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Table of Contents
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| Letter from the Editor |
Hello everyone! As many of you and your practices are already aware, there is a critical iodinated contrast shortage precipitated by the closure of a GE Healthcare factory in Shanghai. The factory was the only manufacturing facility for Omnipaque (iohexol) and was locked down by the Chinese government as part of a broad lockdown in response to a COVID-19 case spike. The facility is just now only at 50% production (as per a recent report from GE) and the shortage will likely persist deep into the summer. The other manufacturers (Bracco, Guerbet, and Bayer, though the last two combine for only about 5% of the US market) are ramping up production but are unable to meet US demand. A recent article in Radiology illustrated the challenges and potential solutions to the issue — please click here to read more Click Here. Below is an infographic from the article that may be useful. Conserving contrast, managing CT protocols, and sharing contrast among or even between health systems are all avenues we are all exploring. Hopefully the summer will see an end to the contrast shortage and the supply chain can be “hardened” with diversification of suppliers from various geographic locations. Best of luck getting contrast! 
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Juan Batlle, MD
Secretary, FRS
juancarlos98@gmail.com |
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| Meet Your 2021 – 2022 FRS Executive Committee |
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President
Rajendra Kedar, MD, FACR |
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President Elect
Chintan Desai, MD, FACR
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Treasurer
Laura Vallow, MD |
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Secretary
Juan Batlle, MD |
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| FRS President’s Message |
Time to register for Florida Radiological Society meetingWe are all excited to host the FRS meeting this year at the Ritz-Carlton, Amelia Island from July 15-July 17. We already have close to 200 registrants. On Friday morning, we will start with the FRS Education Foundation fundraiser with the “Beach fun run and walk”. Proceeds will go to support the FRS Foundation’s resident and medical student activities. You can register this while registering for the meeting or separately as well if you have already registered. This year on Friday, we have combined the FRS and FRBMA program; so, please make sure you take advantage of this extra opportunity as well as credits. We have a fantastic program with local and national faculty. Please see program details at: Click HereContrast shortageDisruption of GE healthcare’s Omnipaque (iohexol iodaneted contrast) manufacturing facility in Shanghai, China has significantly affected patient care. During the shortage, institutions may consider using alternative studies like non-contrast CT, MRI or ultrasound to answer the clinical question. Another option involves repackaging higher volume single-use vials in smaller aliquots. The shortage underscores the importance of sourcing contrast from different vendors, something that can shield institutions from any interruptions in the supply chain. I came across two good articles: “Short-, Mid-, and Long-Term Strategies to Manage the Shortage of Iohexol” Click Here and ‘Iodinated Contrast Shortage Challenges Radiologists” Click HereRadiologist shortageIncreasing demand for imaging studies, COVID related burnout, aging population and too few radiology trainees are causing severe shortage with demand of imaging outpacing number of radiologists. This is not only in the US but is global. This is unlikely to get resolved anytime soon. Please read, International Radiological Societies tackle Radiologist shortage. Click Here
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Very Respectfully,
Raj Kedar, MD, FACR
President, Florida Radiological Society
Professor of Radiology, University of South Florida – Morsani College of Medicine
Director- Body Imaging Education and Fellowship
Chief -Dept of Radiology, Tampa General Hospital |
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Past President
Douglas Hornsby, MD, FACR
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| FRBMA President’s Message |
Making the Transition from Radpeer to Peer Learning
Over the past twelve months our group has been considering the move to peer learning. During that twelve-month period, we would review articles and various examples of peer learning. We evaluated peer learning from both the theoretical standpoint and also looked at some real examples of where groups had already adopted this approach. This article is about the design of our peer learning system rather than an evaluation and comparison of the two approaches. However, before I get into our design, I’ll give a quick overview of the two approaches:
Radpeer: The way our group implemented Radpeer was to have our technologists randomly assign a prior study to the radiologist reading the current study. The radiologist would then score the prior study with one of three rankings (1) Concur with interpretation, (2) Discrepancy, but not ordinarily expected to be made, or (3) Discrepancy, but ordinarily not missed. If the score was either (2) or (3) the radiologist doing the Radpeer would also state whether the miss was clinically significant or was not clinically significant. Note that the radiologist was not involved in selecting the study to be peer reviewed.
Peer Learning: Radiologists self-select cases from their work through the year and then recommend these cases for peer learning. Cases can be selected based on the potential for the educational value of the selected study. They could be misses, excellent calls, or just good discussion cases. The selected cases are anonymized and are then reviewed by the group. The two main differences are that radiologists are purposefully selecting the cases being reviewed and the actual case is not identified as to the reader of the study. (Note if you are interested in more information on peer learning search for the article “Peer Learning defined: What it is and what it is not”. Author: David B. Larson, published by Stanford University School of Medicine).
Ad Hoc
The group approved the adoption of peer learning about six months ago. The group then created an ad hoc committee to design the structure on how we would perform peer learning. In our first meeting we discussed the resources needed to do peer learning. We came to the conclusion that given the potential for having a large number of cases selected we would need to devote physician resources to do some sort of case review and a case selection. In other words, it would be more efficient to preselect cases to be presented rather than review everything submitted. We estimated that case review and selection plus meeting preparation time would average about 20 hours per month. We did not think that was a reasonable level work that we could assign to our full-time radiologists. Therefore, we reached out to our recently retired partners and contracted with one of retiree’s that shared our interest in peer learning. We defined the role as a Peer Learning Consultant, (PLC) and selected Dr. Michael Cavallaro. In hindsight, I feel utilizing the PLC, particularly because it was Dr. Cavallaro, was one of the best decisions we made. From here forward the PLC was involved and in fact crucial to our design and implementation.
Committees
Next, we felt there needed two committees, the QA Committee and the QA Working Committee. The QA Committee is where the group actually goes over the cases. This committee does not direct peer- learning process. Attendance is mandatory and the committee meets four times per year. We felt it was important to ensure that this committee was completely focused on the educational aspect of peer learning and was not spending time on the administrative aspects of peer learning. The President of the group chairs this committee and the PLC presents all cases and leads discussion.
The QA working Committee has seven members and performs the following:
- QA area of focus (if any). Any specific area of focus will be submitted to the radiologists.
- Setting radiologist recommended range for selecting studies monthly (changed as needed).
- Tracking and categorizing submissions.
- Organizing and grouping data to be presented to improve cohesiveness of review.
- Preparing Q&A presentation
- Maintaining log of all work performed. The work product will be organized and categorized at the discretion of the committee.
- All misses will be correlated to other factors if possible (see below). Correlation determination also discussed at QA Committee.
- Track quantitative data using various data points.
- Prepare and submit periodic reports to the QA Committee.
Correlation and categorizing misses
Our PLC wants to correlate misses to determine the cause or to at least determine if there is some statistical evidence that could lead the committees to feel there is a contributory cause.
(a) Possible correlations (some examples):
- Time of day or day of the week study read
- Location where read (home, hospital or office)
- Subspecialty and whether on or not read by subspecialist
- Relative workload when study read
- Biases
- Anchoring bias: failure to shift impression despite receiving contrary information
- Confirmation bias: Searching for data to affirm hypothesis (medical history, age, symptoms etc.)
- Satisfaction of Report: Perpetuating an impression from a prior report.
- Attribution bias: Attributing findings or lack of findings based on patient characteristic or stereotypes
- Satisfaction of search: Decreasing vigilance after differentiating the first abnormality
(a) Busby LP, Coutier JL, Glastonbury CM. Bias n Radiology: The How and Why of Misses and Misinterpretations. Radiographics 2011; 38(1): 236-247.
Dr. Cavallaro believes that this correlation data is an important element of our peer learning design.
In Summary, the three key elements were:
- Finding a passionate leader with available time to lead the program.
- Separate the learning part of peer learning from the work part, and;
- Design the rules in the working committee that will be used for the program and communicate them to the group. The design should be flexible and changes should be made as needed.
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John Detelich, CPA, MBA, CEO
President, FRBMA
jdetelich@radassociates.com |
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| Legislative Update |
The Legislature has just recently completed their second special session. The Special Session was called for May 23rd and ended May 27th. The special session agenda was called to pass legislation relating to property insurance reform. The leadership than added to the call condominium reform legislation.
They met on Tuesday the 24th and completed their business by Wednesday the 25th. They passed legislation on insurance property reform and another piece of legislation that contained a change to building code in order to aid in roof claim abuse, as well as, the post-Surfside condo inspection and reserve reforms. They let the call expire. All were able to be home to enjoy Memorial Day in their districts.
Campaign season is well underway with qualifying for state and federal offices finalized by noon June 17th. Qualifying will clarify who is running for what office.
At this stage there is still a lot of movement. For example, Rep Mike Grieco(D) had announced he was running against Senator Ileana Garcia(R). Today he announced he is withdrawing from the Senate race and not going to seek reelection for his House seat. I am looking forward to seeing it all settle out.
Please feel free to Contact Alison Dudley regarding any campaign related questions. |
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| 2022 Annual Meeting of the FRS & FRBMA |
Please join the Florida Radiological Society and the Florida Radiology Business Management Association for the 2022 Annual Meeting at The Ritz-Carlton Amelia in Amelia Island, Florida July 15-17, 2022. The meeting will focus on “The Evolution of Radiology: Then, Now, and the Future” and will feature lectures by faculty who are leaders in the practice of radiology. We look forward to seeing you in July.
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| Job Posting Opportunities |
Florida Radiological Society is pleased to introduce the opportunity for interested parties to advertise for potential jobs in our monthly FRS Ebrief bulletin.
Advertisement pricing is as follows:
Ebrief Job Posting pricing:
3 months ($100 monthly)
6 months ($90 monthly)
12 months ($80 monthly)
Please contact Lorraine Roger, our Society Administrator for further information on how to advertise in our monthly publication.
Phone: (813) 806-1070
Fax: (813) 806-1071
Email: lroger@flrad.org
We feel that this will provide a valuable service to both our members and our Florida community of Radiology.
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Available Positions
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| Become a PAC Member Today |
Attention FRBMA Members! Please support the cause. We encourage you to be PAC members and supporters; you do not have to belong to the FRS. Donations can be made online through our PAC website www.FLRADPAC.org. Thank you for your donation: Dr. Mergo
It is critical that we support both our Florida PAC and RADPAC in order to bolster our voice in Tallahassee and Washington, respectively. Please join FRS lobbyist Alison Dudley in her special appeal for all Florida radiologists to become Florida PAC members. If you would like to help FRS defend radiology against untoward legislation and introduce bills that have a positive impact on our practices, we need your financial support to re-elect our friends in the state House and Senate. The FRS can also show you simplified ways on how to sign up your radiology group. Contact Lorraine Roger or contact Alison Dudley at for more information. |
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Telephone (813) 806-1070 • Fax (813) 806-1071
5620 W. Sligh Avenue • Tampa, Florida 33634
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| The E-Brief is an exclusive member benefit of Florida Radiological Society, delivering monthly member, chapter and industry news. Please do not reply to this automatic e-mail. For comments or questions about the E-Brief, please contact lroger@flrad.org. |
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