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Doing Well by Doing Good – The ACRIN Fund for Imaging Innovation

Bruce J. Hillman, MD
Department of Radiology, the University of Virginia, Charlottesville, VA

Send correspondence to:

Bruce J. Hillman, MD
Department of Radiology-UVAHS
P.O. Box 800170
Charlottesville, VA 22908
Phone: 434-982-3307
Email: bjh8a@virginia.edu

Editor's Note: The author is the Principal Investigator and Network Chair of the American College of Radiology Imaging Network (ACRIN).

A little sincerity is a dangerous thing, and a great deal of it is absolutely fatal.
- Oscar Wilde

In recent surveys conducted by the American College of Radiology (ACR), members indicated that their principal regard for the activities of the College relate to its efforts in the areas of economics and government relations. The survey results indicated little appreciation of the ACR's role in generating research or of the importance of research to the future well-being of the specialty. This outcome is not particularly surprising. The College is the only organization in our specialty that expends significant resources on economics and policy and in engaging state and federal lawmakers. Moreover, the ACR has frequently communicated these activities to its membership. Much less recognized has been ACR's role in research, which is substantial. Indeed, it will surprise many to learn that the ACR expends much more money each year on research than any other radiological organization and that research is by far the single largest line item in ACR's annual budget.

How could this be possible? Could this stealth item in the budget – ACR's involvement in research – be responsible for the recent increase in members' annual dues? What's the value to members? In fact, ACR's research is an extraordinary member benefit that costs the membership virtually nothing. ACR research is financed not by members' dues but by grants, primarily from the National Cancer Institute (NCI), to support the clinical trials activities of the American College of Radiology Imaging Network (ACRIN) and the Radiation Therapy Oncology Group (RTOG). Total grants to ACRIN and RTOG from all sources totaled over $50 million in 2005, making ACR the 14th largest grantee of NCI.

You will note above my bias that ACR members derive great and underappreciated benefit from the College's participation in research – indeed, in my estimation, benefit at least equal to that of the ACR's more generally recognized economics and government relations activities. The benefit of ACR research to members falls into several categories: the translation of clinical advances into new clinical practices to support the continued growth of the specialty; financial support of troubled academic departments; rigorous, generalizable science in support of payer reimbursement of emerging technologies; interfacing imaging research with the broader world of cancer research to enhance the profile of radiology as a scientific specialty; and the potential to generate revenue by contracting with industry in support of furthering ACR research activities.

In support of my assertions is my belief that the intellectual and economic flourishing of diagnostic radiology, nuclear medicine, and interventional radiology over the last several decades is – more than on any other factor – related to the extraordinary advance of new imaging technologies that have generated a large number of new reimbursable clinical applications for radiologists during that period. Especially given the relentless encroachment on imaging by other specialties, it seems incontrovertable to me that our continued success as a specialty in the future will principally depend on our research capacity to develop and demonstrate the benefit of further innovations that can expand our practices by at least the same measure as what we have experienced over the past twenty years. In brief, I believe that our greatest defense against what I view as inevitable losses of current turf is the development of new, valuable clinical practices.

As in the past, our ability to address this need to expand the scope of our practices will fall on the shoulders of our academic departments. However, as has been recently, convincingly argued in the pages of this journal, many academic radiology departments are in difficult financial straits and are hence unable to conduct quality research [1]. ACRIN provides direct compensation to academic radiology departments for accruing subjects into ACRIN clinical trials and as payment for the intellectual contributions of ACRIN leadership and investigators. In 2004, the last year for which there is complete data, ACRIN paid approximately $26 million to academic radiology departments, or about 1/13th of all National Institutes of Health funding to these departments during that year.

A very tangible benefit of ACR research is that the types of multi-center, multi-discplinary, rigorous clinical trials pursued by ACRIN, when positive, provide more acceptable evidence in support of the College's efforts to secure reimbursement for new clinical practices than do typical, single institutional observational studies. Several recent and ongoing ACRIN activities provide examples of how this benefit might accrue to radiologists. ACRIN's National Lung Screening Trial comparing chest radiography and CT screening uniquely bears the potential to define whether either procedure reduces the mortality from lung cancer; if positive, the trial would support expanded imaging screening and reimbursement for the procedure. An ACRIN trial of dynamic contrast enhanced MRI for advanced breast cancer evaluates whether this procedure can provide oncologists with earlier and more accurate insight into whether a chemotherapeutic regimen is working effectively; this trial is representative of a class of ACRIN trials of PET and MRI as "biomarkers" of therapeutic effectiveness that, if positive, could greatly expand reimbursable indications for these procedures. An ACRIN trial under development will test the capabilities of magnetic resonance spectroscopy (MRS) and diffusion-weighted MRI to grade brain cancers; these applications have been denied reimbursement in the past – despite numerous small single institutional studies - for lack of rigorous, generalizable scientific evidence that the ACRIN trial is designed to provide. Indeed, the very existence of ACRIN has recently provided the intellectual and electronic infrastructure to support a considerable expansion of reimbursable PET procedures. The National Oncologic PET Registry (NOPR) depends on ACRIN to archive and analyze data in support of the Centers for Medicare and Medicaid Services (CMS) initiative to reimburse more broadly for PET procedures in cancer patients while simultaneously gathering through the Registry the evidence to determine PET's ultimate value in this setting.

ACRIN provides an infrastructure for conducting clinical trials that has never before been available in support of our specialty and is involved in the pursuit of 23 multi-center clinical trials. Nonetheless, ACRIN is vulnerable. The recent downturn in NCI funding of all of its activities threatens ACRIN's capacity to continue to serve radiology. Moreover, because all of ACRIN's funding is directed towards cancer, it is unable to address clinical applications important to radiologists in such areas as cardiovascular and neurological disease. More and more diverse funding sources would mean a greater capacity to conduct research that benefits the specialty.

For these reasons, the ACR has initiated a philanthropic campaign aimed at making ACRIN more secure and effective in support of radiology. The ACRIN Fund for Imaging Innovation was initiated with a $1 million donation from the ACR Foundation. Gifts from industry – anchored by $1 million gifts from Siemens Medical Systems and GE - along with significant individual gifts from members of the ACR Board of Chancellors and Council Steering Committee, have brought the total amount in the Fund to over $5.5 million, as of February 1st, 2006. The ACRIN Fund now solicits your support. I hope that I have made a convincing case for why ACRIN's research is critical to the future viability of radiology and radiologists:

• Improved evidence basis to guide practice;
• Translation of emerging technologies into clinical practice;
• Rigorous evidence in support of reimbursement for emerging technologies;
• Key role in revitalizing academic radiology departments;
• Training for tomorrow's researchers;
• Potential to contract with industry and provide resources for ACR research expansion.

A contribution to the ACRIN Fund is an opportunity for you to make an investment in your future. You can do well by doing good. For information on how you can contribute, contact Brad Short at the ACR (bshort@acr.org).

References

1. Dodd G, Fletcher T, Thorwarth W. The crisis in academic radiology: will we help ourselves? J Amer Coll Radiol. 2006;4:243-247.