ACR Bulletin

Covering topics relevant to the practice of radiology

Clinical Research

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The ACR is committed to innovation in radiological clinical studies.

You have to put in the work, take the time to define the research, and then refine the research.

—Etta D. Pisano, MD, FACR
November 22, 2021

Clinical research allows us to quickly translate new technologies and innovations that impact healthcare from the bench into patient care,” says Pamela K. Woodard, MD, FACR, chair of the ACR Commission on Research and professor of radiology and biomedical engineering at the Mallinckrodt Institute of Radiology. “The research determines how new technologies should be used to improve imaging quality and clinical decision-making to best impact patient health and clinical outcomes.”

Radiologists need time to participate in research, however — and, ultimately, time isn’t free. Funds are needed to cover time for radiologists to participate in research, and administration at academic centers needs to involve radiologists in clinical research when possible, Woodard says. “The key to innovation is the engagement of radiologists to provide expertise in clinical context, significance, and impact,” she says.

To facilitate this engagement, the ACR offers several current opportunities for ACR members to apply for research grants through two research centers at the College: the ACR Center for Research and Innovation™ (CRI) and the Harvey L. Neiman Health Policy Institute® (NHPI). These funding opportunities will facilitate future practice innovations through research and education for the benefit of patient outcomes, patient experience, and population health management.

New Funding

Fund for Collaborative Research in Imaging (FCRI) Grant

The ACR has issued a request for applications for its FCRI grant to power compelling, innovative research that advances radiology practices. The FCRI grant, available to all ACR members, fuels pilot projects to test a new idea or support a new area or direction of clinical radiology research.

“The FCRI grant presents researchers with an opportunity to discover new paradigms in patient care,” Woodard says. “Researchers are making new discoveries at a rapid pace, and this grant plays an important role in fueling further innovation.”

Grants generally address a specific hypothesis and generate preliminary data that could be used to justify or strengthen subsequent comprehensive applications to national peer-reviewed funding agencies. The grant project must use ACR systems or staff expertise and outline a plan for future research and funding needs.

“The FCRI grant is a launch pad for cutting-edge radiology research,” says Etta D. Pisano, MD, FACR, ACR chief research officer. “The potential for advances in radiology is boundless, and I strongly urge clinical researchers to apply.”

With an aggressive strategy that includes a wide breadth of priority topics, expanding collaborations is critical. One organization cannot reasonably have all of the data or expertise necessary to tackle every topic on the policy horizon.

—Elizabeth Y. Rula, PhD

Neiman Institute Grants Program

The second research grant opportunity is through the NHPI, which studies the value and role of radiology in evolving healthcare delivery and payment systems. This includes examining quality-based approaches to care and the impact of medical imaging on healthcare and its cost.

The work of the NHPI complements clinical research by paving the way for the policy that improves patient access to needed radiologic care. The operational model of the NHPI is rooted in academic partnerships and collaborations that are central to ensuring relevant research that translates clearly into policy and practice. “With an aggressive strategy that includes a wide breadth of priority topics, expanding collaborations is critical. One organization cannot reasonably have all of the data or expertise necessary to tackle every topic on the policy horizon,” says Elizabeth Y. Rula, MD, executive director of the NHPI.

The NHPI is looking for proposals that meaningfully expand the evidence base that paves the way for advances in radiological practice that improve patient outcomes, reduce health disparities, inform the appropriate use of that care, and demonstrate value to support adequate reimbursement needed to ensure patients have access to a high level of care from trained radiologists.

The NHPI gained support for its new grants program for exactly these reasons — to build bridges and momentum to have a larger positive impact on patient care. To accomplish this goal, having a diverse field of researchers is key. “We see Neiman HPI grants as a way to deepen the bench by partnering with researchers that bring different perspectives, skills, and resources,” says Rula.

In partnership with Pina C. Sanelli, MD, MPH, vice chair of radiology research and director of the Imaging Clinical Effectiveness and Outcomes Research division at Northwell Health, the NHPI also introduced a new fellowship to help foster the next wave of researchers contributing policy research in radiology. The Neiman Institute Fellowship in Clinical Effectiveness and Health Policy Research provides a unique opportunity to gain experience and mentorship, while contributing important evidence on radiology services to inform health policy.

Pandemic Setbacks

“COVID-19 really hurt research that dealt with active patient enrollment for clinical trials,” says Arun Krishnaraj, MD, MPH, chair of the ACR’s Commission on Patient and Family-Centered Care and vice chair for quality and safety at the University of Virginia. “Any study that entails you having to get a volunteer to come in to participate in the hospital is potentially hurt by the pandemic.”

The pandemic impacted research in another way too. “When work started shifting to home-based workstations for many radiologists, there was a bit of a burnout factor — working in isolation and missing out on the kind of novel ideas that happen serendipitously because you are interacting with people,” Krishnaraj says. “The lack of interactions leads to fewer opportunities to find collaborators both within and outside of radiology. One outcome of this new normal are the generation of fewer novel ideas that lead to publications and presentations, the currency academics need not only to have an impact but also to get promoted.”

Pisano agrees that research is a vital part of radiology but points out that funding is only one barrier for some members of the radiology community. “The ability of those individuals who are taking care of children, for instance, who have no time to use grant money for research is not going to be impacted by the availability of the grant,” Pisano says. “For people to squeeze in research and education on top of that requires departmental support.”

Putting in the Work

According to Pisano, you really have to want your research to be published. “The way you get papers published is to actually write down your ideas,” says Pisano. “You have to put in the work, take the time to define the research, and then refine the research.”

“Just having an idea and speaking up in a meeting doesn’t add much value to the system,” Pisano says. “You have to go out and find the money to do the project — you have to hire the people to help you with the project or run a site that is spearheading a project. There are so many things that need to be executed to run a big clinical research project — or a small research project for that matter.”

“With the radiology workforce getting strained — and an unprecedented number of early retirements and people leaving the specialty during the pandemic — finding time for research is challenging,” Pisano says. “Doctors doing clinical medicine are overloaded. There is just not a lot of time or capacity right now for clinical research.”

Forward Thinking

“COVID-19 has highlighted disparities in healthcare — more Blacks, Latinx, and Native Americans have died from COVID-19 in comparison to Whites,” Woodard says. “The answer as to why is multifactorial — more people of color are essential workers but with fewer protections in place. There is more multigenerational housing and less access to emergency-use therapies.”1

Disparities continue in clinical research among White men and women and people of color, Woodard says. “Key factors are barriers to access — including a lack of access to clinical trials because of lack of proximity to a trial center.” There is a transportation issue as well, she says, and potential inability to pay a copay.

While some trials cover patient expenses, large oncology trials and others still include standard-of-care imaging in their paradigms that require a copay, Woodard says. “This can not only severely bias research towards the more privileged but also can prevent access to new life-saving cancer therapies for patients who can’t participate in the trial,” she says.

The ACR is advancing research on a number of fronts, Woodard says. “First and foremost, the CRI’s Tomosynthesis Mammographic Imaging Screening Trial (TMIST) and New Imaging Dementia Evidence for Amyloid Scanning (IDEAS) study seek to understand the impact of new technologists in decision-making,” she says. “TMIST now has 20% of patients recruited who are Black.”

According to Woodard, the New IDEAS program focuses on the recruitment of Black patients with Alzheimer’s disease. “The NIH has shown interest in how registries can also be used to answer clinical questions, leveraging CRI and ACR Data Science Institute® expertise,” Woodard says.

“From our perspective, the challenge of COVID-19 in our research is the different patterns of utilization — stemming both from patients skipping or delaying imaging, but also because of increases in imaging of COVID-19 patients,” Rula says. “As a result, studies have this new confounding factor that makes data interpretation more challenging.”

“Clinical research is imperative, arguably now more than ever, especially considering how COVID-19 has immensely impacted so many areas of medicine,” says Amy Patel, MD, medical director of the Breast Care Center at Liberty Hospital and assistant professor of radiology at the University of Missouri-Kansas City School of Medicine. “It is important to push for clinical research not just from academic institutions, but from private practices that encompasses all demographics and geography, including rural settings.”

“Some radiologists lack the resources, mentorship, sponsorship, and support to take on these research activities within their practices,” Patel says. “The ACR has the powerful ability to support those radiologists who want to do this kind of work.”

ENDNOTES

1. Mogensen MA, Lee CI, Carlos RC. The impact of the COVID-19 pandemic on journal scholarly activity among female contributors. J Am Coll Radiol. 2021;18(7):1044–1047.1.

Author Chad Hudnall  Senior Writer, ACR Press