The Tangible Benefits of Imaging Research


Bruce Hillman, MD

Bruce J. Hillman, MD
Theodore E. Keats Professor of Radiology at the University of Virginia and Network Chair of ACRIN
Although it is not generally appreciated, the ACR is the premier research organization in radiology, with 2004 grants totaling approximately $54 million. For over 25 years, the ACR has received major federal grants and been the entity responsible for developing and pursuing such extensive research efforts as the Radiation Therapy Oncology Group and the radiation oncology Patterns of Care Study. The ACR research offices in Philadelphia, in concert with the professional leadership the ACR has recruited, have been responsible for major advances in clinical care and improving the uniformity and quality of clinical practice.

The most recent major research initiative of the ACR is the American College of Radiology Imaging Network (ACRIN). ACRIN was founded in 1999 when the ACR recruited Bruce J. Hillman, MD, of the University of Virginia, and Constantine Gatsonis, PhD, of Brown University, to serve as the principal investigators of linked Headquarters and Biostatistical Center grants to respond to a request for applications from the National Cancer Institute (NCI). Their successful application led to the development of ACRIN, an organization dedicated to conducting rigorous, multicenter clinical trials of diagnostic imaging and image-guided treatment technologies to improve the length and quality of the lives of cancer patients, provide more rapid access to beneficial technologies, and allay the anxiety of people who do not have cancer. ACRIN has achieved continuous NCI core funding through 2007, received 3 substantial supplemental grants to conduct major screening trials, and partnered extensively with other elements of the cancer research community, foundations, and industry.

ACRIN's research expenditures totaled $36 million in 2004, making it perhaps the single largest item in the ACR's annual budget, but all of ACRIN's activities are funded extramurally; they do not draw upon members' dues or other ACR revenues. This is a remarkable value for ACR members, because the benefits to practicing radiologists of ACRIN's clinical research are real and tangible. Consider the following examples:

  • Many of ACRIN's trials test the value of new technologies. As examples, current or upcoming trials include the evaluation of magnetic resonance spectroscopy for grading brain tumors and novel contrast agents for staging cervical cancer. Demonstration of effectiveness will promote more rapid technology development, regulatory approval, and reimbursement for clinical use.

  • The results of ACRIN's digital mammographic imaging screening trial (DMIST) of digital mammography have the potential to enhance reimbursement for this novel technology.

  • ACRIN's trials of digital mammography (DMIST), CT screening for lung cancer, and CT colonography are among the largest and most publicly visible trials sponsored by NCI. The results of these trials might promote the eventual broad acceptance of imaging screening and increase the numbers of individuals seeking screening.

  • ACRIN is working with a major manufacturer on its trial of magnetic resonance spectroscopic imaging for prostate cancer. Such trials are essential to helping manufacturers validate and improve their products, hastening their translation into clinical practice.

  • ACRIN's serving as a registry for data derived from PET scanning has enabled the Centers for Medicare and Medicaid Services to decide to reimburse PET for previously unreimbursed cancers, thus expanding the use of PET in cancer.

More broadly, ACRIN serves radiologists through its role as a national leader in our specialty's efforts to progress from practice by anecdote and habit toward more evidence-based imaging practice. The overall goal is to improve the appropriateness of care, to retain and expand the use of what works best for patients, and discard that which is ineffective or dangerous.

Despite ACRIN's successes, ACRIN could be doing much more. The budget of the NCI is declining in available real dollars, and there is fierce competition for continuing resources. Much of ACRIN's funding is designated by NCI for specific trials, so that ACRIN is limited in the new trials it can initiate. In addition, ACRIN is limited in its use of NCI funds to investigations of cancer. There are critical issues in imaging cardiovascular and central nervous system disease, among others, that could be addressed by the research infrastructure that ACRIN has developed if separate funding sources could be developed. To address these needs, the ACR is establishing an ACRIN development fund, endowing it with a significant gift, and seeking contributions from industry, foundations, and individuals, including ACR members. Doubtlessly, over the next several months, you will hear much more about this effort in the ACR Bulletin, the JACR, and in other venues. The case for contributing generously to the ACRIN fund is clear—ACRIN's promotion of appropriate care is not only the right thing to do, it will return tangible benefits to the specialty.

To learn more about the ACRIN development fund, contact ACR Campaign Offices at 1891 Preston White Dr, Reston, VA 20191 (800) 227-5463, ext 4975 • brads@acr.org