Throughout the challenges the COVID-19 pandemic has presented, the ACR has been resolute in adapting to the quickly changing radiology landscape. As evidenced by the work of many groups within the College, such as the Commission on Publications and Lifelong Learning (CoPLL), the Commission on Quality and Safety (Q&S), the Commission on Patient- and Family-Centered Care (PFCC), and the Commission on Informatics, among others, the ACR has been reimagining its role for members and the specialty at large.
“During the winter of 2020, when another surge of the coronavirus was upon us, I proposed a challenge to the Board and staff to reimagine the College,” says ACR BOC Chair Howard B. Fleishon, MD, MMM, FACR. “As complexity increases, the imperative to reimagine grows stronger — and ACR operational innovation is happening at a faster pace with greater engagement from more commissions.”
Non-profits exist to have impact. “So, an initial step is to clearly determine our focus,” Fleishon says. “For the ACR, concentrating on impact goes beyond our environmental surveillance and strategic planning process. It relies on candid, data-driven discussions about how current individual commissions and programs will deliver impact in a new environment.”
Pivoting and Learning
“The CoPLL has reimagined the ACR’s resources to better equip our members to engage with their patients,” says Elizabeth Bleu, senior director of the ACR’s department of publications and lifelong learning. To counter the COVID-19 restrictions on in-person gatherings, for example, the Commission reinvented two leading and unique educational programs: the ACR Institute for Radiologic Pathology™ (AIRP) and the ACR Education Center.
“We have changed delivery models within the ACR Education Center from entirely in-person to virtual and hybrid models,” Bleu notes. These virtual and hybrid models will continue beyond the pandemic as an improved offering to participants, she says. The AIRP has undergone a similar transformation.
“With a robust web presence, and multiple new offerings that launched in January, the ACR has implemented an effective campaign to attract medical students and their institutions to participate in educational programs,” Bleu says. In addition, the ACR 2022 Medical Student Symposium in January built upon the success of past events to provide insight into the field of radiology and to encourage students to consider radiology as a career path.
“Although the past two years have been trying for all of us, our team has embraced Dr. Fleishon’s challenge to reimagine the ACR,” says Lori A. Deitte, MD, FACR, chair of the CoPLL. “We are committed to designing meaningful professional development resources and experiences for the membership, including members-in-training and medical students. We want to be inclusive of all career stages and types of practice.”
“ The pandemic provided a critical inflection point for us — we had to build off of our established trajectory to chart a new future path to serve members and patients in this new environment.”
The College has also turned its attention to improving our longstanding in-training exams for residency programs — a reinvention via the transitioning of the DXIT™ and TXIT™ programs into ACR’s internal platform. By surveying training program directors and coordinators, the ACR discovered that robust security measures, virtual proctoring, national benchmarking among programs and within each program, and the psychometric precision of exams are highly valued.
In keeping with the commitment to serve members-in-training and their residency programs, the ACR is now offering residents the option for remote, virtual, in-training testing for DXIT and TXIT. The in-training exams offer residents and program directors an opportunity to evaluate their training progress and identify areas for improvement relative to peers at the same level of training. These assessments provide secure and accurate evaluations and offer residents opportunities for maximizing testing preparation for their upcoming Board exams.
Quality and Safety
“The pandemic provided a critical inflection point for us — we had to build off of our established trajectory to chart a future path to serve members and patients in this new environment,” says Mythreyi B. Chatfield, PhD, executive vice president of ACR Q&S. The ACR, in general, was already forward-looking and set up for remote work and continued services when the pandemic began. This positioned us to move quickly on the new features our members needed when the pandemic began.”
Even before the pandemic, the ACR Q&S department was able to virtually support practices in accreditation and registry participation. “We had already created an electronic platform for content development for guidelines, and a seamless workflow and services,” she says. When the pandemic hit, the Q&S team was ready to support members with fully electronic uploads of images for accreditation and a fully electronic data upload process for registries.
“Then we added a number of other services,” Chatfield says, including:
- Virtual surveys at facilities where they could not be done in-person. These initially began as a temporary measure but will continue in some capacity post-COVID-19.
- A sharper shift to virtual meetings and reserving in-person gatherings for occasions that generate the most value.
- Adding fields to registries to capture COVID-19-related information and running virtual improvement courses to train facilities in structured improvement.
“As a result of this reimagining, we found that virtual surveys for renewals, where appropriate, can reduce disruptions to patient care without compromising facility quality and safety,” Chatfield says. “We will continue to offer these services where possible. The reduction in travel time to support surveys leaves more room to focus on resources to help facilities improve and provide better care."
The ACR Q&S department’s future plans include the expanded use of virtual platforms for meetings to help younger members/junior members who may not be able to get time away from practice for travel — or who have young children at home. “We are also looking for opportunities to capture member input into more of our programs (such as improved field reviews and comment periods),” Chatfield says.
The College also aims to use quality registries beyond their originally intended purpose to track practice patterns. The registries can be used to assess population impacts more nimbly, such as looking at the effects of COVID-19 delays on cancer rates and outcomes. “We want to use our footprint in the Q&S space to coordinate with research registries to set up more innovative and robust work going forward,” Chatfield says.
Registries and Residents
“Many successes throughout the pandemic that fall under the College’s reimagining strategy have come in the form of research and collaboration,” says Durga Gandi, vice president of the ACR’s IT operations and technology solutions. The ACR Center for Research and Innovation™ (CRI) has been assembling the COVID-19 Imaging Research Registry (CIRR) — an effort of the ACR CRI and the ACR Data Science Institute®, in collaboration with the ACR and the Society of Thoracic Radiology (learn more at acr.org/CIRR).
The CIRR is a primary step to advancing the understanding, prevention, and treatment of COVID-19. It is a cross-disciplinary initiative with collaborations extending beyond radiology to engage other clinical experts and diagnostic modalities, including clinical medicine, genetics, biomarker discovery, laboratory sciences, and others. Participating sites contribute demographic information, clinical data on signs and symptoms, imaging exams, laboratory test data, and outcomes for U.S. patients tested for COVID-19. The registry is designed to link to other existing COVID-19 registries and datasets, with use and development of common data elements.
In addition, the ACR has brought together the full power of CRI and ACR Informatics™ resources to launch the innovative ACR National Clinical Imaging Research Registry™ (ANCIRR). The ANCIRR collects images and clinical data from multiple practice settings — enabling researchers to address complex scientific questions and produce results applicable across various care settings, geographic locations, and populations. “As ANCIRR was established, we came up with ways in which facilities can use their data for multiple purposes to support local improvement, as well as research,” Gandi says.
In addition, the ACR, the RSNA, and the American Association of Physicists in Medicine formed a research consortium last year to develop the Medical Imaging and Data Resource Center (MIDRC), funded through the National Institute for Biomedical Imaging and Bioengineering. The open-source database will house medical images from thousands of COVID-19 patients. CIRR is contributing clinical and imaging data to MIDRC. The resource represents the country’s largest medical imaging associations, and its data platform provides a critical tool for doctors and scientists to better understand COVID-19.
“ACR Informatics is also utilizing tools such as Okta, Office 365 (Teams), conflict of interest and legal systems (Agiloft), and other cloud-based tools to allow staff and volunteers to engage with us from anywhere in the world,” Gandi says. All of the tools utilized, and reimagined, represent the ACR’s continued focus on patient care, she says.
Patients and Families
“The PFCC Commission has always recognized the disproportionate impact social determinants of health have had on the populations of patients we care for,” says Arun Krishnaraj, MD, MPH, chair of the ACR’s PFCC Commission. “To this end, our first population health webinar focused on this topic with concrete advice from our participants on how members could address these disparities in their local communities.”
COVID-19 has had a profound impact on the morale of both caregivers and the patients they serve, Krishnaraj says. “From a PFCC perspective, we have always strived to improve the patient experience and understanding of radiological services by developing and deploying resources which facilitate better communication with our patients,” he says. “Whether it be our comprehensive Spanish language content on RadiologyInfo.org, our development of ACR Appropriateness Criteria® summary animations, or a guide on setting up a Patient and Family Advisory Council at your institution, the PFCC is striving to empower members with the tools they need to deliver on the promise of patient-centered care.”
“The PFCC is currently developing the PFCC hub page to improve the user experience,” says Brett W. Hansen, MA, CAE, director of operations with ACR Press. "The idea is to improve the user experience, while getting more exposure for the myriad resources that PFCC provides.” As part of that exercise, the PFCC toolkit content on acr.org has been streamlined, updated, and made more user-friendly.
Also, under the purview of the PFCC Commission, the Patient Education Committee has headed up an initiative to collect artwork from patients and radiologists to display at the ACR annual meeting. This initiative debuted at ACR 2021 and will continue at ACR 2022 to better humanize the individuals who create the radiology experience. The new Patient Engagement Committee, as well as the Quality Experience Committee, have named patients and patient advocates as co-chairs. “This is a first for the College,” Hansen says, “and demonstrates a reimagined commitment to include patient perspectives to achieve and improve radiology excellence.”
“The organization’s overall success will depend on its investing in leading-edge infrastructure so that the ACR can modernize its processes and services,” Fleishon says. “Reimagining an organization is hard. It necessitates thinking outside the box and frequently outside our status quo comfort zone. This process represents an opportunity to be introspective about who we are, to better focus on our mission, and to reinvent better ways to serve our members and patients.”