Virtual job fairs offer many of the same features of in-person job fairs. You can chat with recruiters, attend education sessions, collect literature about employers, win prizes and make sure your résumé goes to the employers that interest you. You can do this all from home, so you can leave that smart suit on the hanger and "attend" the job fair in your comfiest clothes.

The tips for job seekers at virtual job fairs aren't all that different from tips on attending typical job fairs. Stay confident, seek out jobs that interest you, and fit your experience and do your homework ahead of time. Here are a few more tips:

• Don't forget your résumé. If you were attending an in-person job fair, you'd have a stack of résumés ready to hand out to potential employers. A virtual job fair is no different--but you'll save paper. You can upload your résumé at the virtual job fair and choose which exhibitors receive a copy. If you don't have a fresh résumé prepared, try out our ADVANCE résumé builder.
• Homework is key. Prepare for the virtual job fair like you would for a traditional job fair. Take a look at who's exhibiting, and research facilities that interest you. Potential employers' Web sites can contain information that will make or break your desire to work there, and having some background knowledge about a facility can also help you in one-on-one chats with recruiters by really showing your interest. Knowing which facilities you'd like to speak with during the job fair can also save time.
• Ask for help. At an in-person job fair, you likely wouldn't hesitate to ask for directions to a room if you couldn't find your way. If you're having issues with the technology used in the virtual job fair, support staff will be available to help you.
• Remember proper decorum. Sitting in front of your computer isn't necessarily the amped-up, formal atmosphere of a traditional job fair, but you're still speaking with employers--just in a different medium. It may seem comfortable to slip into online habits, but avoid text message shorthand and use correct grammar and spelling when chatting with employers.
• Avoid being a virtual wallflower. Chat with recruiters from facilities you're interested in, and try not to be the virtual equivalent of the job seeker hanging out in the lobby or skirting by all the exhibitors. Ask questions, share your résumé and go get that job you really want.

Be prepared and know the types of jobs you'd like to land. Take advantage of education sessions that go along with the virtual job fairs and treat the virtual job fair much the same way as an in-person job fair.

In the midst of all the heartache surrounding Haiti in the past week, it's been encouraging to see medical imaging step up to help ease the pain. One of the first examples to cross my desk was a statement from the American Society of Radiologic Technologists (ASRT) announcing that the organization was donating $10,000 to the American Red Cross' International Response Fund on behalf of its membership. That was followed by an announcement over the weekend that The Canon Group, which includes its medical imaging division, was donating $220,000 for Haiti relief efforts.

The American College of Radiology also issued a special statement reading, in part, that "The ACR Foundation has begun to make contact with individual radiologists who have provided service in that country. Through these contacts, the ACR Foundation will assess what direct or indirect assistance we may be able to facilitate in the affected region." 

Even individual technologists are stepping up to offer their help: In response to our posting of the ASRT announcement, Michael Fugate, RT(R), a professor of radiography from Santa Fe College in Gainesville, Fla., volunteered to serve in Haiti.

While aid groups are currently looking primarily for professionals with prior experience in disaster relief operations to put on the ground in Haiti, it's heartening to see the example being set thus far by radiology groups, companies and individuals. If you are aware of any other organized efforts to aid in the Haiti relief effort, please feel free to contact Joe Jalkiewicz, Co-editor/Web, at jjalkiewicz@advanceweb.com, or Kerri Reeves, Senior Associate Editor, at kreeves@advanceweb.com.

With knowledge comes power. Fortunately, many Chicagoans just got much more knowledgeable about their own states of health.

YOU! The Experience--a new 15,000-square-foot permanent exhibit at Chicago’s Museum of Science and Industry (http://www.msichicago.org/)--showcases the connection between mind, body and spirit, utilizing medical images donated from Loyola University Chicago Stritch School of Medicine department of radiology.

Nearly 90 percent of the images used in the exhibit’s medical imaging portion--more than 1,000 X-rays, CTs, ultrasounds, mammograms, MRIs, nuc med images and post-processed 3-D data sets--were from Stritch’s donation.

Museum guests choose various medical images to view from touch screen monitors that illustrate the inner workings of their bodies. They can see complex systems, including the difference between a healthy and unhealthy organ, a fetus at different developmental stages or the process of a breaking bone.

With more than 50 interactive stations, participants can peruse what’s most interesting to them; the hope is, this will spur interest in medicine and in their own health.

Images tell stories, and visitors are now “listening” in a new, innovative way. They’re contemplating lifestyle choices, the environment and how medical imaging is impacting our world, bringing awareness to radiology and healthy practices in general.

Sure, the pace relaxes a tad and crowds always thin a little on the Thursday of RSNA week, but McCormick Place was anything but a ghost town yesterday. Even the morning Refresher Course "Malpractice Minefields in Radiology: Mammography, Interventional Procedures and Failure of Communication" didn't scare attendees off. In fact, rather the opposite.

The talk, featuring well-known breast imaging experts Robert A. Schmidt, MD, and Robert L. Vogelzang, MD, along with radiology's legal czar Leonard Berlin, MD, was ripe with great quotes, interesting nuggets and helpful advice. Here's a sampling:

From Dr. Schmidt, who spoke on litigation in mammography:

• Mammography is the most frequent exam involved in malpractice cases.
• There's a scarcity of eyes-on-training courses for mammography, which needs to change.
• "Most doctors know as much about the legal system as their patients know about medicine."
• Delay in breast cancer diagnosis is now the most common cause of medical malpractice lawsuits.
• "Ultrasound is your second best friend in life (after your spouse)...Always, always, always do an ultrasound when there is a palpable lesion."
• Lawyers almost always read the standards, such as ACR's--and you should, too.
• The 5 C's of the defendant physician are: caring, credible, consistent, competent and comprehensive.

From Dr. Vogelzang, who spoke on litigation in interventional radiology:

• The presence of a complication in and of itself is not the big problem. More frequently, it's the failure to recognize it.
• With complications, the common, known or expected are typically those that result in litigation. The unexpected, not heard of and catastrophic are far less common among cases, and they're far less likely to win in court.
• What gets interventional radiologists into trouble is "not knowing what you don't know"--inexperience, new procedures, poor patient selection, lack of knowledge regarding the tools, not having the right tools and bad luck, among other causes.
• "Death will get you sued." Other causes include amputation, hemorrhage and contrast extravasation.
• "With law, the system and culture are very unlike medicine. I think we're certainly different human beings sometimes." The field of law is formal, systematic, has defined rules, is highly structured and is formally adversarial; the medical field is pretty much the opposite.
• Informed consent is almost never a legal issue.

From Dr. Berlin, who spoke on the failure to communicate:

• Failure to communicate a finding has the second highest average of indemnification.
• The big problem is with significant findings that aren't urgent. The urgent ones are communicated; the nonurgent ones are more likely to get lost in a shuffle of complacency.
• Courts are pretty much unanimous about the need for radiologists to communicate a significant finding.
• The average juror knows that expert witnesses lie. But they do typically support/believe published guidelines by a relevant society, such as the ACR.
• Document, document, document. Include the type of communication, date, time, name of people and any pertinent extemporaneous notes made at the time of communication. Those notes carry great weight legally.
• It's OK to have a secretary or technologist communicate the findings.

In other news, the exhibit hall floor was easier to navigate before the 2 pm breakdown. Along with exciting information generated in the booths, the booths themselves didn't disappoint. Exhibit highlights included a fireplace, a huge, electronic billboard; water features; moving lit-up logos on the floor; trees, maps to navigate a booth's extensive floor plan; and, of course, the usual conference rooms, theatres with live presentations, lounge areas and more. I didn't see any live animals this year, although a source told me about a Chihuahua that got loose during Carestream's "Nature-of-Diamonds" gala at the Field Museum. Security was not too pleased. Sorry I missed it.

That's the RSNA for you: practical news you can use coupled with a touch of astonishment. Can't wait til next year!

The big news at RSNA today centered on breast imaging--mammography in particular. Not surprisingly, in a special press conference, panelists comprised of breast cancer screening experts decried the recent mammography recommendations by the U.S. Preventive Services Task Force (USPSTF). As you’ve probably read by now, the recommendations--created by a federal government-funded committee with no medical imaging representation--advise against regular mammography screening for women ages 40-49 at average risk, suggest mammograms be performed only every other year for women between 50 and 74, and state that all breast cancer screening in women over 74 should cease. While the recommendations have been out for several weeks now, the shock, fear and loathing they evoke nonetheless remains strong.

Among top concerns, according to the panel, is that the recommendations will end up in health reform plans, prompting insurance companies to reconsider coverage for annual breast screening starting at 40.

On a more positive note, other breast imaging news released today includes the following research findings:

1. Targeted breast ultrasound can reduce biopsies for women under 40: Two studies explored ultrasound as an alternative to invasive biopsies for young women with lumps or other specific, localized signs or symptoms. In all cases across both studies, targeted breast ultrasound successfully distinguished between benign and cancerous tumors. As a result, the researchers recommend ultrasound as the tool of choice for evaluating palpable lumps in the under-40 population.

2. Annual screening with breast ultrasound or MRI could benefit some women: In a large-scale clinical trial, researchers found that annual screening with ultrasound in addition to mammography may find more cancers in women with dense breasts who are at an elevated risk for breast cancer. For some groups of women, screening with MRI in addition to mammo helps detect breast cancer at an earlier stage. The down side, however, is that supplemental screening with ultrasound or MRI increases the risk of false-positive findings.

Earlier today, the refresher course “Breast Cancer Screening” detailed additional updates and findings surrounding ultrasound, MRI and mammography screening. D. David Dershaw, MD, of Memorial Sloan Kettering, noted that requirements for successful MRI screening are high sensitivity; low false positive rates; cost-effectiveness (a hurdle for breast MRI); and availability and reproducibility. For sensitivity, “MR blows mammography out of the water,” he says. “It’s two to three times better in cancer detection.”

He also answered the question, “Are we finding cancers that are appropriate to find—i.e., that we can do something about?” with a resounding “Yes.” He also confirmed that breast MRI screening isn’t just for one round; “it works again and again and again.”

Unfortunately, some women can’t tolerate/don’t pursue MRI for several reasons, including claustrophobia; time constraints; financial concerns; provider disapproval; disinterest; and frailty, obesity or having metal within the body.

Of course, news, research, dialog and debate spanned all modalities, not just breast imaging. Other topics generating interest today and throughout the show include increased use of teleradiology (including a newcomer company that focuses on X-ray and ultrasound), an emergence of new equipment service companies, workstations featuring multimodality options, price erosion of CR and DR products, an increase in fee-for-service PACS, greater use of refurbished or used equipment, cloud computing, and swinging back to breast imaging--automated breast ultrasound and telemammography.

Stay tuned for more on these and many other hot topics with daily updated research news and our upcoming online audio interviews.

Hurrying, scurrying and a chance of flurrying are often the status quo for an RSNA show, and this week is no exception. Crowds are lighter, however, and that eases the hurry-scurry factor. As for the flurries, we'll see if the forecast proves true. I hope so-it's an added touch of festivity to the decorated Michigan Mile and Chicago's charm this time of year.

Having arrived today a little earlier than planned (plug for Southwest airlines here), I had a rare chance to scope out more RSNA sites and meander around Lakeside Center, snapping photos of all kinds of unsuspecting attendees. Check them out in our daily photo galleries, part of our RSNA coverage.

We've all heard of poster sessions (and there were scads), but highlights of the Lakeside Center also featured digital cases of the day for various subspecialty areas, numerous digital presentations and the Radiology Reading Room of the Future. The latter showcased demos to help attendees learn about quantitative imaging in radiology practice, the image interpretation process and clinical applications. The theme dovetailed nicely with the main message of today's Annual Oration in Diagnostic Radiology by Duke University's Daniel C. Sullivan, MD. The upshot of the session--"Radiology in the Era of Molecular Medicine: Can We Measure Up?"-was: Radiology lacks quantitative diagnostic information that's needed to manage patients at each stage of their disease care, and bringing molecular diagnostics to patient care will help move medicine forward.

Getting there starts with better evidence, said Dr. Sullivan in an engaging presentation that featured video clips from physicians/experts representing cardiology, neurology and other areas of medicine. And by evidence, he means databases with tens or hundreds of thousands of participants (none of this small-scale stuff), along with data mining and feature extraction tools, outcomes-oriented data and data integration.

Moving on to exhibits, no RSNA show is complete without a visit to the exhibit hall-or in this case, three technical exhibit halls: A, B and D. (Not sure what happened to C.) And by visit, I mean visit after visit after visit. The sore feet thing may be the oldest RSNA cliché around, but my left toes in particular will attest to its validity. Yet with 600 exhibitors, the displays warrant their share of scurrying. Highlights I saw today include the impressive new mobile Aurora dedicated breast MRI system. Talk about revving up access for an important and, increasingly validated, breast imaging modality. Featuring a compact 1.5 T MRI, the coach was warm and inviting. I could take a nap curled up in the dressing room right about now.

Bracco showcased its contrast injectors that improve ease of use for technologists and foster the decision-making process for best patient protocols. I swear I thought I saw goose bumps on Bracco's Dave Piazzo as he raved about the injector being far more powerful than ever before.

Fuji, meanwhile, showcased its new D-EVO DR system, the lightest on the market, complete with a detachable cord. It should be released in mid 2010, they say, although with pending FDA approval that could change.

Philips talked about its capital lending options, which have been gaining in popularity ever since the bond market fell apart with the not-too-distant credit crisis. Roughly 25% of the company's customers finance their systems through Philips, which also offers a free software model (the Medical Capital Pro-Forma tool) to calculate cash flow on a system to check affordability and profitability. The refurbished equipment market continues to grow and Philips' offerings are as well, added Paul Szilassy, who described the company's five-step Diamond Select refurbishing process.

That's about all I have time for, but one last warm fuzzy from this blustery town: RSNA is a great place to reconnect. It was great to see ASRT, RBMA and AAPM folk at the show, all of whom we have alliances with, not to mention Steve Renard, consultant extraordinaire from Diagnostic Radiology & Oncology Services. Check out his trend watch story in our December issue that's due out soon, and stay tuned for audio clips from an our interview today about hot buzz on the floor, what's happening in teleradiolgy, radiology's future and more. They'll be up soon as part of our RSNA coverage.

More tomorrow...and nothing against "Quality Counts," but "More, More and Did I Mention More?" should really be the theme of RSNA. No matter how full your brain gets or how chafed your heels may be, there's always something more beckoning you to stay for one last thing. More may be exhausting, but in many ways it's definitely merrier.

"Do more with less." RSNA is abuzz with symptoms of tough economic times. Reimbursements are down, reform is looming. Some facilities are cutting back on purchases, and others have sent fewer employees to the show.

While achieving a high level of patient care is always on the agenda, we're hearing a lot about doing so with a stretched dollar. RSNA is B-I-G big as always, but this year, there's a lot more talk about budgets.

This morning's session, "How Payment Policy Will Impact Technology Development in the 21^st Century" through the ACR, addressed change in CPT coding and the need for radiologists to act for reimbursement. Christopher Ullrich, MD, ended his presentation with the quote: "If you're not at the table, then you are on the menu."

A short walk to the exhibit hall led me to a number of vendors who touted the upgradeability of their products and the desire of customers to attain advancements with current systems. Innovation was never far, but there were fewer completely new, large system announcements this year. Philips showcased the design of new features and applications on existing ultrasound and CT (amongst other) platforms. An AMICAS user from Arcadia (Calif.) Radiology Medical Group was looking to save money for her group last year when she signed on with AMICAS solution--and ended up driving efficiency and growth.

TomoTherapy showcased its compact proton therapy system that's just a fraction of the cost of full-scale technology. Just as at ASTRO, it's generating interest from cost-conservatives home and abroad. The busy buzz at the Carestream booth was for its DRX-Evolution, a modular, flexible DR suite that customers can add on to as their financial timelines allow. Dilon Diagnostics showcased the enhanced Dilon 6800 Gamma Camera. Reps touted its strengths not only for breast-specific gamma imaging but also for general nuclear medicine applications. Finally, a visit to Visage Imaging, which was showcasing its Visage 7 product, explained how this thin-client, enterprise-wide, multimodality system easily plugs into existing PACS so everybody wins.

Financial seminars, this year, educate attendees about retirement planning in the struggling economy, as well as real estate concerns. Still with the focus on "quality counts," attendees are looking to get the most bang for their buck. In that case, I'd advise against the $11.50 ham and cheese sandwiches.

Sunday mornings usually mean sleeping in, pancakes and reading the news with my feet up--hot java in hand. Think Lionel Richie’s “Easy Like Sunday Morning.”

Today felt different, of course. RSNA 2009 kicked off! As I boarded my hotel shuttle, a group of men dressed in suits sprinted down East Wacker Drive, frantically waving down the driver. To their dismay at the early morning hour, the bus was already full. Indeed, the world’s largest medical meeting has descended on Chicago.

The pulse in McCormick Place was no less heightened as I scrambled to pick up my badge. The morning then took a wonderful turn: As attendees entered the opening session, we were greeted by John Primer and the Real Deal Blues Band. The groove was in place for a well-executed keynote by Gary Becker, MD, RSNA president, and day one of the show.

The opening session featured a number of speakers focusing on the theme “Quality Counts.” First up was Maryellen Giger, PhD, president of the American Association of Physicists in Medicine (AAPM), who highlighted how the two organizations work in tandem to achieve goals of quality care.

Edward Michels, MD, president of Chicago’s radiological society, welcomed the audience with appreciation, noting that medical imagers “light up our city.” He touted the comprehensiveness of the exhibit hall, calling it the world’s largest equipment “megamall,” and decided on a one-word description for the conference itself: overwhelming. (Indeed, I came across a McCormick Place employee who confessed that with 15 years tenure at this facility, she still gets lost. That made me feel better.)

The opening session was also an opportunity to recognize the field’s most esteemed professionals: Elliot K. Fishman, MD of Johns Hopkins, with the Outstanding Educator Award; and Sanjiv Sam Gambhir, MD, PhD, of Stanford, with the Outstanding Researcher Award. Both men were introduced with an impressive array of accomplishments, and in turn, they accepted the awards with much humility.

Hillier L. Baker, Jr., MD, CT pioneer, and Henry P. Pendergrass, MD, MPH, expert in pulmonary diagnosis and champion of academic radiology, were recipients of this year’s program dedication.

Valerie Jackson, MD, RSNA’s first vice president, formally introduced Dr. Becker with a brief history (baby pictures included), and the audience was treated to an insightful, succinct oration about radiology’s role in upholding quality care.

Error, waste, fragmentation and abuse are to blame for losing the public’s trust, Dr. Becker says. Out of every $10 spent in health care, $3 is completely wasted. At this rate, we’d be spending $4.4 trillion on health care by 2018. Change--improvement--is essential for radiology’s survival.

Dr. Becker notes, “what you do not measure, you do not know; and therefore cannot improve.” Quantitative science--the ideal of tomorrow--requires numbers. “If not for observation and measurement, there would be no advances.”

Safety, process improvement and satisfaction all need work, Dr. Becker says, in addition to metrics. He also discusses how IT-enabled support tools will help the field achieve P4 medicine: personalized, preemptive, predictive and participatory.

In these uncertain times, radiology must make a commitment to improve its practice. As reform looms, it must be safer and it must be more efficient.

Stephen Swensen, MD, MMM, addressed the audience on care through the patients’ eyes. The perspective of patient-centered radiology is certainly critical to a true transformation to optimal care. National efforts are underway to improve current problems with the system, taking into account the wants and needs of the patients--first. Janet Corrigan, PhD, MBA, discussed the national priorities for transforming health care.

Many more sessions and programs throughout the conference will focus on initiating quality metrics and improving--then upholding--quality. Today’s message was clear: don’t perceive quality as a choice; it’s radiology’s primary responsibility.

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!