Personal Reflections on Four Decades With the College

When the senior partner of Catawba Radiological Associates, the 5-person radiology group I joined in 1984, invited me to attend the North Carolina Radiological Society meeting, I couldn’t have imagined that it would evolve into nearly 40 years of College involvement, ending in a 10-year tenure as its CEO. 

James Harold Owsley, MD, FACR, (also known as Hal), who served on the ACR BOC and as ACR vice president, was very subtle in his encouragement, mentorship and sponsorship during and after my leadership service at the state chapter level. When he had a committee opening in his Commission on General and Pediatric Radiology, which was involved in the early development of “Standards” (now known as the ACR Practice Parameters and Technical Standards), he offered me the chance to serve at the national level. In 1993, the chair of this committee was tasked with leading the development of the ACR Appropriateness Criteria® that would ensure patients received the best imaging test for their clinical condition, and Hal asked me to fill the vacated chair seat. I was incredibly impressed that our College’s volunteer leaders and staff were so committed to ensuring high-quality care and safety for patients. Eventually, that group of staff and member volunteers became the Commission on Quality and Safety and to this day remains driven by the same mission.

Soon thereafter I received a fateful call from John Curry, JD, then ACR CEO. He asked if I would be willing to shift my volunteer efforts toward coding and economics. Before that call ended I had agreed to chair the Committee on Coding and Nomenclature, become the ACR advisor to the AMA CPT® Editorial Panel and serve as the ACR alternate advisor to the recently formed AMA/Specialty Society Resource-Based Relative Value Scale Update Committee (RUC). My term as alternate to RUC Advisor W. Max Cloud, MD, FACR, lasted just one RUC meeting as Max then ascended to BOC vice chair, so I moved up. Our economics staff at that time was comprised of just four people.

As they say, the rest is history. Five years later I was elected to the BOC to chair the Commission on Economics and the following year was appointed by the AMA Board to serve on the AMA CPT Editorial Panel.

I tell this story to emphasize several concepts, particularly for our RFS and YPS colleagues:

1. Look for opportunities to become involved beyond clinical care. It is exciting and professionally rewarding.
2. Mentorship and sponsorship are critical. Treasure those relationships.
3. Be willing to shift gears when a new opportunity presents itself. 
4. The ACR has a long history of being visionary and is unique among radiology organizations in its breadth of volunteer opportunities.
5. The College has come a long way in scope, scale and sophistication during these four decades. 

It is impossible to cite all the radiological advancements during these decades, and I could fill this entire issue of the Bulletin with examples demonstrating how the "ACR is indispensable" to our professions, members and their patients. Instead, I’ll highlight a few that have been incredibly impactful: 

1. As the original digital imaging specialty, radiology needed standards for image processing and transmission. The ACR and the National Electrical Manufacturers Association (NEMA) developed the DICOM^® Standards in 1983 with general acceptance by manufacturers in 1993 and with refinement ever since.
2. As diagnostic imaging evolved, it came to be viewed as a potentially lucrative addition to practices outside radiology. Beginning with mammography, the ACR developed quality guidance that has become the foundation of our accreditation programs to assure patients, referrers and payers that radiologists are providing safe, high-quality imaging. Such guidance now extends to numerous modalities and examinations. Through our diligent advocacy efforts, accreditation is now federally mandated for reimbursement for all specialties providing outpatient advanced imaging services.
3. Single-institution clinical research has significant limitations in the generalizability of findings. The ACR pioneered multicenter collaborative research trials, first in radiation oncology (Radiation Therapy Oncology Group^®) and subsequently in diagnostic imaging (ACR Imaging Network^®). Initially done manually transporting films and files and now fully digitally, this collaborative research provides real-world evidence from both academic and community practices. Trials such as the Digital Mammographic Imaging Screening Trial, the National Lung Screening Trial and the National Oncologic PET Registry resulted in improvements in patient outcomes and population health as well as expanded coverage for life-saving radiology services.
4. Through more than two decades of government relations advocacy efforts, the ACR, working collaboratively with many other specialties, was able to mitigate Medicare reimbursement cuts, first during the era of the Sustainable Growth Rate (SGR) and more recently after the SGR repeal via the MACRA legislation. Just during the past four years this has resulted in more than $1.7 billion in reclaimed reimbursement for radiologists allowing practices to provide optimal care. 
5. Leadership is a core value in the ACR Strategic Plan, and we have demonstrated that commitment through the ACR Radiology Leadership Institute^®. In addition, we are committed to data-driven healthcare improvement as evidenced by the incredibly productive Harvey L. Neiman Health Policy Institute^®. Both are now 12 years old and going strong.
6. My final example is the College’s response to the remarkably rapid rise of AI and machine learning in healthcare. Since the establishment of the ACR Data Science Institute^® in 2017, our volunteer and staff leadership have set the gold standard for organized medicine engagement in guiding the safe, effective, reliable and transparent development and implementation of AI.

There are many truly remarkable achievements over the past 40 years — and the past 100; how exciting that my time as CEO included the ACR’s centennial celebration. I anticipate that the next century will be even more incredible for the College, all of radiology and healthcare. 

As my decade as ACR CEO ends, I feel honored and privileged to have had the opportunity to serve both as a volunteer and as leader of the best staff in organized medicine. Combined with my clinical practice, I cannot imagine a more exciting and fulfilling career and would do it all over again. 

My sincere thanks to everyone I have had the pleasure of working with side by side, most importantly my wife Nancy, who supported (and tolerated) me throughout. 

As the consultant writes in their final note in the patient’s chart, “Will follow with interest.”