target cancer, heart disease and other illnesses. He also highlighted new approaches under development that combine mammalian cells with synthetic polymers to help repair tissues for patients with burns, damaged cartilage, paralysis and vascular disease.

Among advances, he described a dime-sized microchip designed to remain in the body for years. The technology, used in animal research, could potentially serve as a pharmacy-on-a-chip device through which different drugs could be released at different times via telemetry. He also discussed the marvels of tissue engineering-using patient's own cells (bone, cartilage, stem cells) to create virtually any tissue.

 His slides wowed, evident through random midlecture applause and occasional whoops normally reserved for concerts and sporting events. We saw the creation of a human ear later sported by a rabbit, a young boy with a new chest, a toddler whose severe burns were replaced with new skin, and a rat whose previously paralyzed leg regained a good amount of function. Never mind the economy and World Series woes (if you're a nervous Phillies fan, that is); we need to bask in the brightness of these amazing treatment possibilities.

Also wowing attendees, Tim R. Williams, MD, outlined the many facets of physician responsibility in his ASTRO Presidential Address, "The Contract."

"Patients want us to be there for them when they get sick," said Dr. Williams, a radiation oncologist at Boca Raton (Fla.) Community Hospital, "and that's not asking too much."

Such care involves compassion, to be sure, but it also requires something more-experience and acumen. Recalling a patient who hauled in a shopping bag full of literature, including 50 pages of hand-written notes on prostate cancer, Dr. Williams shared: "Data is not necessarily information, and information is not necessarily understanding, and understanding is not necessarily knowledge, and knowledge is not necessarily wisdom."

He also added that while every doctor must be part businessman-after all, they live in the real world, too-the unwritten physician-patient contract stipulates that patients come first.

"We have to be very careful about the Faustian bargain that all doctors make with society," he warned. "As long we put the patients first and only care about their interests, everything else will take care of itself."

He closed with a story about a 6-year-old patient named Diana whom he treated as a resident more than 20 years ago; she had a terminal brain tumor. Shortly before she died, he made a house call to the trailer where she lived. She was lying on the sofa, surrounded by candles and religious ephemera.

"I didn't know what to tell her, but I did mumble a few words. I told her I was sorry I couldn't do anything more for her but that soon she wouldn't have to worry about the nausea any more, and her headaches would go away, and she'd find herself around a lot of really nice people," he recalled. "But that didn't seem to be enough for the moment. It was pathetically inadequate ... So I told her that if I ever amounted to anything in my life that I would never forget her. And that I would always do the best job I could for the patients that I took care of, and that going into the future I would always try to [honor] the Faustian bargain and make sure I kept the patients close to me and do everything I could to make them better."

"I think about Diana once in a while," he added, "and I've always wanted to be able to someday, in Valhalla, tell her that I've honored the contract."

The American Society for Radiation Therapists (ASRT) Radiation Therapy Conference began with a big bang in Howard Dean, MD, former practicing internist, 2004 U.S. presidential candidate and six-term governor of the Vermont, the Green Mountain state. Dr. Dean, with his unique background in medicine and politics, shared insights on "America's Health Care."

To understand how we may, as a nation, revolutionize the health care system, Dr. Dean says we have to gain a better understanding of our past and our future. Noting that employer-based health insurance evolved long ago--during World War II, in fact--he assured attendees that change would not come quickly or easily. However, with a new generation of service-oriented and moderate young voters, there's much promise for development. The generation of today that elected President Barack Obama, believes in working "across broad [partisan] lines to get things done." With values in the right place, young [under 35] Americans want to work together to come up with solutions, Dr. Dean says with excitement. "Changes never happen from the top down. It's always from the bottom up."

So while discussion of health reform seems to be playing out in a rather political, partisan manner, the new generation of centrists will demand more from Washington. They'll demand simple choice and a need for change. Dr. Dean says this will happen when "the fear of change is exceeded by the pain of staying the same."

"If you want real reform," says Dr. Dean, "let the people choose." His "Dr. Dinosaur" public option program in Vermont insured 96 percent of all children, with 99 percent eligible to receive care if their families made less than $66,000 annually. Public option will vastly improve uninsured rates and offer a much-needed boost for small businesses, although he notes other big problems that need solving: reimbursement rates (especially for primary care physicians) and the repercussions of the fee-for-service model. He also stressed the importance of a wellness model of care, as well as grassroots efforts to spur real health care choice.

Dr. Dean conjectured that since radiotherapy is a core service, system of payment and cost control changes shouldn't have that huge of an effect on the specialty in the immediate future. Paul Wallner, DO, who followed Dr. Dean with a presentation on "Changes on the Economics of Radiation Oncology Over the Next Five Years," did not want to speculate on effects of Congress-initiated changes in the works. He simply admitted he wasn't sure that new policy would actually impact radiation oncology greatly on a day-to-day basis.

Dr. Wallner spoke about the unsustainable rising of health care expenses, and how increased utilization of many radiation oncology technologies are contributing to this problem. The penetration of new technologies such as 3-D CRT, IRMT and particle-beam RT escalate costs without substantial proof of improved patient outcomes. IMRT, in fact, is the single fasted growing code in health care, he reports, noting a 10-fold increase of utilization in the past 10 years.

"Efficacy by proclamation" is no longer flying for payers and regulators, he warns. Critical issues face us, including CPT code and RVU changes, political agendas and the state of the economy, for a start. Comparative effectiveness research and radiation oncology benefits management are on the near horizon and will play a large role.

The future of our field as it relates especially to legislative and regulatory changes is uncertain. This week in Chicago, radiation oncology's greatest minds will make predictions--and provide professionals with the information they need to seek success in this complicated climate.

The issue of physician extenders (PE) in radiology--including specialized radiologic technologists--took center stage with a key Friday session of the 24^th annual Economics of Diagnostic Imaging conference. The topic was certainly a timely one: 49 percent of the 180-plus attendees of the Arlington, Va., symposium indicated that they already employ some form of PE in their radiology practice.

“I’m a true believer that appropriately trained and supervised physician extenders can really enhance a practice,” said Richard Duszak, MD, FACR, vice chair of the American College of Radiology (ACR) Commission on Economics. Dr. Duszak detailed ways in which practices can use various types of PEs--radiologist assistants (RAs), radiology practitioner assistants (RPAs), nurse practitioners (NPs) and physician assistants (PAs)--to realize lifestyle benefits (create more time off for practice radiologists), increase professional satisfaction (free up physician time for higher-intensity services) and derive economic benefit.

Dr. Duszak spent much of his session identifying the unique characteristics of the various PEs, separating them into two categories--non-autonomous practitioners (RAs and RPAs) and semi-autonomous practitioners (NPs and PAs).

RAs are advanced-level technologists from baccalaureate or masters programs (11 RA programs exist nationwide). They take responsibility for patient assessment, education and management; perform fluoroscopy and other radiologic procedures; and make initial image observations. They’re unable to perform interpretations (preliminary or final) of any radiology exam or transmit observations other than those of the supervising radiologist. RAs are certified by the American Registry of Radiologic Technologists (ARRT) and recognized by the ARRT and the American College of Radiology (ACR). While the RA position is recognized in at least 11 states, RAs aren’t recognized by Medicare as mid-level practitioners--an important distinction, noted Dr. Duszak.

RPAs, by comparison, are the product of a single baccalaureate program that was formerly what he characterized as a “rigorous” nondegree program: Weber State University in Ogden, Utah (the program also now meets criteria for RA designation). RPAs have one certification body: the Certification Board for Radiology Practitioner Assistants (CBRPA). The ACR, said Dr. Duszak, lacks a position statement on RPAs and didn’t provide input into the program at the time of its development. Dr. Duszak described RPAs as having a scope of practice that is flexible to permit expansion as well as a measure of independence in clinical performance and decision making. At least three states recognize the RPA designation, he said, but Medicare doesn’t recognize RPAs as mid-level practitioners--rendering practices unable to bill Medicare directly for their services.

While RAs and RPAs can facilitate GI fluoroscopy in the inpatient setting, they can’t perform it on Medicare outpatients. Neither RAs nor RPAs can perform GI fluoroscopy in the office setting, place a peripherally inserted central catheter (PICC) or interpret imaging studies.

Dr. Duszak cautioned that both positions have a narrow window of use. He also cautioned practices that use RAs and RPAs in ways that aren’t fully compliant with federal and state statutes. He noted that inter-society dialogue continues with the hope that the RPA designation will be incorporated into the RA designation. He also expressed doubt that Medicare will recognize these positions as mid-level practitioners in the near future. Still, he said RAs--which, like RPAs, command an average salary of roughly $80,000 to $100,000--were “a huge asset” to his former radiology practice in Pennsylvania.

Turning to semi-autonomous practitioners, Dr. Duszak noted that both NPs (mid-level practitioners who are RNs with master’s degrees) and PAs (mid-level practitioners who complete what he characterized as a “medical school minus” master’s program) are recognized by Medicare and most state medical boards. Both practitioners can perform PICC lines as well as spine and joint injections; neither type of practitioner can supervise diagnostic studies nor, in many jurisdictions, interpret imaging studies. NPs command an average salary of roughly $73,200, with PAs earning an average of roughly $84,400, he said. Dr. Duszak recounted his former practice’s success with hiring two PAs for interventional radiology during a “difficult” physician recruiting environment and amid a desire to expand clinical services. Although PA billing proved to be less than the combined salary and benefits of the two positions, he said his practice derived major economic benefits in the form of freed-up physician time, improved clinical service and increased referrals.

Better service was a key point in a subsequent talk delivered by Frank J. Lexa, MD, MBA. He described how radiologists can prevent their practices from becoming a commodity--a mass-produced, unspecialized product that he called
“a business failure”--and add value in health care to re-establish a “contract of trust” with patients.

“Almost anything can be decommoditized if you understand your industry … [and] what people want from you,” said Dr. Lexa, clinical professor of radiology at the University of Pennsylvania Medical Center and adjunct professor of marketing at The Wharton School. He suggested conducting more public outreach efforts and surveying patients with easy-to-complete forms to gauge their expectations. He noted that technologists are more important than front-desk personnel for allaying patient fears and making personal contact--key components in any practice’s decommoditization effort. “I think we can do great things if we [become] something besides being people who put words beside images [in reports],” said Dr. Lexa.

“Hope we don’t scare you too much before Halloween,” cracked program director Lawrence R. Muroff, MD, as he kicked off Thursday’s opening session of the Economics of Diagnostic Imaging 2009 conference. “But turbulent times [are] ahead.”

He wasn’t telling the 180-plus attendees anything the symposium’s subtitle--“Strategies for Success in an Uncertain Economy”--didn’t already portend. Clearly, neither Dr. Muroff nor any of the other speakers at the 24^th annual conference in Arlington, Va., were interested in fear-mongering. Quite the contrary. Their take-home message was this: Don’t be afraid; be prepared.

No one’s quite sure how looming health care reform will impact the medical imaging profession, as components of the plans being bandied about by the House and Senate are in a state of constant flux. “No [plan] will simultaneously decrease cost, increase access, and do all the wonderful things we hope for,” said Frank J. Lexa, MD, MBA, clinical professor of radiology at the University of Pennsylvania Medical Center, who outlined the impact of the 2008 election on radiology practices. Dr. Lexa, who’s also an adjunct professor of marketing at the Wharton School, said the state-level health care reform passed in 2006 by Massachusetts--a reform that is now marked by nine-digit budget shortfalls that are expected to surpass $1 billion by 2010--foretells what could occur after federal reform is passed. Dr. Lexa also said he’s concerned regarding the long-debated public option, which he feels could push out private insurers in a decade. With some form of sweeping reform primed to pass in the House and Senate without the need for a single Republican vote, Dr. Lexa urged radiologists to prepare for continued revenue reductions; re-evaluate costs, contracts and service offerings; and increase their political and societal involvement.

That last sentiment was echoed strongly by Dr. Muroff and David C. Levin, MD, FACR, professor and chairman (emeritus) of the department of radiology at Thomas Jefferson University Hospital. Support a Congressman through individual and societal campaign contributions, he said, and your legislative concerns will be heard. “It’s a sad thing that our democracy is for sale,” said Dr. Levin, “but money talks.” Dr. Muroff added that the trial lawyer wife of one prominent radiologist once told him she was shocked that individual radiologists don’t contribute more money to candidates. If they did, she said, they would be a nigh-unstoppable political force. “The bottom line is, it’s appalling what we [radiologists give],” said Dr. Muroff. “We should expect what’s being done to us at the state and federal level.” Dr. Levin did offer a few encouraging developments for radiology, however. They included an increased awareness on the part of a few legislators regarding the ills of self-referral; and the required accreditation (courtesy of the Medicare Improvements for Patients and Providers Act of 2008, or MIPPA) for all providers of advanced imaging by 2012.

The American College of Radiology (ACR) hopes to become one of those accrediting organizations, said Harvey L. Neiman, MD, FACR, executive director of the ACR. Outlining the College’s legislative initiatives for health care reform--which include expanding the use of appropriateness criteria as an alternative to the controversial radiology benefit managers (RBMs)--Dr. Neiman remarked, “We have no allies … it’s us against the world, and that presents significant problems for us.” His remark elicited knowing chuckles from the audience. Relating a recent meeting with representatives of the Obama administration--which has proposed $260 million over 10 years to support RBM preauthorization in Medicare--Dr. Neiman observed, “The administration clearly has its agenda … I’m [just] not sure it’s in the direction we would agree with.”

The Society of  Diagnostic Medical Sonography's Annual Conference kicked into high gear this weekend with sessions and events designed for inspiring, learning, shopping, honoring and entertaining.

 Inspiring

After the official welcoming address from outgoing SDMS President Shannon Boswell, Victoria Labalme took the stage to deliver Friday morning's Keynote Address, titled "Crazy, Busy, Nuts: Getting Off the Conveyor Belt of Life." 

"What are we running from and what are we running to in our lives, and how do we get off this crazy conveyor belt of life we're on?" Labalme asked in her presentation's central question.  Invoking the imaging of a prism in an entertaining, humorus, fun-filled talk, Labalme told her audience of several hundred that they'll find the answer ultimately by focusing on three key aspects of all relationships: how they look, how they listen and how they love---in relation to both themselves and to others.  "We need to celebrate the people in our lives and we need to celebrate ourselves," Labalme said. "There's so much we wish we were or weren't. We need to ask ourselves, why do I so infrequently want to be the person I am?"

Labalme was followed by Kevin Evans, PhD, FSDMS, who delivered the McLaughlin Memorial Lecture. Titled "The Crisis of Leadership: Relighting the Volunteer Spirit," Evans' presentation served as part call to action and part tribute to his friend and mentor, Stephen McLaughlin, an SDMS luminary who died of brain cancer in 2005, as he encouraged his audience to make service and volunteerism within their chosen field a priority in their lives.

"As a leader, are you building a strong resume or are you building a strong legacy?" Dr. Evans asked in his 50-minute presentation, in which he repeatedly referred to McLaughlin as a prime example of the kind of capable, inspiring leader urgently needed to help the SDMS, and sonography in general, to move forward in the years ahead.

 Learning

Laurence Needleman's General Session, titled Understanding Arterial Stenosis: Clinical Significance, Sonography and Doppler Diagnosis and Interpretation, closed out Friday morning's offerings but kicked off the conference's central educational sessions that ran throughout the rest of Friday, Saturday and Sunday. Attendees could choose from more than 53 sessions offered in four tracks: abdominal, cardiac, Ob-Gyn and vascular sonography.

 "I just came from the session on emergency ultrasound imaging and that was really interesting," Alison Flynt, manager of ultrasound at Tallahassee (Fla.) Memorial Hospital, said Saturday morning. "The courses on neonatal and MSK ultrasound were also very interesting."

The SDMS conference is "great, and it always gives you the most up-to-date information," said Kate Davie, BS, RDMS, a sonographer at Greenville (S.C.) Memorial Hospital, as she toured the exhibit hall on Friday with fellow sonographers Wendy Storm, RT(R), RDMS, RVT; of Monroe, La.; and Meredith Harris, BS, RDMS, Davie's co-worker at Greevnille Memorial.

Shopping

There were, in fact, some shoppers in attendance. Flynt, for her part, said she was intent on checking out options for new ultrasound technology to replace some of her department's equipment, which is getting a little long in the tooth. "A lot of our equipment is seven years old," she said, noting that buying decisions are getting harder to put off despite the tough economy. "We need to bring some musculoskeletal ultrasound into our department," she said. 

Depending on who you spoke to among the vendors, meanwhile, traffic in the SDMS Exhibit Hall was up, down or about the same as last year's.

"I think it's definitely slower at this point," said Courtney Ernst, manager of clinical science and applications, ultrasound, for Hitachi Medical Systems America Inc., as she stood beside the company's booth, which featured live demonstrations of sonography technology. "I also think its a lot smaller this year," Ernst added, in terms of overall vendor attendance and booth sizes. According to SDMS officials, about 65 vendors participated in the exhibitors hall this year. "We're getting a lot interest in our elastography, but we're still hearing a lot of 'we have budget freezes in place.' We've been here a day and a half and gotten maybe two leads," Ernst said.

Over at the Toshiba booth, meanwhile, Cassie Beck Murvay, ultrasound product manager, said Friday morning that traffic at her booth was "probably about the same as last year. It's definitely just as busy as it was last night." (Thursday was the Grand Opening of the Exhibit Hall.).  Several staffing companies, such as Aureus Medical Group and Resouces on Call, said they were getting many inquiries about opportunities, especially from the sizable student contingent at this year's conference.

Honoring and Partying

The SDMS also took time out to honor its own. Friday evening's Awards Dinner recognized the achievements and contributions of sonographers and students from around the United States. The awards dinner was followed by the "Tennesee Two-Step," an evening of dancing and partying to the live country music of Layne Wrye.

Be sure to check out additional information and photos from the SDMS conference and events coming soon to the ADVANCE website. And if you attended the SDMS conference let us know in the comments section what you thought of the conference!

The SDMS took some time Friday evening to honor the achievements and contributions of its professional members as well as up-and-coming sonography students. Following is a list of the major awards and honors presented at the SDMS Awards Dinner:

2009 Fellow Designations

Robert DeJong, RDMS, RDCS, RVT, FSDMS

Pamela Foy, BS, RDMS, FSDMS

Stephen McLaughlin Memorial Lectureship:

Kevin Evans, PhD, RT(R)(M)(BD), RDMS, RVS, FSDMS, delivered this lecture named to honor one of the professionals leading luminaries, who died of a brain tumor in 2005. Dr. Evans' presentation was titled The Crisis of Leadership: Relighting the Volunteer Spirit.

W. Frederick Sample Student Excellence Awards--These awards acknowledge outstanding achievement in writing in the field of diagnostic medical sonography. The award is named in memory of W. Frederick Sample, MD, whose tremendous contributions to the growth and development of the field of sonography have influenced all sonographers and physicians. Because of Dr. Sample's dedication to teaching and research, this award is given to outstanding students in diagnostic medical sonography.

1st Place: Alison Freeberg: False Positive Outcomes of Standard Morphological Imaging Predictors of Fetal Aortic Coarctation

2nd Place: Erika Hutson: An Examination as to the Usefulness of Tourniquet Application When Mapping Upper Extremity Veins for Hemodialysis Assess

1st Place: Bailey Nelson: Fetal Intra-abdominal Umbilical Vein Varix: A Review of the Literature

2nd Place: Tess Mansour: Ultrasound Microbubble Contrast and Liver Applications: A Literature Review

Kenneth R. Gottesfeld Award--This award is presented annually in memory of Kenneth R. Gottesfeld, MD, a founding father in obstetrical sonography. Honorees are recognized for superior writing and contributions to the Journal of Diagnostic Medical Sonography in 2008. Congratulations to the Gottesfeld recipients:

First Place: Kevin D. Evans, PhD, RT(R)(M)(BD), RDMS, RVS, FSDMS; Yvette Ramos, RDMS, RVT, for Image Segmentation for Evaluating Axillary Lymph Nodes

Second Place: Ted Scott, MAppSc, RDMS, RDCS, RVT; Jaime Huff, RDCS; Judy Jones, BSc, RDMS, RDCS, for Increasing the Detection Rate of Normal Fetal Cardiac Structures: A Real-Time Approach

Third Place: Lisa Smith, RDMS; Andrea Perron, RDMS; Angela Perisco, RDMS; for Enhancing Image Quality Using Advanced Signal Processing Techniques

Scientific Presentation Competition-- Authors submit original presentation summary papers, which address clinical research, educational techniques, patient care, sonography department management, case studies presenting a diagnostic challenge, or other areas related to diagnostic medical sonography.

First  Place: Eun Jung Park, for First-Trimester Ultrasound Screening For Fetal Aneuploidy in Twin Pregnancy

Sonographer and Student Poster Competitions--Student

First Place: Kathryn Zale, Ohio State University, Utilizing Power Doppler to Detect Arteriole Blood Flow in the Nerve and Muscle of a Subject

Second Place, Ashley Gilko, Cynthia Medley, Jessica DeLaney and Meghan Dotson, Vanderbilt University Medical Center Diagnostic Medical Sonography Program, for Achy, Breaky Heart

Third Place, Jean Wright and Karen Brown, Kettering College of Medical Arts Sonography Program, for What's Holding You Back? Rendering the Perceptions of 3D/4D Sonography

Sonographer and Student Poster Competitions--Sonographer

First Place: Susan Gomien, RDMS, of Cincinnatti, Ohio, for Echocardiographic Findings in Fetuses with Vascular Lesions or Malformations

Second Place:Regina Keller, RDMS, RDCS, RVT, of Mason, Ohio, for Comparison of Ventricular Cardiac Output in Fetuses with Coarctation

Third Place: Christine Schulte, RDCS, of Cincinnatti, Ohio, for The Preeminent Role of Echocardiography in Kawasaki Disease.

Known for the sounds of country music that have earned it the well-deserved moniker of "Music City, USA," Nashville is playing host to sounds of a different sort this week as it welcomes more than 1,100 sonographers and sonography students to the Society of Diagnostic Medical Sonography's Annual Conference.

The SDMS event, being held at the Gaylord Opryland Resort and Convention Center through Sunday, kicked off Thursday with the pre-conference Student Conclave, Educators Tutorial, and a wide range of tutorials for sonography educators and professionals in four sonographic imaging tracks: abdominal, cardiac, ob.gyn and vascular. Attendees began gathering by 7 a.m. for the sessions that got under way at 8 a.m. sharp.

Now in its third year, having been initiated at the Denver conference two years ago, the Student Conclave featured seven 50-minute sessions designed to answer every student's ever-present question on just about every subject: Why do I need to learn this, anyway?

Frank Miele, for example, delivered a surprisingly entertaining session titled "Math and Everyday LIfe: The Mathematical Perspective All Students Should Know." Admittedly, some of the 300-plus students attending the 8 a.m. class spent much of the time texting friends, sipping coffee or bottles of water and whispering to neighbors, but many others laughed along with Miele's efforts to put a humorous spin on the importance of math not just to every day life chores like balancing the checkbook and calculating how much soil to buy for a landscaping project, but also to sonography, where accurate volume and other calculations are essential.

"I think math is a fear for just about everyone, but he broke it down to a point where I could really understand it a lot better," said Julie Bartlett, RT(R), of Bowling Green, Ky., who attended the Student Conclave with fellow student Leann Wiesemann, RT(R), also of Bowling Green; and their instructor, Angie Mullins, RDMS, RT(R(M)(S), of Bowling Green Technical College. Bartlett and Wiesemann both graduated from X-ray school in May and ar now on track to earn their RDMS by June, they said, in an effort to enhance their marketability.

"It makes us much more marketable," Bartlett said as her friend nodded. Asked if they were concerned about getting a job atter graduation in light of the current recession, Wiesemann said, "Of course!"

"But we do have time for it (the economy) to bounce back again," added Bartlett.

Students also got a chance to demonstrate their knowledge of ultrasound with a lively afternoon game of "Ultra-Jeopardy." Hosted by Marianna Desmond, BS, RDMS, RT(R), clinical coordinator of diagnostic medical sonography at Triton College of River Grove, Ill., and Cathie Rienzo, MS, RDMS, RT(R), pogram director of sonography at Northampton Community College of Bethlehem, Pa., the game pitted five teams of students from sonography schools around the country against each other. Ultimately Team 4, composd of students from Central Ohio Technical College, Columbus Technical College, Baptist College of Health, St. Philips College, Triton College and Fox Institute emerged victorious, amassing 12,292.72 points.

Meanwhile, Mullins and her instructional colleagues took advantage of the Educators Tutorial, which featured a half-dozen sessions on such topics as grant writing, how to choose the right students for a sonography program and even how to improve your teaching skills with analogies-. "I just got done listenig to Sue Ovel, who taught the analogies session, and she just did a great job," Mullins said as she stopped on her way to pick up a snack during the mid-afternoon break.

Referesher courses in the anatomical imaging tracks were also well received--espeically one on ergonomics delivered by Carolyn Coffin, MPH, RDMS, RDCS, RVT--but not everyone was on hand for the conference just for the courses and their associated CE credits. Brandi Canady-Taylor, BS, RDMS, RVT, of Dublin, Ga., said she and six of her fellow sonographers at the Dublin Women's Center "came looking for a new 3D-4D ultrasound machine to replace our current one." Canady-Taylor was sitting next to Ellen Hazzard, RT(R), RDMS, of Winnebago, Ill., who said her own priority was "to get my credits." Hazzard described herself as something of a "freelance sonographer," adding that she currently works for one local infertility specialist, six obstetricians and as a fill-in for a maternal-fetal medicine specialist at a local hospital.

.Thursday's pre-conference sessions closed out with the grand opening of the SDMS Exhibit Hall. Some 75 vendors, ranging from major equipment makers like GE Healthcare, Siemens and Toshiba America Medical System to clinics, hospitals and snography schools like Excelsior College and the Seton Family of Hospitals, were on hand to greet attendees who strolled the aisles nibbling hors d'oeuves and sipping wine, beer and soft drinks. The conference picks up steam on Friday with additional sessions on all four anatomical tracks, as well as the SDMS annual awards and honors program and the "Tennessee Two-Step" evening of dancing, snakcs and live music.

In all, an estimated 1,100 sonographers and students were on hand for yesterday's pre-conference events, which put attendance at just about 10 percent lower than last year's, said Don Kerns, CAE, the SDMS chief operating officer. Kerns said he expected last-minute attendees to put that figure closer to 1,300 when the conference peaks on Friday and Saturday.

Be sure to check out the photo gallery from Day 1 of the SDMS Conference, as well as upcoming coverage of Friday's sessions and events here on the ADVANCE web site.

Connecticut has become the first state in the union to formally ban the use of ultrasound scans on pregnant women for anything but medically necessary/diagnostic purposes. The state's governor signed the bill enacting the ban in June, and it recently came to my attention through this video.

Personally I think it was a step in the right direction, and I hope other states will follow suit. We've reported on this controversial trend in the past, and I'm with the FDA on this one. The agency has officially sanctioned five legitimate uses for ultrasound in pregnancy: confirming pregnancy, determining fetal age, diagnosing congenital abnormalities, evaluating the position of the placenta and determining multiple pregnancies. Any other use of ultrasound technology for "fun and profit" is an abuse of the technology and potentially dangerous.

How about you? Do you think the state did the right thing, or do you think it's much ado about an essentially harmless practice?

Who's feeling the effects of burnout? As I sit here today, I'm having that "don't know how much more I can handle" feeling. The to-do list is endless: work, more work, covering for someone else's work, housework, career-enhancing side work--and let's not forget time for working out.

While life's hecticness and work's busyness occasionally leave me feeling drained, I am thankful. I have it not nearly as bad as many hard working health care professionals I write about. I also am in good health, have an amazingly supportive husband and a vacation in two days!

A recent study in the July/August 2009 issue of Radiologic Technology, the peer-reviewed journal of the American Society of Radiologic Technologists (ASRT), shows there's a significant correlation between burnout levels and health status among radiologic science educators. Burnout is considered a prolonged response to chronic emotional and interpersonal stressors on the job.

Jeffrey B. Killion, PhD, RT(R)(QM), associate professor at Midwestern State University in Wichita Falls, Texas, sent an e-mail with the Maslach Burnout Inventory (MBI) survey to 241 random members of the Association of Educators in Imaging and Radiologic Sciences Inc. It's designed to measure exhaustion, cynicism and professional efficacy in various occupations, and also included questions on health and demographics.

With a 62 percent response rate, the results were mixed. The MBI survey indicated that radiologic science educators experience average levels of emotional exhaustion, low levels of feelings of depersonalization and average levels of feelings about personal accomplishment when compared to a national norm group and practicing radiographers. However, based on their self-reported health status, there was a strong correlation between those who reported adverse health effects--such as heart disease, hypertension and intestinal problems--and those experiencing higher burnout levels.

When I begin to feel burnt out, sleeplessness ensues, headaches attack, muscle tension increases--and motivation suffers. The National Institute for Occupational Safety and Health also notes early warning signs of the health symptoms that indicate job stress include difficulty concentrating, short temper, upset stomach and job dissatisfaction.

Amongst these symptoms, the educators reported that headaches, heartburn and increased blood pressure were the top three conditions that required them to take medication, and that the burnout was affecting the quality of the education they were providing.

To all the educators out there, is burnout affecting your health? To what do you attribute this? A lack of autonomy or control at work? Too little help at your institution? Imaging technologists and administrators, what are your strategies for tempering stress? Do you think burnout is plaguing your facility or health care in general?

Today, I'll take some slow deep breaths, get exercise and eat healthily. This weekend, I'll relax on the beach with a book and a beer. What will you do? Take good care out there, and remember: don't let burnout sneak up on you.

Rather than adhere to that time-honored conference format known as the Q&A session, Tuesday's AHRA '09 featured two talks that emphasized Q&E--quality (as in images) and efficiency (as in workflow).

The equipment of your diagnostic facility might suggest a paragon of diagnostic excellence, but those high-tech offerings don't mean a thing without the zing of efficient workflow, said Eduard Michel, MD, PhD, during his early morning presentation, "Avoiding Eight Pitfalls that Impair Workflow Efficiency."

Articulating how yesterday's workflow attitudes hamstring today's technologies, the medical director and co-founder of Virtual Radiologic Corp. clearly struck a nerve among attendees: Dr. Michel was fielding audience questions until the final seconds of his presentation. Explaining how the workflow of radiologists is traditionally fine-tuned by their predecessors and is therefore highly resistant to change, Dr. Michel identified workflow sinkholes that can harm facilities, and lifelines administrators and practice owners can use to haul themselves out of those holes. Among the areas covered:

• Outdated work lists--These lists, insisted Dr. Michel, should not be created on the basis of what radiologists regard as a fair distribution of duties (a system that invites cherry-picking), but rather, what the group president feels is the best distribution of cases. His solution: a programmable "intelligent work list" that organizes studies based on factors such as a radiologist's specialty.

• Visually dependent workflow navigation--This phenomenon invites interpretation distractions such as computer program menus and toolbar icons. Dr. Michel's solution: eyes-free navigation, including foot pedals that activate monitors and "claw" devices adapted from the video gaming industry that can be programmed to perform onscreen shortcuts.

• Physicians performing nonphysician work--Radiologists fritter away valuable time tracking down clinicians to avoid miscommunication of results. Dr. Michel's solution: Delegate the phone-jockeying to personnel other than radiologists.

• Comparison cases on film or disk--Comparing cases on different media invites extreme frustration. His solution: Import films or old PACS data into a new system and build an old-case archive.

These solutions, said Dr. Michel, can help ensure that workflow efficiency is at its peak, and that maximum levels of revenue continue to flow unfettered into the practice.

Shifting to matters of quality in the talk "Image Quality in the Digital Environment," two presenters with ties to Boston's Massachusetts General Hospital explained how the facility used an ambitious pilot program to reduce costly technologist errors following MGH's 1996 transition to digital imaging.

With digital adoption came a new set of problems involving technologists, said Kathy Tabor-McEwan, BS, RT(R), the former director of clinical operations at MGH and the current executive director at Boca Raton (Fla.) Community Hospital. Increasingly, errors including patient misidentification, failure to complete exams and lack of adherence to positioning standards were interfering with radiologists' ability to perform their duties--and the problem wasn't confined to one modality.

"It really begins and ends with technologists," noted speaker Mary-Theresa Shore, MSM, CIIP, RT(R)(CT)(MR), PACS administrator at MGH and a former technologist. Shore and Tabor-McEwan recognized the challenge they faced: to detail on paper exactly how these errors were affecting radiologists' work so they could explain to technologists the repercussions of their mistakes.

Developing categories to measure image integrity, data integrity and data systems at the site, they documented the extent of the problem and launched a six-month image quality pilot program in 2003 that targeted the emergency radiology department. Technologists received a detailed explanation of the various errors that had occurred at MGH and how those errors were impacting the facility. Although the education effort was not punitive in nature, technologists were defensive initially.

"They felt, ‘You're taking away what we're in control of,'" said Tabor-McEwan. Each technologist was required to attend a Digital 101 lecture, for which they received credit from the American Society of Radiologic Technologists (ASRT). They also received a 10-step information sheet that outlined how various errors had been impacting the facility--and how they could be avoided.

The pilot program was a resounding success: Errors in image integrity dropped 73 percent, and data integrity errors fell by 76 percent. Soon, the program expanded to encompass the entire imaging department. Heartened by its success, Tabor-McEwan plans to implement a similar program at Boca Raton Community Hospital.

Click HERE to read notes from the first day of the conference.

But there's another, easier-to-swallow phrase that strikes to the core of this land of perpetual performance: "The show must go on." And it's not just the creed of this town's veteran entertainers. Even visiting talent embraces the philosophy.

Case in point: The crowd at the 2009 annual meeting of the AHRA--the Association for Medical Imaging Management--was noticeably thinner this year, but that didn't stop the venerable organization from putting forth its best effort. President Penny Olivi, CRA, FAHR, didn't dance around the fact that AHRA '09 attracted roughly 1,000 attendees this year, down roughly 250 to 300 from previous years. "[This year] there was no stimulus for us, but there will be stimulus for you," she pledged during the Grand Opening Ceremony and Kickoff, acknowledging the economy's chilling effect on conference-going.

With a presentation that alternated between exotic, awe-inducing performances by Cirque Du Soleil-type acts and upbeat remarks by AHRA dignitaries, Olivi and fellow organizers managed to lift the room with a recession-defying vibe of enthusiasm and optimism. Among the encouraging announcements: the establishment of a practice management track designed to meet the professional needs of managers. Also: a more aesthetically pleasing and user-friendly AHRA Web site that enables access to desired information with fewer mouse clicks. The revamped site, which went live Monday afternoon, also sports special sections for "featured AHRA members" and breaking industry news.

Even the sobering pragmatism of the keynote speech was leavened with an almost Carson-esque gregariousness and ease of delivery. In his talk "Building a Radiant Future (Or Why Radiology Must Fly)," ABC News aviation correspondent and best-selling author John Nance told the audience, "You're in the middle of a pitched battle between cost and safety." The key to staying aloft in such times, said Nance, is to emphasize effective communication by cultivating health care leaders who can extract and effectively apply the knowledge skills of staff members. This staff cohesion and teamwork can ensure standards of patient safety despite increasing financial pressures, he said.

The "safety first" message became increasingly urgent and sobering by early afternoon, however. Tobias Gilk, president and MRI safety director of Mednovus Inc., warned a capacity crowd that MR-related accidents have increased 400 percent in the last half-decade. Effective solutions have yet to be enacted, said Gilk, who noted that although the Joint Commission and the American College of Radiology (ACR) have published documents outlining safety protocols, the Joint Commission doesn't exercise its enforcement authority. He warned that until such enforcement occurs, victims of MR-related accidents will continue to be avenged in civil suits that most often name technologists and administrators as defendants. He likened the situation to exterminators who would use flamethrowers to deal with a cockroach infestation. "Until baseline regulatory standards hold organizations responsible, the legal system will hold individuals responsible for accidents and injuries," warned Gilk.

Shifting from matters of safety to those of throughput, Robert Junk, president of MRI-Planning, shared tips for boosting efficiency for MRI and CT. Junk's top three suggestions: prep and recover patients outside the scan room; be aware of the conflicts that newer modalities (such as positron emission tomography, or PET) and mobile imaging services (such as mobile MRI) might present; and avoid bottlenecks by matching support space to imaging equipment.

President Obama gave his fourth prime time news conference last night, a six-month "report card" address that focused almost entirely on health insurance reform. I rushed through a workout and dinner, finishing the day's to-do list just as Mr. President greeted the East Room of the White House and his television audience at 8 p.m. Eastern. I anticipated an update about the fate of our troubled health care system--and mainly how the solution would address its weaknesses.

The news conference began with an eight minute speech on the country's dire need for reform. The main message that affects every single American: We will not get the deficit under control without controlling the costs of health care--thanks to Medicare and Medicaid, driving forces behind our federal deficit. Small businesses are struggling to afford employee insurance, and premiums have skyrocketed. Inaction would lead to 14,000 American's losing their health insurance every single day, the president said.

Mr. President has left the "fine details" (how on earth will we pay for this?, amongst other concerns) up to Congress, which are still being negotiated. There's agreement on a few key issues, he said:

"...The reform we're proposing will provide you with more security and more stability. It will keep government out of health care decisions, giving you the option to keep your insurance if you're happy with it...It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money. If you don't have health insurance, or are a small business looking to cover your employees, you'll be able to choose a quality, affordable health plan through a health insurance exchange--a marketplace that promotes choice and competition. Finally, no insurance company will be allowed to deny you coverage because of a pre-existing medical condition."

The administration has estimated that two-thirds of the cost of reform will be funded by reallocating money that's tied up in system inefficiency and waste. Numerous times, he spoke of creating a panel of physicians and medical experts who will assess these inefficiencies annually in the federal sector, and ensure that the most effective tests and procedures are being ordered-not the most expensive ones. He also addressed the role of preventative medicine and information technology (IT) in streamlining care. The rest of the funding--about one-third of the remaining cost--will be financed via taxing the wealthiest Americans. "I continue to insist that health reform not be paid for on the backs of middle-class families," the president said.

There was a good bit of discussion about the country's finances in general; the president has pledged that health insurance reform will not add to our deficit over the next decade. Last night, he made it clear that he did not want to be perceived as a "spending president." The Barack attack has been brutal on the heels of the financial bailout, recovery act and now discussion of a major health care overall, and approval ratings are down.

As I took notes on my laptop, I hoped for something noteworthy regarding plan specifics--or just something of substance I could personally take comfort in. But little came--this seemed more like a campaign address of vague promises, empty rhetoric and clever deflection. The campaigning Obama presented with much more vigor, however.

With legislation still very much in the works, he was quiet on plan details yet loud on drumming up support. In the Q&A portion, when asked about the sacrifices the American people will have to make regarding their care, the president said they'd simply have to "give up paying for things that don't make them healthier," citing duplicate tests and ineffective treatments. Will patients still be referred for advanced tests and procedures when symptoms warrant them? Will they have access to physicians in days and weeks not months and years? Clearly this "solution" will not be met without sacrifices in care, and yet none were voiced.

President Obama also claimed that government will be kept out of health care decisions. He then went on to say that insurance companies will be regulated regarding who they can cover and how much they'll cover for treatment. Sounds exactly like regulation to me.

He also commented that the nation's largest organization representing doctors and nurses has embraced his plan (and the AARP has, too). This is misleading for those outside of the medical community. The American Medical Association (AMA) only accounts for about one-third of physicians; this is not a plan that is widely supported by the medical community, as implied. Would you agree?

The president commented, "What's remarkable at this point is not how far we have left to go, it's how far we have already come."  With so few answers and so many questions, it seems we have a lot farther to go. What's your point of view? How will reform impact medical imaging and/or radiation oncology?

In case you missed it, you have to check out this clip of Kari Callin, 43, on last night's episode of "America's Got Talent" Callin is a radiologic technologist in Seattle, and she  belts out an incredible rendition of "Somewhere." Who knows, she just might be America's answer to Great Britain's Susan Boyle.

View the video here and then tell us what you think!

Joe Jalkiewicz, Editor