ACR Bulletin

Covering topics relevant to the practice of radiology

2020 Hindsight

The past year has thrown the profession a myriad of challenges, but radiology has survived — and even thrived.
Jump to Article

"Through innovation and operational excellence, we continue to be one of the most respected specialties in medicine."

—Howard B. Fleishon, MD, MMM, FACR
November 24, 2020

As we reflect on 2020, we realize how much COVID-19 has changed our lives. The typical holiday cheer will be modified by the need for social distancing, masks, and other health and safety precautions. Many traditional holiday events will take place virtually for the first time.

When the pandemic hit in March, it also disrupted our professional lives and ravaged many of our practices. Volumes dropped precipitously, by as much as 80% in some cases (learn more at Practices applied for relief through the Paycheck Protection Program and applied for advanced payments through CMS (read more at Radiologists were encouraged to work remotely. New health and safety measures were required, including cleaning equipment, increasing time between exams, and adopting teleradiology workflows. Initially, personal protective equipment was a scarce resource. The Centers for Disease Control and Prevention updated recommendations frequently with, at times, confusing guidance. Educational programs had to reinvent themselves almost overnight. Radiology’s role in COVID-19 became a fluid topic as pandemic testing became, and continues to be, a challenge.

Yet, our practices have adapted. Volumes are returning to pre-pandemic numbers. Our educational programs are establishing a new normal. Meetings that have been virtualized are realizing the benefits of reaching a larger audience with the ability to apply new methods for learning and communication.

Radiology is also facing the daunting prospect of an 11% reduction in reimbursement due to the evaluation and management code revaluations. Our government relations team has put together a multipronged approach to address regulatory and legislative opportunities for relief. However, the task is Herculean, especially with all the wind in Washington focused on the recent election, the Supreme Court, and the amount of money that has been dedicated to float the economy during the pandemic. Throughout this challenge, the government relations team has been able to coordinate an alliance of more than 70 organizations to join us in the fight — an incredible accomplishment. ACR is leading the charge and whether or not we are successful before Jan. 1, we have no doubt this fight will continue into 2021.

The radiology profession continues to be resilient. We have faced many legislative and regulatory challenges. My mentors considered Medicare legislation to be the end of radiology. RAPS, the resource-based relative value scale, the multiple procedure payment reduction, the Affordable Care Act, and the Medicare Access and CHIP Reauthorization Act of 2015 have all posed threats to our profession and our ability to provide our patients access to medical imaging. However, we have survived — if not thrived. Through innovation and operational excellence, we continue to be one of the most respected specialties in medicine.

For several years, the rapid development of AI was perceived as an existential threat to radiologists. Some pundits have speculated that decreases in residency applications in the past were due to fears of professional displacement by AI. A glossary of medical startups has been based on AI replacing radiologists. Yet, as the industry matures, more are recognizing that AI tools will facilitate our workflows. AI has the potential to augment our diagnostic and therapeutic capabilities — to extract even more information from the digital data that we produce. In the “Cockpit of the Future,” the vision is to create a workspace where we can process all the integrated information coming to us from not only our studies, but from every silo in healthcare — putting us at the epicenter of patient care and management.1

Above all, radiology continues to be gifted with some of the best and brightest in medicine. Our growing patient-centered focus, data science centricity, palate of minimally invasive therapeutics, emphasis on innovation, and promising future of possibilities continue to attract future innovators, leaders, and entrepreneurs. And, as brought to us by ACR President Geraldine B. McGinty, MD, MBA, FACR, I leave you with a sentiment by the late Irish poet, Derek Mahon: “Everything is going to be all right.”


1. Krupinski E, Bronkalla M, Folio L, Keller B, Mather R, Seltzer S, Schnall M, Cruea R. Advancing the diagnostic cockpit of the future: an opportunity to improve diagnostic accuracy and efficiency. Academic Radiology. 2019;26(4):579-581.

Author Howard B. Fleishon, MD, MMM, FACR,  chair of the ACR BOC