1. science
2. medicine
3. oncology

volume 1
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issue 2
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Fall 2008
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Inside this issue
THE
Beam
Announcing
the ABR Foundation
Summary of the 2008
MOC Summit
Focus on Radiologic Physics
& Radiation Oncology
Focus on
Residents
Frequently Asked
Questions
Calendar
Letter from the Editor
A
ll right . . .
I know
(try not to
deny it) that
everyone has
been waiting
patiently for
the new issue
of The Beam.
So without
further ado,
we present the
second issue
George S. Bisset, III, M.D.
for your reading
pleasure. And
once again, we hope it is filled with salient and
meaningful information.
As always, this issue begins with comments
from our executive director. Dr. Becker has
chosen to deal with a topic that is relevant to
all of us from financial and time-commitment
perspectives. Not all of the material in The
Beam is cheery—some information may elicit
questions and concerns. Please keep in mind
that our chief goal is to communicate with you
about what the American Board of Radiology
(ABR) is doing. Dr. Becker’s comments about
our parent organization, the American Board of
Medical Specialties (ABMS), are both cogent
and thought provoking.
In August, the ABR convened a Summit
that dealt with practice quality improvement
(PQI), which relates to Part IV of maintenance
of certification (MOC). Please read about the
summary of what took place at this full-day
meeting. Remember that Part IV of MOC is
a work in progress. In fact, we have already
taken considerable strides in this area.
2
3
4
5
6
8
Dr. William Casarella, past ABR president
and trustee, has taken charge of a new
philanthropic venture—the ABR Foundation.
The purpose and goals of the Foundation are
laid out in some detail in his article.
In this issue, we are launching our radiation
oncology, physics and resident sections, with
information specific to these three groups of
diplomates and diplomates-to-be. Each section
deals with topics that our trustees feel are
essential for these groups to understand.
In the last issue, we promised an FAQ
section, and we are delivering. The FAQs, which
deal with PQI, are grouped into various categories that we hope will be helpful to you. If you
have burning questions you would like to see
addressed in future issues, please don’t hesitate
to e-mail them to [email protected]. w
From the Executive Director
What Is the ABMS, and What Does It Do?
I
n your busy and increasingly regulated
medical professional life, you are constantly
bombarded with facts, stimuli, changes, and
new requirements. The “alphabet soup” of
organizations issuing this information may seem
overwhelming. However, for board certification,
one organization occupies center stage and sets
the broad guidelines that ultimately affect you
and your practice most directly: the American
Board of Medical Specialties (ABMS).
Since its establishment in 1933, the
ABMS has evolved from a loose affiliation of
four specialty boards to a highly structured
organization with 24 Member Boards that certify
physicians in
more than 145
specialties and
subspecialties.
The ABMS
reviews and
approves all new
certificates and
subcertificates
of its Member
Boards and sets
guidelines and
policies for all of
their certification
and maintenance of certification (MOC) activities.
In Dec. 2007, Kevin Weiss, MD, MPH, then
director of the Institute for Healthcare Studies
at Northwestern University, became the new
ABMS president and CEO. Dr. Weiss has
a sense of urgency due to today’s medicaleconomic climate. He reasons that, increasingly,
government will be forced to foot the healthcare
(continued on Page 2)
Gary J. Becker, M.D.
What is the ABMS?
(continued from Page 1)
bill for Americans and therefore will need
to oversee the process, including physician
performance assessment.
The Board Enterprise (ABMS and its
Member Boards) is the most logical and wellequipped public agent for this assessment
role. Dr. Weiss contends that if we don’t take
immediate action, other organizations in the
wings may take on the challenge themselves.
Contenders might include the National Quality
Forum, the Joint Commission, the AQA Alliance,
and individual state medical boards. Dr. Weiss
asserts that we must embrace the responsibility
for physician performance assessment by
pursuing an aggressive agenda of Board
Enterprise programs.
Not surprisingly, these programs will be
costly. ABMS derives the bulk of its revenue
from dues paid each year by its Member Boards
(in proportion to the number of certificates
issued by each board). In 2007, the ABR’s dues
were $106,000; and with current ABMS budget
projections, our dues will more than quadruple in
the next three years.
Like other Member Boards, ABR’s operating
revenues are derived entirely from diplomate
and candidate fees. As momentum builds, we
have been aggressively urging fiscal restraint
and positioning our trustees in key roles on
ABMS committees and task forces. Only by
participating in the process can we hope to have
a significant voice in managing programs and
controlling expenses.
ABR trustees and staff leadership are committed to a markedly expanded role and active
involvement in ABMS activities. We are determined to achieve the proper balance in recognizing and safeguarding the best interests of the
public, our patients, and you—our diplomates. w
From the ABR Foundation Board Chairman
A New Venture in Philanthropy: The ABR Foundation
T
he American
Board of
Radiology
has decided
to join other
ABMS boards
in creating a
foundation
dedicated to
education,
research, and
public welfare
in our field. The
American Board
William Casarella, M.D.
of Radiology
Foundation (ABRF) is now a registered
501c3 organization eligible for tax-deductible
philanthropy, with the following mission: “To
demonstrate, enhance, and continuously
improve accountability to the public in the use
of medical imaging and radiation therapy.”
The specific goals of the ABRF are:
l To improve the health of the public through
research and educational programs that
address national healthcare challenges.
l To convene medical organizations to
explore broad, timely topics of pubic interest
related to the radiological sciences.
l To engage the public about the advantages
of accreditation, certification and maintenance
of certification in improving healthcare.
At a board retreat held in Atlanta on June
6 - 7, 2008, the Board of the ABRF proposed
to take responsibility for the August summit
meetings, beginning in 2009 (see article on
Page 8). The focus of the first meeting will be
our profession’s accountability for diagnostic
imaging and radiation treatment. Justification
of radiological procedures based on risk, cost,
safety, and patient benefit in the context of
national healthcare issues will be at the core
2
of the meeting. It will be multidisciplinary,
including emergency medicine professionals,
physicians, oncologists, cardiologists,
orthopedists, general surgeons, and general
internists. The ABRF’s support for the summit
meeting will continue on an annual basis.
Given the limited amount of funding
currently available, major research grants are
beyond immediate reach. However, the ABRF
may wish to support research projects that
The mission of the
ABR Foundation is to
demonstrate, enhance,
and continuously
improve accountability
to the public in the use
of medical imaging and
radiation therapy.
address our accountability for quality, safety
and cost effectiveness.
The ABRF has already supported two
research studies related to certification and the
testing process. One, completed by Caroline
Hollingsworth, M.D., of Duke University,
included a project to validate the conversion
of the pediatric category examination in
diagnostic radiology from its current oral format
to a completely computer-based program. This
project has paved the way for the successful
conversion of a major examination and has
provided data that will be helpful as the
diagnostic radiology oral exam transitions to a
computer-based exam in the near future.
A second project was proposed and
completed by James R. Duncan, M.D., Ph.D.,
and his colleagues at Washington University’s
Mallinckrodt Institute of Radiology. This project
group created a web-based simulation tool
consisting of clinical scenarios with interactive
testing in interventional radiology.
The ABRF Board also authorized and
funded a key initiative on professionalism in
radiology. A planning conference was proposed
to create durable materials in promoting
professionalism, and it is anticipated that
a curriculum will be designed to weave the
principles of professionalism into our training
programs and maintenance of certification
requirements. We are seeking input from other
boards that have experience in this area,
specifically, the American Board of Internal
Medicine. This could be a theme for the 2010
summit meeting.
The ABRF is still refining its mission, with
our main emphasis focused on serving the
public. To achieve this, we want to enhance
our specialty’s leading role in the major issues
that confront medicine, including accountability
to the public for the practice of radiology,
professionalism, promotion of quality and
safety, and development of personalized
medicine as it relates to radiology. These
issues should be addressed at a venue
different from that used to approach radiologic
science.
For more information on the ABR
Foundation, visit our new website at www.
abrfoundation.org. w
The 2008 MOC Summit: Practice Quality Improvement
I
n light of an increasing demand to define
standards in radiation dose regulation,
the American Board of Radiology (ABR)
Maintenance of Certification (MOC) Summit
in Chicago demonstrated that radiologic
professionals are stepping up to the plate.
“I am pleased to see how deeply our profession is committed to the safe and optimal use of
radiation,” said G. Donald Frey, Ph.D., a professor
of radiology at the Medical University of South
Carolina in Charleston and an ABR trustee.
Presenters at the August 9 Summit
addressed dose-reduction concerns for
both diagnostic and therapeutic procedures.
National initiatives, such as the Image Gently
campaign (promoting radiation protection
for children) and the American College of
Radiology’s National Radiology Data Registry
(NRDR), were featured as examples of critical
radiology initiatives already in progress.
Fifty-five individuals representing 26
societies attended this year’s summit. In
addition, various representatives of state and
governmental agencies were present.
The ABR has demonstrated a strong
commitment to making patient safety and
radiation safety the main focus of its PQI
initiatives. These initiatives will be designed
and implemented through collaborative efforts
with radiologic specialty societies, which
have the required content expertise. The safe
use of radiation is a defining characteristic
distinguishing diagnostic radiology, radiation
oncology, and radiologic physics from other
specialties.
“MOC is the best tool to protect our
profession right now,” said keynote speaker
Kevin Weiss, M.D., CEO of the American
Board of Medical Specialties. “We need
to change the mind-set so that the board
exam is not considered an exit exam from a
residency, but an entrance exam into a lifetime
of professional development.” This statement
set the tone for a stimulating and productive
summit.
Summit leaders and attendees, especially
physicists, emphasized that any radiation
dose calculation is only an estimate and that
generalizations may be misleading to the
public. Presenters acknowledged conflicting
findings and opinions on what constitutes dose,
to what degree it affects patients, and how best
to reduce dose.
Disputes over conundrums, such as which
model best describes cancer-inducing effects
or whether low doses can cause cancer, “are
nonproductive arguments we have permitted
to invade our profession,” said Louis Wagner,
Ph.D., a professor in the
Department of Diagnostic
and Interventional Imaging
at The University of
Texas at Houston Medical
School. Dr. Wagner went
on to say that while we
may not know everything
about radiation risk, we
do know enough to be
concerned and take action
regarding the factors that
we can control.
Marilyn Goske, M.D., alliance chair for Image Gently, speaks at the 2008
Most counterproductive
summit on radiation safety in pediatric imaging.
is the notion that there
is no safe dose, said Dr.
not repeat the scan]?”
Wagner. “There is no safe hot dog, vegetable,
Speakers at the summit also addressed
bed, bathroom, shower, tub, jacket, cup of
the need for more proactive efforts to collect
coffee or glass of water,” he said. “But just as
data on emerging techniques like fluoroscopy
we can purify water, put down bath mats and
and intensity-modulated radiation therapy
keep medication out of the reach of children,
(IMRT). They discussed new challenges to
we can keep radiation dose down at a safe and
dose calculation presented by multimodality
productive level to be of most benefit to our
therapies and secondary risk factors, such as
patients.”
Added Dr. Frey: “While you can quibble with scanner head leakage and scatter radiation.
The summit also examined rising trends in
these papers from a scientific point of view,
cardiovascular imaging and methods for
you can’t quibble with the popular media. They
regulating increasingly popular procedures like
need to understand that we are taking the
initiative and steps to reduce radiation dose for “triple rule-out CT angiography.”
At breakout sessions during the summit,
the good of the population.”
attendees brainstormed templates for
Identifying causes of repeat exams and
measurable, achievable performance quality
judging their usefulness is of major concern.
improvement (PQI) projects within four
The American College of Radiology (ACR)
categories: radionuclides, CT, angiography/
is developing tools to identify repeat exams
fluoroscopy, and radiation oncology. The
and to measure dose. Laura Coombs,
sessions yielded preliminary ideas for more
Ph.D., director of data registries in the ACR
than 15 new projects, including structured
Department of Quality and Safety, explained
reporting of radiation dose-delivery techniques,
a project to establish a dose index registry as
protocols to reduce radiation to the lens and
part of the National Radiology Data Registry
orbit in children undergoing repeated head
(NRDR). Eleven sites in the U.S. and two in
CTs, a national data registry of estimated
Germany plan to participate. Information will
dose in angiography and fluoroscopy
be collected from DICOM headers via a patch
procedures, iodine therapy for thyroid cancer,
installed on Siemens scanners and extracted
and IMRT targeting. The ABR will work with
by ACR-developed software. Future plans for
the project include a nationwide expansion and corresponding societies in the coming months
to formulate plans for executing the projects.
will involve additional vendors. ACR will work
“If we do nothing, I’m sure the government,
with the Integrating the Healthcare Enterprise
the payors, and industry will be willing to take
(IHE®) initiative to develop radiation exposure
the lead,” said N. Reed Dunnick, M.D., RSNA
modulation for scanners and software.
Board Liaison for Science and ABR President,
“When necessary, radiologists must also
take the initiative to communicate with referring “but it will be clumsy. Nobody knows our
business better than we do. We need to be
physicians,” said Dr. Weiss. “If you have a
carrying the flag on quality.” Dr. Dunnick is the
situation where a separate doctor orders a
Fred Jenner Hodges Professor and chair of the
CT scan, or says he didn’t like the way one
Department of Radiology at the University of
was performed and wants it done again,
Michigan Health System in Ann Arbor. w
often everybody shrugs their shoulders and
Editor’s Note: Thanks to RSNA News for
acquiesces. How often will you actually make
information used in this article.
the call to do what is right for the patient [and
3
Focus
on Radiologic Physics
by the ABR Radiologic Physics Trustees
The MOC Personal Database (PDB):
Functionality and Organization
T
he key to managing our increasingly active
professional lives is Organization—with a
capital “O”! To assist in this area, the ABR has
established a personal database (PDB) for
each radiologic physics diplomate participating
in maintenance of certification (MOC). Your
PDB, found on the ABR website, is a functional
tool that will guide you through the various
components of MOC and help you organize
each step in the process.
Upon successful completion of the oral
exam, all diplomates are given access to their
password-protected PDBs. The ABR manages
the technical aspects of PDBs, and diplomates
are responsible for effectively using them to
officially communicate their MOC activities to
the ABR.
After you log on to your PDB (e-mail ID
plus personally selected password), you will
have access to the full scope of MOC as it
personally applies to you:
l Review the requirements of each MOC
component: professional standing, lifelong
learning & self assessment, cognitive
expertise, and practice quality improvement.
l View your personal 10-year cycle time line.
l Assess your progress through automatic
accounting, which allows you to compare your
completed activities with the requirements of
each component.
Input CME, SAM,
and SDEP (selfdirected education
project) credits as you
earn them.
l Attest to yearly
completion of your
PQI activities.
l When the time
comes, attest to your
professional standing
(or, for medical
physicists to whom
it is applicable, update The radiologic physics trustees include (from left): Richard L. Morin, Ph.D.;
Geoffrey S. Ibbott, Ph.D.; G. Donald Frey, Ph.D.; and Stephen R. Thomas,
your state licensure
Ph.D., Associate Executive Director.
status).
l View scheduled
opportunities to take the cognitive exam.
authenticated, meaning that if you are
l Update your contact information.
randomly audited (a low-probability
l Pay your annual MOC fee.
requirement of the ABMS), you will not need
As an added bonus, sign up for the free
to produce any further evidence of verification,
CME Gateway, a cooperative effort initiated
such as certificates.
by the RSNA and ACR to provide a one-stop
We urge you to become a frequent visitor
to your PDB to ensure that it remains up
resource for monitoring one’s CME credit.
to date. Both throughout and at the end of
Currently, the SNM, ARRS, SIR, ASNR, SPR,
the 10-year cycle, the ABR uses your PDB
and CAMPEP are participating in this “virtual
record as the basis for communicating with
data base” that allows automatic transfer of
you about your progress, and ultimately, your
CME credits to your PDB. The advantages are
successful completion of MOC requirements.
two-fold:
l Your CME credit from Gateway member
We are confident that as a radiologic physics
diplomate, you will recognize the organizational
organizations will appear automatically in your
benefit of effectively using your PDB. w
PDB (self-entry not required).
l The ABR regards these credits as
l
Focus
on Radiation Oncology
by Bruce G. Haffty, M.D., ABR Trustee and President-elect
H
istorically,
oversight of
initial certification
(IC) examinations
for trainees in
radiation oncology,
diagnostic
radiology, and
radiologic physics
has been the
ABR’s major
responsibility.
The IC process for radiation oncology involves
assembly of three written examinations in
physics, radiation and cancer biology, and
clinical radiation oncology. In addition, the ABR
administers the oral exam, which includes eight
categories: gastrointestinal, gynecological,
4
genitourinary, lymphoma, head and neck,
breast, pediatric/central nervous system, and
lung.
Six ABR radiation oncology trustees
traditionally oversaw the written and oral
examinations in their clinical areas of expertise.
The remaining two categories were assigned
oral and written examination chairs from
among our highly qualified and dedicated
volunteers. The trustees also worked closely
with physicists and radiation/cancer biologists
to oversee written examinations in those areas.
Over the past several years, implementation of the new maintenance of certification
(MOC) process has substantially increased
the responsibilities of the ABR and its trustees.
As a result, we have recently expanded
the IC examination committee by reaching
out to our network of volunteers. Each of
the eight categories now has written and
oral examination chairs, and the trustees
work closely with them. In addition, the oral
examination chairs, trustees, and many of our
dedicated volunteers continue to serve as oral
examiners in Louisville each year.
The ABR remains committed to the
validity and integrity of its examinations, the
IC process, and the new MOC process. We
simply could not fulfill all of our responsibilities
without the help of our dedicated volunteers.
Most recently, volunteers also have engaged in
other MOC activities, including preparation of
self-assessment modules (SAMs) and practice
quality improvement (PQI) initiatives.
We gratefully acknowledge our dedicated
volunteers, who have contributed to the
certification process throughout the years.
(See sidebar on Page 5 for a list of our current
trustees and exam chairs.) Thank you! w
Radiation Oncology Trustees
and Examination Chairs
We would like to thank current radiation
oncology trustees and examination chairs,
who are listed below by category and in
this order: trustee, oral exam chair, and
written exam chair.
Gastrointestinal: Christopher
Willett, Duke University; William Regine,
University of Maryland; Lisa Ann Kachnic,
Boston University Medical Center.
l Gynecological: Beth Erickson,
Medical College of Wisconsin; Kaled
Alektiar, Memorial Sloan-Kettering Cancer
Center; Akila Viswanathan, Brigham &
Women’s Hospital.
l Genitourinary: Anthony Zietman,
Massachusetts General Hospital; Allan
Pollack, University of Miami; Peter
Johnstone, Indiana University.
l Lymphoma: (Trustee, N/A); Andrea
Ng, Brigham & Women’s Hospital; Richard
Tsand, Princess Margaret Hospital.
l Head and Neck: Kian Ang, MD
Anderson Cancer Center; Robert Amdur,
University of Floria/Shands Cancer Center;
Robert Foote, Mayo Clinic College of
Medicine.
l Breast: Bruce Haffty, UMDNJ-Robert
Wood Johnson Medical School; Julia
White, Medical College of Wisconsin; Larry
Solin, Albert Einstein Philadelphia.
l Pediatric/Central Nervous System:
Larry Kun, St. Jude’s Children’s Research
Hospital; John Suh, Cleveland Clinic
Foundation; Arnold Paulino, Methodist
Hospital/Baylor.
l Lung: (Trustee, N/A); Jeffrey Bradley,
Washington University; Benjamin Mosvas,
Henry Ford Hospital.
l
Log onto your personal
database (PDB) today at
www.abronline.org
View your progress on
CME, SAMs, & PQI
l
l
Locate SAMs
l
Get updates
l
Check your fee status
Focus
on Residents
by Duane G. Mezwa, M.D., ABR Trustee
ABR: A Lifetime of Engagement
W
elcome to
the first
installment of the
section of The
Beam that covers
issues of interest
to residents who
are in the board
certification
process. In this
inaugural section,
I would like to
recommend that you become familiar with the
ABR website at www.theabr.org.
This website serves as a valuable source
of information that will be important to you
throughout your training. Of current interest
to you is the detailed information available
on the site regarding exams, fees, and the
initial certification process for specialties and
subspecialties. When you become a diplomate,
you will find vital information regarding the
maintenance of certification (MOC) process.
The site will keep you up to date on the latest
developments and activities of the ABR Board
as well.
Residents Taking Exams in 2009
If you are planning to take any initial
certification exam in 2009, you should have
registered and submitted fees by Sept. 30,
2008. Late registrations can be accepted
through 5 p.m. MST on Oct. 31; however, a
$400 late fee will apply.
NRC Authorized User Designation
All diagnostic radiology residents who
intend to become authorized users of 131I
can begin the process by downloading the
necessary forms from the ABR website at www.
theabr.org/Images/NRC_Forms_A_B_DR.pdf.
Completion of the forms (documentation
training) is a necessary part of the process.
You also must pass the testing requirement to
be designated as AU-eligible.
First-year Residents ONLY
If you are a first-year diagnostic radiology
resident or are registering with the ABR for
the first time, by now your program director
should have informed you about your personal
database (PDB) on the ABR website at www.
abronline.org. You also should have received
your personal login and setup information by
e-mail. (If not, please contact your director.)
All information about your progress will be
housed on your PDB. This does not apply to
residents already in the exam process.
The PDB for radiation oncology residents
is currently under construction and will be
functional soon. Again, ONLY first-year
residents or those who are registering with the
ABR for the first time are required to register.
When the radiation oncology PDB is ready,
information will come through your program
director.
Future Changes in
Diagnostic Radiology Testing
As you are all aware, monumental
changes in the testing of diagnostic radiology
residents are coming. However, this will not
affect anyone currently in the process. Those
entering radiology residency training in
2010 will be the first group to experience
the new examination timing and process. A
very detailed list of FAQs and an information
sheet are posted at www.theabr.org/DR_Pri_
home.htm.
Communicating with the ABR
For all our candidates, I encourage you to
visit the ABR website and familiarize yourself
with everything it offers. This is your connection
to the Board. Be sure to check back frequently
as it is updated with new information on a
regular basis.
Updating all relevant information (such
as your e-mail, mailing address, and phone
number) is vitally important so the Board can
track your progress and assist you throughout
the current certification and future MOC
processes. For new residents, use your PDB
as described above. For residents already in
the exam process, you can fax or e-mail your
current information to the ABR: (520) 790-2900
or [email protected].
If you have suggestions for topics to be
addressed in this section, please feel free to
contact me at [email protected]. w
5
?
Frequently
Asked
Questions
T
his issue’s FAQs are designed to answer your questions about
practice quality improvement (PQI). We’ve divided the questions
into four sections: general, diagnostic radiology, radiation oncology,
and radiologic physics.
General Questions
?
What is the objective of MOC, Part IV – PQI?
Simply stated, maintenance of certification (MOC), conceived at the American Board of
Medical Specialties (ABMS MOCTM) nearly a decade ago, is intended to ensure that diplomates
fulfill their professional responsibility to help make healthcare safe, efficient, effective, timely,
patient-centered, and equitable.
There is a national imperative to oversee and measure the activities of all medical
professionals since these activities directly impact patient outcomes. Although other healthcare
stakeholders have expressed interest in taking on this role, there is no organization or authority
better suited to set performance standards and provide oversight than the Member Boards of the
ABMS. MOC, which began as the response of all 24 medical certifying boards to public concerns
regarding quality of care and medical error, is rapidly transforming into the accepted framework for
career-long individual professional development.
Through Part IV, diagnostic radiologists, radiation oncologists, and radiologic physicists are
required to demonstrate commitment to practice quality improvement (PQI). The mandate to
provide tangible evidence of a critical evaluation of each diplomate’s practice performance is at
the core of PQI. Remember that the overriding objective of MOC, especially Part IV, is to improve
the quality of healthcare through diplomate-initiated learning and quality-improvement activities.
Radiation Oncology
by Lawrence W. Davis, M.D.
ABR Associate Executive Director
for Radiation Oncology
?
How many PQI projects are required?
Three projects are required during each
10-year period. Those with fewer than ten
years in their maintenance of certification cycle
should check the ABR website for the number
required to satisfy the Part IV requirement:
www.theabr.org/RO_MOC_TimelinesIntro.htm.
?
What types of PQI projects are
available?
One or two of the projects may be individually
based and qualified by self-attestation. These
may be generated by the physician or his/her
department.
At least one of the projects must be
society-based and qualified in advance by
the ABR as meeting all Part IV requirements
and contributing to developing centralized
databases relevant to radiation oncology.
?
How do I choose a PQI project?
A PQI project must meet the following criteria:
l Be important to patient care
l Be relevant to your practice
l Be achievable in your practice environment
l Have identifiable metrics suited to repeated measurements throughout the MOC cycle
l Include an action plan to address areas for improvement and remeasurement to assess any progress and/or improvement
l Be reasonably likely to result in improved quality/safety
What society PQI initiatives are
currently qualified by the ABR?
l For those at participating institutions
recognized by the American College
of Radiology (ACR), Quality Research in
Radiation Oncology (Q-RROTM):
www.qrro.org
l For American Society for Therapeutic
Radiology and Oncology (ASTRO)
members, Performance Assessment for
the Advancement of Radiation Oncology
Treatment (PAAROT): http://asro.astro.org/
PAAROT/Default.aspx
l For American Radium Society (ARS)
members, Conservative Treatment of Early
Stage Invasive Breast Cancer: www.
americanradiumsociety.org/members/
l From the ACR, R-O PEERTM: www.acr.
org/accreditation/radiation/ro_apply/MOC-
ROPeerAgreement.aspx
?
?
?
How do I actually “do” a project?
For each project, you should gather and analyze data. Then you should implement a plan for
improvement, based on the results gathered. Finally, you should measure again to see if progress
has been made.
?
How do I show the ABR that I have satisfied the requirements of Part IV?
Sign on to your personal database (PDB) at www.abronline.org and attest to your yearly
PQI participation. You should retain all source data about the project in case you are randomly
selected by the ABR for an MOC audit. w
6
Where can I find more information
about PQI for radiation oncology?
l Go to www.theabr.org/RO_MOC_PQI.htm.
l In the International Journal of Radiation
Oncology, Biology, Physics (IJROBP)
article, “American Board of Radiology
Maintenance of Certification – Part IV:
Practice Quality Improvement for Radiation
Oncology” 2007 May 1;68(1):7-12: www.
theabr.org/Images/RO_White_Paper.pdf w
Diagnostic Radiology
by Kay H. Vydareny, M.D.
ABR Associate Executive Director
for Diagnostic Radiology
?
How many projects must I perform
during the 10-year cycle?
You should spend your first year learning all
you can about quality improvement principles
and PQI. Throughout the remainder of your 10year MOC cycle, you are required to complete
three PQI projects. For any project you
undertake, once the target level of performance
has been achieved, you should: 1) sustain the
gain, 2) periodically remeasure in this area,
and 3) move on to another PQI project.
?
What type of PQI project is
recommended?
The ABR suggests projects in the following
areas:
l Patient safety
l Report timeliness
l Comparison of your practice to the
published ACR practice guidelines and
technical standards (using the communica tion guideline and one other guideline or
technical standard of your choice):
Radiologic Physics
by Stephen R. Thomas, Ph.D.
ABR Associate Executive Director
for Radiologic Physics
?
How do I start the PQI process?
As an initial step, review the radiologic
physics (RP) white paper on PQI posted on
the ABR website: https://www.abronline.
org/downloads/PQI_RP_Whitepaper_
Medphys_08212007.pdf.
Then review the sample PQI projects in
the three RP disciplines: www.theabr.org/
RP_MOC_PQI.htm.
The first-year requirement is to learn
as much as possible about PQI concepts.
Opportunities for this training, including online
courses and specific reference materials, also
are listed on the website: www.theabr.org/
RP_MOC_Req.htm (scroll down to view Part IV).
?
What project areas are acceptable for
radiologic physics PQI?
PQI projects must meet the criteria listed in
the general FAQs. For individual PQI projects,
Patient/referring physician survey
Accuracy of interpretation/double reading
l Any other project that will help to improve
patient safety/quality in your practice
Finalization
Communication
l Outcomes
l
l
l
l
?
How do I determine what to measure?
The following website has numerous links
to resources that will help you determine what
and how to measure the results of your project:
www.rsna.org/Quality/sources.cfm.
Anatomy of a Diagnostic Radiology
Procedure
Considering all of the steps in the workflow
of a radiology procedure can help you zero
in on precisely what needs improvement. For
almost any procedure in diagnostic radiology,
the following 10 steps tend to apply. For a
given topic or procedure type in your practice,
you may find opportunities for improvement
at any one or a combination of these steps/
components:
l Procedure request
l Procedure scheduling
l Location of procedure (e.g., hospital, clinic,
institution, department)
l Procedure personnel
l Procedure protocol
l Safe procedure performance
l Interpretation
five topic areas are highlighted in the RP white
paper:
l Safety for patients, employees, and the
public
l Accuracy of analyses and calculations
l Report timeliness and communication
issues
l Practice guidelines and technical standards
l Surveys (including peer review of self assessment reports)
These topic areas are provided as
guidelines, and diplomates may define other
possibilities relevant to their practices. At the
August 2008 summit meeting, professional
societies such as AAPM, RSNA, ACR, and
ACMP were encouraged to develop PQI
project templates for radiologic physics.
?
What steps are involved in performing a
PQI project and fulfilling the requirements?
Learn as much as possible about PQI concepts
during year 1. In years 2 - 5, select a PQI
project and proceed with the following steps:
l Collect baseline data relevant to the chosen
project
l Review and analyze the data
l Create and implement an improvement plan
?
What society PQI initiatives are
currently qualified by the ABR?
l From the American College of Radiology (ACR) National Radiology Data Registry
(NRDR), the CT Colonography Registry: https://nrdr.acr.org/portal/CTC/Main/
page.aspx
l From the Society for Pediatric Radiology (SPR), Performance of Voiding Cysto urethrogram (VCUG) Examinations: Safety, Quality of Care, Practice Guideline:
www.pedrad.org/displaycommon.cfm?an=4
?
Where can I find more information
about PQI for diagnostic radiology?
l Go to www.theabr.org/DR_MOC_PQI.htm
or http://pqi.arrs.org/
l In May 2007, an article on PQI for diagnostic
radiology was published simultaneously
in several journals: Academic Radiology,
Radiology, RadioGraphics, American
Journal of Roentgenology, and Journal of
the American College of Radiology. To read
the article, go to http://www.theabr.org/
Images/DR_White_Paper.pdf. w
Remeasure and track
Evaluate and report participation to the
ABR, using your personal database (PDB)
At the end of year 5, you will decide
whether or not further improvement in practice
can be anticipated if you continue working
on the same project in years 6-10. If not, you
should identify another project and initiate it for
years 6 - 10.
l
l
?
If I hold multiple time-limited
certificates, will I be required to
complete a PQI project in each certification
specialty within a given 10-year cycle?
No. You may choose a PQI project that is
focused and relevant within one area of
certification and pursue that topic. However, in
the next cycle or when starting a new project,
you should focus on another certification area.
?
Where can I find more information about
PQI for radiologic physics?
l Go to www.theabr.org/RP_MOC_Req.htm
l Review the radiologic physics (RP)
white paper on PQI: https://www.abronline.
org/downloads/PQI_RP_Whitepaper_
Medphys_08212007.pdf. w
7
The ABR Calendar . . . . . . . . . . . . . . . . . . . . . .
November 2008
9-10 DR subspecialty* IC and conditioned
DR IC oral exams in Louisville
9 NRC test assembly meeting in Louisville
December 2008
2-3 DR subspecialty* MOC exams at
RSNA Annual Meeting, Chicago
11-12 DR subspecialty* MOC exams in Tucson
January 2009
9-10 DR IC test assembly meeting, Tucson
11-12 RO IC test assembly meeting, Tucson
30 Conditioned DR, RO, and RP IC
exams at Pearson VUE testing centers
February 2009
1 Registration begins for 2009 DR subspecialty* IC exams.
March 2009
6 NRC exam at Pearson VUE testing centers
12 VIR subspecialty MOC exam at SIR
Annual Meeting in San Diego
April 2009
2-3 DR subspecialty* MOC exams in Tucson
April 2009 (cont.)
17-18 RP IC test assembly meeting in Tucson
24 RO MOC exam at Pearson VUE testing centers
30 Registration deadline for 2009 DR subspeciality* IC exams
May 2009
21 Neuroradiology MOC exam at
ASNR Annual Meeting in Vancouver
31-June 3
DR, RO, and RP IC oral exams in
Louisville
July 2009
1 Registration begins for 2010 DR, RO, and RP IC exams
9-11 RO IC exams at Pearson VUE testing centers
August 2009
6-7 ABRF Summit in Washington, D.C.
September 2009
1-3 RP IC exam at Pearson VUE
testing centers
10-11 DR IC exam at Pearson VUE
testing centers
30 Registration deadline for 2010 DR, RO, and RP IC exams
ABR Website Offers
Volunteer Opportunities
T
he volunteer section of the ABR site
has gone live! The site includes charts
listing volunteer activities for diagnostic
radiology, radiation oncology, and radiologic
physics. Each activity has information on time
commitment, amount of travel, method, and
colleague interaction. When volunteers click on
an activity, they receive the e-mail address of
an ABR staff member who can tell them more.
To view the volunteer site, go to www.theabr.
org/volunteer/volunteers.htm.
The ABR is on the fast track, and we
need volunteers to help us keep pace with
current developments in U.S. medicine. Our
commitment is for ABR certification to reflect
the massive changes in medicine while
remaining a respected and credible exercise of
professional self-regulation.
Volunteers can choose from opportunities
of many sizes and shapes to contribute to the
future of their specialties. If you’re interested
in becoming more involved with the ABR, we
want to hear from you! w
8
October 2009
2 RO MOC exam at Pearson VUE testing centers
3 ABR 75th Anniversary Celebration
in Tucson (date tentative)
November 2009
8-9 DR subspecialty* IC and conditioned
DR IC oral exams in Louisville
December 2009
TBA DR subspecialty* MOC exams at
RSNA Annual Meeting, Chicago
7-8 DR subspecialty* MOC exams in Tucson
IC = Initial Certification (computer-based)
MOC = Maintenance of Certification (computer-based)
DR = Diagnostic Radiology
RO = Radiation Oncology
RP = Radiologic Physics
*DR subspecialties include neuroradiology, nuclear
radiology, pediatric radiology, and vascular & interventional
radiology.
For more information on fees, exam dates, and locations,
go to www.theabr.org/FeeDateLocation.htm.
The American Board of Radiology
5441 East Williams Blvd., Suite 200,Tucson, Arizona 85711
Phone: 520-790-2900 Fax: 520-790-3200
www.theabr.org l www.abronline.org
Board of Trustees
President
N. Reed Dunnick, M.D.
President-Elect
Bruce G. Haffty, M.D.
Secretary-Treasurer
Richard L. Morin, Ph.D.
Assistant Executive Directors,
Initial Certification
Diagnostic Radiology Dennis M. Balfe, M.D.
Radiation Oncology
Beth A. Erickson, M.D.
Radiologic Physics Richard L. Morin, Ph.D.
Assistant Executive Directors,
Maintenance of Certification
Diagnostic Radiology:
James P. Borgstede, M.D.
Radiation Oncology
Lawrence E. Kun, M.D.
Radiologic Physics
G. Donald Frey, Ph.D.
Subspecialty Certification
George S. Bisset, III, M.D.
Other Trustees
K. Kian Ang, M.D., Ph.D.
Thomas H. Berquist, M.D.
John K. Crowe, M.D..
Glenn S. Forbes, M.D.
Milton J. Guiberteau, M.D.
Geoffrey S. Ibbott, Ph.D.
Valerie P. Jackson, M.D.
Ella A. Kazerooni, M.D.
Matthew A. Mauro, M.D.
Duane G. Mezwa, M.D.
Anne C. Roberts, M.D.
Janet L. Strife, M.D.
Christopher G. Willett, M.D.
Anthony L. Zietman, M.D.
Foundation Board
of Directors
Chairman
William Casarella, M.D.
Board Members
K. Kian Ang, M.D., Ph.D.
Dennis M. Balfe, M.D.
Robert E. Campbell, M.D.
N. Reed Dunnick, M.D.
Glenn S. Forbes, M.D.
Bruce G. Haffty, M.D.
William R. Hendee, Ph.D.
Lawrence E. Kun, M.D.
C. Douglas Maynard, M.D.
Richard L. Morin, Ph.D.
Anne C. Roberts, M.D.
ABR Directors
Executive Director
Gary J. Becker, M.D.
Senior Advisor
Robert R. Hattery, M.D.
Comments, suggestions or questions?
l [email protected]
Copyright 2008 lThe American Board of Radiology
Associate Executive Directors
Diagnostic Radiology
Kay H. Vydareny, M.D.
Radiation Oncology Lawrence W. Davis, M.D.
Radiologic Physics Stephen R. Thomas, Ph.D.
Administration
Jennifer Bosma, Ph.D.
Newsletter Staff
Executive Editor
George S. Bisset, III, M.D.
ABR Staff Editor/Layout
Donna Breckenridge
Design
Jennifer Hutson
Copy Editor
debbi Weitzell